Oral Sex as a Potential Route for Toxoplasma Gondii Transmission: Experiment with Human Semen and Laboratory Mice Model

PURPOSE

Toxoplasma gondii is one of the most widespread parasites in the human population globally. Several modes of its transmission have been proposed: some are well-researched and confirmed, others remain unconfirmed. One unconfirmed hypothesis pertains to potential transmission of Toxoplasma gondii via oral sex (fellatio) in humans. A recent study found tissue cysts in the semen of men with latent toxoplasmosis. Therefore, we aimed to test the hypothesis of Toxoplasma gondii transmission through oral sex experimentally.

METHODS

Eighty-two laboratory mice were orally administered semen samples from 41 men with latent toxoplasmosis. These semen samples were examined for the presence of Toxoplasma gondii DNA using PCR.

RESULTS

We detected Toxoplasma gondii DNA in three of the 41 semen samples from men with latent toxoplasmosis. Oral administration of semen samples to laboratory mice did not result in parasite transmission.

CONCLUSION

We have not demonstrated the transmission of Toxoplasma to mice by oral exposure to semen from infected men. While this does not conclusively rule out the possibility of such transmission in humans, the results suggest that, if it does occur, this mode of transmission is likely infrequent.

Differences in socio-demographics status, risk behaviours, healthcare uptake and HIV/ sexually transmitted infections (STIs) between brothel-based and street-based female sex workers in Yunnan, China

BACKGROUND

Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China's epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects.

METHODS

A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs.

RESULTS

A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs.

CONCLUSIONS

Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

Update on known and emergent viruses affecting human male genital tract and fertility

Many viruses infect the male genital tract with harmful consequences at individual and population levels. In fact, viral infections may induce damage to different organs of the male genital tract (MGT), therefore compromising male fertility. The oxidative stress, induced during viral-mediated local and systemic inflammation, is responsible for testicular damage, compromising germinal and endocrine cell functions. A reduction in sperm count, motility, number of normal sperm and an increase in DNA fragmentation are all common findings in the course of viral infections that, however, generally regress after infection clearance. In some cases, however, viral shedding persists for a long time leading to unexpected sexual transmission, even after the disappearance of the viral load from the blood.The recent outbreak of Zika and Ebola Virus evidenced how the MGT could represent a reservoir of dangerous emergent viruses and how new modalities of surveillance of survivors are strongly needed to limit viral transmission among the general population.Here we reviewed the evidence concerning the presence of relevant viruses, including emergent and re-emergent, on the male genital tract, their route of entry, their adverse effects on male fertility and the pattern of viral shedding in the semen.We also described laboratory strategies to reduce the risk of horizontal or vertical cross-infection in serodiscordant couples undergoing assisted reproductive technologies.

Sexual Transmission of Viral Hepatitis

Ongoing sexual transmission presents a significant barrier to viral hepatitis control. Endemic transmission of hepatitis A virus continues through communities of men with male sex partners, despite vaccine availability. Increased incidence of hepatitis B virus from 2014-2018 prompted expanded vaccination guidelines, but uptake and physician awareness remain poor. Hepatitis C virus while strongly associated with injection drug use, is also transmitted by high-risk sexual contact. Despite universal screening recommendations and curative treatment, incidence continues to increase. Even with safe and highly effective vaccinations or treatments, sexual transmission of viral hepatitides must be addressed to achieve disease elimination.

Characterization of an air-liquid interface primary human vaginal epithelium to study Ebola virus infection and testing of antivirals

Ebola virus (EBOV) is the causative agent of the often-fatal Ebola virus disease (EVD) characterized by hemorrhagic fever in humans and non-human primates. Sexual transmission from male survivors has been at the origin of multiple outbreak flare-ups between 2015 and 2021. However, this route is still poorly understood and the resulting EVD from it is also understudied. To support epidemiological studies documenting sexual transmission to women, and as a transition from previously using monolayer vaginal epithelial cells (VK2/E6E7), we first determined the biological relevance of two similar air-liquid interface models of the human vaginal epithelium (VEC and VLC Epivaginal™) and then characterized their susceptibility to EBOV and virus-induced inflammation. Finally, we evaluated toxicity of Polyphenylene Carboxymethylene (PPCM) microbicide in VLC and reassessed its antiviral effect. As expected, the VEC, but also VLC model showed stratified layers including a lamina propria under an epithelial structure similar to the full thickness of the human vaginal epithelium. However, we could not detect the immune cells featured in the most relevant model (VLC) of the vaginal epithelium using the dendritic cell CD1a and CD11c markers. Consistent with our previous work using the VK2/E6E7 cell line, infectious virus was detected from the apical side of both primary human cell systems, but only when using a high infective dose, with titers remaining at a constant level of 103-4 pfu/ml over 7 days suggesting lasting infectious virus shedding. In addition, infection caused disruption of the epithelium of both models and virus antigen was found from the apical superficial layers down to the lamina propria suggesting full virus penetration and overall confirming the susceptibility of the human vaginal tissue for EBOV. Just like previously seen in VK2/E6E7 cells, VLC infection also caused significant increase in inflammatory markers including IL-6, IL-8, and IP-10 suggesting vaginitis which is again consistent with tissue lesions seen in non-human primates. Finally, both virus infection and virus-induced inflammatory response in VLC could be prevented by a single 5-min PPCM microbicide treatment prior infection.

Does SARS-CoV-2 Affect Human Semen? A Systematic Review and Meta-Analysis

Contradictory results have been reported regarding effects of the SARS-CoV-2 upon human semen. A timely and up-to-date systematic review with meta-analysis appears necessary. This study aimed to deliver pooled prevalence (PP) of SARS-CoV-2 in semen and pooled semen parameters as compared with the uninfected. The relevant databases were scanned by two authors for observational studies reporting analysis of semen in COVID-19 patients. The SARS-CoV-2-infected were assigned to group A (exposed arm), whereas the uninfected to group B (unexposed arm). Newcastle-Ottawa Scale was used to address the risk of bias. PRISMA guidelines were adopted. In case of homogenous studies, fixed-effects model was followed, whereas for heterogenous studies random-effects model was used. Of 990 studies, 24 were eligible involving 1589 subjects (947 in group A and 642 in group B). The "comparability" domain was biased the most. SARS-CoV-2 RNA was detected in three studies among 8 individuals producing the PP of 1.76% (95% CI 0.72-3.21). Sperm concentration was reduced significantly (WMD = -16.23 [95% CI -25.56 to -6.89], as well as total sperm in ejaculate (WMD = -34.84 [95% CI - 43.51 to -26.17]) and sperm volume (WMD =  - 0.48 [95% CI - 0.59 to - 0.36] in group A as compared with controls. There was a non-significant effect upon progressive motility and leukocyte presence in semen. SARS-CoV-2 RNA in semen among the infected individuals is detected infrequently. By this token, sexual transmission through semen is of low probability and little concern for public health. However, significant decrease in sperm volume, sperm concentration, and total sperm in ejaculate has been noted. The current data, though, are limited, and more studies with longer follow-up are needed to evaluate the further impact.

Presence of Toxoplasma gondii tissue cysts in human semen: Toxoplasmosis as a potential sexually transmissible infection

OBJECTIVES

Toxoplasma gondii is a widely prevalent protozoan parasite in human populations. This parasite is thought to be primarily transmitted through undercooked meat and contamination by cat feces. Here, we seek to determine if Toxoplasma gondii cysts can be found within human semen.

