Journal of Sexually Transmitted Diseases The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Knowledge and Practice of Clinicians regarding Syndromic Management of Sexually Transmitted Infections in Public Health Facilities of Gamo Gofa Zone, South Ethiopia Thu, 29 Oct 2015 13:27:20 +0000 Background. Sexually Transmitted Infections (STIs) are the leading causes of morbidity among young adults. This study assessed the knowledge and practice of clinicians regarding syndromic management of STIs in public health facilities of Gamo Gofa Zone, Southern Ethiopia. Methods. Facility based cross-sectional study with mixed methods of data collection was conducted in public health facilities of Gamo Gofa Zone. The study included 250 clinicians and 12 health facilities, 26 mystery clients were hired, and 120 STI patient cards were reviewed. Data was entered in EPI info version 7.0.1 and analyzed by SPSS version 20. Results. Of the participated clinicians, 32 (12.8%) were trained on syndromic management of STIs. Highest knowledge of clinicians was for urethral discharge (27.2%). Professional category of clinicians and type of health facility (AOR = 0.194; 95% CI = 0.092, 0.412) were determinants of urethral discharge knowledge. Of the cards reviewed, only in 8.3% of cards and 19.23% of mystery clients did the clinicians correctly follow the guideline. Conclusion. Knowledge and practice of clinicians regarding syndromic management of STIs in study area were poor. Efforts should be made to increase the knowledge of clinicians by providing training on syndromic management of STIs and supportive supervision should be regular. Addisu Alemayehu and Wanzahun Godana Copyright © 2015 Addisu Alemayehu and Wanzahun Godana. All rights reserved. Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck Mon, 21 Sep 2015 07:07:56 +0000 Oral cancer is one of the commonest causes for mortality and morbidity with squamous cell carcinoma being the sixth most frequent malignant tumour worldwide. In addition to tobacco and alcohol, human papilloma virus (HPV) is associated with a proportion of head and neck cancers. As in cervical cancers, HPV types 16 and 18 are the cause of malignant transformation. HPV-positive cancers of head and neck have unique characteristics such as occurrence in a younger age group, distinct clinical and molecular features, and better prognosis as compared to HPV-negative carcinomas. They also possess the potential for prevention by using vaccination. The present review describes in detail the salient features of HPV associated oral squamous cell carcinoma (OSCC), its differences from HPV-negative OSCC, diagnostic features, and recent strategies in prevention and management. Vidya Ajila, Harish Shetty, Subhas Babu, Veena Shetty, and Shruthi Hegde Copyright © 2015 Vidya Ajila et al. All rights reserved. Clinicoetiological Characterization of Infectious Vaginitis amongst Women of Reproductive Age Group from Navi Mumbai, India Mon, 17 Aug 2015 15:35:05 +0000 Vaginitis is one of the commonest reproductive tract infections in sexually active women. In the present study clinicoetiological characterization of infectious vaginitis amongst 380 women of reproductive age group (18–45 years) was done. Bacterial vaginosis (BV) was detected by Nugent’s scoring, Candida infection by culture, and trichomoniasis (TV) by wet mount. One hundred and ten (28.9%) women presented with symptoms of vaginitis. The presenting symptoms were vaginal discharge 106 (96.4%), vulval itching/irritation 19 (17.3%), malodor 5 (4.5%), pain in abdomen 3 (2.7%), and dysuria 1 (0.9%). The commonest etiology detected was Candida in 33 (30%) cases, of which 18 (54.5%) were C. albicans and 15 (45.5%) non-albicans Candida (NAC) infections. The NAC isolates were C. glabrata (), C. tropicalis (), and C. krusei (). BV and TV were observed in 19 (17.3%) and 2 (1.8%) cases, respectively. A statistically significant association between Candida infection and presence of curdy-white discharge () and vulval itching/irritation () was noted. To conclude, we observed the etiological predominance of Candida infection, with considerable prevalence of NAC, indicating the need for microbiological investigation up to species level in cases of Candida infections, to ensure appropriate management. Anuradha Narayankhedkar, Anahita Hodiwala, and Arati Mane Copyright © 2015 Anuradha Narayankhedkar et al. All rights reserved. Awareness and Knowledge of Sexually Transmitted Infections among Secondary School Adolescents in Ado Ekiti, South Western Nigeria Sun, 09 Aug 2015 14:01:11 +0000 Objective. To determine the awareness and knowledge of sexually transmitted infections among adolescents in Ado, South Western Nigeria. Methods. The study was a descriptive cross-sectional design. Five hundred and fifty adolescents selected from public and private secondary schools in Ado Local Government Area of Ekiti State were recruited using a multistage sampling technique. Results. Four hundred and ninety-nine (92.4%) respondents had heard about sexually transmitted infections before, the three most important sources of information being electronic media (68.7%); teachers (68.1%); and print media (44.9%). Eighty percent of the respondents knew only one STI and the two most commonly mentioned ones were HIV/AIDS (78.0%) and gonorrhea (23.0%). More than 75% of the respondents knew the modes of transmission of STIs while some of them equally had misconceptions. The most important symptoms mentioned were weight loss (77.4%), painful micturition (68.9%), and genital ulcer (54.1%). On the whole, only 6.9% of the respondents had good knowledge of STIs; the rest had fair and poor knowledge. Conclusion. Secondary school adolescents in Ado Local Government Area have only a fair knowledge of sexually transmitted diseases. STI studies should be inculcated into the school curriculum and media publicity/enlightenment campaigns about them should be intensified. E. O. Amu and P. T. Adegun Copyright © 2015 E. O. Amu and P. T. Adegun. All rights reserved. Towards the Elimination of Syphilis in a Small Developing Country Thu, 16 Jul 2015 07:11:36 +0000 Objective. To describe the current epidemiological features of syphilis and congenital syphilis in Trinidad, 2009–2012. Methods. All laboratory confirmed syphilis cases diagnosed through a vertical program in the Ministry of Health, between 1/1/2009 and 31/12/2012, were identified. All relevant data were collected including address which was geocoded and mapped using ArcGIS 10.0 (Esri). Both spatial techniques and standardized incidence ratios were used to determine hot spots. Results. The annual cumulative incidence rate for syphilis remains high varying from 39 per 100 000 population in 2009 to 29 per 100 000 in 2012. We identified 3 “hot spots,” in urban areas of Trinidad. Young men and particularly young women in childbearing age 15–35 living in urban high density populations were commonly infected groups. Conclusion. The incidence of syphilis continues to be very high in Trinidad. New initiatives will have to be formulated in order to attain the global initiative to eradicate syphilis by 2015. Kameel Mungrue, Jeffrey Edwards, Azizah Fyzul, Billy Boodhai, Adita Narinesingh, and Shasta Nanlal Copyright © 2015 Kameel Mungrue et al. All rights reserved. External Quality Assessment for the Detection of Chlamydia trachomatis in Urine Using Molecular Techniques in Belgium Thu, 25 Jun 2015 13:52:08 +0000 Chlamydia trachomatis is a major cause of sexually transmitted bacterial disease worldwide. C. trachomatis is an intracellular bacterium and its growth in vitro requires cell culture facilities. The diagnosis is based on antigen detection and more recently on molecular nucleic acid amplification techniques (NAAT) that are considered fast, sensitive, and specific. In Belgium, External Quality Assessment (EQA) for the detection of C. trachomatis in urine by NAAT was introduced in 2008. From January 2008 to June 2012, nine surveys were organized. Fifty-eight laboratories participated in at least one survey. The EQA panels included positive and negative samples. The overall accuracy was 75.4%, the overall specificity was 97.6%, and the overall sensitivity was 71.4%. Two major issues were observed: the low sensitivity (45.3%) for the detection of low concentration samples and the incapacity of several methods to detect the Swedish variant of C. trachomatis. The reassuring point was that the overall proficiency of the Belgian laboratories tended to improve over time. Bernard China and Kris Vernelen Copyright © 2015 Bernard China and Kris Vernelen. All rights reserved. Comprehensive HIV/AIDS Knowledge and Sexual Behavior among University Students in Ambo, Central Ethiopia: Implication to Improve Intervention Tue, 09 Jun 2015 07:28:33 +0000 Background. Ethiopia has one of the lowest HIV prevalence rates in East Africa, but there are still more than one million people estimated to be living with HIV in Ethiopia. This study was aimed at assessing the comprehensive HIV/AIDS knowledge and sexual behavior among university students. Methodology. A cross-sectional comparative study was done with quantitative and qualitative data collection with a stratified sampling technique. The quantitative data were edited, coded, entered, and analyzed using SPSS software version 20. Result. Both comprehensive knowledge of HIV/AIDS transmission and prevention method were higher in the intervention group (75.8% and 48.5%) than comparative group (68.6% and 42.5%) which had a significant difference (). Life time sexual intercourse was higher in the intervention group (40.8%) as compared to the comparative group (34.6%). But sexual condom utilization in the past 12 months was higher in the intervention group (73.2%) as compared to the comparative group (56.9%) which had a significant difference (). Similarly, history of sexual transmitted disease report was higher in the comparative group (6.3%) as compared to the intervention (4.6%). Among sexual experience respondents in the last 12 months, 32% of them in the intervention and 35.5% of them in the comparative group have had multiple sexual partners. Conclusion. The intervention group had higher comprehensive knowledge of HIV/AIDS and condom utilization. But a higher percentage of students were engaged in risky sexual behavior. Therefore, emphasis should be given on designing different strategy to reduce risky sexual behavior and increase comprehensive HIV/AIDS knowledge. Zekariyas Sahile, Mulugeta Mekuria, and Abenezer Yared Copyright © 2015 Zekariyas Sahile et al. All rights reserved. Monitoring HIV Epidemic in Pregnant Women: Are the Current Measures Enough? Mon, 19 Jan 2015 08:24:20 +0000 Introduction. Burden of HIV in pregnant women follows overall epidemic in India. Hence, it is imperative that prevalence calculations in this group be accurate. The present study was carried out to determine prevalence of HIV in pregnant women attending our hospital, to determine trend of HIV infection and to compare our results with reported prevalence. Methods. All pregnant women are routinely counselled for HIV testing using opt-out strategy. Year-wise positivity and trend were determined in these patients over a period of five years. The positivity in different age groups was determined. Results. 