BackgroundBacterial vaginosis (BV) is an infection that has a prevalence between 10% to 50% worlwide. BV results in an imbalance of the normal vaginal flora. Microorganisms associated with BV have been isolated from the normal flora of the male genital tract, and their presence could be related to the recurrence of BV after antibiotic treatment. Therefore, the treatment of sexual partners could decrease the recurrence of infection and possibly the burden of the disease.ObjectivesTo assess the effectiveness in women and the safety in men of concurrent antibiotic treatment for the sexual partners of women treated for BV.Search methodsWe searched the Cochrane Sexually Transmitted Infections Group Specialized Register (23 July 2016), CENTRAL (1991 to 23 July 2016), MEDLINE (1946 to 23 July 2016), Embase (1974 to 23 July 2016), LILACS (1982 to 23 July 2016), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (23 July 2016), ClinicalTrials.gov (23 July 2016) and the Web of Science T (2001 to 23 July 2016). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies.Selection criteriaRandomized controlled trials (RCTs) that compared the concurrent use of any antibiotic treatment with placebo, no intervention or any other intervention by the sexual partners of women treated for BV.Data collection and analysisThree review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in the included studies. We resolved any disagreements through consensus. We assessed the quality of the evidence using the GRADE approach.Main resultsSeven RCTs (1026 participants) met our inclusion criteria, and pharmaceutical industry funded four of these trials. Five trials (854 patients) compared any antibiotic treatment of sexual partners with placebo. Based on high quality evidence, antibiotic treatment does not increase the rate of clinical or symptomatic improvement in women during the first week (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.96 to 1.03; 712 participants, four studies; RR 1.06, 95% CI 1.00 to 1.12; 577 patients, three studies, respectively), between the first and fourth week (RR 1.02, 95% CI 0.94 to 1.11; 590 participants, three studies; RR 0.93, 95% CI 0.84 to 1.03; 444 participants, two studies; respectively) or after the fourth week (RR 0.98, 95% CI 0.90 to 1.07; 572 participants, four studies; RR 1.03, 95% CI 0.90 to 1.17; 296 participants, two studies; respectively). Antibiotic treatment does not led to a lower recurrence during the first and fourth week (RR 1.28, 95% CI 0.68 to 2.43; 218 participants, one study; low quality evidence) or after the fourth week of treatment (RR 1.00, 95% CI 0.67 to 1.52; 372 participants, three studies; low quality evidence) in women, but increases the frequency of adverse events (most frequently gastrointestinal symptoms) reported by sexual partners (RR 2.55, 95% CI 1.55 to 4.18; 477 participants, three studies; low quality evidence).Two trials (172 participants) compared any antibiotic treatment for sexual partners with no intervention. When we compared it with no intervention, the effects of antibiotic treatment on recurrence rate after the fourth week (RR 1.71, 95% CI 0.65 to 4.55; 51 participants, one study), clinical improvement between the first and fourth week (RR 0.93, 95% CI 0.70 to 1.25; 152 participants, two studies) and symptomatic improvement after the fourth week (RR 0.66, 95% CI 0.39 to 1.11; 70 participants, one study) were imprecise and there were no differences between groups. We downgraded the quality of the evidence to low or very low.Authors' conclusionsHigh quality evidence shows that antibiotic treatment for sexual partners of women with BV, compared with placebo, does not increase the rate of clinical or symptomatic improvement during the first, between the first and fourth or after the fourth week into the women. Low quality evidence suggests that antibiotic treatment does not led to a lower recurrence rate during the first and fourth or after the fourth week of treatment into the women, but increases the frequency of adverse events reported by sexual partners. Finally, compared with no intervention, antibiotic treatment does not decrease the recurrence rate after the fourth week and does not increase the frequency of clinical or symptomatic improvement between the first and fourth or after the fourth week into the women, respectively.
