Sexually Transmitted Infections in Male Prison Inmates: Risk of Development of New Diseases

OBJECTIVE:

To measure incidence and main risk factors related to sexually transmitted infections (STIs) in Daroca Prison (Zaragoza, Spain).

METHOD:

A retrospective cohort study (2005-2013) to measure the incidence of STI and a cross-sectional study to measure risk factors.

RESULTS:

Of the 203 inmates, 79 developed an STI, 37 had a previous STI, 55.2% lacked knowledge on STI prevention, and 28.9% showed behaviours unfavourable for STI prevention. The incidence rate was 6.5 STIs per 1,000 inmates-year. The most frequent STIs were hepatitis B (39.7%), Ureaplasma urealyticum (19.1%), herpes simplex (16.2%) and HIV (8.8%). The risk (hazard ratio, HR) of acquiring a new STI was significantly higher in inmates with a history of previous STI (HR=2.61; 95%CI: 1.01 to 6.69), and was at the limit of significance for non-preventive behaviour (HR=2.10; 95%CI: 0.98 to 4.53), but not in knowledge related to STIs (HR=1.33; 95%CI: 0.58 to 3.07).

CONCLUSION:

The most important risk factors in prison are behaviours related to STIs and previous history of STIs. Other factors are being a repeat offender, injecting drug use, or being in a methadone programme. Health personnel and peer education can facilitate prevention and control.

Purchase full article [in Spanish] at:  http://goo.gl/JK43p2

By:  Sánchez Recio R1, Alonso Pérez de Ágreda JP2, Santabárbara Serrano J2.

• 1Centro Penitenciario de Daroca, Secretaría General de Instituciones Penitenciarias, Ministerio del Interior, Zaragoza, España. Electronic address: rsanchezrecio.1979@gmail.com.
• 2Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España
• Gac Sanit. 2016 Mar 14. pii: S0213-9111(16)00019-4. doi: 10.1016/j.gaceta.2016.01.010.

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A Retrospective Study of the Pattern of Sexually Transmitted Infections in Males: Viral Infections in Emerging Trend

INTRODUCTION:

Sexually transmitted infections (STIs) continue to be a major public health problem with significant burden on the society even after so many health care programmes being organized by the governmental and non-governmental organizations and awareness created among general public about STIs. Male patients are common visitors to STI clinic than females who are generally traced as a contact in our society.

AIM:

The aim of this study was to give an overview of the pattern of STIs among males at a tertiary care teaching hospital over a period of 5 years.

MATERIALS AND METHODS:

A retrospective chart review of the data collected from the clinical records of all male patients, who had attended the STI clinic of Chengalpattu Medical College Hospital, Chengalpattu, Tamil Nadu, for various complaints during the 5 year period from 2010 to 2014 was carried out. All male patients with confirmed STIs were included in the study and those patients without any evidence of STIs either clinically or serologically were excluded from the study.

RESULTS:

Out of the 4454 male cases who had attended the STI clinic, 175 (3.93%) patients had STIs. Genital wart accounted for the maximum number among the STIs with 61 cases (34.86%), followed by genital herpes 56 (32%), urethral discharge 19(10.86%), non-herpetic genital ulcerative diseases 17(9.71%) and serological test for syphilis (RPR) was reactive in 22 (12.57%) patients. HIV was positive in 68 (1.53%) among the total 4454 male patients attended the clinic.

CONCLUSION:

Viral STIs occur significantly more than the bacterial STIs because of its incurable and recurrent nature. Health programmes should be still more focused on creating awareness about the minor STIs and to remove the stigma so that the patients attend the proper health care facilities in the early stage itself for treatment thereby, complications and further transmission of the STIs can be avoided.

Year wise distribution of male cases attended the STI clinic.

Year	Total number of cases	Genital herpes	Genital wart	Genital ulcerative diseases- Non-Herpetic	Urethral discharge	RPR- reactive	HIV - positive
2010	899	9	12	3	5	4	20
2011	812	16	11	2	5	4	15
2012	755	11	12	3	3	9	8
2013	712	9	13	5	3	3	13
2014	1276	11	13	4	3	2	12
Total	4454	56	61	17	19	22	68

Total number of STI and HIV cases among males.

Year	Total number of STI clinic attendees - males	STI cases	HIV
2010	899	33 (3.67%)	20 (2.2%)
2011	812	38 (4.68%)	15 (1.85%)
2012	755	38(5.03%)	8 (1.05%)
2013	712	33 (4.63%)	13 (1.83%)
2014	1276	33 (2.59%)	12(0.94%)
Total	4454	175 (3.93%)	68 (1.53%)

Full article at:   http://goo.gl/U85zgG

By:  Swamiappan M1, Chandran V2, Prabhakar P3.

