Symposium 8 (WHO) … Advancing the prevention of STI through innovations in technology and delivery methods: opportunities and new horizonsS44–S48
Symposium 9 … The sexual health of specific groupsS49–S53
Symposium 10 … Human papilloma virusS54–S57
Closing ceremonyS58
Oral Session Abstracts
Oral session 1O01–O12
Oral session 2O13–O18
Oral session 3O19–O30
Poster Abstracts
BehaviourP001–P018
ClinicalP019–P072
EpidemiologyP073–P122
Health ServicesP123–P132
MicrobiologyP133–P155
PreventionP156–P169
Public HealthP170–P185
SocialP186–P190
Speaker’s Abstracts
Opening ceremony:
S01 Sex, passion and addiction: brain mechanisms
Adolf Tobeña
Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autónoma de Barcelona, Bellaterra, Barcelona
Human sexual behaviour follows the phases of wanting, liking and satiety involved in the pleasure cycle of common rewards. The brain mechanisms and networks involved in sexual desire (anticipation) and sexual liking (consummation) have been progressively detailed though there is less data on sexual satiety. Human sexual appetites interact with other incentives and pleasures, but their relative potencies expect still a systematic approach. The propensity to develop sexual compulsions with the full attributes of uncontrolled and addictive passions will be linked to individual variations within the neurohormonal systems mediating sexual wanting and tasting and to special sensorial and evocative qualities of sexual auto and hetero-gratification. Although the functional neuroanatomy of sex is similar to that of other pleasures, advances in brain research will likely uncover particular routes and mechanisms mediating singularities of sexual hunger and satisfaction which pave the way for adventurous and addictive forms of sex behaviour.
S02 Sexual behaviour, sexually transmitted infections and HIV among men-who-have-sex-with-men in Europe
Axel Jeremias Schmidt1,2
1Communicable Diseases Division, Swiss Federal Office of Public Health (FOPH), Bern, Switzerland
2Sigma Research, London School of Hygiene and Tropical Medicine, UK; www.emis-project.eu
Sexual behaviours, sexual identities, their presence in public discourse and the way we approach sexual partners have undergone profound changes in the past 30 years – especially since the advent of universal Internet access. The AIDS crisis has dramatically challenged the sexual behaviour of men-who-have-sex-with-men (MSM) and motivated condom use as the dominant precautionary behaviour at least for anal intercourse outside steady partnerships. However, with effective anti-HIV medication now widely available, test and treat approaches to HIV prevention have become increasingly common, even among non-governmental organisations (NGOs), and this has led many to assimilate screening for other sexually transmitted infections (STIs) (including hepatitis) into clinical services delivered in the community. However, even today, state- and institution-level homophobia is a major obstacle to accessing effective health care for gay men in many countries. In response, gay sexual health centres such as ‘Checkpoints’ have opened in many major Western European cities, though the first opened in Eastern Europe as recently as 2014 in Riga. The understanding of determinants of sexual transmission is still in its infancy, and mono-causal thinking is widespread. This lecture will start with underlining the differences between homo- and heterosexual networks, as well as the influence of the size and structure of sexual networks on STI transmission. It will then highlight major findings of the European MSM Internet Survey (EMIS), a 25-language study conducted in 38 countries in 2010, supported by a multitude of NGOs and the largest study of its kind. Rates of STI testing do currently not reflect new partner acquisition, as demonstrated by the recency of various sexual practices with non-steady partners (see Figure 1). EMIS data suggest that STI prevention messages should differ from HIV prevention messages, as STI testing rates need to be driven by the number of sexual partners, regardless of condom use. Gay-friendly, non-judgmental, easily accessed and affordable services are contributing to more STI testing among MSM. However, increasing testing rates will not be effective if testing is not tailored to the sexual behaviour of gay men.
Symposium 1: Male sexual dysfunction
S06 How does male sexual dysfunctions affect female sexual function?
Maria Fernanda Peraza
Fundació Puigvert, Barcelona
The exclusiveness of female sexual response makes the erotic and emotional bond with the partner, an important issue associated with normal development of this sexual response. The aim of this lecture is to discuss this theme on heterosexual couples, but does not means that female homosexual couples are excluded, from suffering these frequent changes, and describe the mechanisms of emergence of reactive sexual dysfunction in women to erectile dysfunction and premature ejaculation of her partners, and the counselling for these cases.
Symposium 2: Resistance and typing of STI pathogens
S08 Neisseria gonorrhoeae: antimicrobial resistance in Spain
Judit Serra-Pladevall, MJ Barbera, G Roig, R Bartolome and R Juvé, A Andreu
Microbiology Department, Vall d’Hebron Hospital, Barcelona
Neisseria gonorrhoeae has developed resistance to all antibiotics that have been used, so it is important to monitor its antimicrobial susceptibility. The aim of this revision is to analyse the evolution of antimicrobial susceptibility of N. gonorrhoeae in our area and to compare these data with those from the rest of Spain and from other European countries. We have analysed 785 strains isolated from patients who attended in Vall d’Hebron Hospital, in the Drassanes STD clinic and in 150 primary care centres in Barcelona, from July to December 2011 and from January 2013 to December 2014. Along all this period, we have observed an increase in penicillin resistance rate. From 2011 to 2013, the rate of azitromycin resistance raised, but from 2013 to 2014, it decreased. From 2011 to 2013, the CMI50 and CMI90 of cefixime increased from 0.016 and 0.125 mg/l to 0.032 and 0.25 mg/l, respectively. In contrast, from 2013 to 2014, they decreased from 0.032 and 0.25 mg/l to 0.016 and 0.094 mg/l. The resistance to ciprofloxacin was about 50% along these three years. All the strains remained susceptible to spectinomycin. Looking through European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) data, Spain has higher resistance rates than the European average. In 2011, 15% of the Spanish strains presented decreased susceptibility (DS) to cefixime, which was twofold higher than the mean of the European strains. The same happened with azithromycin; in Spain, 14% of the strains were resistant, whilst in Europe, the mean of resistance was 5.3%. In conclusion, although there is a fear that gonococcus can become a ‘superbug’, looking through our data and European Centre for Disease Prevention and Control’s (ECDC) data, we can be optimistic, because since 2011 no strain with high resistance to extended-spectrum cephalosporins (ESCs) has been reported, and strains with DS to these antibiotics are declining since the end of 2013. However, resistance to azithromycin is increasing.
EMIS-2010: Recency of various sexual practices with non-steady partners and of STI testing (N ∼ 120,000).
S09 Risk factors for antimicrobial-resistant gonorrhoea in Europe
G Spiteri1, M Cole2, AJ Amato-Gauci3 and M Unemo4
1Depart. Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC) Stockholm, Sweden
2Public Health England, UK
3Head of HIV, STI and Hepatitis Disease Programme, European Centre for Disease Prevention and Control (ECDC) Stockholm, Sweden
4Örebro University Hospital, Örebro, Sweden
Background: Antimicrobial-resistant Neisseria gonorrhoea is a global public health issue due to the limited alternatives for treatment. Understanding risk factors for resistant gonorrhoea is therefore essential to target surveillance and interventions. Surveillance of gonococcal antimicrobial resistance (AMR) in Europe is performed by the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), coordinated by the European Centre for Disease Prevention and Control.
Objective: To link AMR and epidemiological case data obtained in Euro-GASP, in order to improve the understanding of risk factors associated with gonococcal AMR in Europe.
Methods: Data on isolates from 2013 (n = 1994, 21 countries) were analysed to identify risk factors associated with resistance to azithromycin, cefixime and ciprofloxacin using univariate and multivariable logistic regression analyses of odds ratios (OR). Variables analysed included age, gender, mode of transmission, site of infection and concurrent chlamydial infection.
Results: Cefixime-resistant isolates (minimum inhibitory concentration, MIC > 0.125 mg/l) were significantly associated with heterosexual males (OR: 5.32) and females (OR: 1.34), compared to men who have sex with men (MSM). Ciprofloxacin resistance (MIC > 0.5 mg/l) was significantly associated with male heterosexuals (OR: 1.57 compared to MSM), and those without a concurrent chlamydial infection (OR: 1.57) in the multivariable analysis. Azithromycin resistance was significantly associated with heterosexual males (OR: 2.39). More isolates obtained from genital sites, compared to extra-genital sites, displayed cefixime and ciprofloxacin resistance; genital and pharyngeal sites, compared to anorectal sites, harboured more isolates with azithromycin resistance.
