The Resurgence of Lymphogranuloma Venereum: Changing Presentation of Lymphogranuloma Venereum in the Era of HIV Preexposure Prophylaxis, 2004 to 2022

BACKGROUND

Before the early 2000s, the sexually transmitted infection lymphogranuloma venereum (LGV) was rare in high-income countries. Initially, most cases in these countries were among symptomatic men who have sex with men (MSM) living with HIV. In the context of widespread HIV preexposure prophylaxis (PrEP), LGV's epidemiology may be changing. We aimed to characterize the epidemiology and clinical presentation of LGV in the PrEP era.

METHODS

A retrospective chart review was performed on all LGV cases occurring between November 2004 to October 2022 in British Columbia (BC), Canada. Cases were stratified by having occurred before (2004-2017) or after widespread PrEP availability in BC (2018-2022). Annual rates and test positivity percentages were calculated. Bivariate logistic regression was performed to identify drivers of asymptomatic infection in the PrEP era.

RESULTS

Among 545 cases identified, 205 (37.6%) occurred pre-PrEP and 340 (62.4%) occurred during the PrEP era. Most cases were among MSM (97.2%). The estimated rate of LGV has doubled from 2018 to 2022, reaching 1535.2 cases per 100,000 PrEP users. Most PrEP-era cases were among HIV-negative individuals (65.3%), particularly those on PrEP (72.6%). Cases in the PrEP era were often asymptomatic compared with pre-PrEP (38.6% vs. 19.3%; P < 0.001). Users of PrEP were more likely to experience asymptomatic infection compared with HIV-negative PrEP nonusers (odds ratio, 2.07; 95% confidence interval, 1.07-3.99).

CONCLUSIONS

In the context of increased asymptomatic testing, LGV may be increasing in BC. Most infections now occur among HIV-negative MSM. A high proportion of infections are asymptomatic.

Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada

OBJECTIVES

Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC.

METHODS

We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing.

RESULTS

Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p < 0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p = 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93).

CONCLUSION

gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.

Characterizing female infectious syphilis cases in British Columbia to identify opportunities for optimization of care

INTRODUCTION

The rate of infectious syphilis continues to increase among females in British Columbia (BC) and Canada, raising concerns of increased incidence of congenital syphilis. We characterized syphilis cases among females in BC to identify opportunities to prevent syphilis and optimize its care.

METHODS

All cases of infectious syphilis diagnosed in BC between March 13, 2018 and December 31, 2020 and reported as female gender were reviewed. Demographics, risk factors and concurrent conditions were collected from a provincial surveillance system. Subgroup analyses comparing cases with and without housing instability, substance use, mental illness and a recent sexually transmitted infection (STI) were conducted to understand differences between these subgroups. Statistical associations were calculated using chi-square or t-tests.

RESULTS

There were 226 reported cases of female infectious syphilis in BC during this period: 38 (16.8%) in 2018; 74 (32.7%) in 2019; and 114 (50.4%) in 2020. Mean age was 32 years (range 15-75 years). Of those who reported concurrent conditions, most cases had experiences with housing instability (71.1%), substance use (68.2%) and mental illness (83.9%), while 42.9% had a recent STI. Cases who reported housing instability or substance use were significantly more likely to have experiences with a recent STI, street involvement, transactional sex, mental illness and income assistance (all p<0.01).

CONCLUSION

Our findings highlight the importance of fostering an enabling environment for syphilis care. Concurrent services to support individuals with syphilis as well as housing instability, substance use and mental illness, may help prevent syphilis and improve wellbeing.

Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada

BACKGROUND

Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN) or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts.

METHODS

All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. χ2 Tests compared indicators between PN approaches.

RESULTS

Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean [SD], 5.5 [5.2] days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least 1 notifiable partner, for a total of 1094 partners (mean [SD], 3.9 [5.5] partners/patient). Compared with PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1% [573/817] vs. 89.8% [211/235]; P = 1.88 × 10-9), but there was no difference in the proportion of partners tested and/or treated (90.2% [517/573] vs. 86.7% [183/211]; P = 0.203), and diagnosed (12.8% [66/517] vs. 16.4% [30/183]; P > 0.271).