Introduction Both Trichomonas vaginalis (TV) and bacterial vaginosis (BV) cause vaginitis and place women at higher risk for HIV infection. Both are treated with metronidazole (Mtz) but at different doses. The purpose of this study was to examine the co-occurrence of these infections and BV treatment outcomes among TV+/BV+ women multi-dose Mtz for the treatment of TV. Methods Women attending three sexually transmitted disease clinics in the southern US who had a diagnosis of TV (culture or NAAT confirmed) were interviewed and examined for BV using a Nugent score ≥7. Women were randomised to either 2 g single dose or 500 mg Mtz BID for 7 days multi-dose for the treatment of TV and followed 3–12 weeks post TV treatment and retested for both TV and BV. Medical records were abstracted for Amsel criteria for a subset of the cohort. Results Of 528 TV+ women at baseline, 49.8% also had BV per Nugent score, 44.3% reported a history of BV and 5.9% also had yeast. Of 289 women whose medical records were abstracted, 23.5% had a vaginal discharge consistent with BV (i.e. thin and white/grey), and 34.1% were BV+ per Amsel at baseline. Of the 46 women who were BV+ at baseline per Amsel (i.e. diagnosed at point of care) and per Nugent (i.e. lab diagnosed) and were treated with multi-dose Mtz, 96% reported taking all their medicine. While 36% of these women reported condomless sex during follow-up, there was no association between sexual exposure and BV status at TOC. Of these 46 women, 42.9% remained BV+ at TOC and 19.4% reported BV-related symptoms. BV status at TOC was not associated with TV cure rates (p>0.56). Conclusion A high rate of BV co-infection (49.8%) was found among women with TV, much of which was asymptomatic. The rate of BV persistence post multi-dose Mtz was also high both microbiologically (42.9%) and clinically (19.4%) and did not appear to be influenced by TV treatment status. Additional research and development of novel therapeutics (i.e. biofilm disruptors) are urgently needed for women with BV, particularly among TV+ women where BV rates are high.
Introduction Buschke-Löwenstein tumour (BLT) is a very rare sexually-transmitted disease associated with human papillomavirus (HPV) type 6 and 11, but rare cases of oncogenic HPV types including HPV 16 and HPV 18 were also reported. BLT is located in the genital, anorectal and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. Buschke-Löwenstein tumour can be associated with a high rate of recurrence and a risk of malignant transformation to invasive SCC, especially in patients with oncogenic types of HPV. Methods We report the case of a 59-year-old female patient who addressed our clinic for a large, exophytic, cauliflower-like tumour involving the vulva, perineum and perianal regions with 20 years duration. The first lesions had been appeared on vulva and after 3 years period they grown slowly and covered perineum and perianal area. They had cauliflower like surface, with different sizes. In some points erosions and yellowish secretion with odour are observed. Results Histologic examination of a biopsy specimen of large tumour presented nets of well-differentiated squamous cell carcinom, as well as a marked mononuclear cell infiltrate and conspicuous koilocytosis. HPV DNA for 6, 11 types was detected with PCR. Conclusion The patient was sent to the gynaecology surgery department for excision and remains under the supervision of the dermatology and oncology department for rapid treatment of relapses and early detection of malignant transformation.
Introduction Recurrent genital herpes is conventionally treated with acyclovir 200 mg 5 times a day orally which is inconvenient to take by the patients. We studied the effectiveness and safety of acyclovir 1 gm single oral dose once a day for 5 days in treatment of recurrent genital herpes. Methods Patients presenting with recurrent genital herpes were included in the study. After a complete clinical and laboratory evaluation, the patients were treated with acyclovir 1 gm single oral dose once a day for 5 days and followed up on days 5, 7 and 10 to determine the response to treatment and adverse effects. Results There were 19 patients (18 males and 1 female, between 18–47 years of age; mean age: 33.52±8.09 years), of which 18 patients completed the study. Seven (39%) of them had complete healing of the ulcer on day 5, 13 (72%) on day 7 and 16 (89%) by day 10. Mean percentage healing of ulcer was 72.53±22.24, 87.73±15.22 and 95.00±7.07 on day 5, 7 and 10 respectively. Visual analogue score (VAS) showed complete improvement in VAS in 9 (50%) patients on day 5, 13 (72.22%) on day 7 and 17 (94.5%) on day 10. The mean time of complete improvement in VAS was 6.38±2.97 days. Mean of percentage improvement in VAS was 81.92±20.87 on day 5, 90.00±15.18 on day 7 and 92.00±17.88 on day 10. Mean healing time of the lesions was 6.86±2.67 days (range 3–12 days). There were no significant adverse effects of the therapy. Conclusion The study demonstrated that oral acyclovir 1 gm once a day as single daily dose is effective and safe for the treatment of recurrent genital herpes. There was significant healing of lesions, which reduces morbidity, psychological distress and risk of transmission of infections to sexual partner. Further studies are however needed to confirm our results.