Discussion: AMR gonococcal isolates were significantly associated with heterosexuals, particularly heterosexual males. More AMR strains in genital sites compared to anorectal sites supported this finding. The linkage of epidemiological data to the AMR of gonococcal isolates allows identification of groups at higher risk for acquiring AMR gonococci and targets of enhanced surveillance and control measures. However, it is not possible to tailor treatments according to risk groups based on available Euro-GASP data.
S10 The molecular epidemiology of syphilis
Craig Tipple
Imperial College Healthcare NHS Trust, London, UK
The molecular typing of Treponema pallidum (subspecies pallidum) (T. pallidum), the causative organism of syphilis, began in 1998 with a description by the US Centres for Disease Control (CDC) of a method to characterise two of its genes (arp and tpr). This typing method has been used widely, and a systematic review in 2011 found 57 subtypes over eight geographic areas. More recently, with the increasing availability of gene sequence analysis, enhancements to the CDC method have discriminated more accurately between T. pallidum strains allowing both the further subdivision of CDC types and the characterisation of temporal changes in predominant strain types. Moreover, enhanced typing has permitted the description of an association between neurosyphilis and a particular strain type (14 d/f). This more detailed genotypic analysis has also raised the possibility that T. pallidum strain types may vary not only within populations but also within individuals during the course of an infection. Of interest, these changes may represent alterations to functional genes and therefore to disease activity. Of course, it also has implications for molecular epidemiology as strains were previously thought to be stable. At the level of the T. pallidum species, genomic differences are also being established which may allow discrimination between the yaws- and syphilis-causing organisms. T. pallidum strains can also be defined by the presence or absence of two 23s rRNA mutations (A2058G and A2059G) which confer macrolide antibiotic resistance. The global prevalence of these mutations varies widely (0.7% in Taiwan to 80% in Sydney) and is rising in some centres. The use of macrolides to treat syphilis can only be recommended with accompanying genotypic resistance testing or close observation for treatment failure. In summary, molecular techniques have advanced the field of T. pallidum research greatly providing insights into pathogenesis, epidemiology and antibiotic resistance.
S11 Genotyping Chlamydia trachomatis: possibilities and limitations
Björn Herrmann
Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden
Chlamydia trachomatis has a highly conserved genome that provides limited sequence variation to enable genotyping. The predominating target for typing has been the ompA gene coding for a major outer membrane protein (MOMP). However, the resolution is limited, and in recent years, three different multilocus sequence typing (MLST) schemes have been developed. Two are based on housekeeping genes and are suitable for evolutionary studies. The third has more variable targets and is intended for short-term clinical epidemiology and has been applied to a variety of clinical specimens. A striking difference between C. trachomatis strains infecting heterosexuals and men having sex with men has been disclosed. It has also shown that the lymphogranuloma venereum (LGV) infections seen in Europe during the last decade have been of clonal nature. Furthermore, in heterosexuals, a few genetic chlamydia variants have been found to predominate and seem to be globally spread. An alternative typing technique is based on tandem repeat sequence polymorphism, resulting in loci with a ‘variable number of tandem repeats’ (VNTR) that can enable discrimination by fragment size or sequencing. Array typing, i.e. using nucleotide polymorphism in target genes, has also been used but has the limitation to only detect known genetic variants, in contrast to sequence-based typing. Whole genome sequencing is powerful for typing, and with decreasing costs, it can be applied in clinical studies. Since large amount of target DNA is needed, it is still difficult to apply this technique on non-cultured chlamydia samples. Whole genome sequencing has the potential to elucidate pathophysiological mechanisms behind the clinical spectrum of chlamydial disease. Genotyping of C. trachomatis strains can be used for identification of LGV and for cluster, network and phylogenetic analyses.
Plenary session 1
S12 Heterosexual swingers
Nicole HTM Dukers-Muijrers
Dep. of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, Netherlands; Department of Medical Microbiology, Maastricht University Medical Centre (MUMC+), Netherlands, CAPHRI School for Public Health and Primary Care, Maastricht University, Netherlands
There is one particular high-risk group for sexually transmitted infection (STI) which worldwide is being consistently overlooked. This group concerns swingers, i.e. heterosexuals whom as a couple practice mate swapping, group sex and/or visit sex clubs for couples. They are involved in unprotected sex with concurrent sexual partners, and therefore more prone to STI acquisition and transmission than other ‘non-swinging’ heterosexual adults. Also, drug use and same-sex activities are no exception. Swingers have been shown to have a high STI prevalence, similar to men who have sex with men. Swingers comprise a most likely large – but hidden – population. Although the exact number is unknown, one of the largest dating websites for swingers, with two million registered members from over 50 different countries, estimates there are more than 15 millions of swingers worldwide. There are few data on their sexual health care seeking behaviour. It is likely that not all swingers attend STI care. Also, STI services do not usually have a protocol to identify swingers when they enter care. International guidelines for screening and counselling of this group are also lacking. By their high-risk behaviour and STI prevalence, swingers do classify as an STI high-risk group; this would justify their inclusion as a specific target in prevention and care. Here, an overview of the available – albeit scarce – literature on heterosexual swingers will be presented, and comparisons with other STI risk groups will be presented. This will be combined with practice-based examples originating from an STI clinic that serves many swingers.
S13 Bacterial vaginosis as a sexually transmitted infection
Gilbert GG Donders1,2
1Femicare Clinical Research for Women, Tienen, Belgium
2Antwerp University Hospital, Antwerpen, Belgium
Bacterial vaginosis (BV) is defined as a disturbance of the vaginal microflora whereby the normal lactobacillary-dominant miroflora has been replaced by 100- to 1000-fold greater numbers and 10-fold greater variety of anaerobic microorganisms that cause a strongly fishy-smelling vaginal discharge. Despite enormous evolutions in techniques to discover and quantify previously unknown and uncultivable bacteria, we still do not understand its real cause and pathogenesis. Since its recognition as an entity, it has been clear that this disease is more frequent in women when they start being sexually active and that its prevalence is correlated to the number of sex partners and to the frequency of unprotected vaginal sexual intercourse. Still these findings are not confirmed in all studies, and condoms fail to protect all cases of transmission. Furthermore, the higher frequency in lesbian women is not associated with the use of sex tools, but with practices of oral sex, indicating non-sexual transmission way occur. On the one hand, BV is associated with an increased risk of having human papillomavirus (HPV), Trichomonas, and GC/CT cervicitis, and with an increased acquisition risk of HIV and herpes simplex virus (HSV)2, but on the other hand, it may appear and disappear spontaneously and occurs in virgins post-menstrually. Also in some studies, only mobiluncus-positive BV is a risk factor for CT and pelvic infection, while the other types of BV were not, and in other studies, aerobic vaginitis (AV, another type of disturbed lactobacillary flora) was associated with CT, while BV was not. Concerning treatment, recurrences are frequently encountered, even after proper antibiotic therapy and despite refraining from sexual contact. Furthermore, treatment of sexual partners is not efficient in decreasing these recurrences rates. In summary, BV has many characteristics of a sexually transmitted infection (STI), but its pathogenesis is not always in line with the classical STI.
S14 Non-venereal treponematoses: the example of yaws
Quique Bassat
Barcelona Institute for Global Health, University of Barcelona, Spain
As a paediatrician, with special interest in infectious disease epidemiology and public health, Dr Bassat tries to combine his clinical work with biomedical research in those diseases that most affect the poor and vulnerable. Intermittently based in Manhiça, Mozambique, where he has lived for over six years, his research has included clinical trials related to malaria prevention and treatment. He has studied the burden, trends and characterisation of malaria in children admitted to hospital, and the overlapping symptomatology between malaria and other common infectious diseases, including bacterial pneumonia or diarrheal diseases. In recent years, he has coordinated the implementation of various P. vivax-related studies in Brazil, India or Papua New Guinea and has also devoted attention to the neglected infection yaws. Additionally, he is interested in understanding cause of death in resource-constrained countries, with a special emphasis on post-mortem procedures. Yaws is a chronic, disfiguring infection caused by Treponema pallidum subsp. pertenue. This, most neglected among the WHO neglected tropical diseases, is currently endemic in 13 countries. Recently, a single dose of the oral antibiotic azithromycin was shown to be highly effective in the treatment of the disease, raising hopes that it could finally be eradicated. Yaws eradication would be a milestone for universal coverage and shared prosperity in the early post-2015 era. It would add to the success of other disease eradication programmes, i.e. smallpox, dracunculiasis and polio. In light of this, the WHO has launched an ambitious new strategy, the Morges strategy, to eradicate yaws by 2020. The approach to eradication consists of a single dose of oral azithromycin to be given to entire populations in areas known to harbor yaws followed by surveys every six months to detect and treat remaining cases. The efficacy of this approach was demonstrated in a study of mass treatment performed in rural villages of Lihir Island, Papua New Guinea. Of 16,092 residents, 83% received mass treatment and were monitored for one year; the prevalence of active yaws decreased from 2.4% to 0.3%, and there was near absence of seroreactivity in children one to five years of age. Progress towards eradication has been made, including the update of the epidemiological situation from endemic countries, the validation of point-of-care and molecular diagnostic tests, an initial design for a mass treatment strategy and early discussions regarding the economic aspects of eradication. However, a significant scale-up is needed to reach the goal of eradication by 2020.