CONCLUSIONS

Public health- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.

Human Immunodeficiency Virus Seropositivity and Early Syphilis Stage Associated With Ocular Syphilis Diagnosis: A Case-control Study in British Columbia, Canada, 2010-2018

BACKGROUND

The incidence of syphilis has been increasing worldwide in the last 20 years, disproportionately impacting those living with human immunodeficiency virus (HIV). Alongside this increase, several jurisdictions have reported increasing incidences of syphilis-related complications, including ocular syphilis. We sought to characterize ocular syphilis cases in British Columbia (BC), Canada.

METHODS

This case-control study compared ocular syphilis cases, matched (1:4) to syphilis controls, that were diagnosed in BC between January 2010 and December 2018. Multivariable logistic regression was used to identify potential correlates of ocular syphilis, where variables were included in the final model if significant (P ≤ .05).

RESULTS

During the study period, there were 6716 syphilis diagnoses, including 66 (0.98%) ocular syphilis cases. The median age of cases was 49.5 years (interquartile range 39-59). Most (87.8%) patients were male, where 54.6% identified as men who have sex with men. The most common ophthalmologic diagnosis was panuveitis (42.4%). Of ocular syphilis patients, 48.5% were living with HIV at the time of their syphilis diagnosis, compared to 26.4% of controls (P = .001). The proportion of syphilis cases with ocular syphilis increased from 0.48% in 2010 to 0.83% in 2018. The final multivariable model demonstrated correlates between ocular syphilis and early syphilis stage, including primary/secondary (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.86-13.24) and early latent (OR 4.29, 95% CI 1.62-11.34) stages, and HIV serostatus (OR 2.16, 95% CI 1.14-4.09).

CONCLUSIONS

Ocular syphilis increased over the study period, both in absolute numbers and as a proportion of all syphilis cases, a finding consistent with other jurisdictions. These findings highlight the importance of vigilance for ocular syphilis, to avoid diagnostic and treatment delays.

FAB: First UK feasibility trial of a future randomised controlled trial of Family focused treatment for Adolescents with Bipolar disorder

BACKGROUND

This first mixed-methods UK trial examined the feasibility and acceptability of a future definitive randomised controlled trial (RCT) to evaluate whether Family Focussed Treatment for Adolescents with Bipolar Disorder (FFT-A) UK version can improve family functioning and well-being as part of the management of Paediatric Bipolar Disorder (PBD).

METHOD

The trial used a randomised, parallel group, non-blinded design where participants received FFT-A UK (16 sessions over 6 months) immediately or after 12 months (delayed arm). Measures of family functioning, well-being and quality of life of the young person and the main carer (most commonly a parent) were completed at baseline, 6 and 12-months in both arms. Primary outcome measures included rates of eligibility, consent and retention along with estimates of variability in the measures and assessment of the intervention delivery. Qualitative interviews allowed assessment of participants' views about FFT-A and the trial processes.

RESULTS

Twenty-seven of 36 young persons with PBD and their families consented; of these, 14 families were randomised to the immediate and 13 to the delayed arm. Two families from the immediate arm withdrew consent and discontinued participation. Quantitative measures were completed by 22 families (88%) at 6-months and 21 families (84%) at 12-months. Qualitative interviews were conducted with 30 participants (9 young people, 15 parents and 6 other family members). Nine families attended 3 post-trial focus groups.

CONCLUSION

It was feasible to recruit and retain to this trial. The results highlighted that trial design and measures were acceptable to participants. A benefit in family relationships was reported by participants which they attributed to the intervention in qualitative interviews. Families recommended that future modifications include definitive trial(s) recruiting participants in the age range 15-25 years as it felt this was the age range with maximum need. Trial registration ISRCTN, ISRCTN59769322. Registered 20 January 2014, http://www.isrctn.com/ISRCTN59769322.

Child Caries Management: A Randomized Controlled Trial in Dental Practice

This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005).

Spin-On Dielectrics: Good News and Bad News!