Introduction Online HIV/STI testing is an alternative to in-clinic testing, but may lead to missed opportunities for education due to the lack of provider-delivered pre/post-test counselling. GetCheckedOnline (GCO) is an online testing service offered through an urban STI clinic in Vancouver. It was designed to include concepts typically conveyed during in-clinic HIV counselling sessions (e.g., window period, public health reporting). The aim of this study was to compare knowledge of key HIV test concepts between clients testing through GCO and in-clinic. Methods GCO and clinic participants were concurrently recruited over 11 months. Participants were invited to complete an anonymous online survey 2 weeks after receipt of test results. Knowledge of key concepts related to HIV testing was measured using a 6-item true/false test previously developed through a modified Delphi process, cognitive testing and psychometric evaluation. Linear regression was used to assess the association between site (GCO vs. clinic) and overall test scores, after adjustment for age, education, immigration history, language, sexual orientation, and testing history. Results 404 HIV-negative participants were included in the analysis (73 GCO, 331 in-clinic). HIV test knowledge scores averaged 0.4 points higher among GCO (mean score 4.5) than among clinic (4.1) testers (p=0.01). Following adjustment for relevant covariates, this difference decreased to 0.2 points (p=0.15). Likewise, there was no difference in mean HIV test knowledge scores among first-time testers (n=50; 3.7 GCO, 3.6 in-clinic; p=0.75). Conclusion Post-test knowledge of HIV test concepts addressed in standard pre-test counselling was high in both groups and not significantly different following adjustment. Our study suggests that equivalent education about core HIV testing concepts can be achieved through web-based HIV/STI testing, and illustrates the importance of designing services to intentionally address relevant educational messages covered in provider-delivered HIV test counselling.
Introduction There is no consensus on gender differences in clinical outcomes of HIV-infected patients. Immunologic, virologic, and survival data for patients receiving antiretroviral therapy (ART) show an inconsistent presence and direction of a gender gap. Gender and sexual behavior-based outcomes analysis is lacking in Guatemala, which has largely sexual transmission of HIV. We examine outcomes of HIV-positive Guatemalans receiving ART over a 9 year period. Methods Retrospective cohort analysis was conducted using a database of treatment-naïve patients offered free ART at the Clinica Familiar Luis Angel Garcia in Guatemala City from 2004 to 2014. Multivariate Cox regression was used to study gender differences in all-cause mortality, immunologic failure (CD4 <100 cells/µL twice or CD4 < baseline) and virologic suppression (viral load <50 HIV-1 RNA copies/mL within 1 year of starting ART). Results 4248 patients were included: 2605 men, 1617 women, and 26 transgender patients (analysed separately). Compared to men, women had higher median CD4 counts (198 vs. 126 cells/µL, p<0.001) and lower median viral loads (6.48 × 104 copies/mL vs. 11.27 × 104 copies/mL, p<0.001) at baseline. In multivariate analysis, mortality decreased with female gender (HR 0.52, 95% CI 0.29–0.93, p=0.029) while it increased with age (HR 1.02, 95% CI 1.003–1.04, p=0.02) and inconsistent condom use (HR 9.36, 95% CI 2.61–33.63, p=0.001). In women alone, these factors did not predict mortality. In men alone, mortality increased with inconsistent condom use (HR 23.26, 95% CI 2.89–187.3, p=0.003), and number of sexual partners (HR 1.02, 95% CI 1.001–1.039, p=0.041). Gender did not predict immunologic failure. Female gender predicted a lower rate of viral suppression (HR 0.6, 95% CI 0.41–0.85, p=0.005). Conclusion Women receiving ART have lower mortality than men when adjusted for sociodemographic factors and sexual behaviours. Sexual risk factors affect genders differently and can predict treatment outcomes in previously infected patients.
Introduction Syphilis reinfections are playing an increasing role in syphilis transmission in a number of populations. The assessment of reinfection and response to treatment depends on accurately measuring intraindividual changes in non-treponemal tests (delta-NTTs). In a 0 to 6 month delta-RPR determined by routine RPR testing (RT), samples would be tested 6 months apart with differences in reagent batches, environmental temperatures and observers all leading to measurement errors. We hypothesised that conducting paired RPR (PT) would enable a more accurate determination of delta-RPR than RT. Methods 120 patients with a new diagnosis of syphilis were followed up at 0,3,6,9,12,18 and 24 months with RPRs performed via RT at each study visit and at any suspected reinfection. RPR PT was performed at 0 and 6 months and at any suspected reinfection. Results The quantitative agreement +/-1 dilution among PT and RT was 97.4%. There was no difference in the proportion with an incomplete serological response at 6 months: 21 (19.4%) and 19 (17.6%) according to PT and RT, respectively (p=0.726). There was no statistically significant difference between 0 to 6 month delta-RPR as determined by PT and RT in predicting seroresponse at 12 months (86.1% and 91.6% agreement with 12 month classification, respectively, p=0.262. PT did not reduce the numbers of those classified with asymptomatic reinfections. Conclusion In our setting routine PT is unlikely to be worth the considerable effort and cost it entails. Further research is required to assess its utility in specific circumstances.