METHODS

We used a mixture of histological and immunofluorescence stains to visualize Toxoplasma gondii cysts in thin smears of human semen. Further, we probed for presence of bradyzoite-specific mRNA transcription using in-situ hybridization.

RESULTS

We visualized Toxoplasma gondii cysts in ejaculates of immune-competent and latently infected human volunteers. We confirmed the encystment by probing transcription of a bradyzoite-specific gene in these structures. These observations extend previous observations of the parasite in semen of several non-human host species, including rats, dogs, and sheep.

CONCLUSIONS

Toxoplasma gondii infection is a clinically significant infection, in view of its high prevalence, its purported role in neuropsychiatric disorders such as schizophrenia, as well as in the more serious form of congenital toxoplasmosis. Our demonstration of intact Toxoplasma gondii cysts in the ejaculate supports the possibility of sexual transmission of the parasite and provides an impetus for further investigations.

Recent advances on human mpox

Mpox has been a concern of public health and travel caution. Using databases of WHO, CDC, google scholar, and PubMed, we searched recent literatures and reviewed the history, genomic mutation/evolution, host cell response pathways, regulation policy, vaccine and therapy development. Recent studies showed that current mpox has many genomic mutations related to regulation by APOBEC3. Current mpox has also been suggested to be associated with sexual transmission. Vaccination should be applied and anti-mpox drug should be urgently developed. More investigations are needed to ensure outbreak prevention.

The virology of human monkeypox virus (hMPXV): A brief overview

First described in 1958, the human monkeypox virus (hMPXV) is a neglected zoonotic pathogen closely associated with the smallpox virus. The virus usually spreads via close contact with the infected animal or human and has been endemic mostly in parts of the African continent. However, with the recent increase in trade, tourism, and travel, the virus has caused outbreaks in countries outside Africa. The recent outbreak in 2022 has been puzzling given the lack of epidemiological connection and the possible sexual transmission of the virus. Furthermore, there is limited understanding of the structural and pathogenetic mechanisms that are employed by the virus to invade the host cells. Henceforth, it is critical to understand the working apparatus governing the viral-immune interactions to develop effective therapeutical and prophylactic modalities. Hence, in the present short communication, we summarize the previously reported research findings regarding the virology of the human monkeypox virus.

Molecular detection of vector-borne pathogens in semen from dogs in southeastern Brazil

Vector-borne pathogens (VBPs) are primarily transmitted by arthropod vectors, but secondary ways of transmission have been described, including via venereal route. Nonetheless, there is still limited research on possible sexual transmission of VBPs in dogs. We molecularly investigated the presence of vector-borne pathogens in semen from dogs living in an area where these agents are endemic. Upon PCR testing, seven out of 22 (31.8%) semen samples tested positive for at least one VBP, whereas simultaneous positivity to two or more pathogens was detected in three (13.6%) dogs. Among pathogens detected in semen, Trypanosoma cruzi (n = 1) and Leishmania infantum (n = 3) were identified to species level by restriction fragment length polymorphism analysis. Attempts to sequence PCR products from other pathogens were unsuccessful, but coupled epidemiological and molecular data suggest the presence of Anaplasma platys (n = 5), Babesia vogeli (n = 1) and Ehrlichia canis (n = 1) in semen from dogs. Further experimental studies would be needed to confirm the sexual transmission hypothesis for these VBPs and also the possible implications of these findings for canine reproduction.

Presence of Trypanosoma vivax DNA in cattle semen and reproductive tissues and related changes in sperm parameters

The present work investigated the presence of Trypanosoma vivax in semen and reproductive tissues of experimentally infected cattle and evaluated changes in seminal parameters. Two groups of cattle were established: T01 - experimentally infected with T. vivax (n = 8) and T02 - not experimentally infected with T. vivax (n = 8). After infection, blood (every seven days until 182 days post-infection - DPI), semen (7, 14, 35, 56, 70, 120 and 182 DPI) and reproductive tissue (after euthanasia, 182 DPI) were collected to search for T. vivax using different techniques, including PCR, Woo and Brener. Seminal parameters, including turbulence, motility, concentration, and vigor, were also analyzed. Packed cell volume (PCV) of the animals was determined weekly and weight gain was calculated. The PCR revealed T. vivax DNA in 7/56 semen samples of post-infection T01 cattle. Trypanosoma vivax DNA was detected in the semen of 5/8 animals at 7, 14, 56, 70 and 120 DPI, in the testis of four, and in the epididymis and fat located around the testis of two others. Trypomastigote forms of T. vivax were not found in any semen sample. Sperm of T01 cattle had lower turbulence (p ≤ 0.05) at 7, 14, 35, 56, 120 and 182 DPI, lower vigor (p ≤ 0.05) at 120 DPI and more sperm abnormalities (p ≤ 0.05) than T02. Digital dermatitis was observed among T01 cattle. Animals of T01 had lower PCV values than did those of T02 for most of the evaluations performed and T02 animals gained more weight during the experiment. The results highlight the presence of T. vivax DNA in semen of infected cattle and the importance of this disease for male breeding cattle. Further research is needed to determine whether T. vivax can be sexually transmitted in cattle.

Safety issues in semen banks during the COVID-19 pandemic: data from a European survey

PURPOSE

We performed a survey among European semen banks enquiring safety protocols during the COVID-19 pandemic. We report the experience from a center searching SARS-CoV-2 mRNA in semen of patients undergoing cryopreservation from May 2020 to January 2021.

METHODS

A questionnaire was submitted to accredited semen banks of the European Academy of Andrology (EAA) and the Italian Society of Andrology and Sexual Medicine (SIAMS). A total of 22 centers answered to the survey. SARS-CoV-2 mRNA in semen was evaluated by RT-PCR in 111 subjects banking in the Semen Bank of Careggi University Hospital (Florence, Italy).

RESULTS

No particularly drastic safety measures were adopted by the majority of the centers to prevent the risk of contamination or transmission of the virus. The most common strategy (77.3%) was the administration of an anamnestic questionnaire. About half of the centers request a negative nasopharyngeal swab (NPS) before cryopreservation. Few centers use a quarantine tank, in case of late response of NPS, and only 4 store in a dedicated tank in case of infection. SARS-CoV-2 mRNA was not found in 111 semen samples cryopreserved in the Florentine bank.

CONCLUSIONS

European semen banks use different measures to handle semen samples for cryopreservation during COVID-19 pandemic. The request of NPS is advised to better manage couples undergoing ART and to protect the personnel operating in the bank/ART center. Finally, due to the areas of uncertainties of an almost unknown virus, it is absolutely recommended the use of safe devices for sample handling and storage.

Hepatitis A Outbreaks and Environmental Circulation of Genotype IA Strains in the São Paulo City, 2017-2018

Hepatitis A virus (HAV) is the major cause of enterically transmitted infectious hepatitis. Between 2016 and 2017, the number of confirmed cases of hepatitis A virus (HAV) increased from 64 to 786 in São Paulo affecting mainly adults aged between 18 and 39 years (80%) and males (88%). To support epidemiological surveillance, the present study monitored the presence of HAV in urban sewage samples collected bimonthly for 1 year (November 2017-November 2018) in the central region of the city, where most of cases were detected. Sewage samples were concentrated by polyethylene glycol precipitation and HAV RNA was quantified by RT-qPCR. Nucleotide sequencing targeting the VP1/2A junction region was carried out to genotype the HAV strains. HAV was detected in 76.9% (40/52) of the samples, with a geometric mean viral load of 5.09 × 10⁴ (± SD 4.51 × 10⁵) genome copies (GC/L) (Mauá Street) and 5.27 × 10⁴ (± SD 1.26 × 10⁶) GC/L (Prestes Maia Avenue). Of the 40 positive samples, 8 were typed as HAV subgenotype IA [100% nucleotide (nt) identity with HAV strain VRD_521_2016]. Highest homology was obtained with sequences from European countries (Italy, Spain) and Israel, all of which had reported recent HAV outbreaks associated with men who have sex with men. Our results highlight that wastewater surveillance is a useful tool to support investigating HAV outbreaks in the community, including circulating genotypes.