Five classes of spin-on dielectrics are discussed: polysilicates, polysiloxanes, polysilsesquioxanes, polyhydrocarbons, and polyimides. The emphasis is on the first three materials because very few polyhydrocarbon spin-on materials are available for study while spin-on polyimides sorb significant amounts of water. The polymer chemistry of the silicates, siloxanes, and silsesquioxanes is linkage through Si-O-Si-O bonds. Polyhydrocarbons are primarily linked through C-C bonds. As the name implies, polyimides are linked through (usually aromatic) imide groups. Because of their polar nature, polyimides, polysilicates, and polysiloxanes have dielectric constants >3, while the large hydrocarbon content of the remaining materials results in a dielectric constant of <3. Films of polysilicates are relatively brittle and thus are limited to a thickness <1 μm. On the other hand, films of polysilsesquioxanes, polyimides, and polyhydrocarbons can be readily deposited to a thickness >1 μm. Polysilicates have high temperature (>900°C) stability and do not react with O2; most polyhydrocarbons decompose above ˜350°C and oxidize readily; some polyimides are stable to 500°C; polysiloxanes and polysilsesquioxanes readily survive 425°C in N2. (Films of the latter two materials are converted to silicates upon heating at high temperatures in O2 or steam.) The infrared spectrum of a 425°C-cured silicate film shows the presense of Si-OH bonds and water, but after a 900°C anneal, the spectrum is almost identical to that of thermal oxide. The spectra of films of polysiloxanes or polysilsesquioxanes do not exhibit Si-OH absorption. Water retention in films is deleterious to the electrical and mechanical (swelling) properties of the dielectric and to making good aluminum-to-aluminum electrical contact through submicron vias. The water leads to a mobile charge (H+) phenomenon that is readily detected by a Triangular Voltage Sweep technique. Except for polysilicates, solutions of the other spin-on materials have reasonably long (weeks-to-months) shelf-lives. Polysilicate solutions are sols and tend to gel; the time to gelling is a function of solids content and solvent. Even though they exhibit shortcomings, polysiloxanes appear to be best suited as interlevel dielectrics in multilevel metalization schemes.

How accurate are Townsend Deprivation Scores as predictors of self-reported health? A comparison with individual level data

OBJECTIVES

To determine the accuracy of area based Townsend Deprivation Scores (TDSs) as proxies for individual level deprivation and to compare the ability of TDSs and individual level measures of deprivation to predict selfreported health.

METHODS

Using data from a self completed health and behaviour survey sent to a random sample of households in Newcastle upon Tyne, UK, the ability of TDSs, calculated at the enumeration district and ward level, to predict selfreported health was compared to that of an individual level measure of deprivation similar to TDSs. The correlation between each of these measures of deprivation was also investigated.

RESULTS

Enumeration district TDSs were similarly predictive of self-reported health as the individual level measure of deprivation. Ward-level TDSs showed a much weaker association with self-reported health. Although statistically significant, no deprivation measure accounted for more than 3 per cent of the variation in self-reported health. There was a strong correlation between the individual level measure of deprivation and enumeration district, but not ward-level TDSs.

CONCLUSIONS

TDSs calculated at the enumeration district level are strongly correlated with a similar measure of deprivation calculated at the individual level and are similarly predictive of health. This is not the case for TDSs calculated at the ward level. Enumeration district TDSs are good proxies for individual level deprivation in Newcastle upon Tyne. This may not be the case in more mobile populations.

Physical, sexual and emotional violence against women: a general practice-based prevalence study

OBJECTIVE

To determine the prevalence of domestic violence, childhood abuse and sexual assault experienced by women attending general practitioners.

DESIGN

A cross-sectional, questionnaire-based prevalence survey.

SETTING

15 general practices in metropolitan Melbourne between November 1993 and February 1994.

SUBJECTS

3026 women over the age of 18 attending for a consultation.

RESULTS

The response rate was 72%. Over a quarter of women in relationships had been victims of physical or emotional partner abuse in the previous year, one in 10 having experienced severe physical violence. Thirteen percent of women had experienced rape or attempted rape, 10% had been severely beaten during childhood and 28% had experienced childhood sexual abuse involving physical contact. The abuse had been disclosed to the woman's doctor by only 27% of those who had experienced partner or childhood physical abuse (mostly because the doctor had never asked) and 9% of those who had experienced sexual abuse (mostly because the woman did not see it as relevant to the consultation).