Introduction Bowenoid papulosis (BP) is virally induced disease caused by high risk HPV viruses, the most common type 16 and rarely type 18, 32, 39, 42, 48,53, 58. Smoking, early sexual initiation, promiscuity, risk sexualbehavior, uncircumcised sexual partners, immunosuppression, pregnancy, oral contraceptives are other causative factors for BP. The disease affects both sexes equally and is typical of young, sexually active people, aged between 20 and 40.Clinical features of BP are solitary or multiple confluent rapidly increasing papules with red-brown colour and diameter 2–10 mm, with uneven papillary or flat-to verrucous surface. They are localised on external genitalia bilaterally and symmetrically. In men cover foreskin, glans penis, in women labia majora, perianal area. This histology make difficult differential diagnosis with Morbus Bowen in anogenital area. Conducted destructive treatment in outpatient settings is with unsatisfactory therapeutic effect. Methods We report the case of 45 year old female who addressed our clinic for multiple confluent papules with red-brown colour and diameter 2–10 mm., with uneven papillary or flat-to verrucous surface on external genitalia area bilaterally and symmetrically. Results Histologic examination of a biopsy specimen established acanthosis, parakerathosis, hyperkerathosis, koilocytosis and atypical cells with hyperchromic bi, multinuclei occupying almost half the thickness of the epidermis to the extent of bowenoid dysplasia. Conclusion The patient was treat with Imiquimod 5% cr. for 8 weeks with non significant results an partial vulvectomy (willingness of the patient) was performed.
Introduction The WHO Global HIV drug resistance network (HIV-ResNet), was stablished to monitor the emergence and help to control the transmission of HIV-1 drug resistant strains. The TDR is progressively increasing over the last years in some Brazilian regions, mainly where the epidemic is concentrated. This study evaluated the trends in the prevalence of TDR mutations and dynamic of subtypes, among drug-naïve HIV-1 infected individuals from vulnerable group populations in the context of the WHO HIV-ResNet. Methods We analysed a total of 536 HIV-1 sequences collected during 2005 to 2014, targeting drug naïve pregnant woman from four public antenatal care units and 159 recently diagnosed (<1 year) individuals identified in VCTs in all Rio de Janeiro state. The profiles of TDR mutations were evaluated using the updated WHO transmitted resistance mutation list and HIV-1 genetic diversity evaluated by phylogenetic analysis. Results Overall, the prevalence of TDR was 12.5% (CI95%, 7.15% to 16.5%) being, 5.8% (CI95%, 2.5% to 9.15%) to the nucleoside reverse transcriptase inhibitors (NRTIs), 3% (CI95%, 0.1% to 4.85%) to non-nucleoside inhibitors (NNRTIs) and 3.7% (CI95%, 1.24% to 7.5%) to protease inhibitors (PIs). Both studied groups showed similar TDR prevalence for all drug classes. The timidine-associated mutations (TAMs) and M184V were the most prevalent TDR mutations found in RT gene, followed by K103N, T215 revertants and F77L. The M46I PI associated mutation was the more frequent, followed by V82A and L90M. HIV-1 subtype B was the most prevalent (80%), followed by F1 (7.5%), subtype C (4%) and BF recombinants (3.5%). In addition to non-B HIV-1 subtype A1, G, CRF02_AG, CRF31_BC, FC and DF recombinants, identified in 4% of genotyped samples. Significant difference was observed in the two groups, where subtype F (12%) was more prevalent in pregnant woman, while subtype C prevalent in new diagnosed subjects (5.9%). Conclusion This work tried to study trends of HIV-1 TDR and the genetic diversity in Rio de Janeiro state, the second major HIV/AIDS epidemic in Brazil. The results demonstrated a sustained low prevalence of TDR to the PIs, recent accumulation of resistance associated to the NRTIs and reduction to NNRTIs over the years. The time trend of TDR observed, seem to reflect changes in antiretroviral therapy in Brazil over time. HIV-1 subtype B was the most prevalent in the study, but the increasing prevalence of subtype C and the identification of others non-B and recombinants infections, suggest the recent introduction and spreading of these viruses, respectively south Brazil and African countries in Rio de Janeiro. Support: Oswaldo Cruz Foundation-IOC/FIOCRUZ, Brazilian Ministry of Health (DDAHV-CQV/MS), Pan-American Health Organization-PAHO and World Health Organization-WHO
Introduction The expansion of Family Health in the City of Rio de Janeiro, as well as the structure that minimally requires one pharmacist per unit of Family Health Clinic, this professional has been often acting as protagonists in the success of the Treatment and follow-up. In this context, the pharmacist performance in all stages of syphilis care has become paramount for the success of the treatment, acting in all care stages. Methods Prevention - opportunize the patient‘s visit to the pharmacy to identify individuals risk and eligible for actions as pharmaceutical consultation or a educational group, as responsible for the custody and control of the syphilis Rapid test allows the knowledge of the cases even before the dispensation. Surveillance and notification of public health problems - as soon as the knowledge of the diagnosis, by rapid test result or the demand for the dispensing of the medicine, is also responsible for that notification, and it is up to him to make that request to the professional who made the diagnosis or even to make the notification. Oriented Dispensation - it is of paramount importance and the pharmacist’s legitimate responsibility that this patient initiates his treatment with all the necessary information: the clarification on the duration of treatment, the importance of being done correctly, the transmissibility of the disease as well as the importance the treatment of the partner (s) for the success of the conduct. Pharmaceutical consultation - classify the risk of not adhering to treatment and use convincing strategies considering that any may be the reasons for resistance to treatment and qualified listening from a professional with the technical expertise to evaluate case by case and sensitivity to conduct the situation can make the difference in completing this treatment. Results and Conclusion The analysis makes it possible to perceive how the routine of the pharmacist integrated into the Family Health offers several tools that make the conclusion of the treatment in an appropriate way of the pharmacist’s responsibility.