Surveillance and control of meningococcal disease in the COVID-19 era: A Global Meningococcal Initiative review

This review article incorporates information from the 4th Global Meningococcal Initiative summit meeting. Since the introduction of stringent COVID-19 infection control and lockdown measures globally in 2020, there has been an impact on IMD prevalence, surveillance, and vaccination compliance. Incidence rates and associated mortality fell across various regions during 2020. A reduction in vaccine uptake during 2020 remains a concern globally. In addition, several Neisseria meningitidis clonal complexes, particularly CC4821 and CC11, continue to exhibit resistance to antibiotics, with resistance to ciprofloxacin or beta-lactams mainly linked to modifications of gyrA or penA alleles, respectively. Beta-lactamase acquisition was also reported through horizontal gene transfer (bla_ROB-1) involving other bacterial species. Despite the challenges over the past year, progress has also been made on meningococcal vaccine development, with several pentavalent (serogroups ABCWY and ACWYX) vaccines currently being studied in late-stage clinical trial programmes.

Knowledge about clinical presentation, prevention strategies and sexual transmission of Zika virus infection among women of reproductive age in an endemic area

Background

The recognition of the causal association between Zika virus (ZIKV) infection during pregnancy and congenital abnormalities including microcephaly underlines the importance of preventing this disease in pregnant women (PW) and women of childbearing age (WCA). Although Brazil and other Latin American countries reported a significant reduction in the number of ZIKV infections in recent years, epidemic waves can recur in settings with previous outbreaks as conditions for transmission remain optimal and susceptible populations are continuously replenished.

Methods

In this cross-sectional study, we enrolled 64 PW and 260 non-pregnant WCA attending routine medical appointments in two primary care units in Sao Paulo, Brazil, and assessed knowledge and attitudes about ZIKV infection and prevention.

Results

Most women reported knowing that ZIKV is transmitted through the bite of Aedes mosquitos, and most knew that acute symptoms are similar to those seen in Dengue infection. Furthermore, most participants correctly described that ZIKV infection during pregnancy may cause detrimental outcomes for the newborn. However, most ignored that ZIKV infection can be asymptomatic, and only 15% knew about the risk of ZIKV sexual transmission. We found no statistically significant differences between PW and WCA regarding knowledge about ZIKV sexual transmission. Knowledge about ZIKV sexual transmission was significantly associated with education; among participants with ≤12 schooling years, only 9.0% (95%CI 3.4-18.5%) correctly answered that ZIKV can be sexually transmitted, compared to 12.9% (95%CI 8.2-18.8%) among participants with 12-14 schooling years, and to 24.4% (95%CI 15.9-34.9%) of participants with ≥15 schooling years (p = 0.015). Education remained independently associated with knowledge about sexual transmission of ZIKV in a multivariate logistic regression model adjusted for age, race and pregnancy status (p = 0.022).

Conclusion

Our findings underscore the urgent need of educational and family planning programs that may help prevent detrimental outcomes of ZIKV infection in an endemic area of Brazil.

A Zika Endemic Model for the Contribution of Multiple Transmission Routes

Zika virus disease is a viral disease primarily transmitted to humans through the bite of infected female mosquitoes. Recent evidence indicates that the virus can also be sexually transmitted in hosts and vertically transmitted in vectors. In this paper, we propose a Zika model with three transmission routes, that is, vector-borne transmission between humans and mosquitoes, sexual transmission within humans and vertical transmission within mosquitoes. The basic reproduction number [Formula: see text] is computed and shown to be a sharp threshold quantity. Namely, the disease-free equilibrium is globally asymptotically stable as [Formula: see text], whereas there exists a unique endemic equilibrium which is globally asymptotically stable as [Formula: see text]. The relative contributions of each transmission route on the reproduction number, and the short- and long-term host infections are analyzed. Numerical simulations confirm that vectorial transmission contributes the most to the initial and subsequent transmission. The role of sexual transmission in the early phase of a Zika outbreak is greater than the long term, while vertical transmission is the opposite. Reducing mosquito bites is the most effective measure in lowering the risk of Zika virus infection.

How do biases in sex ratio and disease characteristics affect the spread of sexually transmitted infections?

The epidemiology of sexually transmitted infections (STIs) is inherently linked to host mating dynamics. Studies across many taxa show that adult sex ratio, a major determinant of host mating dynamics, is often skewed - sometimes strongly - toward males or females. However, few predictions exist for the effects of skewed sex ratio on STI epidemiology, and none when coupled with sex biased disease characteristics. Here we use mathematical modelling to examine how interactions between sex ratio and disease characteristics affect STI prevalence in males and females. Notably, we find that while overall disease prevalence peaks at equal sex ratios, prevalence per sex peaks at skewed sex ratios. Furthermore, disease characteristics, sex-biased or not, drive predictable differences in male and female STI prevalence as sex ratio varies, with higher transmission and lower virulence generally increasing differences between the sexes for a given sex ratio. Our work reveals new insights into how STI prevalence in males and females depends on a complex interaction between host population sex ratio and disease characteristics.

SARS-CoV-2 infection and human semen: possible modes of contamination and transmission

Background

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has turned into a global pandemic with multitudinous health impacts.

Main body

In light of the higher vulnerability of men to COVID-19 than women, there is rising concerns on the impact of SARS-CoV-2 infection on male fertility and possibilities of seminal contamination and transmission. The pandemic has attributed to the brief suspension of many fertility clinics and pathology laboratories, though many remained functional. Few reports reflect that SARS-CoV-2 can contaminate the semen of COVID-19 patients as well as that of recovering patients. The viral invasion into the testis may be due to the disrupted anatomical barriers of the testis by the inflammatory responses, and the persistence of the virus in the semen may be facilitated by the testicular immune privilege. Since SARS-CoV-2 is an enveloped RNA virus, it is also theoretically possible that this virus can remain viable in the semen samples even after cryopreservation with liquid nitrogen.

Conclusion

The present review emphasizes the possibilities of seminal dissemination of SARS-CoV-2 and thereby the chances of its sexual transmission. These perceptions and predictions are to facilitate immediate necessary actions to improvise the standard precautionary procedures for laboratory practices, including semen analysis or processing the semen sample for fertility treatments.

Persistence of Zika virus RNA in the epididymis of the murine male reproductive tract

Zika virus (ZIKV) can infect developing fetuses in utero and cause severe congenital defects independent of route of maternal infection. Infected men can shed ZIKV RNA in semen for over six months. Whether prolonged viral RNA shedding in semen indicates a persistent infection in the male reproductive tract is unknown. We hypothesized that if ZIKV establishes a persistent infection in the male reproductive tract (MRT), then immunosuppressant treatment should stimulate ZIKV replication and seminal shedding. Male mice were infected with ZIKV and immunosuppressed when they shed viral RNA but not infectious virus in ejaculates. Following immunosuppression, we did not detect infectious virus in ejaculates. However, we did detect ZIKV positive and negative sense RNA in the epididymal lumens of mice treated with cyclophosphamide, suggesting that ZIKV persists in the epididymis. This study provides insight into the mechanisms behind ZIKV sexual transmission, which may inform public health decisions regarding ZIKV risks.