31,609 women were tested of which 279 (0.88%) were positive. Positivity showed a declining trend over study period and significant quadratic trend (biphasic, ) was observed. The positivity in older age group ≥35 years (1.64%) was significantly more than younger age groups (0.76% in 15–24-year and 0.94% in 25–34-year age group) (). Conclusion. A significant decline in HIV positivity was seen over the study period. Taking into account heterogeneous nature of HIV epidemic even within the same district, analysis at local levels especially using the prevention of parent to child transmission of HIV program data is critical for HIV programming and resource allocation. Purva Sarkate, Supriya Paranjpe, Nayana Ingole, and Preeti Mehta Copyright © 2015 Purva Sarkate et al. All rights reserved. Young Risk Takers: Alcohol, Illicit Drugs, and Sexual Practices among a Sample of Music Festival Attendees Sun, 14 Dec 2014 00:10:09 +0000 Background. Alcohol and other drug use and sexual risk behaviour are increasing among young Australians, with associated preventable health outcomes such as sexually transmissible infections (STIs) on the rise. Methods. A cross-sectional study of young people’s health behaviours conducted at a music festival in Melbourne, Australia, in 2011. Results. 1365 young people aged 16–29 completed the survey; 62% were female with a mean age of 20 years. The majority (94%, ) reported drinking alcohol during the previous 12 months; among those, 32% reported “binge” drinking (6+ drinks) at least weekly. Half (52%) reported ever using illicit drugs and 25% reported past month use. One-quarter (27%) were identified as being at risk of STIs through unprotected sex with new or casual partners during the previous 12 months. Multivariable analyses found that risky sexual behaviour was associated with younger age (≤19 years), younger age of sexual debut (≤15 years), having discussed sexual health/contraception with a doctor, regular binge drinking, and recent illicit drug use. Conclusion. Substance use correlated strongly with risky sexual behaviour. Further research should explore young people’s knowledge of alcohol/drug-related impairment and associated risk-taking behaviours, and campaigns should encourage appropriate STI testing among music festival attendees. Rebecca Jenkinson, Anna Bowring, Paul Dietze, Margaret Hellard, and Megan S. C. Lim Copyright © 2014 Rebecca Jenkinson et al. All rights reserved. Sexual Transmission of HCV in Heterologous Monogamous Spouses Mon, 24 Nov 2014 06:39:04 +0000 We screened for evidence of HCV infection in healthy heterologous monogamous spouses of chronic HCV patients and studied the relation with various risk factors. A cross-sectional study of fifty healthy monogamous heterosexual spouses of HCV-positive index cases was carried out. All participants were HBV and HIV negative. The association with various risk factors was studied. Five spouses (10%) showed evidence of HCV infection. Two partners were positive for HCV antibody alone (4%) and 3 for antibody and HCV PCR (6%). No association was found between HCV infection and various sociodemographic parameters with the exception of older age categories. Intraspousal transmission of HCV may be an important source of spread of HCV infection. The reservoir of HCV-infected individuals in Egypt is sizable, and sexual transmission of HCV may contribute to the total burden of infection in Egypt. Mona M. Rafik, Yehia El Shazly, Amal A. Abbas, Walid Abd Elhady, Dina Ragab, and Dina AlShennawy Copyright © 2014 Mona M. Rafik et al. All rights reserved. Prevalence of Trichomoniasis, Vaginal Candidiasis, Genital Herpes, Chlamydiasis, and Actinomycosis among Urban and Rural Women of Haryana, India Wed, 29 Oct 2014 00:00:00 +0000 Despite being curable reproductive tract infections (RTIs) including sexually transmitted infections continue to be a major health problem in developing countries. The present study was undertaken to know the prevalence of trichomoniasis, vaginal candidiasis, genital herpes, chlamydiasis, and actinomycosis in rural and urban women of Haryana by using wet mount, PAP smear, and fluorescent microscopic examination. Patients suspected of suffering from bacterial vaginosis were given treatment and were not included in the study. RTIs were seen in 16.6% of urban and 28.7% of rural women. The highest prevalence seen was that of trichomoniasis in both rural (24.2%) and urban (15.7%) women, followed by candidiasis (4.2% in rural and 0.6% in urban women), genital herpes (0.3% in rural and 0.2% in urban women), and chlamydiasis (0.02% in rural and 0.05% in urban women). Pelvic actinomycosis was seen in 