Introduction To describe the incidence and risks factors of ART induced nephrotoxicity and chronic kidney disease (CKD) in HIV-1-infected adults with low body mass index (<18.5kg/m2). Methods A retrospective cohort study at the Ambulatory Treatment Centre in Brazzaville, Congo. Patients with estimated glomerular filtration rate (eGFR) decrease by 25% compared to baseline or a 0.5 mg/dL increase in Serum creatinine (Scr) above baseline were classified as having nephrotoxicity, and CKD was defined as a value less than 60 ml/min per 1.73m².We used Cox proportional hazards regression models to determine factors associated with nephrotoxicity and CKD. Results Of 325 patients, 73.23% were women. Median values was: age: 37.55 years (IQR: 33.51–44.96), weight: 45 kg (IQR: 41–49), CD4 count: 137.5 cells/µl (42 – 245). In the first 24 – months followup on ART incidence rate of nephrotoxicity and CKD was 27.95 and 7.44 per 100 person – years respectively. Multivariate analysis identified as a risk factor of nephrotoxicity, baseline haemoglobin below or equal 8 g/dL (aHR=2.25; 95% CI, 1.28–3.98; p=0.005), eGFR between 60–80 (aHR=0.33; 95% CI, 0.20–0.56; p=0.001) and below 60 ml/min/1.73m2 (aHR=0.11; 95% CI, 0.03–0.46; p=0.003), and the use of tenofovir (aHR=1.51; 95% CI, 1.01–2.26; p=0.04). Each 10 year older age was associated with an increased risk of developing CKD (aHR=1.95; 95% CI, 1.2–3.17; p=0.007). Conclusion Incidence of nephrotoxicity and CKD were high. HIV positive patient with low BMI at baseline need close monitoring of their renal function when treated with tenofovir.
Introduction Gummatous syphilis presenting as nasal septal perforation is well described in the classic literature, but rarely encountered in the current antibiotic era. We present a man with a destructive nasal process with a delayed diagnosis of tertiary (late benign) syphilis. Case Description A 45 year old Eritrean gentleman presented with an ulcero-nodular lesion of the left nares, progressive over the previous six months. He denied trauma or illicit drug inhalation. Exam was remarkable for left nasal cavity with an eroding destructive lesion perforating through the nasal septum and left nasal ala. He had no clinical signs or symptoms of neurosyphilis. Multiple biopsies revealed acute-on-chronic inflammation with focal necrosis and no evidence of malignancy. Fungal, treponemal and routine bacterial stains were negative, and tissue cultures were negative. Imaging indicated no bony destruction. The patient was treated for presumed cellulitis with multiple courses of oral antibiotics (cephalexin, amoxicillin) with no improvement in symptoms. At follow up, the patient tested negative for human immunodeficiency virus (HIV) infection and negative for anti-neutrophil cytoplasmic antibodies (ANCA). Serologic tests for syphilis were ultimately performed, revealing a rapid plasma reagin (RPR) titer of 1:512 with a reactive florescent treponemal antibody absorption test (FTA-ABS). A CSF evaluation was normal, with no pleocytosis and normal protein and glucose. Treatment was initiated with benzathine penicillin G, three doses of 2.4 million units each at one-week intervals. Clinical response to treatment is pending at the time of this report. Discussion Gummatous syphilis is of clinical importance because of its potential for local destruction and disfigurement of the nasal structures. Early recognition and management has important individual and public health implications and this case would remind contemporary physicians that “the great imitator” could lurk behind unusual presentations.
