Sexually Transmitted Diseases: From HPV to HTLV - Clinical Profile and Associated Factors

The Brazilian Ministry of Health recommends the performance of serological tests in patients with clinical signs of Sexually Transmitted Diseases. However, data are lacking to affirm the necessity of testing these patients for human T-lymphotropic virus type 1 or type 2. This is a cross-sectional study with 120 patients seen at the Sexually Transmitted Diseases unit of the Sanitary Dermatology Outpatient Clinic of Rio Grande do Sul. The serum from none of the patients was positive for human T-lymphotropic virus type 1 or type 2. Viral warts were the most frequent diagnosis. Drug use was confirmed as a risk factor and high educational levels were found to be a protective factor against Sexually Transmitted Diseases.

Below:  Frequency distribution of the variables according to the syndromic approach to STD diagnosis

		Genital ulcer	Discharges*	Genital warts	Pelvic Pain	Total	p
History of HIV	Yes	6	3	5	0	14	0.253§
	No	21	30	53	3	107
Drugs use	Yes	15	25	48	3	91	0.039§
	No	12	8	10	0	30
Condoms use	Always	10	10	19	0	39	0.282§
	Sometimes	12	18	32	1	63
	Never	5	5	7	2	19
Steady partner	Yes	18	18	36	1	73	0.593§
	No	9	15	22	2	48
Multiple partners	Yes	8	13	16	1	38	0.702§
	No	19	20	42	2	83
Partner with STD	Yes	5	9	10	0	24	0.433§
	No	12	11	33	2	58
	Does not know	10	13	15	1	39

*the sum of the urethral and vaginal discharges.

§Pearson's chi-square test

Full article at:   http://goo.gl/ZJc1JO

By:   Fabíola Suris da Silveira^1,2 and Renan Rangel Bonamigo^1,3

¹Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) – Porto Alegre (RS), Brazil.

²Hospital Nossa Senhora da Conceição – Porto Alegre (RS), Brazil.

³Ambulatório de Dermatologia Sanitária da Secretaria de Saúde do Estado do Rio Grande do Sul – Porto Alegre (RS), Brazil.

MAILING ADDRESS: Fabíola Suris da Silveira, Av Joao Pessoa, 1327 Farroupilha, 90040001 - Porto Alegre - RS, Brazil. E-mail:moc.liamtoh@sirusibaf

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Tinea Genitalis: A New Entity of Sexually Transmitted Infection? Case Series & Review of the Literature

Key messages

• Sharply demarcated erythematous scaling plaques or pustules in the genital region should raise suspicion of tinea, especially after sexual intercourse in South East Asia.
• To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment and adequate isolation and identification of the pathogen is essential.
• Marked inflammatory reaction after starting antifungal treatment is frequent and requires systemic prednisone.

Objective

Investigation on recent cases of tinea genitalis after travelling to South East Asia.

Methods

Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses.

Results

The case series includes seven patients. In six patients, Trichophyton interdigitale (former Trichophyton mentagrophytes) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work.

Conclusions

Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. interdigitale. To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory.

Below:  Erythematous scaling plaques and follicular pustules in an 18-year-old patient

Below:  Pubic area with succulent ulcerated nodules with seropurulent discharge 2 days after beginning of antifungal treatment

Full article at:   http://goo.gl/5kbCMt

By:   Isabelle Luchsinger,1 Philipp Peter Bosshard,2 Romano Silvio Kasper,2 Dominic Reinhardt,1 and Stephan Lautenschlager1

1Outpatient Clinic of Dermatology, Triemli Hospital, Zurich, Switzerland

2Department of Dermatology, University Hospital Zurich, Zurich, Switzerland

Correspondence to Professor Dr Stephan Lautenschlager, Outpatient Clinic of Dermatology, Triemli Hospital, Herman Greulichstrasse 70, Zurich CH-8004, Switzerland; Email: hc.hcireuz.ilmeirt@regalhcsnetual.nahpets

 

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Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting

Background

Quantifying sexually transmitted infection (STI) prevalence and incidence is important for planning interventions and advocating for resources. The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable STIs: chlamydia, gonorrhoea, trichomoniasis and syphilis.