Evaluating the independent influence of sexual transmission on HBV infection in China: a modeling study

Background

The long-term impact of sexual transmission on the hepatitis B virus (HBV) infection in China remains unclear. This study aims to estimate the independent influence of sexual transmission on HBV infection.

Methods

Based on the natural history of HBV infection and three national serosurvey data of hepatitis B in China, we developed an age- and sex-specific discrete model to describe the transmission dynamics of HBV. The initial conditions of the model were determined according to the age- and sex-specific national serosurvey data in 1992. Based on the national survey data of hepatitis B in 1992 and 2006, by using the Markov Chain Monte Carlo (MCMC) method, we estimated the age- and sex-specific seroclearance rates of hepatitis B surface antigen (HBsAg) and the horizontal transmission rates as well as their 95% confidence intervals (CI). Then we used the age- and sex-specific national serosurvey data of hepatitis B in 2014 to test the accuracy of our model-based estimation. Finally, we evaluated the independent impact of sexual transmission on HBV infection and discussed the long-term effect of promotion of condom use in China.

Results

We estimated that the annual rates of HBsAg seroclearance for males and females aged 1–59 years were respectively 1.04% (95% CI, 0.49–1.59%) and 1.92% (95% CI, 1.11–2.73%). Due to sexual transmission, in 2014, the total number of chronic HBV infections in people aged 0–100 years increased 292,581, of which males increased 189,200 and females increased 103,381. In 2006, the acute HBV infections due to sexual transmission accounted for 24.76% (male: 31.33%, female: 17.94%) and in 2014, which accounted for 34.59% (male: 42.93%, female: 25.73%). However, if the condom usage rate was increased by 10% annually starting in 2019, then compared with current practice, the total number of acute HBV infections from 2019 to 2035 would be reduced by 16.68% (male: 21.49%, female: 11.93%). The HBsAg prevalence in people aged 1–59 years in 2035 would be reduced to 2.01% (male: 2.40%, female: 1.58%).

Conclusions

Sexual transmission has become the predominant route of acute HBV infection in China, especially for men. The promotion of condom use plays a significant role in reducing the cases of acute HBV infection.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10408-5.

A Dynamic Model to Assess Human Papillomavirus Vaccination Strategies in a Heterosexual Population Combined with Men Who have Sex with Men

Vaccination is effective in preventing human papillomavirus (HPV) infection. It is imperative to investigate who should be vaccinated and what the best vaccine distribution strategy is. In this paper, we use a dynamic model to assess HPV vaccination strategies in a heterosexual population combined with gay, bisexual, and other men who have sex with men (MSM). The basic reproduction numbers for heterosexual females, heterosexual males and MSM as well as their average for the total population are obtained. We also derive a threshold parameter, based on basic reproduction numbers, for model analysis. From the analysis and numerical investigations, we have several conclusions. (1) To eliminate HPV infection, the priority of vaccination should be given to MSM, especially in countries that have already achieved high coverage in females. The heterosexual population gets great benefit but MSM only get minor benefit from vaccinating heterosexual females or males. (2) The best vaccination strategy is to vaccinate MSM firstly as many as possible, then heterosexual females, lastly heterosexual males. (3) Given a fixed vaccination coverage of MSM, distributing the remaining vaccines to only heterosexual females or males leads to a similar prevalence in the total population. This prevalence is lower than that when vaccines are distributed to both genders. The evener the distribution, the higher the prevalence in the total population. (4) Vaccination becomes less effective in reducing the prevalence as more vaccines are given. It is more effective to allocate vaccines to a region with lower vaccination coverage. This study provides information that may help policymakers formulate guidelines for vaccine distribution to reduce HPV prevalence on the basis of vaccine availability and prior vaccination coverage. Whether these guidelines are affected when the objective is to reduce HPV-associated cancer incidence remains to be further studied.

Mycoviral diversity and characteristics of a negative-stranded RNA virus LeNSRV1 in the edible mushroom Lentinula edodes

Bioinformatics and RT-PCR analysis of RNA from four Lentinula edodes samples identified 22 different virus-like contigs comprising 15 novel and 3 previously reported viruses. We further investigated the Lentinula edodes negative-stranded RNA virus 1 (LeNSRV1) isolated from a symptomatic sample, whose virion is a filamentous particle with a diameter of ~15 nm and a length of ~1200 nm. RT-PCR analysis detected LeNSRV1 in 10 of the 56 Chinese L. edodes core collection strains and 6 of the 22 monokaryotic strains from the L. edodes strain HNZMD. Genetic variation analysis showed that the sequences encoding the nucleocapsid protein (ORF2) from all the aforementioned LeNSRV1 positive strains are very conservative. The results presented here may enrich our understanding of L. edodes virus diversity and the characteristics of LeNSRV1, and will promote further research on virus-host interaction in L. edodes.

Investigation of SARS-CoV-2 in Semen of Patients in the Acute Stage of COVID-19 Infection

Introduction

The presence of new coronavirus (SARS-CoV-2) in semen and the possibility of sexual transmission have become new subjects of curiosity. There is a discrepancy regarding this issue in the literature. The presence of SARS-CoV-2 in semen has been investigated in a limited number of studies, and mostly in recovering patients. We aimed to investigate the presence of SARS-CoV-2 RNA in semen of patients with a positive nasopharyngeal swab test for SARS-CoV-2 in the acute stage.

Methods

We enrolled adult male patients who were hospitalized with confirmed SARS-COV-2 infection in the study. In addition to routine laboratory and radiological tests, semen sample was obtained from volunteers and transferred to the Turkish Public Health Institution, National Virology Laboratory. The samples were processed for the detection of SARS-CoV-2 RNA on the day of collection.

Results

Sixteen patients were included in the study. The median age was 33.5 years (18–54). All but one had respiratory symptoms. None of the patients had a history or symptoms of urogenital disease. All semen samples were obtained during hospitalization and in the acute stage of the infection. The median time to obtain a semen sample after positive nasopharyngeal test was 1 day (0–7). All semen samples were detected as negative for SARS-CoV-2 PCR.

Discussion/Conclusion

Although all semen samples were obtained in acute stage of the infection when the nasopharyngeal swab test was positive, we did not detect SARS-CoV-2 in semen. The results of our study support the thought that sexual transmission via semen does not have an important role in the person-to-person transmission of SARS-CoV-2. We think that our study will provide new information to fill the gap in the literature.

Probable sexual transmission of brucellosis

Brucellosis, a bacterial zoonosis, is transmitted directly or indirectly from infected animals (mainly domesticated ruminants and pigs) to humans. People are generally susceptible to brucella, which is mainly transmitted by direct contact, digestive tract and respiratory tract. Since brucella can be discharged from various secretions and feces after human infection, sexual transmission has become a potential mode of transmission. We report a case of highly suspected sexually transmitted brucellosis infection patient, which was discharged after treatment with etimicin + minocycline.

Can dengue virus be sexually transmitted?

It has been well documented that Zika virus (ZIKV) can be sexually transmitted. Dengue virus (DENV) shows many similarities with ZIKV; both belong to the genus Flavivirus and share the same main vector route of transmission. Moreover, they share overall architectural features on a molecular level, with a highly similar structure and distinctive insertions, deletions and mutations of their respective E proteins, and it has been suggested that they use a common pathophysiological pathway. In view of similarities with other sexually transmissible viruses, the question arises as to whether DENV could also be sexually transmissible. Limited animal model data do not suggest otherwise. The presence of dengue virus in - and human-to-human, non-vector transmission from - various bodily fluids other than semen or vaginal secretions has been documented anecdotally. Several anecdotal reports described prolonged presence of DENV in semen, urine and vaginal secretions. In 2019, two cases of likely sexual transmission were reported from Spain and South Korea, respectively. We discuss the evidence for and against a relevant DENV sexual transmission potential, highlight controversies and propose a future research agenda on this issue.