Introduction Kaposi’s Sarcoma (KS) is the most common HIV related neoplasm since the outburst of the HIV epidemic in early 1980s. After the widespread use of highly active antiretroviral therapy (HAART) its incidence has declined drastically, but even today patients find themselves infected with HIV after developing KS. Methods Case Report. Results We report the case of a 36 years old, African-american, bisexual man who had his HIV diagnosis on october 2014 after the onset of violaceous, nodular skin lesions all over his body six months earlier. At first visit to our service he has presented with 70 skin lesions, 69 of them were violaceous and nodular, one oral mucous lesion and typical biopsy-proven gastric and sigmoid lesions. His CD4 count was 99 cels/mm3 and HIV viral load was 3412 copies/mm3 (log 3.533). His KS was classified as T1S1. The most disturbing finding, though, was an aberrant presentation of KS on his 2nd left pododactyl, affecting and disturbing the entire normal architecture of this toe, making it three times bigger than usual, displacing the fingernail, along with other nodular lesions on the dorsal face of the left feet.This lesion was very secretive, with a clear and foetid fluid. Patient had already started TDF/3TC/EFZ plus sulfametoxazol-trimetoprim 1 week earlier and we prescribed liposomal doxorubicin, 20mg/m2 each 21 days, alongside with special dressings on this tumoral lesion thrice a week. He achieved undetectable viral load and CD4 cell count of 117 cells/mm3 four months later. Patient received 26 chemotherapy sessions from December 2014 to April 2016, with a total dosage of 852 mg of liposomal doxorubicin and achieved a complete response, with healing of all skin, mucous and visceral lesions, including a full recovery of the 2nd pododactyl. Conclusion A combination of HAART plus extensive chemotherapy and proper dressings was successful to completely heal an unusual aberrant tumour in a patient with disseminated KS.
Introduction There is increasing urgency to document changing antimicrobial resistance (AMR) patterns of N. gonorrhoea (GC) in different parts of the world. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporin. The surveillance for AMR in Kenya and the region was undertaken to determine the frequency and diversity of antimicrobial resistance of gonococcal isolates from Sex Workers Outreach Program (SWOP) Clinic. Methods The survey tested 238 isolates over a period of 4 years from participants presenting with cervical/vaginal discharge. Samples collected were inoculated directly on modified Thayer martin media (MTM), transported to GASP Laboratories at KAVI-Institute of Clinical Research and identified by standard bacteriological procedures. Antibiotic susceptibility testing of GC isolates was performed using diffusion gradient method. The MICs of penicillin, tetracycline, ciprofloxacin, spectinomycin, erythromycin, Azithromycin, cefixime and ceftriaxone were determined by the E-test method. The strains were defined as susceptible, intermediate and resistant using the WHO guidelines, all the findings were validates at WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital in Sweden. Results 41 isolates in 2012,119 isolates in 2013, 24 isolates in 2014 and 54 isolates in 2015 showed 100% susceptaility for cefixime, ceftriaxone and spectinomycin, with a mean susceptibility of 82%, 37.7%, 19.5%, 1.6% and 0% for azithromycin, erythromycin, ciprofloxacin, penicillin and tetracycline respectively. Resistance for ciprofloxacin had rise from 56% in 2012, 58.8% in 2013, 66.7% in 2014 to 68.5% in 2015. Conclusion Spectinomycin, cefixime, ceftriaxone, azithromycin are useful. Ciprofloxacin the most prescribed antibiotic is no longer reliable for treatment of GC. Continuous surveillance is essetial to mordify treatmet guidelies. Worsening GC drug resistance will compromise effective treatment and decrease disease control efforts.
Introduction Positive user experiences are key to trust and repeated use of online services (known as e-Loyalty). GetCheckedOnline (GCO) is an online testing service for HIV/STI where clients complete a risk assessment, print lab forms, submit specimens at a lab, and retrieve results online (if negative) or by phone. We surveyed GCO clients on their perceptions of using the service. Methods We invited first-time GCO users (who consented to be contacted for research) to complete an anonymous online survey 2 weeks following reporting of test results. Survey questions were analysed descriptively and included demographics, reason for test, and how participants heard about GCO. Satisfaction, convenience, ease of use, and e-Loyalty (intention to use again, recommend to others) were measured using 5-point Likert scales and collapsed (low to neutral vs high responses). Results Between July 2015-Sept 2016, 23% of 1099 first-time GCO users consented to be contacted for research and 136/208 (65%) of users contacted agreed to participate in the survey. Participants had a median age of 33 years, 80% were white, 67% male, 43% straight, and 43% men who have sex with men. The most common testing reasons were: routine test (64%), risk event/exposure (44%) and new relationship (22%). Participants heard about GCO from clinics/health providers (38%), campaigns (26%), social media (18%), and friends or partners (13%). Almost all participants were satisfied with GCO overall (93%) and with their experience of receiving results (96%), 92% agreed GCO was convenient, 87% found GCO easy to use, and 83% rated the experience of submitting specimens as good or excellent. E-Loyalty was also high: 97% intended to use GCO again and 96% would recommend GCO to others. Conclusion We found very high satisfaction with and loyalty to GCO among first-time users, indicating a successful service model from a client perspective. In addition to uptake and test outcomes, user experience is a key outcome for evaluation of online HIV/STI testing services.