Symposium 3 (ECDC): Promoting the sexual health of MSM in a changing prevention landscape
S15 Surveillance of sexually transmitted infections among men who have sex with men in the European Union/European Economic Area
Gianfranco Spiteri1 and AJ Amato-Gauci2
1Dep. Surveillance and Response Support Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
2Head of HIV, STI and Hepatitis Disease Programme, European Centre for Disease Prevention and Control, Sweden
The European Centre for Disease Prevention and Control coordinates surveillance of chlamydia, gonorrhoea and syphilis among 30 European countries since 2009. Trends of sexually transmitted infections (STIs) are increasing in many European Union/European Economic Area (EU/EEA) countries. Men who have sex with men (MSM) are a key vulnerable population. The aim of this analysis was to investigate the contribution of MSM to the epidemiology of STI in Europe and describe recent trends. Data from countries reporting surveillance data for chlamydia, gonorrhoea and syphilis between 2009 and 2013 were analysed. Number of cases reported, proportion of cases by transmission and age-group (15–19, 20–24, 25–34, 35–44, 45 and over) were analysed. Time trends in number of cases were analysed using linear regression. Chlamydia data were reported by 24 countries, gonorrhoea by 27 and syphilis by 28 countries for the whole period. The number of reported cases increased between 2009 and 2013 by 7% for chlamydia (p value for trend = 0.04), 78% for gonorrhoea (p value for trend < 0.01) and by 18% for syphilis (p = 0.3). The proportion of cases among MSM increased for all three infections during this time, from 4% in 2009 to 7% in 2013 for chlamydia, 30% to 45% for gonorrhoea and 39% to 60% for syphilis. The proportion of cases among MSM increased among all age-groups for all three infections. These results provide evidence that MSM are disproportionately affected STI; reported cases among MSM increased substantially between 2009 and 2013 among EU/EEA countries. The observed trends may have been affected by changes in surveillance systems, levels of testing and more widespread use of more sensitive tests (for gonorrhoea specifically), but the magnitude of the observed increases among MSM is a cause for concern and indicates the need for intensified comprehensive prevention interventions for MSM in Europe.
S16 State of the HIV response among men who have sex with men in the European Union/European Economic Area
Andrew J Amato-Gauci
Head of HIV, STI and Hepatitis Disease Programme, European Centre for Disease Prevention and Control, Sweden
In 2004, the Dublin Declaration was agreed at a high-level conference ‘Breaking the Barriers – Partnership to Fight HIV/AIDS in Europe and Central Asia’ aiming to galvanise political action to tackle the epidemic in the region. This talk draws on data reported by European Union/European Economic Area (EU/EEA) countries as part of monitoring activities for the Dublin Declaration and UNAIDS global reporting in 2010, 2012 and 2014, and on surveillance data reported to European Centre for Disease Prevention and Control (ECDC) and WHO’s Regional Office for Europe since 2004 to summarise progress achieved and current challenges. In 2014, 80% of countries reported that their prevention funding targets the populations most affected by HIV; 90% reported that HIV prevention is delivered at scale for people who inject drugs; 77% reported the same for men who have sex with men (MSM) and 67% for sex workers. The number of heterosexually acquired cases among men and women originating from countries with generalised HIV epidemics has decreased by 60% and 61%, respectively. HIV cases among people who inject drugs decreased by 36%. Cases of HIV transmitted from mother to child declined from 359 in 2004 to 218 in 2013. AIDS cases decreased from 9389 in 2004 to 4369 in 2013. However, reported cases among MSM increased by 33% since 2004. Between 2004 and 2013, new cases among MSM aged 20–24 years nearly doubled and increased by 83% among 15- to 19-year-olds. Prevention efforts have been strengthened, and data show decreasing cases among some risk groups. However, rising number of cases among MSM, particularly younger MSM who are likely to have been infected more recently, is of concern. Current prevention efforts may not be having the necessary impact to reduce transmission. The coverage, uptake and targeting of evidence-based prevention programmes across the region need to improve.
S17 A comprehensive approach to the prevention of HIV and STI in Europe
J Casabona, A Pharris and AJ Amato-Gauci The MSM guidance expert group
In all countries of the European Union and European Economic Area, men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections including gonorrhoea, syphilis, chlamydia and hepatitis B and C. In several countries in the region, the incidence of these infections has increased among MSM, in some cases markedly, over the last decade. There is evidence that services to prevent, diagnose and treat infections transmission, as well as other interventions to prevent transmission, are not being delivered at the appropriate scale to impact on transmission patterns.
Based on a systematic review of the literature and expert opinion, the European Centre for Disease Prevention and Control suggests that there is good evidence to ensure that vaccinations, condom and lubricants, HIV and STI testing and treatment, health promotion, MSM-competent health services, and targeted care for MSM living with HIV are considered for inclusion in national and sub-national public health programmes in countries in Europe. The evidence indicates that these services and interventions can effectively prevent and reduce HIV and STI transmission among MSM, address the needs of MSM who are living.
Prevention services for MSM should be targeted following the analysis of relevant and reliable epidemiological data, so that services are directed at the appropriate scale to those geographical and risk populations most at risk of HIV and STI infection. Combinations of the suggested key interventions including behavioural, biomedical and structural approaches- should be offered to MSM in order to achieve synergy and the highest levels of effectiveness. Prevention needs and preferences of MSM vary across and within country settings, by individual and over time. Offering and implementing prevention packages in collaboration with the target group, or where appropriate, by the target group, is crucial to the success of national and sub-national prevention programmes.
As many countries in Europe experience constrained public health budgets, it is more important than ever to implement targeted and evidence-based measures that address the groups most affected by the HIV epidemic as well as those most at-risk for disease acquisition and transmission. The promotion of sexual health using positive messages framed in an empowering environment in relation to individual needs, will ensure greater effectiveness of the prevention efforts resulting in increased sexual health and reduced new infections of HIV and other STI in Europe.
S18 Understanding the impact of men who have sex with men smartphone applications on HIV prevention in Europe
C James1, J Harbottle1, S Paparini2, G Spiteri3, AJ Amato-Gauci3 and T Noori3
1Terrence Higgins Trust, London
2London School of Hygiene and Tropical Medicine, London
3European Centre for Disease Prevention and Control (ECDC), Stockholm
Background: The European Centre for Disease Prevention and Control (ECDC) and Terrence Higgins Trust (THT) conducted a pilot project to help understand what the role of smartphone apps is within the EU’s response to the HIV epidemic in men who have sex with men (MSM). This project aims to understand how HIV prevention organisations in the EU are currently using MSM smartphone apps in their work and how this can be further developed and to consider the wider role of smartphone app use on the HIV epidemic in MSM.
Method: To meet these two aims, the project conducted a literature review on the impact of MSM smartphone apps, an EU-wide survey of over 200 MSM prevention professionals and stakeholders, 10 in-depth interviews with individual MSM and stakeholders from across the EU and an Expert Meeting in Stockholm in February 2015 which was attended by representatives from community organisations, public health units, academic institutions and government agencies from the EU and USA.
Results: Smartphone apps are perceived to be thoroughly interwoven with MSM’s social and sexual behaviour and HIV prevention needs throughout the EU. Despite their importance to MSM, smartphone apps were ranked fourth (behind websites, saunas and gay clubs) in terms of their importance to stakeholder’s current HIV prevention work with only 37% undertaking activity on the platforms.
Conclusions: While smartphone apps are a key aspect of MSM lives and sexual behaviour in the EU, many MSM HIV prevention organisations require guidance and support to incorporate them into behavioural and awareness raising interventions. The project recommends the creation of guidance and practical tools to aid organisations in this work and the creation of EU-wide and international frameworks to share best practice and to engage with the private sector create mutually beneficial partnerships.