• 1Assistant Professor, Department of Skin and STD, Chengalpattu Medical College & Hospital , Chengalpattu, Tamil Nadu, India .
• 2Associate Professor, Department of Skin and STD, Chengalpattu Medical College & Hospital , Chengalpattu, Tamil Nadu, India .
• 3Junior Resident, Department of Skin and STD, Chengalpattu Medical College & Hospital , Chengalpattu, Tamil Nadu, India .
• J Clin Diagn Res. 2016 Jan;10(1):WC01-3. doi: 10.7860/JCDR/2016/16142.7138. Epub 2016 Jan 1. 

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Sexually Transmitted Infections and Use of Contraceptives in Women Living with HIV in Denmark - The SHADE Cohort

BACKGROUND:

No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.

METHODS:

WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.

RESULTS:

In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.

CONCLUSION:

The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.

Full article at:   http://goo.gl/jR36Xj

By:  Thorsteinsson K1, Ladelund S2, Storgaard M3, Rønsholt FF4, Johansen IS5, Pedersen G6, Nielsen LN7, Bonde J8, Westh H9,10, Obel N4,9, Katzenstein TL4,9,Lebech AM11,9.

• 1Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. kristina.thorsteinsson@gmail.com.
• 2Clinical Research Center, Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark.
• 3Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
• 4Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
• 5Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
• 6Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
• 7Department of Infectious Diseases, Hillerød Hospital, Hillerød, Denmark.
• 8Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
• 9Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
• 10Department of Clinical Microbiology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
• 11Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
• BMC Infect Dis. 2016 Feb 16;16(1):81. doi: 10.1186/s12879-016-1412-7. 

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Seroprevalence of Herpes Simplex Virus Infection in HIV Coinfected Individuals in Eastern India with Risk Factor Analysis

Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes while HSV-1 is responsible for orolabial and facial lesions. In immunocompromised individuals, like HIV patients, impaired immunity leads to more frequent symptomatic and asymptomatic HSV infection. 

Fifty-two blood samples from HIV patients with clinically diagnosed HSV infection were taken as cases, while 45 blood samples each from HIV-infected (HIV control) and noninfected patients without any herpetic lesion (non-HIV control) were taken as control. Serum was tested for IgM and IgG antibodies of both HSV-1 and HSV-2 by ELISA. The seroprevalence was compared among the three groups of study population, considering the demographic and socioeconomic parameters. 

The HSV-2 IgM was significantly higher (p < 0.005) in the HIV patient group (34.6%) than the HIV control (2.2%) and non-HIV control (2.2%) groups, whereas HSV-2 IgG seroprevalence was higher in both HIV patient (61.5%) and HIV control (57.8%) groups than the non-HIV control group (17.8%). 

The prevalence of HSV-2 was significantly higher in persons with multiple partners and in the reproductive age group. The overall seroprevalence of HSV-1 IgM was too low (<5%), whereas it was too high (about 90%) with HSV-1 IgG in all three study groups.

Below: Prevalence of HSV-1 IgM and IgG in HIV pt., HIVc, and non-HIVc group

Below:  Prevalence of HSV-2 IgM and IgG in HIV pt., HIVc, and non-HIVc group

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By:  Nag S1, Sarkar S2, Chattopadhyay D3, Bhattacharya S4, Biswas R5, SenGupta M2.

• 1Department of Microbiology, IIMSAR & BCRH, Haldia, West Bengal, India.
• 2Department of Microbiology, Medical College Kolkata, 88 College Street, Kolkata, West Bengal, India.
• 3ICMR Virus Unit, I.D. and B.G. Hospital, GB-4, 1st Floor, 57 Dr. S. C. Banerjee Road, Beliaghata, Kolkata, India.
• 4Department of Medicine, Medical College Kolkata, 88 College Street, Kolkata, West Bengal, India.
• 5Department of Community Medicine, A.I.I.H. & P.H., Kolkata, West Bengal, India.

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Herpes Simplex Virus Seroprevalence & Seroconversion among Active Duty US Air Force Members with HIV Infection

BACKGROUND:

Herpes simplex virus (HSV) infection is associated with an increased risk of both HIV transmission and acquisition. We evaluated longitudinal HSV serology and sexually transmitted infections (STIs) among active duty US Air Force (USAF) members with HIV infection.