Introduction Herpes simplex virus type 2 (HSV-2) infection increases the risk of bacterial vaginosis (BV). We hypothesised that the biologic mechanism of this association is that genital HSV-2 shedding increases inflammation, resulting in increased presence and quantity of BV-associated bacteria (BVAB). Methods HSV-2 seropositive women with a clinical history of BV in the past 12 months collected daily genital swabs for HSV detection and vaginal swabs for Nugent score and analysis of the microbiome for 28 days. BV was defined as Nugent score>=7. Quantitative PCR (qPCR) with species specific primers for Lactobacillus crispatus, L. iners, L. jensenii, Gardnerella vaginalis,Megasphaera and BVAB-2 were performed. HSV was detected using real-time qPCR. The presence of each bacterial species was compared on days with and without HSV shedding using Poisson regression. Results Forty-eight women (median age 40; 48% white) with a median of 2 genital HSV-2 recurrences in the prior year (range 0–12) were enrolled for a total of 1277 days of observation. Genital HSV shedding was detected on 134 (10%) days. Of 960 days with Nugent score available, BV was present on 351 (37%) days. The risk of BV was not significantly different in the presence of HSV shedding (RR=0.84, 95% CI=0.66–1.07). Several bacterial species appeared to be detected more frequently on days with HSV shedding as compared to days without shedding (L. crispatus: 53% vs. 44%, L. jensenii: 56% vs. 49%, Megasphaera: 58% vs. 41%, BVAB-2: 49% vs. 37% of days, respectively), although these findings were not statistically significant. The study is 80% completed; data for at least 12 additional women is anticipated, which will provide additional statistical power. Conclusion Genital HSV-2 shedding may be associated with dynamic shifts in the vaginal microbial community and may increase the presence of BVAB. A study to assess whether the use of suppressive treatment for HSV (daily valacyclovir) decreases the presence of BVAB, or BV (twice weekly metronidazole) decreases HSV shedding, is ongoing.
Introduction The Human Immunodeficiency virus (HIV) epidemic is characterised by the dominance of HIV type 1 (HIV-1) worldwide. Consequently, antiretroviral therapy (ART) and drug resistance studies have focused almost exclusively on HIV-1. In Ghana both HIV-1 and HIV-2 co-circulate with lack of data on HIV-2 drug resistance mutations. We sought to determine drug resistance mutations in HIV-2 patients in Ghana. Method We used purposive sampling to collect blood from 16 consented patients confirmed as HIV-2 and dual HIV-1/2 by serology and molecular assays. Real-time RT-PCR assay was used to determine the viral load of patients by using an HIV-2 RNA International Standard from the National Institute for Biological Standards and Control (NIBSC). Nucleic acid (RNA and DNA) were extracted from plasma and peripheral blood mononuclear cells (PBMC) respectively. The reverse transcriptase (RT) and protease (PR) genes of HIV-2 were amplified by PCR, sequenced and analysed for drug resistance mutations and subtype information. Results HIV-2 RNA was detected in 7 of 10 ART-naïve and 2 of 6 ART-experienced patients. Detectable HIV-2 viral loads in these patients ranged from below the lower limit of quantification (<2.35 log IU/ml) to 5.45 log IU/ml. One ART-experienced patient had M184V, K65R and Y115F mutations in RT sequences from both plasma and PBMC. There were no drug resistance mutations identified from ART- naïve samples. Conclusion This is the first study in Ghana to show evidence of mutations in HIV-2 strains from patients receiving HIV-1 targeted antiretrovirals. The results prompt monitoring of drug resistance to improve clinical management of HIV-2 infected patients.