Zika virus-spread, epidemiology, genome, transmission cycle, clinical manifestation, associated challenges, vaccine and antiviral drug development

Zika Virus (ZIKV) is a Flavivirus transmitted primarily via the bite of infected Aedes aegypti mosquitoes. Globally, 87 countries and territories have recorded autochthonous mosquito-borne transmission of ZIKV as at July 2019 and distributed across four of the six WHO Regions. Outbreaks of ZIKV infection peaked in 2016 and declined substantially throughout 2017 and 2018 in the Americas region. There is the likely risk for ZIKV to spread to more countries. There is also the potential for the re-emergence of ZIKV in all places with prior reports of the virus transmission. The current status of ZIKV transmission and spread is, however, a global health threat, and from the aforementioned, has the potential to re-emerge as an epidemic. This review summarizes the past and present spread of ZIKV outbreak-2007-2019, the genome, transmission cycle, clinical manifestations, vaccine and antiviral drug advancement.

Mathematical model of zika virus dynamics with vector control and sensitivity analysis

In this paper, we have developed and analyzed a deterministic Zika model considering both vector and sexual transmission route with the effect of human awareness and vector control in the absence of disease induce death. To formulate the model, we assume that the Zika virus is being first transmitted to human by mosquito bite, and then it is being transmitted to his or her sexual partner. The system contains at most three equilibrium points among them one is the disease free and other two are endemic equilibrium points, exists under certain conditions. The theoretical analysis shows that the diseases-free equilibrium is locally and globally asymptotically stable if the basic reproduction number is less than one. Theatrically we have established that endemic equilibrium point which is locally asymptotically stable if the basic reproduction number is greater than one. The system exhibits backward bifurcation when the transmission probability per biting of susceptible mosquito with infected humans crosses the critical value. We estimate the model parameters and validate the model by fitting the model with the reported Zika infected human data from 1 to 36 week of 2016 Zika outbreak in Colombia. Furthermore, using the normalised forward sensitivity index method we have established that the model parameter mosquito biting rate, recruitment rate of mosquito, transmission probability per biting of Susceptible (infected) humans with infected (susceptible) mosquito, rate of awareness in host population, recovery rates of infected human are most sensitive parameters of the considered Zika model. Lastly, some conclusions are given to control the spreading of the Zika disease.

Transmission Dynamics and Control Mechanisms of Vector-Borne Diseases with Active and Passive Movements Between Urban and Satellite Cities

A metapopulation model which explicitly integrates vector-borne and sexual transmission of an epidemic disease with passive and active movements between an urban city and a satellite city is formulated and analysed. The basic reproduction number of the disease is explicitly determined as a combination of sexual and vector-borne transmission parameters. The sensitivity analysis reveals that the disease is primarily transmitted via the vector-borne mode, rather than via sexual transmission, and that sexual transmission by itself may not initiate or sustain an outbreak. Also, increasing the population movements from one city to the other leads to an increase in the basic reproduction number of the later city but a decrease in the basic reproduction number of the former city. The influence of other significant parameters is also investigated via the analysis of suitable partial rank correlation coefficients. After gauging the effects of mobility, we explore the potential effects of optimal control strategies relying upon several distinct restrictions on population movement.

Zika virus knowledge, contraception use, and lessons learned from a Dominican Republic pilot study

OBJECTIVE

To assess knowledge of the Zika virus (ZIKV), use of contraceptives, and sources of health information in rural communities in the Dominican Republic.

METHODS

Over 4 days in March 2017, a research team traveled to four rural communities in the Dominican Republic to provide healthcare services. Overall, 90 men and women consented to a voluntary verbal 12-question survey.

RESULTS

Of the participants, 55% were not certain whether ZIKV is transmitted sexually; 75% of participants were either not sure or thought ZIKV was not present in their community. Charlas (informal discussions led by community health workers) were cited as the most common source for public health information. Prevalence of contraceptive use was 26.6% hormonal and 1.1% long-acting reversible contraception (LARC); 30.0% cited no use of contraception.

CONCLUSION

Significant deficits in ZIKV knowledge, underutilization of LARCs, and socioeconomic factors exist that constrain the application of WHO recommendations for preventing ZIKV infection. Additional and more robust surveys are needed to assess public health education and interventions, critical for disease prevention in communities facing current and future epidemics.

Zika knowledge and prevention practices among U.S. travelers: a large cross-sectional survey study

BACKGROUND

The aim of this study was to investigate what factors predict knowledge about Zika transmission, symptomology, and treatment among U.S. travelers and, additionally, to evaluate how Zika knowledge influences the adoption of personal protective behaviors.

METHODS

Data were collected as part of a cross-sectional survey study using a probability-based internet panel of U.S. travelers in June 2017. We ran logistic regression models of factors predicting Zika knowledge (high vs. low) and of knowledge predicting adoption of personal protective measures.

RESULTS

We found that traveling to a Zika endemic country and travelers' gender were both significantly predictive of higher Zika knowledge (odds ratio (OR): 1.48, 95% confidence interval (CI): 1.14-1.93 and OR: 1.44, 95% CI: 1.08-1.92), adjusting for age, race, education, income, and trip purpose. Additionally, among travelers to Zika endemic countries, individuals with higher Zika knowledge had significantly higher odds of engaging in preventive behaviors compared to those with lower knowledge. However, few travelers knew about the sexual transmission of Zika and adopted sexual prevention measures.

CONCLUSIONS

Our findings suggest that there are gaps in knowledge about the risks and transmission of Zika and travelers with low knowledge are less likely to engage in the appropriate prevention methods. Significantly, few U.S. travelers have knowledge of the sexual transmission of Zika and, accordingly, there is less overall engagement with prevention measures for this transmission mechanism than for vector-borne transmission.

Duration of seminal Zika viral RNA shedding in immunocompetent mice inoculated with Asian and African genotype viruses

Prior to the emergence of Asian genotype Zika virus (ZIKV) in the Western hemisphere, sexual transmission in humans was documented. Sexual transmission by African genotype ZIKVs has not been assessed in laboratory animal models, due to rapid and high mortality rates of immunodeficient mice following inoculation. To overcome these limitations, immunocompetent C57Bl/6 mice were used to longitudinally assess Asian and African genotype ZIKV sexual transmission potential. Furthermore, to determine if enhanced pathogenesis of African genotype ZIKVs is due to structural determinants, PRVABC59 prM/E was replaced with African MR766 prM/E (chimeric ZIKV). The African genotype and chimeric ZIKV elicited greater pathogenic effects in the male reproductive tract and generated higher viremias. Yet, the duration, magnitude and efficiency of seminal shedding of infectious virus and viral RNA were similar between chimeric-, African and Asian genotype ZIKV-inoculated mice. These data show that increased male reproductive tract pathology does not increase sexual transmission potential.

Hepatitis A incidence, seroprevalence, and vaccination decision among MSM in Amsterdam, the Netherlands

BACKGROUND

Several outbreaks of Hepatitis A virus (HAV) were recently documented among men who have sex with men (MSM) in Europe. We investigated the HAV incidence among MSM in Amsterdam, the Netherlands; and HAV seroprevalence and HAV vaccination decision among MSM visiting the Sexually Transmitted Infection (STI) clinic in Amsterdam.