1.4% of rural and 0.06% of urban women using intrauterine contraceptive devices. Mixed infection of Trichomonas vaginalis with Candida spp. was seen in 6.3% of rural women only. It is desirable to have a baseline profile of the prevalence of various agents causing RTIs in a particular geographic area and population which will help in better syndromic management of the patients. Brij Bala Arora, Megha Maheshwari, Naiya Devgan, and D. R. Arora Copyright © 2014 Brij Bala Arora et al. All rights reserved. Prevalence and Predictors of Self-Reported Consistent Condom Usage among Male Clients of Female Sex Workers in Tamil Nadu, India Sun, 01 Jun 2014 06:54:31 +0000 Clients of female sex workers (FSWs) possess a high potential of transmitting HIV and other sexually transmitted infections from high risk FSWs to the general population. Promotion of safer sex practices among the clients is essential to limit the spread of HIV/AIDS epidemic. The aim of this study is to estimate the prevalence of consistent condom use (CCU) among clients of FSWs and to assess the factors associated with CCU in Tamil Nadu. 146 male respondents were recruited from the hotspots who reportedly had sex with FSWs in exchange for cash at least once in the past one month. Data were analyzed using bivariate and multivariate methods. Overall, 48.6 and 0.8 percent clients consistently used condoms in the past 12 months with FSWs and regular partners, respectively. Logistic regression showed that factors such as education, peers’ use of condoms, and alcohol consumption significantly influenced clients’ CCU with FSWs. Strategies for safe sex-behaviour are needed among clients of FSWs in order to limit the spread of HIV/AIDS epidemic in the general population. The role of peer-educators in experience sharing and awareness generation must also be emphasized. Saumya Rastogi, Bimal Charles, and Asirvatham Edwin Sam Copyright © 2014 Saumya Rastogi et al. All rights reserved. Care Seeking Behaviour and Barriers to Accessing Services for Sexual Health Problems among Women in Rural Areas of Tamilnadu State in India Thu, 20 Mar 2014 17:41:55 +0000 Background. Sexually transmitted infections (STIs) may be either asymptomatic or symptomatic. Regardless of the presence or absence of symptoms all STIs can lead to major complications if left untreated. Objective. To assess the care seeking behaviour and barriers to accessing services for sexual health problems among young married women in rural areas of Thiruvarur district of Tamil Nadu state in India. Methods. A community based cross-sectional study was conducted in 28 villages selected using multistage sampling technique for selecting 605 women in the age group of 15–24 years during July 2010–April 2011. Results. The prevalence rate of reproductive tract infections (RTIs) and STIs was observed to be 14.5% and 8.8%, respectively, among the study population. Itching/irritation over vulva, thick white discharge, discharge with unpleasant odor, and frequent and uncomfortable urination were most commonly experienced symptoms of sexual health problems. Around three-fourth of the women received treatment for sexual health problems. Perception of symptoms as normal, feeling shy, lack of female health workers, distance to health facility, and lack of availability of treatment were identified as major barriers for not seeking treatment for RTIs/STIs. Conclusion. Family tradition and poor socioeconomic conditions of the family appear to be the main reasons for not utilizing the health facility for sexual health problems. Integrated approach is strongly suggested for creating awareness to control the spread of sexual health problems among young people. Rejoice Puthuchira Ravi and Ravishankar Athimulam Kulasekaran Copyright © 2014 Rejoice Puthuchira Ravi and Ravishankar Athimulam Kulasekaran. All rights reserved. Erratum to “Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India” Sun, 16 Mar 2014 07:06:39 +0000 Purnima Madhivanan, Bhavana Niranjankumar, Reshma Shaheen, Poornima Jaykrishna, Kavitha Ravi, Savitha Gowda, Vijaya Srinivas, Anjali Arun, and Karl Krupp Copyright © 2014 Purnima Madhivanan et al. All rights reserved. Trichomonas vaginalis Incidence Associated with Hormonal Contraceptive Use and HIV Infection among Women in Rakai, Uganda Tue, 04 Mar 2014 12:29:12 +0000 Background. Data on the incidence of Trichomonas vaginalis and use of hormonal contraception (HC) are limited. Methods. 2,374 sexually active women aged 15–49 years from cohort surveys in Rakai, Uganda, were included. Incidence of T. vaginalis was estimated per 100 person years (py) and association between HC (DMPA, Norplant, and oral contraceptives) and T. vaginalis infection was assessed by incidence rate ratios (IRR), using Poisson regression models. Results. At baseline, 34.9% had used HC in the last 12 months, 12.8% HIV+, 39.7% with high BV-scores (7–10), and 3.1% syphilis positive. The 12-month incidence of T. vaginalis was 2.4/100 py; CI (1.90, 3.25). When stratified by type of HC used, compared to women who did not use HC or condoms, incidence of T. vaginalis was significantly higher among users of Norplant (adj.IRR = 3.01, CI: 1.07–8.49) and significantly lower among DMPA users (adj.IRR = 0.55, CI: 0.30, 0.98) and women who discontinued HC use at follow-up (adj.IRR = 0.30, CI: 