Introduction Verrucous squamous cell carcinoma (SCC), which was first described in 1948 by Ackermann, was reported in the oral cavity, anus, penis and female genitalia. This carcinoma is a low-grade SCC tumour and exhibits slow invasive growth. Regional lymph node metastases are rare and distant metastases have not been reported yet. Penile verrucous SCC carcinoma represents 5% to 16% of all penile SCC and in 33% of cases is associated with HPV type 6,11. Lack of circumcision, poor hygiene, phimosis, tight prepuce and chronic infection are other important causative factors for penile verrucous SCC carcinoma. We are reporting a case of a 70 year-old male patient who has come to our clinic with enlarging erythematous, exophytic papillary mass with foul smell located on glans penis for four- month duration. The patient is a chain-smoker and immunosuppresed due to the treatment of a non- Hodgkin lymphoma. He reported occurrence of multiple condylomata acuminata on genital area with a long lapse, which was treated with local destructive therapy and electrocoagulation. His medical history includes also ischaemic heart disease and coronary insuffiency. Methods: Histological examination established verrucous SCC carcinoma - hyperkeratosis, parakeratosis, acanthosis with bulbous downward projections into the dermis and well-differentiated tumour cells with invasion in reticular derma with depth of 2.122 mm and desmoplastic stromal reaction. Polymerase Chain Reaction for HPV DNA detected HPV type 6. Results and conclusion The surgical excision and amputation penis partialis in Urology surgical department showed that there was not invasion of the tumour in corpora cavernosa and corpus spongiosum and it was classificated as T1NxMx. The patient remains under the supervision of the dermatology and oncology specialists for eventual relapses.
Introduction Safe blood transfusions remain a challenge in Africa where sexually transmitted diseases (STIs) mainly hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and HIV are hyper-endemic. Amongst, HBV is ranked the 7th leading cause of annual global deaths. HBV has up to 10 genotypes (A-J) and all show uniqueness in prognosis, response to therapy and geographic distribution. In Africa, 30%. (A, D and E) of these genotypes have been identified circulating in different cohorts. Up to date, there is no data on the prevalence and molecular characterisation of HBV in blood donors in Botswana. The study aims to identify HBV genotypes circulating in Botswana blood donors and update its prevalence in comparison to other identified STIs in the cohort. Methods A one-year cross-sectional study for consecutive hepatitis B surface antigen positive (HBsAg+) allogeneic blood donations confirmed using ELISA was done. HBV genome extraction was done using UltraSense DNA/RNA Kit followed by a 25 µl polymerase chain reaction (PCR) reaction made of master-mix containing SuperScript Platinum III polymerase and two primers Core-F and Werle-AS covering 2.1 kb region (PreS2, PreS1, S and part of Pol region). Big Dye sequencing chemistry was performed on 82% (41/50) successful PCR products of which 87.8% were successfully sequenced and genotyped. Results Sub-genotype A1 (48%) serotype adw2 and D (52%) serotype ayw2 were confirmed in the cohort. Escape mutations A120L and 130 R in two genotype A samples were found associated with failure to vaccine and detection. Allogeneic donations at National Blood Transfusions Services in Botswana (NBTS) during study were 10 798. Prevalence of HBsAg+ was 0.92%. Co-infections confirmed were of Syphilis 1.72%, 1.54% for HIV and 0.43% for Hepatitis C. The total population’s age was normally distributed with mean of 29±1.7 years and a range of 44 years. Conclusion Predominant genotype amongst Botswana blood donors is D3. There is a major concern to address STIs in Botswana much work is being done on HIV but the results reflect a burden of all STIs.
Introduction Effective partner treatment (PT) is essential to interrupt transmission, prevent re-infections, and may reduce the prevalence of chlamydia. Dutch guidelines allow direct PT of current and most recent ex-partners of a chlamydia patient when they present for testing, but no prescriptions without contact with the partner. As part of a project concerning the potential of Patient Initiated PT (PIPT) for chlamydia (PICC-UP; Patient Initiated Contact treatment for Chlamydia), we investigated attitudes towards PIPT among health staff at sexual health centres (SHC). Methods An online anonymous questionnaire was sent to all 73 physicians and 248 nurses employed at 25 Dutch SHCs. The questionnaire was based on focus groups conducted with health staff, and included Likert-scale questions on opinions and attitudes towards PIPT. Descriptive analyses were performed. Results The overall response rate was 36%. In general, health staff was critical towards PIPT without counselling. 97% of respondents agreed that current steady partners should get treatment immediately, and 43% thought so for casual partners. However, a smaller proportion would give medication via the index patient: 51% for a steady and 8% for a casual partner. Respondents were more likely to apply PIPT if there was a high chance of infection but a small chance the partner would present for testing. Furthermore, checking allergies and contra-indications before antibiotic prescription was considered essential by 97%. Most (60%) preferred acquiring this information via direct contact with the partner; 30% favoured telephone or internet. Hardly any differences were seen between answers of physicians or nurses. Conclusion Physicians and nurses from SHCs find PT for chlamydia important, but their attitude towards PIPT is reluctant. They would consider PIPT for current steady partners or for partners who may not present for testing, preferably after some form of contact with the partner. For further development of PIPT strategies, involvement of the implementing health professionals is essential.