METHODS

Using surveillance data from 1992 to 2017 of MSM with acute HAV in Amsterdam, we estimated the incidence by calendar year and age. We explored HAV seroprevalence by calendar year and age, determinants for HAV seropositivity, and opting-in/out for HAV vaccination using data collected among MSM that visited the STI clinic between 2006 and 2017 and were included in a nationwide Hepatitis B virus (HBV) vaccination programme. Offering HAV vaccination at the STI clinic differed over three consecutive periods: not offered, offered for free, or offered for 75 euros. Logistic regression analyses were used to explore determinants.

RESULTS

HAV incidence increased in 2016/17 after 4 years of absence and peaked in MSM around 35 years of age. Among MSM visiting the STI clinic, HAV seroprevalence was 37% (95%CI = 35-40%), which was constant over the period 2006-2017, and increased with age (p < 0.001). Determinants for HAV seropositivity in multivariable analysis were: older age (p < 0.001), originating from an HAV endemic country (p < 0.001), and being HBV seropositive (p = 0.001). MSM opted-in more frequently when HAV vaccination was offered for free versus paid (89% versus 11%, respectively; p < 0.001). Younger MSM were less inclined to vaccinate when payment was required (p = 0.010). Post-hoc analyses showed that 98% versus 46% of MSM visiting the Amsterdam STI clinic would be protected against HAV infection if HAV vaccination was offered for free or for 75 euros, respectively.

CONCLUSIONS

The MSM population of Amsterdam is vulnerable to a new HAV outbreak. We strongly recommend that MSM have access to free hepatitis A vaccination.

[Analysis on the epidemic features of male HIV-infected and AIDS patients by sexual transmission in Shandong Province from 2007 to 2016]

Objective: To analyze the epidemic features of male HIV-infected and AIDS patients by sexual transmission in Shandong Province. Methods: Data on HIV-infected people and AIDS patients (HIV/AIDS) were derived from HIV/AIDS Comprehensive Response Information Management System. To analysis the epidemiological data of male HIV/AIDS by sexual transmission reported in Shandong Province from 1997 to 2016. Results: A total of 8 584 HIV/AIDS were reported by heterosexual transmission or homosexual transmission from 2007 to 2016. 2 421 cases were reported by heterosexual transmission and 6 163 cases were reported by homosexual transmission. Among cases infected by heterosexual transmission. The average age of cases infected by heterosexual transmission was (38.13±12.39) and (31.62±10.22) among cases who infected by homosexual transmission (t=24.95, P<0.001). 84 cases were reported by homosexual transmission and 138 cases by heterosexual transmission from 2007 to 2008, and 6 079 cases were reported by homosexual transmission and 2 283 cases by heterosexual transmission from 2009 to 2016. A total of 770 cases were dead after reported. Among the dead cases, 337 cases were infected by homosexual transmission and 433 cases by heterosexual transmission (χ(2)=328.21, P<0.001). 61.4% of the dead cases by heterosexual transmission were no longer than 6 months after reported and 54.3% in homosexual transmission (χ(2)=3.96, P=0.047). Conclusion: Homosexual transmission has been the main transmission of HIV/AIDS in Shandong Province. Epidemiological features and social demographic characteristics of each sexual transmission were different. As part of HIV cases developed to death in 6 months.

Treatment as Prevention for HIV Infection: Current Data, Challenges, and Global Perspectives

In 2008, the Swiss National AIDS Commission issued a statement about the safety of HIV treatment in terms of reduced transmission in serodiscordant couples to reduce transmission in serodiscordant couples. This was subjected to debate until 2011 when the HIV prevention trial network 052 published the first randomized study about HIV transmission in serodiscordant couples, where no transmission was observed when the infected person was under effective antiretroviral treatment (ART). Later, the Partners of People on ART-A New Evaluation of the Risks (PARTNER) and the opposites attract studies, which first involved a large number of men who have sex with men (MSM), also showed no transmission, even in condomless receptive anal intercourse (CLAI). In this article, we first review the major studies' data showing the efficacy of ART in HIV transmission in serodiscordant couples at public health scale. Second, we discuss the implications and challenges behind the treatment as prevention strategy regarding the 90-90-90 UNAIDS targets to end the HIV epidemic.We now have strong evidence that ART reduces the risk of transmission of HIV from a positive partner to their negative partner. However, far beyond ART, combining prevention policies is crucial to avoid a new increase in the overall HIV incidence.

American trypanosomiasis and Chagas disease: Sexual transmission

OBJECTIVE

To contribute to the discussion on the research findings indicating the sexual transmission of American trypanosomiasis and Chagas disease in humans.

METHODS

A review of the literature was performed to investigate the routes of transmission of Trypanosoma cruzi parasites and to evaluate the distribution of Chagas disease, which is now found across five continents.

RESULTS

The epidemiological profile of American trypanosomiasis, which is still considered a neglected disease of the poor people of Latin America, has changed over time. A family-based study demonstrated that the blood protozoan T. cruzi can be transmitted sexually from infected males and females to naïve mates.

CONCLUSIONS

Evidence that Chagas disease can be transmitted sexually, coupled with the migration of individuals with Chagas disease to previously non-endemic countries and increased travel to endemic countries, has implications for public health. Improved screening of blood supplies and prenatal care are required to prevent congenital spread.

Underreported injection drug use and its potential contribution to reported increase in sexual transmission of HIV in Kazakhstan and Kyrgyzstan

Background

We conducted a cross-sectional integrated bio-behavioral survey among sex partners of persons who inject drugs (PWID) to explore reasons for reported increase in reporting of heterosexually transmitted HIV in Kazakhstan and Kyrgyzstan.

Methods

Sexual partners of PWID were recruited through PWID. Behavioral data were collected through semi-structured interviews. Dried blood spots were obtained and tested for HIV and hepatitis C virus antibodies (HCVAb). Descriptive univariate and bivariate analyses, and multivariate analyses using logistic regression modeling were performed to identify factors associated with HIV and HCV infections.

Results

Among 1982 sex partners of PWID, overall HIV prevalence was 6.4%; 5.1% and 12.9% among those reported never and ever injecting drugs, respectively (p < 0.001). Overall, HCVAb prevalence was 21.3%; 15.0% and 53.9% among those reported never and ever injecting drugs, respectively (p < 0.001). Of HCV-positive participants, 58% and 34% (p < 0.001) reported prior history of injecting drug use among men and women, respectively. HIV prevalence was lower among HCV-negative (4.2%) compared to HCV-positive participants (14.4%) (p < 0.001). HIV prevalence was 3.5% (95%CI = 2.4–4.6) in a subset of female participants with no reported prior injecting drug use history and who were HCVAb-negative and did not report having an HIV-positive sex partner. Participant sex and number of sex partners as well as use of condoms in the past 12 months were not associated with HIV seropositivity.

Conclusions

High prevalence of HCV among sex partners of PWID who denied ever injecting drugs suggests underreporting of injecting practices. The increased attribution of HIV infection to sexual transmission based on self-report may be partly explained by underreporting of injection drug use due to stigmatization of this behavior.

[Characteristics of HIV sexually transmission and challenges for controlling the epidemic in China]

Sexual transmission became the major mode of HIV infection in this country and accounted for 95% of the newly diagnosed cases, 67% and 28% of heterosexual and male homosexual infections, respectively, in 2016. Heterosexual transmission was mostly reported in South-west while male homosexual transmission in North-east and major metropolitan areas. Elderly and young students became the two special groups of people with increased reported HIV cases in the past years, with major modes of transmission as both heterosexual and homosexual. HIV testing and treatment of all HIV infections have been national control strategies and implemented and have significantly reduced HIV sexual transmission among sero-discordant couples. However, about one-third HIV infections remained undiagnosed. HIV infection through sexual transmission will remain a challenge in the years to come.