METHODS:

USAF members diagnosed with HIV between 1996 and 2012 were included and divided into 2 groups: 1996-2004 (n=131) and 2005-2012 (n=266). HSV-1 and -2 serology was evaluated at HIV diagnosis. Longitudinal HSV-1 and -2 serology and ICD-9 codes for HSV and non-HSV STIs were also examined for those with ≥1 year of follow-up.

RESULTS:

Patients were most commonly Caucasian (44.2%) or African American (43.4%) men with a median age of 28 years at HIV diagnosis. HSV-2 seroprevalence at HIV diagnosis decreased from the period of 1996-2004 (48.8%) to 2005-2012 (30.1%). Odds of HSV-2 seropositivity was significantly greater for non-Caucasians and for HIV diagnosis between 1996 and 2004, with a trend observed for those age >30 years at HIV diagnosis. 

A total of 81 (20.4%) patients developed STIs by ICD-9 codes, including 24 (6.1%) new genital herpes diagnoses, during a median follow-up of 4.6 years. HSV-2 seroconversion occurred in 33 of 253 (13.0%) with an incidence rate of 5.07 per 100 person-years.

CONCLUSION:

Although HSV-2 seroprevalence at HIV diagnosis decreased over time, high-risk sexual behaviors were ongoing as evidenced by the high proportion of new STI diagnoses and HSV-2 seroconversions. Continued education to reduce risk behaviors is warranted to prevent acquisition and transmission of STIs in HIV-infected persons.

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By:  Cohen JA1, Sellers A2, Sunil TS2, Matthews PE3, Okulicz JF4.

• 1San Antonio Military Medical Center, Department of Internal Medicine, JBSA Fort Sam Houston, TX, United States.
• 2Institute for Health Disparities Research, University of Texas at San Antonio, San Antonio, TX, United States.
• 3Mike O'Callaghan Federal Medical Center, Infectious Disease Service, Nellis AFB, NV, United States.
• 4San Antonio Military Medical Center, Infectious Disease Service, JBSA Fort Sam Houston, TX, United States. Electronic address: jason.f.okulicz.mil@mail.mil.
• J Clin Virol. 2016 Jan;74:4-7. doi: 10.1016/j.jcv.2015.11.012. Epub 2015 Nov 14.

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Correlates to Seroprevalent Herpes Simplex Virus Type 2 among Rural Appalachian Drug Users

Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcer disease and, along with substance abuse, an important HIV risk factor. Therefore, the purpose of this study was to examine HSV-2 seroprevalence in a sample of drug users in rural Appalachia. 

Rural Appalachian individuals age 18 or older reporting non-medical use of prescription opioids, heroin, crack/cocaine, or methamphetamine in the past 6 months (n = 499) were included. Behavioral, demographic, and sexual network data were collected using interviewer-administered questionnaires. 

Participants' serum was tested for HSV-2 antibodies using the Biokit rapid test (Lexington, MA). The estimated population seroprevalence of HSV-2 was 14.4% (95%CI: 9.6-19.4%). Only 8.8% were aware of being HSV-2+, and unprotected sex was reported in 80% of serodiscordant sexual relationships. 

In a multivariate model, female gender, age, older age at first oral sex, and frequency of unprotected sex in the sexual network were independently associated with HSV-2 seropositivity. Despite lower seroprevalence than that reported in similar studies of substance abusers, targeted interventions to reduce sexual risk behavior are warranted in this underserved population. 

Network-informed approaches with particular focus on women, older individuals, and those engaging in frequent unprotected sex are recommended.

Purchase full article at:   http://goo.gl/F5Ecrl

By:  Stephens DB1,2, Young AM2,3, Mullins UL2, Havens JR1,2.

• 1Department of Behavioral Science (https://behavioralscience.med.uky.edu/), University of Kentucky College of Medicine, Lexington, Kentucky.
• 2Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, Kentucky.
• 3Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky. 
• J Med Virol. 2016 Mar;88(3):512-20. doi: 10.1002/jmv.24358. Epub 2015 Aug 27.

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Predictors of the Sexual Well-being of Individuals Diagnosed with Herpes and Human Papillomavirus

Research suggests that having a sexually transmitted infection (STI) such as genital herpes and human papillomavirus (HPV) can negatively affect sexual well-being. However, there is little research examining factors associated with poorer sexual well-being among individuals with a STI. 

This study investigated the extent to which stigma experiences, individual characteristics, and STI characteristics were associated with multiple aspects of sexual well-being among individuals diagnosed with herpes and/or HPV. Participants were an average of 36 years old (SD = 11.58) and included 188 individuals with herpes and/or HPV who completed measures of sexual activity, sexual problems, and sexual cognitive-affective factors. 