0.09, 0.99). HIV infection was associated with an increase in incidence of T. vaginalis (adj.IRR = 2.34, CI: 1.44, 3.78). Conclusions. Use of Norplant and being HIV+ significantly increased the risk of T. vaginalis, while use of DMPA and discontinuation of overall HC use were associated with a decreased incidence of T. vaginalis. Heena Brahmbhatt, Richard Musoke, Frederick Makumbi, Godfrey Kigozi, David Serwadda, Maria Wawer, and Ronald Gray Copyright © 2014 Heena Brahmbhatt et al. All rights reserved. Married Men Perceptions and Barriers to Participation in the Prevention of Mother-to-Child HIV Transmission Care in Osogbo, Nigeria Wed, 19 Feb 2014 09:14:29 +0000 Men’s role in HIV prevention is pivotal to changing the course of the epidemic. Men’s barriers toward participation in Prevention of Mother-to-Child Transmission (PMTCT) have not been adequately documented. This study is therefore designed to determine men’s level of awareness and barriers to their participation in PMTCT programmes in Osogbo, Nigeria. This study was a descriptive qualitative one that utilized Focus Group Discussion (FGD). One-hundred and sixty married men were selected by convenience sampling and interviewed. Data collected were analysed using content analysis technique. Demographic data were analysed using SPSS 15.0 software to generate frequency tables. Participants mean age was 31.9 ± 5.9 years. Many of the participants had heard about PMTCT and the majority agreed that it is good to accompany their wife to Antenatal Care (ANC) but only few had ever done so. Societal norms and cultural barriers were the leading identified barriers for male involvement in PMTCT programmes. The majority of the participant perceived it was a good idea to accompany their wife to antenatal care but putting this into practice was a problem due to societal norms and cultural barriers. Community sensitization programmes such as health education aimed at breaking cultural barriers should be instituted by government and nongovernmental agencies. Ademola L. Adelekan, Elizabeth R. Edoni, and Oladipupo S. Olaleye Copyright © 2014 Ademola L. Adelekan et al. All rights reserved. Women and Children First: The Impact of Sexually Transmitted Infections on Maternal and Child Health Tue, 18 Feb 2014 08:22:19 +0000 Consuelo Beck Sagué, Carolyn Black, Stephen A. Morse, and George Schmid Copyright © 2014 Consuelo Beck Sagué et al. All rights reserved. Assessment of Sexual and Reproductive Health Status of Street Children in Addis Ababa Thu, 26 Dec 2013 09:07:56 +0000 Street children worldwide do not have the information, skills, health services, and support they need to go through sexual development during adolescence. This study is undertaken to systematically investigate the fit between street children’s sexual and reproductive health needs and the existing services. A cross-sectional study was conducted among 422 street children and four service providers. About 72.5% of the respondents were sexually active during data collection and 84.3% of males and 85.7% of females tended to have multiple sexual partners. More than two-thirds (67.3%) of the participants had used at least one type of substance. History of substance use (OR = 2.5; 95% CI = 1.42–4.56) and being on the street for the first one to three years (OR = 5.9; 95% CI = 1.41–7.22) increased the likelihood of having sexual activity. More than half (64.9%) of the street children did not attend any kind of sexual or reproductive health education programs. Lack of information on available services (26.5%) was the biggest barrier for utilization of local sexual and reproductive health services. From the individual interview with coordinator, the financial and networking problems were hindering the service delivery for street children. In conclusion, street children who are special high risk group have not been targeted and hence continue to remain vulnerable and lacking in sexual and reproductive health services and sexual health services are poorly advertised and delivered to them. Demelash Habtamu and Addisie Adamu Copyright © 2013 Demelash Habtamu and Addisie Adamu. All rights reserved. Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the “Technology to Systems Gap” Sun, 22 Dec 2013 10:12:56 +0000 Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after () and further increased to 96.8% () after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (), but it improved significantly from 70.2% to 84.3% () after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches. Linda Severe, Daphne Benoit, Xi K. Zhou, Jean W. Pape, Rosanna W. Peeling, Daniel W. Fitzgerald, and Kedar S. Mate Copyright © 2013 Linda Severe et al. All rights reserved. The Epidemiology of Herpes Simplex Virus Type-2 Infection among Pregnant Women in Rural Mysore Taluk, India Thu, 14 Nov 2013 09:57:53 +0000 Objectives. To assess the prevalence and determinants of herpes simplex virus type 2 (HSV-2) infections among pregnant women attending mobile antenatal health clinic in rural villages in Mysore Taluk, India. Methods. Between January and September 2009, 487 women from 52 villages participated in this study. Each participant consented to provide a blood sample for HSV-2 and HIV testing and underwent an interviewer-administered questionnaire. Results. HSV-2 prevalence was 