HIV-RNA decay in paired blood and semen samples of subjects receiving their first dolutegravir-based ART regimen

BACKGROUND AND OBJECTIVES

We aimed to investigate to what extent a first-line DTG-based ART regimen reduces HIV-RNA in semen compared to plasma.

STUDY DESIGN

In this prospective, observational study, ART-naïve, HIV-infected males starting their first ART regimen with DTG plus TDF/FTC or ABC/3TC were enrolled. Paired blood (BP) and seminal plasma (SP) samples were collected at baseline (T0) and at week-2/4/12/24 after ART initiation. Sexually transmitted infections (STI) were ruled out before enrolment.

RESULTS

Median baseline HIV-RNA levels were lower in SP compared to BP (657 versus 38.200 copies/ml, p < 0.001), three subjects had undetectable semen HIV-RNA. After 12 weeks of treatment, HIV-RNA was below the quantification limit in both BP and SP of 11 pts (61.1%). Discordant results were obtained in 6 subjects (33.3%), showing quantifiable HIV-RNA in blood only (2 cases) and in semen only (4 cases). Finally, one subject had a positive HIV-RNA in SP/BP. At W24, only in 2/16 subjects (12.5%) HIV-RNA was detectable in semen, while in the others it was negative on SP/BP. No concurrent STI was found in subjects with detectable VL in semen.

CONCLUSIONS

DTG demonstrated effectiveness in reducing VL with different kinetics in blood and semen, despite seminal viral suppression after 6 months of ART was not obtained in the totality of subjects.

Changes in Providers' Self-Efficacy and Intentions to Provide Safer Conception Counseling Over 24 Months

High rates of fertility desires, childbearing and serodiscordant partnerships among people living with HIV (PLHIV) in Uganda underscore the need to promote use of safer conception methods (SCM). Effective SCM exist but few PLHIV benefit from provider-led safer conception counseling (SCC) and comprehensive national SCC guidelines are still lacking. Providers' self-efficacy, intentions and attitudes for SCC impact provision and should inform development of services, but there are no longitudinal studies that assess these important constructs. This study reports on changes in providers' knowledge, attitudes, motivation and confidence to provide SCC among a 24-month observational cohort of Ugandan HIV providers. Compared to baseline, providers evidenced increased awareness of SCM, perceived greater value in providing SCC, saw all SCM but sperm washing as likely to be acceptable to clients, reported consistently high interest in and peer support for providing SCC, and perceived fewer barriers at the 24-month follow-up. Providers' intentions for providing SCC stayed consistently high for all SCM except manual self-insemination which decreased at 24 months. Self-efficacy for providing SCC increased from baseline with the greatest improvement in providers' confidence in advising serodiscordant couples where the man is HIV-infected. Providers consistently cite the lack of established guidelines, training, and their own reluctance to broach the issue with clients as significant barriers to providing SCC. Despite providers being more interested and open to providing SCC than ever, integration of SCC into standard HIV services has not happened. Concerted efforts are needed to address remaining barriers by establishing national SCC guidelines and implementing quality provider training.

Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013-2017) but not in the newly-arrived Asian-born

Background

We examined differences in incident HIV infection between newly-arrived Asian-born and other men who have sex with men (MSM) after the introduction of universal HIV treatment guidelines in 2015 and pre-exposure prophylaxis in 2016.

Methods

Clinical, demographic, laboratory and behavioural data on MSM presenting for HIV testing at the Melbourne Sexual Health Centre from July 2013 to June 2017 were extracted. We compared the proportion of newly-arrived (four years or less in Australia), Asian-born and other MSM tested each year who were diagnosed with incident HIV infection (negative test within one year or diagnosis with indeterminate or negative Western Blot).

Results

We analysed 35,743 testing episodes in 12,180 MSM, including 2781 testing episodes in 1047 newly-arrived Asian-born MSM. The proportion of other MSM tested each year who were diagnosed with incident HIV infection fell from 0.83% in 2014 to 0.38% in 2017 (p = .001), but did not fall in newly-arrived Asian-born MSM (from 1.18% in 2014 to 1.56% in 2017, p = .76). In the multivariate logistic regression, in 2016/2017 but not in 2014/2015, being newly-arrived Asian-born was associated with an increased odds of diagnosis of incident HIV infection (aOR 3.29, 95%CI 1.82–5.94, p < .001).

Conclusions

The epidemiology of HIV in Melbourne Australia has changed dramatically. While there has been an overall reduction amongst MSM, the incidence of HIV in newly-arrived Asian-born MSM remains high. Failing to address these new inequalities leaves individuals at risk and may offset the population benefit of biomedical HIV prevention.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3325-0) contains supplementary material, which is available to authorized users.

Study protocol of "Our Choice": a randomized controlled trial of the integration of safer conception counseling to transform HIV family planning services in Uganda

BACKGROUND

About 40% of HIV-positive women in sub-Saharan Africa become pregnant post-diagnosis. Despite about half of their pregnancies being planned, safer conception methods (SCM) are underutilized among serodiscordant couples, partially due to the fact that safer conception counseling (SCC) has not been integrated into routine HIV family planning (FP) services.

METHODS

Our Choice is a comprehensive FP intervention that promotes unbiased childbearing consultations to ensure clients receive SCC or contraception services to achieve their desired reproductive goals. The intervention is theoretically grounded and has demonstrated preliminarily feasibility and acceptance through pilot testing. This three-arm cluster randomized controlled trial compares two implementation strategies for integrating Our Choice into routine FP services vs. usual care. Six sites in Uganda will be randomized to receive either (1) Our Choice intervention with enhanced training and supervision provided by study staff (SCC1), (2) Our Choice intervention implemented by the Ministry of Health's standard approach to disseminating new services (SCC2), or (3) existing FP services (usual care). Our Choice and usual care FP services will be implemented simultaneously over a 30-month period. Sixty clients in serodiscordant relationships who express childbearing desires will be enrolled by a study coordinator at each site (n = 360) and followed for 12 months or post-pregnancy (once, if applicable). Analysis will compare intervention arms (SCC1 and SCC2) to usual care and then to each other (SCC1 vs. SCC2) on the primary outcome of correct use of either SCM (if trying to conceive) or dual contraception (if pregnancy is not desired). Secondary outcomes (i.e., pregnancy, use of prevention of mother-to-child transmission services, condom use, and partner seroconversion) and cost-effectiveness will also be examined.

DISCUSSION

Findings will provide critical information about the success of implementation models of varying intensity for integrating SCC into FP, thereby informing policy and resource allocation within and beyond Uganda.

TRIAL REGISTRATION

NCT03167879 ClinicalTrials.gov, Registered 30 May, 2017.

Hepatitis B virus infection among sexually active individuals in Nigeria: a cross-sectional study

Introduction

Hepatitis B virus (HBV) infection is a major health challenge in sub-Saharan African countries. Chronic HBV infection is a risk factor for severe disease progression. Perinatal and sexual transmissions of Hepatitis B virus are the main routes of infection in HBV endemic countries like Nigeria. However, there is paucity of data as regards the major contributory route of transmission to chronic HBV infection in this region. Also, in Nigeria, not everyone at high risk of the infection has been identified. Therefore our study investigated the prevalence of HBV infection among sexually active individuals in Nigeria.