CONCLUSION

There is a high prevalence of physical, sexual and emotional violence against women as well as poor communication about this violence to their general practitioners.

RECOMMENDATION

Medical practitioners should be more proactive in questioning women about violence.

Psychotropic drug use by women: current prevalence and associations

OBJECTIVE

To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables.

DESIGN

A cross-sectional, questionnaire-based survey.

SETTING

Metropolitan Melbourne between November 1993 and February 1994.

SUBJECTS

Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation.

OUTCOME MEASURES

Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics.

RESULTS

The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension.

CONCLUSIONS

Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.

Size determination of Streptococcus mutans 10499 by laser light scattering

We have performed three different optical experiments to determine the mean size of the bacterial strain Streptococcus mutans 10449, a microorganism with dimensions comparable to the wavelength of the light used in our experiments. The three optical measurements give size values which are consistent with one another and favorably comparable to the consistency we found in identical measurements on a test system of polystyrene spheres of dimensions similar to the bacteria. Homodyne time correlation and power spectrum spectroscopy both depend on the coherence and monochromaticity of laser light for the determination of the mean diffusion coefficient of the scatterers. The Stokes-Einstein equation then relates the diffusion constant to the cell size. Differential light scattering relies for the interpretation of experimental data on the classical theoretical analysis of the angular distribution of scattered light from a scattering object. The three methods yield mean values for the radius of S. mutans 10499 of 0.324 +/- 0.006 mum, 0.0325 +/- 0.007 mum, and 0.315 +/- 0.009 mum, respectively. However, since intensity correlation spectroscopy provides a direct measure of polydispersity, it would appear to be the preferred single measurement technique for size determination.

Laser light scattering measurement of dextran-induced Streptococcus mutans aggregation

Intensity fluctuation spectroscopy was used to study dextran-induced aggregation of Streptococcus mutans bacteria. Smoluchowski's theory of colloidal flocculation provided a consistent model of the agglutination process. Our experiments indicated that aggregation was inhibited by the negatively charged surfaces of the cells, while dextran polymers effectively bound organisms together. Our experimental data were consistent with the quantitative predictions of a polymer bridge model of agglutination.

Effect of nutritional and enzymatic methionine deprivation upon human normal and malignant cells in tissue culture

Human embryonic lung fibroblasts (F-136-35-56) capable of growing in medium containing DL-homocysteine instead of L-methionine and human acute lymphoblastic leukemia cells (CCRF-HSB-2) with absolute methionine requirement exhibited dose-dependent growth inhibition when semipurified L-methionine-degrading enzyme (L-methioninase, EC 4.4.1.11) was added to the tissue cultures. When D-homocystine was added to the cultures together with L-methioninase (0.1 units/ml, which completely degraded the available L-methionine in tissue culture), the F-136-35-56 cells continued to grow whereas the CCRF-HSB-2 cells were completely inhibited. In mixed cultures of the two cell lines with added L-methioninase + D-homocystine or L-methioninase + L-homocysteine thiolactone, the normal fibroblasts grew and synthesized DNA vigorously, whereas the lymphocytic malignant cells lost their viability completely and died within 3 to 4 days.

Effect of postnatal litter size on adult aggression in the laboratory mouse

Growth, emotionality, food competition, and aggression were examined in mice nursed in litters of 3 or 9 and reared in isolation until testing. Animals from large litters were lighter at weaning and in adulthood and were more emotional in the open field than subjects from small litters. They did not win more food competition tests than subjects from small litters although their consummatory behavior during food competition tests was greater. Subjects from large litters were more aggressive in initial encounters, but over repeated encounters became more submissive. In a 2nd open-field test, emotionality of large-litter subjects was reduced more than that of subjects from small litters. When later placed in group-living cages, subjects from small litters sustained less long term physical assault than subjects from large litters. High correlations were found between the 4 measures of brief aggression.