6.7% (95% confidence interval (CI) 4.4–9.0), and one woman tested positive for HIV. The median age of women was 20 years and 99% of women reported having a single lifetime sex partner. Women whose sex partner traveled away from home had 2.68 (CI: 1.13–6.34) times the odds of being HSV-2 seropositive compared to women whose sex partner did not travel. Having experienced genital lesions was also associated with HSV-2 infection ( value = 0.08). Conclusion. The 6.7% HSV-2 prevalence was similar to results obtained in studies among pregnant women in other parts of India. It appeared that most women in this study contracted HSV-2 from their spouses and few regularly used condoms. This finding highlights the need for public health policies to increase awareness and education about prevention methods among women and men living in rural India. Aaron F. Bochner, Purnima Madhivanan, Bhavana Niranjankumar, Kavitha Ravi, Anjali Arun, Karl Krupp, and Jeffrey D. Klausner Copyright © 2013 Aaron F. Bochner et al. All rights reserved. The Impact of Integration of Rapid Syphilis Testing during Routine Antenatal Services in Rural Kenya Tue, 05 Nov 2013 10:56:59 +0000 We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011–February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 28 RST-positive women and recorded 34 treatment kits as used. Individual-level data from three high-volume clinics supported that the intervention did not negatively affect HIV test uptake. Integrating RSTs into rural ANC services increased syphilis testing and detection. Record keeping on treatment of syphilis in RST-positive women remains challenging. Eleanor Fleming, Jared Oremo, Katherine O'Connor, Aloyce Odhiambo, Tun Ye, Simon Oswago, Clement Zeh, Robert Quick, and Mary L. Kamb Copyright © 2013 Eleanor Fleming et al. All rights reserved. Sexually Transmitted Infections in Women Participating in a Biomedical Intervention Trial in Durban: Prevalence, Coinfections, and Risk Factors Sun, 03 Nov 2013 14:06:20 +0000 Background. Sexually transmitted infections (STIs) continue to be a significant public health problem especially among women of reproductive age in Africa. Methods. A total of 2236 women that had enrolled in the MDP301 vaginal microbicide trial were tested for the presence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Treponema pallidum, and Trichomonas vaginalis (TV). Results. CT was identified as the most prevalent STI (11%) followed by TV (10%), NG, and Syphilis (3%). The highest prevalence of coinfection was reported between T. pallidum and TV (19.67%, ), followed by CT and TV (13.52%, ). Risk factors that were significantly associated with STI acquisition were women of 23 years of age or younger (HR: 1.50, 95% CI 1.17, 1.93), baseline STI with CT (HR: 1.77, 95% CI 1.32, 2.35), TV (HR: 1.58, 95% CI, 1.20, 2.10), and T. pallidum (HR: 5.13, 95% CI 3.65, 7.22), and a low education level (HR: 1.30, 95% CI 1.02, 1.66). Conclusion. Young women with lower education and a history of STIs are at high risk of multiple STIs. Prevention programs should consider target approach to STI prevention among young women. This trial is registered with ISRCTN64716212. Nathlee Samantha Abbai, Handan Wand, and Gita Ramjee Copyright © 2013 Nathlee Samantha Abbai et al. All rights reserved. Remembering the Children: Implementation and Success of a Robust Method for Identifying and Testing Children of HIV Patients Wed, 30 Oct 2013 11:20:21 +0000 Background. Children of HIV patients are a historically neglected demographic by HIV services. It has been recommended by CHIVA that HIV services have a robust method of detecting and testing untested children. We note that no such method is either in widespread use or in the literature. Method. In December 2011, a one-page proforma to identify HIV untested children and a clear multidisciplinary pathway to test them were implemented. Twelve months later the uptake of the proforma and pathway, the numbers of patients and children identified for testing, and their outcomes were audited. Results. The proforma was completed in 192/203 (94.6%) eligible patients. Twenty-five (21.5%) of 118 identified offspring had not been tested. Ten (8.5%) of these were <18 years old. All were reported to be clinically well. Ten children were referred for testing, seven were tested immediately, and three were tested within 18 months of identification. All children were tested HIV negative. Discussion. We have identified a method of identification that is easy and robust and provides a user-friendly safety net to empower healthcare providers to identify and test children at risk. We recommend the implementation of such strategies nationwide to prevent death due to undiagnosed HIV in children. Christopher Darlow, Peter Tovey, Fiona Wallis, Clare Knowles, Ian Fairley, Charles Lacey, and Fabiola Martin Copyright © 2013 Christopher Darlow et al. All rights reserved. Measurement of Stigma in Men Who Have Sex with Men in Hanoi, Vietnam: Assessment of a Homosexuality-Related Stigma Scale Wed, 30 Oct 2013 08:40:46 +0000 Objective. To develop and assess a homosexuality-related stigma scale among men who have sex with men (MSM) in Hanoi, Vietnam. Methods. We conducted a cross-sectional study using respondent-driven sampling in Hanoi, Vietnam, in 2011. We used a cross-validation