S19 Implementing pre-exposure prophylaxis for men who have sex with men – challenges and opportunities
AK Sullivan on behalf of the PROUD Study Group
Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
Pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine is an effective biomedical intervention to prevent HIV transmission in men who have sex with men (MSM); both as a daily regimen and on demand. Delivered as part of a comprehensive risk-reduction bundle of care, PrEP reduces HIV acquisition by 86%, with one infection averted for every 13–18 individuals treated for one year. Recent studies demonstrate high levels of acceptability and compliance with dosing regimens. Concerns relating to risk compensation were not realised, few adverse events occurred and cost-effectiveness has been demonstrated. The studies attracted a particularly at-risk population with significantly higher than expected HIV incidence in those not on active treatment. This intervention offers a unique opportunity to impact on the HIV epidemic in MSM. However, making it widely accessible to MSM across health care settings, especially as individual need is likely to vary over time, presents numerous challenges. Funding both of the infrastructure to deliver it and the cost of the drug itself, even in the face of clear public health benefit, is uncertain in the current financial climate, and specialisation may, as has been observed to an extent in the US, restrict access and awareness. Translation of these findings into routine clinical delivery will require a systematic means to identify a risk threshold, integration of PrEP into routine clinical practice, safety monitoring, capacity to deliver the full risk-reduction bundle, staff education and training and increased public awareness; many, if not all, of these present significant challenges and risk of opportunity costs as yet ill defined. Improved data collection, reporting and monitoring will be essential to provide further real-life evidence of this potentially epidemic modifying intervention. The parallel challenge is to mirror this for all those at increased risk of HIV infection.
Symposium 4: Update on HIV infection
S20 HIV epidemiology update
Andrew J Amato-Gauci
Head of HIV, STI and Hepatitis Disease Programme, European Centre for Disease Prevention and Control
Since 2008, the European Centre for Disease Prevention and Control (ECDC) in close collaboration with the World Health Organization Regional Office for Europe (WHO Regional Office) have coordinated the enhanced surveillance of HIV/AIDS in Europe. Standardised HIV surveilance in the EU has been carried out since 1984, previously under the Disease Specific Network based in Paris, the Euro-HIV, funded as a project by the European Commission.
For 2013, 29 157 HIV diagnoses were reported by 30 EU/EEA countries, giving a rate of 5.7 per 100000 population. The overall rate for men in the EU/EEA was 8.9 per 100 000 population as opposed to the rate of 2.6 per 100 000 population in women. The overall male-to-female ratio was 3.3 with the predominant mode of transmission in these countries being sex between men.
The data suggests that there is still scope for scaling up evidence-based HIV prevention interventions tailored to the local epidemiological context and targeted at those most at risk. Interventions targeted at men who have sex with men should be a cornerstone of HIV prevention in all EU/EEA countries. Given the proportion of HIV cases among migrants in many EU/EEA countries, migrant sensitive prevention services are also crucial. Expansion of HIV counselling and testing should ensure earlier diagnosis and access to treatment that will reduce the number of late presenters and improve treatment outcomes.
S21 Update in HIV infection – HIV testing
Dr AK Sullivan
Consultant Physician HIV/GU Medicine, Chelsea and Westminster Healthcare NHS Foundation Trust, London UK
Undiagnosed HIV infection and late stage diagnosis remain a challenge throughout Europe. Despite extensive work to expand testing, 50% of patients newly diagnosed with HIV have a CD4 cell count <350 cells/uL. Innovative testing strategies, new technology and legislative change could all potentially increase access to HIV testing, especially by those most affected by the epidemic. Studies have demonstrated the effectiveness of new testing strategies such as HIV indicator condition guided testing, with European wide programmes such as OptTEST being designed to expand delivery. Increased use of home sampling and, in some countries, legislative change to allow home testing afford greater access and convenience. Harnessing new technology and social media to promote and offer HIV testing is hoped to further increase access to testing and, crucial for some, repeat regular testing. However stigma and timely access to treatment and care remain significant barriers in many regions.
Bacterial sexually transmitted infections (STIs) are characterised by short incubation period, high prevalence of symptomatic subjects and high transmission rate. Syphilis and gonorrhoea have a long history and also lymphogranuloma venereum (LGV) is quite an old disease, first reported in 1833 and described in 1913. Bacterial STIs have acquired increasing relevance in the last year for several reasons:
– Epidemiological changes with huge increase in incidence of syphilis starting from the former USSR countries at the end of the last century and then to the western world mainly among men who has sex with men (MSM) and in the big cities
– The relevant problem of multiple antimicrobial resistance for Neisseria gonorrhoeae concomitant with the progressive loss of interest of the major pharmaceutical companies in the research for new antibiotics
– he spread of a new epidemic with different clinical characteristic of LGV, mainly related to HIV-positive MSM
– Syphilis and HIV have epidemiological and biological relationship, but still there is discussion on the real role of syphilitic infection in HIV patients and vice versa
– Still there are doubts and controversies regarding the real incidence and the clinical management of neurosyphilis, specially in the HIV setting
– Third-generation cephalosporins are the drug of choice for the treatment of uncomplicated gonorrhoea; data have been published about the progressive loss of efficacy of these drugs and the need of new and potent antibiotics
– The development of nuclear amplification techniques (NAAT) for the diagnosis of gonorrhoea has provided very sensitive and useful tools, but, up to now, NAAT are not able to detect antibiotic resistance
– LGV epidemic has clearly demonstrated how the attention for safe-sex practices among HIV MSM has fallen and must be therefore reinforced.
S25 Emergence of hepatitis C virus among HIV-positive men who have sex with men: what have we learnt the past 10 years
Thijs JW van de Laar
Department of blood-borne infections, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
Since 2004, outbreaks of sexually transmitted hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM) have been reported from Europe, North America, Australia and Asia. Molecular and classical epidemiological studies confirmed that the increase in HCV incidence coincided with the introduction of combination antiretroviral therapy (cART) for HIV. The expanding pool of people living with HIV, increased and/or altered sexual risk behaviours after the introduction of cART and the popularity of Internet all might have contributed to the successful introduction of HCV among MSM. Multiple behavioural and biological risk factors have been associated with HCV acquistion, including receptive unprotected anal intercourse with multiple partners, sex under the influence of drugs, rough sexual techniques, concurrent sexually transmitted infection (STI), low CD4 count and HIV status. In itself, microtrauma of the intestinal mucosa caused by sexual activity could provide a porte d’entrée for HCV, but it does not explain why HIV-negative MSM remain largely unaffected. The role of HIV, or the exact underlying immunological or behavioural factors facilitating sexual transmission of HCV, still remain to be elucidated. With HCV becoming endemic among HIV-positive MSM in high-income countries, what will be the health consequences on the long term? New and more successful treatment regimens will become available, but will that be enough to limit irreversible liver damage in a yet vulnerable population, to prevent continuous HCV-reinfection among high-risk individuals and to turn around the HCV epidemic?
S26 Serogroup C invasive meningococcal disease among men who have sex with men
Agnès Libois
Saint-Pierre University Hospital, Brussels, Belgium
Neisseria meningitidis can cause invasive meningococcal disease (IMD) as septicaemia and/or meningitis. Most cases in Europe are caused by serogroups B and C. In recent years, outbreaks of IMD caused by N. meningitidis serogroup C (MenC) have been described in men who have sex with men (MSM): 22 cases in New York between 2010 and 2013, five cases in Berlin between 2012 and 2013 and around 10 cases in Paris between June 2013 and December 2014. Those clusters are caused by a strain with high case fatality. Sexual contact with partners from abroad, Gay pride and other festivals may facilitate the spread of this MenC strain. In France, vaccination is currently recommended for MSM and all individuals ≥25 years attending social venues associated with the gay community. The vaccination should be considered for all persons travelling in Europe and planning to attend Gay pride or other festival associated with the gay community.