The results showed that experiences of stigmatization were the most important predictors of sexual well-being. Participants who perceived were stigmatized by others as well as those who internalized negative social attitudes to a greater extent reported poorer sexual well-being across all dimensions, over and above individual and STI characteristics. The implications of these findings for sexual health professionals are discussed.

Purchase full article at:   http://goo.gl/dPqW6R

By:  Foster LR1, Byers ES2.

• 1Department of Psychology, University of New Brunswick, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada.
• 2Department of Psychology, University of New Brunswick, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada. byers@unb.ca.
• Arch Sex Behav. 2016 Feb;45(2):403-14. doi: 10.1007/s10508-014-0388-x. Epub 2014 Nov 19. 

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The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women

BACKGROUND:

Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk.

METHODS:

In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption.

RESULTS:

Visiting alcohol outlets was associated with having more sex partners, more unprotected sex acts, higher levels of transactional sex, and HSV-2 infection. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex.

CONCLUSIONS:

Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2.

Full article at:   http://goo.gl/y0VL6y

By:   Molly Rosenberg,^1,2,3,* Audrey Pettifor,^2,3,7 Annelies Van Rie,² Harsha Thirumurthy,^3,4 Michael Emch,^2,3,5 William C. Miller,^2,6 F. Xavier Gómez-Olivé,^7,12 Rhian Twine,⁷ James P. Hughes,⁸ Oliver Laeyendecker,^9,10 Amanda Selin,³ andKathleen Kahn^7,11,12

Michael Hoonbae Chung, Academic Editor

¹Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America

²Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

³Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁴Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁵Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁶Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁷MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

⁸Department of Biostatistics, University of Washington, Seattle, Washington, United States of America

⁹Laboratory of Immunoregulation, NIAID, NIH, Baltimore, Maryland, United States of America

¹⁰Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America

¹¹Centre for Global Health Research, Umeå University, Umeå, Sweden

¹²INDEPTH Network, Accra, Ghana

University of Washington, UNITED STATES

PLoS One. 2015; 10(5): e0125510.

Published online 2015 May 8. doi:  10.1371/journal.pone.0125510

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Increase in Sexually Transmitted Infections among Men Who Have Sex with Men, England, 2014

Abstract

Surveillance data from sexual health clinics indicate recent increases in sexually transmitted infections, particularly among men who have sex with men. The largest annual increase in syphilis diagnoses in a decade was reported in 2014. Less condom use may be the primary reason for these increases.

Figure 1. New diagnoses of selected sexually transmitted infections among men who have sex with men who attended sexual health clinics, England, 2005–2014. *First episode. †Primary, secondary, or early latent.

Sexually transmitted infections (STIs) are a major public health concern; they can facilitate the transmission of HIV and are associated with severe disease. Treatment for some STIs, especially gonorrhea, has been compromised by antimicrobial drug resistance (1). In 2014 in England, there were 439,243 diagnoses of STIs. Although this number reflects a very small decline (0.3%) relative to 2013, numbers of diagnoses of syphilis and gonorrhea rose substantially, by 33% (from 3,236 to 4,317) and 19% (from 29,419 to 34,958), respectively (2). This number of syphilis diagnoses is the highest reported in England since 1949, and the number of gonorrhea diagnoses is the highest reported since 1986. These increases resulted almost entirely from increased diagnoses among men who have sex with men (MSM), among whom diagnoses of syphilis and gonorrhea increased 46% (from 2,375 to 3,477) and 32% (from 13,629 to 18,029), respectively (Figure 1), resulting in the highest number of diagnoses of these STIs since reporting among MSM began in 1994. We explored the epidemiology of these and other STIs among MSM and describe recent trends.

Below:  Figure 1. New diagnoses of selected sexually transmitted infections among men who have sex with men who attended sexual health clinics, England, 2005–2014. *First episode. †Primary, secondary, or early latent.

Figure 2. Rate of diagnoses (per 1,000 sexual health screens) of chlamydia, gonorrhea, and syphilis (primary, secondary, and early latent) and proportion of extragenital chlamydia and gonorrhea diagnoses among men who have sex with men who attended sexual health clinics, England, 2009–2014. Surveillance codes for extragenital infections were introduced mid-2011 and are only available for chlamydia and gonorrhea diagnoses.

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

By:   Hamish Mohammed , Holly Mitchell, Bersabeh Sile, Stephen Duffell, Anthony Nardone, and Gwenda Hughes

Author affiliations: Public Health England, London, UK

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