approach. Factor analysis was performed, and interitem correlation matrices were constructed to identify the latent factor structures, examine the goodness of fit, and assess convergent and discriminant validity of the determined scales. Internal consistency checks were performed in split samples and whole sample, and separately for each determined factor. Results. The findings were consistent in split samples. Three homosexuality-related stigma factors were identified: enacted homosexual stigma, perceived homosexual stigma, and internalized homosexual stigma. The fit indices of the confirmatory factor analysis in both split samples supported the hypothesized three-factor structures (in subsamples A and B: /degrees of freedom ratio = 1.77 and 1.59, nonnormed fit index = 0.92 and 0.94, comparative fit index = 0.93 and 0.95, and the root mean square of approximation = 0.06 and 0.05, resp.). The interitem correlation supported the convergent and discriminant validity of the scales. The reliability of the three scales indicated good consistency (Cronbach’s alpha: 0.79–0.84) across split samples and for the whole data. Conclusion. Our scales have good psychometric properties for measuring homosexuality-related stigma. These comprehensive and practical tools are crucial not only to assess stigma against MSM and its consequence, but also to guide the development of interventions targeting MSM, as well as to evaluate the efficacy of existing stigma reduction efforts in Vietnam and other countries with similar settings. Huy Ha, Michael W. Ross, Jan M. H. Risser, and Huong T. M. Nguyen Copyright © 2013 Huy Ha et al. All rights reserved. Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India Sun, 01 Sep 2013 14:17:56 +0000 Background. We describe a one-year evaluation study comparing SCIL intervention of mobile provision of integrated ANC/ HIV testing with an enhanced (SCIL+) intervention of community mobilization strategy providing conditional cash transfers (CCT) to women’s SHG for identifying and accompanying pregnant women to mobile clinics. Methods. Twenty pairs of villages matched on population, socioeconomic status, access to medical facilities, and distance from Mysore city were divided between SCIL and SCIL+ interventions. The primary study outcome was the proportion of total pregnancies in these villages who received ANC and HIV testing. Results. Between April 2011 and March 2012, 552 pregnant women participated in SCIL or SCIL+ interventions. Among women who were pregnant at the time of intervention delivery, 181 of 418 (43.3%) women pregnant at the time of intervention delivery received ANC in the SCIL arm, while 371 of 512 (72.5%) received ANC in the SCIL+ arm (); 175 (97%) in the SCIL and 366 (98.6%) in the SCIL+ arm consented to HIV testing (). HIV prevalence of 0.6% was detected among SCIL clinic, and 0.9% among attending SCIL+ clinic attendees. Conclusion. Provision of CCT to women’s microeconomic SHG appears to significantly increase uptake of ANC/HIV testing services in rural Mysore villages. Purnima Madhivanan, Bhavana NiranjanKumar, Reshma Shaheen, Poornima Jaykrishna, Kavitha Ravi, Savitha Gowda, Vijaya Srinivas, Anjali Arun, and Karl Krupp Copyright © 2013 Purnima Madhivanan et al. All rights reserved. Investigating Recent Testing among MSM: Results from Community-Based HIV Rapid Testing Attendees in France Sun, 28 Jul 2013 08:18:38 +0000 Background. We aimed to identify factors associated with recent HIV testing in MSM who attended two experimental community-based and nonmedicalized voluntary counselling and testing programmes (CB-VCT) targeting MSM in France. Methods. This analysis was based on data collected in 2009–2011 through a self-administered pretesting questionnaire. An index measuring the level of participants’ sexual orientation disclosure was built: the higher the index, the greater the disclosure. Factors associated with recent HIV testing (last test ≤ 1 year) were identified using a multivariate logistic regression model adjusted for the CB-VCT programme of enrolment. Results. 716 MSM provided data on testing history. Overall, 49% were recently tested for HIV and 51% were not. Recently tested MSM had a higher homosexuality disclosure index (adjusted OR [95% confidence interval]: aOR = 1.2 [1.1–1.4]), reported more inconsistent condom use during anal sex with men (aOR = 1.6 [1.2–2.1]), and were less likely to have sex under the influence of club drugs (aOR = 0.6 [0.4–1.0]). Conclusion. New testing strategies should focus on those who live their homosexuality relatively secretly and those who use club drugs before sex. Governments should develop policies which encourage improved social acceptance of homosexuality as concealment of sexual orientation represents a major barrier to testing. Nicolas Lorente, Karen Champenois, Jérôme Blanche, Marie Préau, Marie Suzan-Monti, Marion Mora, Lionel Fugon, Maria Patrizia Carrieri, Luis Sagaon-Teyssier, Jean-Marie Le Gall, Bruno Spire, and Yazdan Yazdanpanah Copyright © 2013 Nicolas Lorente et al. All rights reserved. High-Risk Sexual Behavior Is Associated with Postexposure Prophylaxis Nonadherence among Men Who Have Sex with Men Enrolled in a Combination Prevention Intervention Wed, 10 Jul 2013 10:13:38 +0000 Methamphetamine use among men who have sex with men (MSM) is associated with