S27 HHV-8-related diseases
Nicolas Dupin1,2,3
1Service de Dermatologie, Hôpital Cochin, APHP, Paris, France
2Inserm U1016, Université Paris Descartes, Paris, France
3Centre National de Référence de la Syphilis, APHP, Paris, France
The virus HHV-8 celebrated its 20th birthday in December 2014, and its relationships with Kaposi sarcoma are not completely elucidated. HHV-8 is an enigmatic virus, with an inhomogeneous distribution and a salivary transmission, while it is not a ubiquitous virus, at least in western countries. In those countries, HHV-8 is more prevalent in gay men with 20%–30% of gay infected by the virus, while the rate of infection in heterosexuals is very low under 5%. HHV-8 has a unique genetic equipment rending is role in Kaposi sarcoma more than plausible. While the virus is necessary, it appears that it is not sufficient as the development of Kaposi is frequently associated with immunosuppression whatever the cause (iatrogenic, viral, age related). Kaposi sarcoma should be more considered as an opportunistic tumour than a viral-induced cancer, and the best treatment for Kaposi sarcoma is immune restoration at least when it is possible. HHV-8 is also associated with two rare lymphoproliferations, the multicentric form of Castleman disease and primary effusion lymphoma. All three diseases can occur in the same patient, and more than 75% of patients with Castleman disease may have Kaposi sarcoma. However, although HHV-8 is common to these diseases, the picture of the infection and the relation between the virus and the specific disease is quite different. The status of the virus is not the same in Kaposi sarcoma and lymphoproliferative diseases. In Kaposi sarcoma, the target cells are probably an endothelial precursor or the lymphatic endothelium; in Castleman, the target cells are monotypic IgM-λ plasmoblast localised in the mantle zone of the lymph nodes. Most of spindle cells in Kaposi sarcoma are latently infected, while some plasmoblast in Castleman support lytic infection. The best treatment for Kaposi sarcoma is the restoration of immunity, while Castleman is less sensitive to immune restoration.
S28 Enterocolitis and proctitis
Henry JC de Vries1,2,3,4
1STI Outpatient Clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, the Netherlands
2Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
3Centre for Infectious Diseases and Immunology Amsterdam (CINIMA), Amsterdam, the Netherlands
4Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
Proctitis is defined as an inflammatory syndrome of the distal 10–12 cm of the anal canal, also called the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via mutual masturbation. Neisseria gonorrhoea, Chlamydia trachomatis (including lymphogranuloma venereum), herpes simples virus and Treponema pallidum are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), a significant proportion of women have anal intercourse and therefore may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include itching, pain, cramps (tenismus) and discharge in and around the anal canal. Asymptomatic proctitis occurs frequently and can only be shown by laboratory tests. The majority of rectal chlamydia and gonococcal infections is asymptomatic. Therefore, when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from bacterial and protozoan STIs, which are often spread without penile penetration.
Symposium 6: Male syndromes
S30 Mycoplasmas, ureaplasmas, and other exotic causes of male urethritis
JS Jensen1, M Frølund1, P Lidbrink2, A Wikström2, S Cowan3 and P Ahrens1
1Microbiology and Infection Control, Statens Serum Institut, Copenhagen S, Denmark
2Dept. of Dermato-venereology, Karolinska University Hospital, Stockholm, Sweden
Background: The etiology of non-gonococcal urethritis (NGU) remains unexplained in 30–40% of patients.
Aim: To elucidate the role of suspected pathogens in a well characterized population of male STD clinic attendees.
Methods: First void urine from men attending Swedish STD clinics were examined for Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Ureaplasma urealyticum, U. parvum, adenovirus, herpes simplex virus, Neisseria meningitidis, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae by species-specific quantitative real-time PCRs.
Results: The study enrolled 187 men with acute NGU (symptoms ≤ 30 days) and 24 with chronic NGU (symptoms >30 days) as cases, and 73 men without NGU as controls. C. trachomatis and M. genitalium were associated with NGU. Macrolide resistance in M. genitalium was rare (3%). In multivariate analysis, detection of U. urealyticum was significantly more common in acute NGU (20%), but not in chronic NGU (13%) compared with controls (11%). Bacterial load ≤1.3 × 103 geq/ml was associated with NGU. Using the expanded panel of assays, 24% of acute NGU cases remained idiopathic.
Conclusions: C. trachomatis and M. genitalium were associated with NGU, as was U. urealyticum with bacterial loads ≤1.3 × 103 geq/ml urine. Virus and H. influenzae might explain few NGU cases, but the etiology in at least 24% of acute NGU patients was unexplained.
S31 Male genital skin diseases
Gemma Martin-Ezuerra
Hospital del Mar, Barcelona
The majority of skin conditions can affect the genitalia. Some of them reproduce the same characteristics as the disease in other parts of the body. However, there are a number of common skin conditions whose genital component differs from the appearance of the disease elsewhere. When unique localisation is on the genitalia, the diagnosis can be challenging because most of the signs and symptoms of the disease are non-specific. Differential diagnosis has to be performed with Sexual Transmitted Infections.
From different clinical cases, we will discuss the differential diagnoses of inflammatory skin diseases affecting the genitalia. They present as balanoposthitis, and include conditions such as psoriasis, eczema, lichen sclerosus or lichen planus. Cases with skin ulceration involving the glans will be presented, including cases of erythema multiforme, BehÓet disease and fixed drug eruption; some of them misdiagnosed as herpes simplex infection. Finally, tumoral skin diseases affecting the genitalia will be discussed.
Symposium 7: STI challenges beyond 2015
S33 Clinical management of neurosyphilis: filling the gaps
M Janier
STD Clinic, University Hospital Saint-Louis AP-HP and Saint-Joseph, Paris, France
Neurosyphilis has been the great fear of patients and doctors from the works of Fournier at the end of the XIXth century (tabès 1875, general paresis 1894) with the terrifying idea that asymptomatic neurosyphilis would slowly and silently destroy the nervous system of infected people, and progress to clinical disease with a historical consequence of overtreating syphilitic patients. Discussions are still running after one century, due mainly to the necessity of a very long clinical follow-up and to the impossibility of culturing Treponema pallidum, although both yesterday rabbit inoculation and today PCR are far from having solved the problem. We have only indirect and imperfect criteria (i.e. serologies) for defining both asymptomatic neurosyphilis and its cure. There is no consensus on how to select patients for CSF control and/or for enhanced treatment. We will review all the areas of controversy in the field (serum STS, CSF STS, treponemicidal levels of penicillin). The multiplication of isolated clinical cases and non-comparative and retrospective studies have led to the general impression that neurosyphilis could be more prevalent and that recommended regimens for uncomplicated syphilis should be enhanced in HIV-infected patients, but there is no evidence-based data to support it, the few prospective comparative trials having failed to demonstrate any difference between HIV-infected and HIV-negative patients. Definition of symptomatic neurosyphilis itself is a difficult/impossible challenge: the clinical presentations are extremely diverse, encompassing ophtalmological, otological, spinal and cerebral manifestations, occurring both in early syphilis (meningeal) and in late syphilis (parenchymatous), none of them being specific of the disease. The 2014 European syphilis guideline recommends CSF control in a very limited number of cases, i.e. overt neurological/ocular/auditory symptoms. We certainly need to be cautious, facing a continuous vivid syphilis epidemic in Europe, to screen, examine the patients with special attention to neurological examination and to treat early syphilis. We also must recognise that the recommended therapeutic syphilis regimen (benzathine penicillin G) is simple and extremely efficient, cases of symptomatic neurosyphilis being rare and progression to neurosyphilis after BPG exceptional, whatever the HIV status.
S36 Chlamydia testing training in Europe (CATTE): overcoming barriers to establishing routine chlamydia testing in general practice for young adults
Cliodna Mcnulty1, Claire Rugman1, Nina Ockendon1, Ellie Ricketts2, Katy Town1, Anneli Uuskula3, Anna Tisler-Sala3, Hans Fredlund4, Johanna Haraldsson4, Brigitte Dunais5, Soline Detanne5, Kate Folkard1 and Pia Touboul5
1PHE, Gloucester, UK
2NHS, Gloucester, UK
3Tartu University, Tartu, Estonia
4Orebro Unsty, Orebro, Sweden
5Nice University, Nice, France
Background: Chlamydia is the most common sexually transmitted infection (STI) in Europe, and chlamydia control activities remain variable. Chlamydia testing training in Europe (CATTE) is a complex educational intervention aiming to increase chlamydia testing by general practice (GP) staff in young people. CATTE was adapted and implemented in four EU partner countries (England, Estonia, France, Sweden), led by Public Health England.
Aim: To evaluate the impact of CATTE on target groups (GP staff, trainers).
Methods: CATTE comprises a Train the Trainer package for GP staff trainers, and GP staff materials. Training was delivered in GP surgeries. Qualitative (thematic) analysis was performed on interviews with GP staff (mean 8/country) and trainers (mean 6/country). Results were discussed at face-to-face meetings.