Methods and Findings

WHO’s 2012 estimates were based upon literature reviews of prevalence data from 2005 through 2012 among general populations for genitourinary infection with chlamydia, gonorrhoea, and trichomoniasis, and nationally reported data on syphilis seroprevalence among antenatal care attendees. Data were standardized for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. In 2012, among women aged 15–49 years, the estimated global prevalence of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7–4.7%), gonorrhoea 0.8% (0.6–1.0%), trichomoniasis 5.0% (4.0–6.4%), and syphilis 0.5% (0.4–0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0–3.6%), gonorrhoea 0.6% (0.4–0.9%), trichomoniasis 0.6% (0.4–0.8%), and syphilis 0.48% (0.3–0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100–166 million), 78 million of gonorrhoea (53–110 million), 143 million of trichomoniasis (98–202 million), and 6 million of syphilis (4–8 million). Prevalence and incidence estimates varied by region and sex.

Conclusions

Estimates of the global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections with curable STI each day. The estimates highlight the urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available. Improved estimation methods are needed to allow use of more varied data and generation of estimates at the national level.

Below:  Estimated prevalence (and 95% UI) of chlamydia, gonorrhoea, trichomoniasis, and syphilis in women and men aged 15–49 years by WHO region, based on 2005–2012 data

Below:  Incidence (and 95% UI) of chlamydia, gonorrhoea, trichomoniasis, and syphilis in women and men aged 15–49 years by WHO region, based on 2005 to 2012 data

Full article at:  http://goo.gl/pSlqZk

By:   

Lori Newman, Sami Gottlieb, James Kiarie, Marleen Temmerman

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Jane Rowley, Stephen Vander Hoorn, Nalinka Saman Wijesooriya

Consultant to Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Stephen Vander Hoorn

Statistical Consulting Centre, University of Melbourne, Melbourne, Australia

Magnus Unemo

WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Örebro University Hospital and Örebro University, Örebro, Sweden

Nicola Low

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Gretchen Stevens

Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland

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Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. 

New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. 

For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. 

Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.

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By:  Seña AC1, Hsu KK2, Kellogg N3, Girardet R4, Christian CW5, Linden J6, Griffith W7, Marchant A8, Jenny C9, Hammerschlag MR10.

• 1Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill.
• 2Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain.
• 3Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio.
• 4Division of Child Protection Pediatrics, Department of Pediatrics, University of Texas Health Science Center at Houston.
• 5Child Abuse and Neglect Prevention, Children's Hospital of Philadelphia, Pennsylvania.
• 6Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
• 7Women's Emergency Services, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
• 8Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
• 9Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle.
• 10Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn. 

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Epidemiology of Sexually Transmitted Infections in Visitors for the London 2012 Olympic Games: A Review of Attendees at Sexual Health Services

Mass gatherings and large sporting events, such as the Olympics, may potentially pose a risk of increased sexually transmitted infection (STI) transmission and increase burden on local STI services. The objectives of this analysis were to assess whether the STI profile of Olympic visitors differed from that of the local STI clinic population and to investigate what impact these visitors had on local STI services.

Self-administered questionnaires (completed by 29,292 patients) were used to determine the visitor status of patients attending 20 STI clinics, between July 20, 2012, and September 16, 2012, in the host cities, London and Weymouth. Using routine surveillance data from the Genitourinary Medicine Clinic Activity Dataset version 2, Olympic visitors were compared with usual attendees (local residents and non-Olympic visitors) in terms of their demographic characteristics, services utilized, and STIs diagnosed using univariate and multivariate methods.

Compared with usual attendees, Olympic visitors were more likely to be heterosexual males (56.0% vs. 34.9%, P = 0.001), aged between 15 and 24 years of age (47.1% vs. 34.0%, P = 0.001), of white ethnicity (81.9% vs. 66.4%, P = 0.001), and born in Australasia, Asia, North America, or South America (18.8% vs. 12.0%, P = 0.006). Olympic visitors constituted 1% of new clinic attendances and were less likely to be diagnosed as having a new STI (adjusted odds ratio, 0.69; 95% confidence interval, 0.48-0.98; P = 0.040).

In this first multisite study to examine the effect of Olympic visitors on local sexual health services, the 2012 Olympic Games was found to have minimal impact. This suggests that a "business as usual" approach would have been sufficient.

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By:  Sile B1, Mohammed H, Crook P, Hughes G, Mercer C, Cassel J, Coyne K, Hartley A, Hall V, Brook G.

• 1From the *HIV/STI Department and †Field Epidemiology Services, Public Health England, London, UK; ‡University College London, London, UK; §Brighton and Sussex Medical School, Brighton, UK; ¶Public Health England, Kent, Surrey, UK; ∥Sussex PHE Centre, Horsham, UK; **Department of Sexual Health and HIV, Homerton University Hospital, London, UK; ††Infection and Immunity Department, Barts Health NHS Trust, London, UK; and ‡‡Department of Genitourinary Medicine, Central Middlesex Hospital, London, UK. 