Methods

Blood samples collected from 463 participants (360 sexually active individuals and 103 teenagers) recruited from health institutions across the country were tested for the presence of HBsAg, and HBV nucleic acid related antigen (HBVNRAg) by ELISA. Positive samples were further tested for the presence of HBeAg and antiHBe by ELISA. Data were analyzed using Chi-square and binary logistic regression at p = 0.05.

Results

HBsAg and HBVNRAg were detected in 10.4% and 7.6% of the participants respectively. STI clinic attendees had the highest prevalence for HBsAg (17%; p = 0.002). Teenagers had the lowest HBsAg (1.9; p = 0.002) and HBVNRAg (2.9%; p = 0.0001) prevalence rates. Male gender (p = 0.01) and reproductive age group (p=0.009) were the major predictors of chronic HBV infection.

Conclusion

Sexual transmission was identified as the major contributor to chronic HBV infection. Sexually active individuals especially those with STIs are high risk groups for chronic HBV infection. Interventions targeted at this group is therefore recommended.

First case of sexually transmitted asymptomatic female genital tuberculosis from spousal epididymal tuberculosis diagnosed by active screening

Tuberculosis screening was performed for a healthy asymptomatic woman to determine whether she had been infected with active genital tuberculosis via sexual intercourse with her husband who had epididymal tuberculosis. Vaginal swab culture yielded Mycobacterium tuberculosis. Furthermore, whole genome sequencing revealed that the two causative isolates were genetically identical. This appears to be the first report on the sexual transmission of genital tuberculosis from a man to an asymptomatic woman, detected by active screening for genital tuberculosis and molecular analysis, including whole genome sequencing. Active screening for genital tuberculosis in the female partner should be considered soon after diagnosis of male genital tuberculosis, even when the female partner is asymptomatic.

Diagnostic implications for sexual transmission

As asymptomatic infections represent 80% of ZIKV-infected individuals, sexual transmission is a rising concern. Recent studies highlighted a preferential association of ZIKV with the cellular fraction (CF) of different specimen types. Our aim was to evaluate the presence of ZIKV-RNA in different body fluids, focusing on semen specimens to assess the ZIKV-RNA content in either the unfractionated sample, its CF or seminal plasma (SP). In addition, to establish if the presence of ZIKV genome was associated with active virus replication, we measured the levels of negative-strand ZIKV-RNA. ZIKV total-RNA was detected in blood, urine and unfractionated semen, and neg-RNA in semen CF and SP samples longitudinally collected from two ZIKV-positive men followed at the National Institute for Infectious Diseases "L. Spallanzani", Italy. In both patients, ZIKV total-RNA was detected in CF with ct values always lower than in the corresponding unfractionated samples, and was observed even in the CF from negative unfractionated semen samples. In Patient 2, neg-RNA was also detected in CF, suggesting ongoing viral replication. Our results demonstrate higher clinical sensitivity of CF as compared to whole semen testing, emphasizing the need to extend ZIKV-RNA testing to CF, to rule out virus presence and the possible risk of sexual transmission.

An autochthonous sexually transmitted Zika virus infection in Italy 2016

We describe two cases of Zika virus infection involving an Italian patient returning from the Dominican Republic and his wife, who remained in Italy and had not travelled to Zika virus endemic areas in the previous months. The infection was transmitted through unprotected sexual intercourse after the man's return to Italy.

Persistence and infectivity of Zika virus in semen after returning from endemic areas: Report of 5 cases

BACKGROUND

There are limited data about the persistence and infectivity of Zika virus in semen of symptomatic travelers returning from endemic areas and even less data in asymptomatic cases.

OBJECTIVE

We investigated the persistence and infectivity of ZIKA virus in semen in five patients with Zika virus infection returning to Spain from endemic areas.

STUDY DESIGN

We evaluated the epidemiological, clinical and virological characteristic of the five patients. In semen we detected ZIKA virus by PCR, partial sequencing and cell culture. We also performed phylogenetic analysis.

RESULTS

We detected Zika virus RNA (Asian lineage) by PCR in semen samples from day 14th to day 96th since the day of illness onset. Semen viral culture was positive for Zika virus in two patients at days of illness 30 and 69 by virus propagation. Phylogenetic analysis strongly suggested male to female sexual transmission in a couple returning from Maldives.

CONCLUSION

This case series confirms that Zika virus RNA can be detected in semen up to three months after infection. Viral culture of semen samples shows prolonged infectivity that can lead to sexual transmission of Zika virus.

Impact of Zika virus for infertility specialists: current literature, guidelines, and resources

In the past 2 years, Zika virus has emerged from obscurity onto the world stage-traversing and transcending clinical specialties, basic science disciplines, and public health efforts. The spread of Zika virus has serious implications for the specialty of reproductive endocrinology and infertility. Our patients, practices, and labs-worldwide and specifically in the USA-have been impacted by this teratogenic, sexually transmitted, largely asymptomatic virus. While the World Health Organization's Public Emergency of International Concern designation has lapsed as major epidemics have subsided and understanding of risks is in part clarified, the acute and long-term threat to pregnant patients is not over. The risk of wider spread in the USA is not insignificant, the subtler and long-ranging consequences beyond microcephaly are not fully known, large geographic areas of risk still contain naïve populations, and whether Zika will continue to be an intermittent risk in endemic areas is uncertain. Staying up to date with the burgeoning research on Zika virus is an important objective for the infertility specialist. Here, we review in detail the most relevant recent developments, discuss applicable guidelines, and propose strategies for contributing to a reduction in the risk and burden of Zika virus.

Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy

Background

More and more HIV-1-infected men on effective antiretroviral treatment (ART) have unprotected sex in order to procreate. The main factor influencing transmission is seminal HIV shedding. While the risk of HIV transmission is very low, it is difficult to assess in individuals. Nevertheless, it should be quantified.

Results

We retrospectively analysed seminal plasma HIV-1 shedding by 362 treated HIV-infected men attending a medically assisted reproduction centre (1998–2013) in order to determine its frequency, the impact of the antiretroviral regimen on HIV shedding, and to identify shedding patterns. The HIV-1 virus loads in 1396 synchronized blood and semen samples were measured, and antiretroviral treatment, biological and epidemiological data were recorded.

We detected isolated HIV-1 shedding into the seminal plasma in 5.3% of patients on efficient antiretroviral treatment, but there was no association with the HIV antiretroviral drug regimen or the CD4 cell count. These men had undergone more regimen changes since treatment initiation and had been on the ongoing drug regimen longer than the non-shedding men. The patterns of HIV seminal shedding among patients with undetectable HIV blood virus load varied greatly. HIV seminal shedding can occur as long as 5 years after starting antiretroviral treatment.

Conclusions

The seminal HIV load was used to monitor risk for infertile HIV-infected patients on an assisted reproductive technology program. This can still be recommended for patients who recently (6 months) started ART, or those with a poor history of adherence to ART but may also be usefull for some patients during counselling. Residual HIV seminal shedding is probably linked to breaks in adherence to antiretroviral treatment but local genital factors cannot be ruled out.

Zika Virus Infection

In less than 2 years since entry into the Americas, we have witnessed the emergent spread of Zika virus into large subsets of immunologically naïve human populations and then encountered the devastating effects of microcephaly and brain anomalies that can arise from in utero infection with the virus. Diagnostic evaluation and management of affected infants continues to evolve as our understanding of Zika virus rapidly advances. The development of a safe and effective vaccine holds the potential to attenuate the spread of infection and limit the impact of congenital infection.