increased HIV prevalence, due to increased engagement in high-risk sexual behavior. Fifty-three HIV-negative, methamphetamine-using MSM were enrolled in a biobehavioral combination prevention intervention in Los Angeles, CA, to assess the feasibility of administering postexposure prophylaxis (PEP) in combination with contingency management (CM) to prevent HIV seroconversion. The study combined a CM behavioral intervention targeting reductions in methamphetamine use with a PEP biomedical intervention for HIV prevention. Those who reported recent exposure to HIV were initiated on tenofovir/emtricitabine- (Truvada-) based PEP (). This secondary analysis sought to determine whether sexual risk taking was associated with PEP adherence. Regression analyses controlling for participant sociodemographics demonstrated that, at baseline, increased number of lifetime sexually transmitted diseases (STDs; Coef. = −0.07; 95% CI= (−0.12) – (−0.01)) and recent episodes of unprotected anal intercourse (UAI; Coef. = −0.01; 95% CI= (−.01) – (−0.002)) were associated with reductions in medication adherence. Given these associations between baseline sexual risk and PEP adherence, providers working with high-risk MSM may look to target reductions in sexual risk taking; this will reduce direct risk of HIV infection and may work to optimize medication adherence in the case of PEP initiation. Jesse B. Fletcher, Joshua A. Rusow, Hung Le, Raphael J. Landovitz, and Cathy J. Reback Copyright © 2013 Jesse B. Fletcher et al. All rights reserved. Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention Mon, 08 Jul 2013 11:33:58 +0000 Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM () from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed. George Ayala, Keletso Makofane, Glenn-Milo Santos, Jack Beck, Tri D. Do, Pato Hebert, Patrick A. Wilson, Thomas Pyun, and Sonya Arreola Copyright © 2013 George Ayala et al. All rights reserved. Pharyngeal Gonorrhoea in Women: An Important Reservoir for Increasing Neisseria gonorrhoea Prevalence in Urban Australian Heterosexuals? Wed, 26 Jun 2013 11:48:05 +0000 We aim to characterize sexual behavioral aspects of heterosexual Neisseria gonorrhoea (NG) acquisition in two Sexually Transmitted Diseases clinics in Sydney, Australia, in 2008–2012. Of 167 NG cases, 102 were heterosexually acquired with a trend of increasing NG prevalence in heterosexuals from 1.1% (95% CI 0.6–2.1) in 2008 to 3.0% (95% CI 2.0–4.0) in 2012 (). Of heterosexual male cases, unprotected fellatio was the likely sexual activity for NG acquisition in 21/69 (30.4%) and commercial sex work (CSW) contact the likely source in 28/69 (40.6%). NG prevalence overall in CSW (2.2%) was not significantly higher than in non-CSW (1.2%) (), but in 2012 there was a significant increase in NG prevalence in CSW (8.6%) compared to non-CSW (1.6%) (). Pharyngeal NG was found in 9/33 (27.3%) female cases. Decreased susceptibility to ceftriaxone (MIC ≥ 0.03 mg/L) occurred in 2.5% NG isolates, none heterosexually acquired. All were azithromycin susceptible. A significant trend of increasing prevalence of heterosexual gonorrhoea in an urban Australian STD clinic setting is reported. We advocate maintenance of NG screening in women, including pharyngeal screening in all women with partner change who report fellatio, as pharyngeal NG may be an important reservoir for heterosexual transmission. Outreach to CSW should be enhanced. M. Josephine Lusk, Ruby N. N. Uddin, Monica M. Lahra, Frances L. Garden, Ratan L. Kundu, and Pam Konecny Copyright © 2013 M. Josephine Lusk et al. All rights reserved. The Role of Sexually Transmitted Infections in HIV-1 Progression: A Comprehensive Review of the Literature Mon, 24 Jun 2013 09:36:35 +0000 Due to shared routes of infection, HIV-infected persons are frequently coinfected with other sexually transmitted infections (STIs). Studies have demonstrated the bidirectional relationships between HIV and several STIs, including herpes simplex virus-2 (HSV-2), hepatitis B and C viruses, human papilloma virus, syphilis, gonorrhea, chlamydia, and trichomonas. HIV-1 may affect the clinical presentation, treatment outcome, and progression of STIs, such as syphilis, HSV-2, and hepatitis B and C viruses. Likewise, the presence of an STI may increase both genital and plasma HIV-1 RNA levels, enhancing the transmissibility of HIV-1, with important public health implications. Regarding the effect of STIs on HIV-1 progression, the most studied interrelationship has been with HIV-1/HSV-2 coinfection, with recent studies showing that antiherpetic medications slow the time to CD4 <200 cells/µL and antiretroviral therapy among coinfected patients. The impact of other chronic STIs (hepatitis B and C) on HIV-1 progression requires further study, but some studies have shown increased mortality rates. Treatable, nonchronic STIs (i.e., syphilis, gonorrhea, chlamydia, and trichomonas) typically have no or transient impacts on plasma HIV RNA levels that resolve with antimicrobial therapy; no long-term effects on outcomes have been shown. Future studies are advocated to continue investigating the complex interplay between HIV-1 and other STIs. Helen M. Chun, Robert J. Carpenter, Grace E. Macalino, and Nancy F. Crum-Cianflone Copyright © 2013 Helen M. Chun et al. All rights reserved.