Results: Common and country-specific themes impacting on the success of CATTE were observed in all partner countries. Four major themes were: opportunities to discuss sexual health with colleagues/patients, keeping sexual health topical, practice staffing organisation/capacity and comparing testing rates with peers. These included barriers to and facilitators of success. Barriers included time available to offer testing in GP staff consultations, remembering to offer testing, difficulty offering testing in non-sexual health consultations, and data acquisition requirements. Facilitators included ease of implementation, whole practice approach, variety/flexibility of supporting materials, normalising chlamydia testing and comparing testing rates with peers.
Conclusions: Some barriers to chlamydia testing in GP can be overcome using CATTE, although some remain. As such, tailoring the choice of training components could help maximise effectiveness.
S37 Developing a 2016–2021 global health sector strategy for sexually transmitted infections
Nathalie Brouteta, Andrew Sealea,b, Heine Maraisa,b, Andrew Ballb and Igor Toskina
aDepartment of Reproductive Health & Research (RHR), World Health Organization, Geneva, Switzerland
bHIV/AIDS Department, World Health Organization, Geneva, Switzerland
As the world looks to 2030, and prepares to meet the challenges of an ambitious set of Sustainable Development Goals, the World Health Organization is developing three global health sector strategies to cover: HIV/AIDS, viral hepatitis and sexually transmitted infections (STIs). The strategies will cover 2016–2021 and will be finalised for consideration by the 69th World Health Assembly (WHA) in 2016. In 2006, the WHA approved the global strategy for the prevention and control of STIs: 2006–2015 (resolution WHA59.19). The final progress report on implementation of the strategy will be presented to the WHA in 2016. The proposed strategic action framework for 2016–2021 seeks to guide WHO and country action and include focused sections describing: the rationale, framework and imperative for action; guiding principles; the importance of strategic information and accountability; sections describing essential quality health sector services and interventions; a focus on achieving impact and equity through a focus on key populations, settings and locations; a focus on innovation; and sections describing how best to finance a robust STI response.
Plenary session 2
S38 The evolution of sexually transmitted infections with special regard to bacterial pathogens
Dan Danielsson and Magnus Unemo
WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden
Most studies on bacterial sexually transmitted infections (STIs) have focused on prevention, diagnosis and treatments with emphasis on the emerging antibiotic resistance, epidemiology and pathogenesis. The rapid development of molecular technologies and genetics has facilitated an evolutionary approach to the study of bacterial STI pathogens which generates new questions with new answers. Bacterial STI pathogens are proved to have relatively small genomes like other bacteria adapted for specific niches. They are derived either from free-living ancestors or from ancestors in animals through genome reduction, by loss of genes but also acquisition through horizontal gene transfer (HGT), duplications of genes, rearrangements and recombinations for survival in their econiche. Most genes are essential, and accumulations of mutations can be lethal. Two further explanations have proved particularly valuable; first, phylogeny and origins; second, the co-evolution of pathogens and hosts. Phylogenetic studies have thus shown that STIs are nothing new but have been interacting with hosts in nearly all species, including plants, for eons. They have also elucidated how organisms often make the transition from a non-genital habitat to genital econiche, and how selected forces after this transition shape the pathogens and their hosts with extraordinary specialisation for sexual transmission. With delicacy outside the protected genital econiche, the STI pathogens have proved to be masters of survivors. Persistence, however, is connected with trade offs for the host; chronic infection with chronic inflammation with sequels as infertility. Phylogenies, origins and the initial global spread of the six bacterial STIs – syphilis, chancroid, donovanosis, chlamydia, Mycoplasma genitalium infections and gonorrhoea – will be discussed.
S40 Sex and drug use among men who have sex with men
Dr Adam Bourne
Lecturer, Sigma Research, London School of Hygiene & Tropical Medicine, UK Adam.bourne@lshtm.ac.uk
Background: Recreational drug use among men who have sex with men (MSM) in most western European countries has historically centred on ‘club drugs’ such as ecstasy and cocaine. However, emerging clinic and community data indicate a gradual transition towards drugs such as GHB/GBL, mephedrone and crystal methamphetamine. These drugs can trigger feelings of intense sexual arousal, sometimes leading to a combination of drugs and sex in a practice often referred to as ‘Chemsex’. This paper will review literature relating to chemsex and describe the findings of a focussed, qualitative study of this topic among MSM in London.
Methods: In-depth qualitative interviews were conducted with 30 MSM who reported using crystal methamphetamine, mephedrone or GHB/GBL during sex. They were recruited via commercial advertising across London. Interviews explored personal experiences of using these drugs during sex, including the harms people perceived or experienced, or had witnessed in others. Experiences of help-seeking to manage drug use were also explored. Data were subjected to an inductive thematic analysis. The findings of this study were situated within the wider literature on chemsex and sexualised drug use among MSM in Europe.
Results: Men described how GHB/GBL, mephedrone or crystal methamphetamine facilitated sex with a high number of partners, often as group sex taking place over several days. Accounts of sexual assault while under the influence of chemsex drugs were reported, as was unintended unprotected anal intercourse (with potential HIV sero-discordant partners). While many men felt in control of their chemsex, others were experiencing significant harms to their social, emotional, physical and sexual well-being, but described difficulty accessing relevant harm reduction information or services.
Conclusions: Changing trends in drug use among MSM in London have not been matched by a re-positioning of harm reduction services to meet their needs. Generic drug harm reduction services across western Europe that have typically catered for opiate users need to take account of both the types of drugs that gay men are using and the unique setting within which their use occurs. Sexual health services should develop or upscale drug services situated within their clinics and improve linkages to psycho-therapeutic services.
Symposium 8 (WHO): Advancing the prevention of STI through innovations in technology and delivery methods: opportunities and new horizons
S44 WHO initiatives on STI point-of-care tests and behavior interventions: intermediate results and perspectives
I Toskin1, S de Vasconcelos1, B Cooper1, R Peeling2 and M Murtagh2
1Department of Reproductive Health & Research (RHR), World Health Organization, Geneva, Switzerland
2London School of Hygiene & Tropical Medicine, UK
Background: Advancing the field of diagnostic testing for STIs and innovations in behaviour interventions that aim to improve primary prevention and increase health-seeking behaviour can revolutionize STI control in the near future by providing clients targeted essential STI services.
Throughout the last decade, substantial research has been conducted to develop evidence-based behaviour interventions and point-of-care tests (POCTs) to detect STIs that contribute to health outcomes from an STI/HIV perspective. These include research on behaviour change and health seeking behaviour that aim to promote delay in sexual debut; consistent condom use; partner reduction strategy; HIV/STI testing; as well as proof-of-concept and validity of POCTs. The POCTs offer patients the opportunity to receive definitive diagnoses and appropriate treatment in a single visit. The STI POCT concept also includes innovative delivery techniques such as home and community-based tests, on-site delivery, as well as self-testing after purchase of a test online or over-the-counter.
Objective: To develop Target Product Profiles (TPPs) for STI POCTs as well as to map promising techniques for brief behaviour interventions aiming to increase health-seeking behaviour and to reduce risk taking.
Method: In 2014, WHO Department of Reproductive Health and Research (RHR) completed the systematic review and landscape analysis of promising STI POCTs and other diagnostic technologies to detect N. gonorrhoeae, C. trachomatis, T. vaginalis, and human papillomavirus (HPV), and conducted an International Technical Consultation on STI POCTs.
A systematic review of techniques for brief behaviour interventions within the context of primary STI/HIV prevention and health-seeking behaviour was also completed.
Results: The main outcomes are: – Development of Target Product Profiles (TPPs) for POCTs to detect N. gonorrhoeae, C. trachomatis, T. vaginalis, HPV, and syphilis;
– Compilation of a comprehensive list of evidence-based techniques for brief behaviour interventions.
Conclusion: All of these achievements allowed the RHR Department to initiate the development of research protocols for an independent multi-country validation of promising: (a) STI POCTs; (b) techniques for behaviour interventions aimed at STI/HIV primary prevention and health-seeking behaviour in key populations and adolescents/young people in low- and middle-income countries; and (c) research on the development of new diagnostic tests.