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Comparing Databases: Determinants of Sexually Transmitted Infections, HIV Diagnoses & Lack of HIV Testing among Men Who Have Sex with Men

Early detection and treatment of STI/HIV are public health priorities. Our objective was to compare characteristics of men who have sex with men (MSM) in Dutch data available in 2010 from EMIS, an international internet survey, Schorer Monitor, a Dutch internet survey, and data from STI- clinic visits, since these might be subject to different and unknown biases.

Data from Dutch MSM Internet Surveys (EMIS _NLN = 3,787; Schorer Monitor, SMON N = 3,602), and 3,800 STI clinic visits (SOAP) were combined into one dataset. We included factors that were measured in all three databases. The socio-demographics included were age (at the time of the survey), zip code, and ethnicity. Behavioural variables included were the number of sexual partners, condom use with last sexual partner, drug use, being diagnosed with STI, being diagnosed with HIV, and HIV testing. Outcomes we investigated were being diagnosed with STI, HIV, and never been tested for HIV.

Logistic regressions showed that determinants for being diagnosed with STI were having more sexual partners, drug use, and having had an HIV test (aORs 1.3 to 17.1) in EMIS and SMON. Determinants for being diagnosed with HIV in all three databases were older age, living in Amsterdam, and having more partners (aORs 1.8 to 4.4). In EMIS and SMON, drug use, non-condom use, and having STI were additional determinants (aORs 1.6 to 8.9). Finally, determinants associated with never been tested for HIV were being younger (only SOAP), living outside of Amsterdam, having fewer partners, no drug use, and no STI (aORs 0.2 to 0.8).

Risk factors from internet surveys were largely similar, but differed from STI clinics, possibly because it involves self-reports rather than diagnoses or because of differences in timing. The difference between the internet surveys and STI clinic data is much less pronounced for having never been tested, suggesting both are appropriate for this outcome. These findings shed light on conclusions drawn from different data sources, as well as the comparability of recruitment strategies, the robustness of risk factors, consequences of phrasing questions differently, and on (policy) implications based on different data sources.

Full article at:  http://goo.gl/yvXnCE

By:  Chantal den Daas^1*, Maaike Goenee², Bouko H. W. Bakker², Hanneke de Graaf² and Eline L. M. Op de Coul¹

¹Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, The Netherlands

²Rutgers, Utrecht, The Netherlands

 

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Childhood Lead Exposure & Sexually Transmitted Infections: New Evidence

The adverse health effects of lead exposure in children are well documented and include intellectual and behavioral maladies. Childhood lead exposure has also been linked to impulsive behaviors, which, in turn, are associated with a host of negative health outcomes including an increased risk for sexually transmitted infections (STI). The purpose of this study was to assess the association of lead exposure with STI rates across census tracts in St. Louis City, Missouri.

Incident cases of gonorrhea and chlamydia (GC) during 2011 were identified from the Missouri Department of Health and Senior Services and aggregated by census tract. We also geocoded the home address of 59,645 children >72 months in age who had blood lead level tests performed in St. Louis City from 1996 to 2007. Traditional regression and Bayesian spatial models were used to determine the relationship between GC and lead exposure while accounting for confounders (condom and alcohol availability, crime, and an index of concentrated disadvantage).

Incident GC rates were found to cluster across census tracts (Moran's I=0.13, p=0.006). After accounting for confounders and their spatial dependence, a linear relationship existed between lead exposure and GC incidence across census tracts, with higher GC rates occurring in the northern part of St. Louis City 

At the census-tract level, higher lead exposure is associated with higher STI rates. Visualizing these patterns through maps may help deliver targeted interventions to reduce geographic disparities in GC rates.

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By: Nelson EJ1, Shacham E2, Boutwell BB3, Rosenfeld R4, Schootman M2, Vaughn M5, Lewis R6.

• 1Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA. Electronic address: nelsonej@slu.edu.
• 2Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA.
• 3Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA; School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA. Electronic address: bboutwell@slu.edu.
• 4Department of Criminology and Criminal Justice, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 6312, USA. Electronic address: richard_rosenfeld@umsl.edu.
• 5School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA.
• 6Department of Environmental and Occupational Health, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA. Electronic address: lewisrd@slu.edu.  

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