S45 STI point-of-care tests and technologies: results of systematic reviews and landscape analysis
Rosanna W Peeling
London School of Hygiene & Tropical Medicine, UK
Point-of-care tests (POCTs) offer patients the opportunity to receive definitive diagnosis and appropriate treatment, if necessary, in a single clinic visit. Partner notification can also be initiated without delay. Some POCTs are sold over-the-counter for home use or available from the Internet. The quality of POCTs is highly variable, and their accuracy may be further compromised if performed by untrained users without appropriate instructions. WHO conducted systematic reviews on the performance of POCTs for sexually transmitted infections (STIs). POCTs for antibody detection of syphilis show reasonable performance compared to laboratory-based treponemal assays and have been used with rapid HIV tests in prenatal screening in the dual elimination of mother-to-child transmission of HIV and syphilis. Antigen detection POCTs for the diagnosis of genital chlamydial and gonococcal infections show acceptable specificity compared to nucleic acid amplification tests, but their sensitivities need improvement if they were to be useful for increasing the specificity of syndromic management for vaginal discharge. POCTs for the detection of Trichomonas vaginalis and human papillomavirus show reasonable performance against reference standard technology, but the latter are not truly POCTs. A landscape analysis shows that multiplex and near POCTs are already on the horizon and automated sample-in answer-out POC devices are in the pipeline. Advancing the field of diagnostic testing for STIs can potentially improve STI surveillance and facilitate better patient management and more effective STI control.
S46 Advancing control of sexually transmitted and genital infections through technology innovations in diagnosis and care: opportunities and new horizons
Tariq Sadiq
St George’s, University of London, UK
Effective sexually transmitted infection (STI) control is challenged by inadequate access to prompt diagnosis and treatment for patients and partners, poor community STI surveillance for targeting public health interventions and changing antimicrobial resistance (AMR) patterns. Rapid testing for STI diagnosis and AMR may address these issues by enabling immediate optimised treatment and partner notification. Rapid STI self-tests, away from points of care, may better reach those disproportionately affected, such as young people. However, these require carefully evaluated strategies for implementation. Modern microfluidic and nanotechnology devices provide a basis to develop a new generation of accurate rapid diagnostics that have potential to be coupled to modern broadband Internet connected mobile phones, adding the possibility of at-risk individuals testing remotely, away from health services but connected to further management care pathways. This may give scope for reducing STI transmission and providing greater personal control of sexual health.
S47 New biomedical approaches in HIV prevention – why do information, education, awareness and behaviour still matter?
Christine Winkelmann
Federal Centre for Heath Education, Germany
Background: The field of sexually transmitted infection (STI) prevention is closely related to and influenced by developments in HIV prevention. In HIV prevention, biomedical approaches advanced very rapidly over the last years. Lately, two studies demonstrated the effectiveness of pre-exposure prophylaxis (PrEP) to prevent HIV infections (IPERGAY and PROUD 2015). These developments put pressure on the concept of combination prevention (UNAIDS 2010) by stressing biomedical approaches over structural and behavioural approaches.
Data: Data that European countries report to European Centre for Disease Prevention and Control (ECDC) on STIs often show an increase in prevalence and also demonstrate that the general population is affected by STIs – e. g. chlamydia among young women (ECDC). Human papillomavirus (HPV) vaccination rates are not as high as they could be in some countries. PrEP or TaSP can give good protection against an HIV infection but not against infections with other STIs. The studies mentioned above showed a high prevalence of other STIs among men who have sex with men (MSM).
Discussion: Biomedical approaches offer to a certain degree and under certain conditions protection against HIV, but not against STIs. If STI prevention is understood in a broad way, behavioural and structural approaches are nowadays as much needed as before, especially taking into account that STIs affect broad population groups. Condom use still is a key to STI prevention, the promotion of vaccines as well (HPV, hepatitis). At the same time, good clinical health services (sex-friendly and easily accessible) need to be in place to diagnose and treat STIs. Another corner stone of a comprehensive STI prevention is broad school-based sexuality education (BZgA and WHO Regional Office for Europe 2010). This form of education helps to build awareness of STIs including common symptoms, communication skills and information on counselling and medical services.
Conclusion: In times of impressive advances in the field of biomedical prevention, it is of great importance to anchor prevention under the paradigm of combined prevention including behavioural and structural prevention.
S48 What perspectives for sexual health and the development of the public health law in respect of human rights in France
Thierry Troussier and Ingrid Geray
UNESCO Chaire, France
Aims: To approach across public health issues and specifically the fight against sexually transmitted infections (STIs) and HIV in France, policy responses related to sexual health in France.
Data: Sexual health is now clearly defined as a state of well-being (WHO2). WHO and UNAIDS (2010) recommended in 2011 to integrate this new paradigm in the promotion of sexual and reproductive health programmes to include the fight against HIV and STIs. The programmes that have brought improved sexual health outcomes include varieties of actions implemented simultaneously. The promotion of sexual health recognises the need for complementarity of actions across a number of key areas including human resources quality in sufficient number, access for all to universal health coverage, the approach rights that seeks to integrate the norms, standards and principles of international agreements of human rights, access to education for all, taking into account in every activity of a programme of social and cultural determinents.
Discussions: To establish a sexual and reproductive health programme, a multi-sectoral approach is needed, including in the following five areas: legislation and human rights, education, society and culture, economy and the health systems. Sexual health should include in it transverse programmes promoting and protecting the rights to hope to improve health outcomes. In France, this was integrated approach to communication strategies and prevention since 2012 INPES, the Social Security Health Act 2015 to license and financed the merger of STI screening centre (CIDDIST) and HIV (CDAG) free centre of screening and diagnostic information (CeGIDD). The new law being voted in parliamentary bodies Health has incorporated this new approach in his articles.
Conclusion: The promotion of new sexual health strategies in connection with the fight against STIs, planning, the fight against sexual violence, reducing inequality requires a reorganisation of the health care offer, training of health professionals, a review of topics to address in sex education and the promotion of education from an early age.
Symposium 9: The sexual health of specific groups
S49 Sexual health of adolescents and young people in Europe
Christine Winkelmann
AIDS Prevention, Federal Centre for Health Education (BZgA), Köln, Germany
This overview of the state of sexual health of adolescents and young people in Europe is based on the analysis of various indicators, including age of first intercourse, contraceptive use and sexually transmitted infection (STI) prevalence among others. A case is made to introduce two activities – youth-friendly health services and holistic sexuality education – to protect and to improve the sexual health of young people. Adolescence is a period of vulnerability. The individual is faced with development tasks and challenged by biological and psychological processes. The risk perception of adolescents differs from that of adults, and at the same time, adolescents are more engaged in experimentation. At the same time, their access to reliable and unbiased information and education as much as to youth-friendly health services is often limited. Data from Health Behaviour of School-Aged Children Study show that an average of 25% of 15-year-olds in the European Region self-reports having had sexual intercourse. Data from the same study and several national studies show a rate of condom use over 70%. The rate of use of the contraceptive pill is much lower and varies between over 60% in Germany and under 10% in Spain. Data from Eurostat show that the number of pregnancies among women between 15 and 19 varies in Europe. And data from European Centre for Disease Prevention and Control (ECDC) illustrate that adolescents and young people are highly affected by chlamydia. The data on sexual violence are patchy, but it can be assumed that substantial numbers of children and adolescents suffer from different forms of sexual violence. Overall, the indicators to measure sexual health focus on risk; more positive indicators such as sexual satisfaction, self-esteem and self-actualisation are still not used widely. Two measures are crucial in improving the sexual health of adolescents and young people: the introduction of school-based holistic sexuality education and the access to youth-friendly health services. Good information and education linked to the acquisition of skills and the promotion of attitudes help to empower adolescents to protect their own health and that of their partner. At the same time, adolescents need good access to health services that are youth- and ‘sex’-friendly. These services need to offer medical care, counselling and education in an open and non-judgmental way that addresses the specific needs of adolescents. Adolescents are the adults of tomorrow. Investing in their sexual health is an important and necessary investment in the future.
S50 Lesbian sexual health in Europe: a review of the current evidence
Jake Bayley
Newham University Hospital, London, UK
Lesbians, or women who have sex with women, have disproportionately higher levels of morbidity from numerous health issues especially related to sexual health. Data show that women who identify as lesbian have higher rates of smoking, alcohol use, depression and eating disorders compared to their heterosexual counterparts. They are also much less likely to engage in national screening programmes (i.e. cervical or breast screening) as campaigns are generally designed with heterosexual women in mind. Many lesbians also cite discrimination from health care professionals when trying to access these services. There is relatively little data regarding this population, but data from the UK suggest that those presenting to services have higher rates of pathology, mainly bacterial vaginosis and thrush, as compared to their heterosexual counterparts. Safe-sex education should be tailored to include information on transmission of sexually transmitted infections (STIs) in relation to lesbian sexual practices and be aware that a proportion of women will also have sex with men, increasing the risk of STI acquisition. All women should be routinely screened in line with national or European guidelines, regardless of perceived or informed sexuality. Services should be mindful of the language used by clinics and clinicians so as not to assume heterosexuality in women attending. Equality of sexual health and well-being across all European countries should be a priority as levels of discrimination and health service delivery for this population vary dramatically throughout Europe. This includes education of patients and clinicians, plus robust and well-funded research to inform service needs and influence national policy to improve outcomes. This will help to address the sometimes significant stigma and discrimination that deters these patients from engaging with health systems.
S51 Older people in Britain with health issues: why are some sexually satisfied and others not?
B Erens1, KRK Mitchell1, LJ Gibson1 S Clifton2 and K Wellings1
1London School of Hygiene and Tropical Medicine, UK
2University College London, UK
Background: As people age, they are increasingly likely to experience health issues that affect their sex life, at a time of increasing social expectation of a fulfilling sex life continuing into older age. While some individuals continue to enjoy a satisfying sex life in the face of multiple and significant health issues, others stop having sex or are no longer satisfied.
Aim: This presentation will describe variation in sexual satisfaction of older people with health issues, identifying factors that modify the influence of poor health on sexual satisfaction.
Methods: National probability sample survey (third British National Survey of Sexual Attitudes and Lifestyles) of 15,162 men and women aged 16–74 years. We analysed data from 388 men and 279 women aged 55–74 years who said they had a health condition, disability or had taken medication that had limited their sexual activity or enjoyment in the last year. Follow-up qualitative interviews with 20 of these men and women explored their experiences in depth.
Results: Twenty-seven percent of men and 17% of women aged 55–74 years reported having a health condition (or taking medication) that affected their sex life; 42% of these men and women said they were satisfied with their sex life. Ill health played variously a causal role, an exacerbating role or a negligible role in shaping sexual satisfaction. The impact of ill health or medications could be direct (e.g. erectile difficulties) or indirect (e.g. relationship strain, fear of sex exacerbating ill health and fatigue). Relationship status was a key modifying factor, with partner communication, partner’s sexual desire and partner’s own health playing a role. Attitudes towards sex and ageing were also important modifying factors.
Conclusion: We found substantial variation in sexual activity and satisfaction among older people with health conditions. Much of the variation is explained by relationship status and quality, and expectations about sex.
S52 Transgender sexual health issues: HIV infection, sexually transmitted infections and dermatological manifestations
Fabrice Bouscarata, Jean David Pommierb, Florence Michardb, Bao Phungb, Elisabeth Bouvetb and Yazdan Yazdanpanahb
aService de Dermatologie et CIDDIST (Centre d’Information de Dépistage et de Diagnostic des Infections sexuellement transmises), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France
bService des Maladies Infectieuses et Tropicales, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France
Transgender persons (TG) identify with a sex that differs from that they were assigned at birth. TG have a high risk of HIV/sexually transmitted infection (STI). We focus on male-to-female TG (TGMF) by reporting data (1) on TG referred to HIV-STI diagnosis centre (1999–2002; 2013–2014), (2) on HIV+ TGMF in our HIV cohort and (3) Specific dermatological complications.
(1) TGMF in HIV-STI Centre
1999–2002: 156 TGMF out of 21,150 patients; 54% (n = 85) were tested HIV-seropositive. All were sex workers, 95% were South Americans, 111 (70%) received hormones, 80 silicon injection (54%), 54 (34%) had breast prosthesis, four had genitoplasty. Forty-three HIV+ (51%) TGMF had syphilis, and 25 required BPG (21 latent, four recent syphilis). Three had tuberculosis, five genital warts, three gonorrheae, three Chlamydia trachomatis, two anal herpes, one M contagiosum; 10 had silicon complications, two infections on breast prosthesis and two complications of genitoplasty.
2013–2014: Prospective study on TGMF (preliminary results on the first 24-month period): 103 TGMF, 90 (87%) were sex workers, 16 (15.5%) were HIV+, 34% had previous STI including 26 syphilis (25%). Extensive data and results will be shown.
(2) TGMF in HIV cohort (n = 4500), 140 HIV+ TGMF were studied. Mean age was 38.5 years. HIV infection was controlled by antiretroviral therapy (ART) in 92% of cases. Ninety-six percent were South American, had been or were sex workers (95% and 65%). Most suffer from alcohol dependence. Three had genitoplasty. Eighty-two percent had received silicon injections and developed complications (54%): pain, inflammation, infiltration, cellulitis and ulcerations in 66%, 56%, 27%, 18% and 16%. Sixty-five percent received hormones. Most patients had previous STI (81%): syphilis (51%), anogenital warts (23%), uretritis (7%), tuberculosis (27%), hepatitis B (HBV) (10%) and hepatitis C (HCV) infection (3%).
(3) Complications of silicon injections were frequent. Classification of these complications will be proposed, and original observations will be presented.
S53 Rape and sexual assault of men
TJ McManus1,2
1Bart’s Health, London, UK
2The Haven Sexual Assault Referral Centre, Whitechapel, London, UK
Rape and sexual assault of men are underreported crimes worldwide. There are many reasons for this underreporting. The act may not be recognised as a crime, sex between men may be a taboo subject and men who have been assaulted may presume that if they disclose they will experience a negative response. In 2003, in England and Wales, rape and sexual assault of men were recognised as crimes. The Ministry of Justice in England and Wales estimated that 12,000 males were raped or experienced sexual assault by penetration in 2014. The latest available police-recorded sexual offences report 1274 males reporting rape in 2011/2012. Men may disclose to partners, friends, family, health personnel, voluntary organisations or the police. They should always be believed by health personnel; the police will investigate the crime. In London, the police have a team of highly trained officers who specialise in investigating sexual violence and supporting survivors. The National Health Service and police, jointly, have set up sexual assault referral centres. These centres provide forensic examinations in calm surroundings and post-assault follow-up. Men often choose to report sexual violence to sexual health experts. A sexual history should always include questions about sexual violence. It is important that health services have a robust protocol for dealing efficiently and sympathetically with men who disclose. A simple algorithm will be presented and will include timely referral for forensic examination, when to offer HIV post-exposure prophylaxis and hepatitis B vaccination. A sexual health screen and counselling should be offered. There are myths which make disclosure by the survivor difficult. Some of these myths will be discussed. Women can be perpetrators of sexual assault on men.
Symposium 10: Human papilloma virus
S55 High-resolution anoscopy to screen for anal intraepithelial neoplasia in HIV-positive men
Henry JC de Vries1,2,3,4
1STI Outpatient Clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, the Netherlands
2Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
3Centre for Infectious Diseases and Immunology Amsterdam (CINIMA), Amsterdam, the Netherlands
4Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
Anal cancer is an increasing problem among patients with HIV, especially among HIV-positive men who have sex with men (MSM) with incidence rates 100 per 100,000 person-years. This is much higher than the incidence of cervical cancer in HIV-negative women before standard cytological screening was introduced. Therefore, routine screening for anal premalignant lesions is subject of discussion. As with cervical cancer, anal cancer is preceded by a precursor called anal intraepithelial neoplasia (AIN). High-resolution anoscopy (HRA) is increasingly advocated to screen HIV+ MSM for anal cancer and its precursor lesions, AIN. The standard for AIN detection is high-resolution anoscopy in combination with biopsies and histopathological analysis of suspect lesions. Since the early 90s, high-resolution anoscopy is practiced at the University of California, San Francisco. Currently, the lack of experienced anoscopists is a major obstacle for the expansion of AIN screening programmes. Training programmes should be implemented to facilitate future AIN screening. However, high-resolution anoscopy is a complicated procedure, and no guidelines exist to identify lesions suspect for AIN. The quality of high-resolution anoscopy depends on the experience of the anoscopist in recognising abnormal mucosa and adequately targeting biopsies. Therefore, high-resolution anoscopists need extensive training and have a long learning curve. More information on the challenges and pitfalls in HRA are needed for the development of screening algorithms and guidelines. In this presentation, a study will be presentend in which we analysed interobserver agreement in classifying features of intra-anal lesions suspect for AIN and to compare these features with their histopathological outcome. Moreover, we have quantified the learning curve to master the art of high-resolution anoscopy.
Closing ceremony:
S58 Negative attitudes towards male homosexuality and their effects on health and well-being
Kai J Jonas
University of Amsterdam, Amsterdam, the Netherlands
Although attitudes towards male homosexuality have greatly improved in many countries, many gay men and individuals living with HIV still experience discrimination and stigma frequently, or even on a daily basis. In the first part of the talk, I am going to review the most prominent effect negative attitude effects on health and well-being. Secondly, I am going to discuss stigma effects on pre-exposure prophylaxis (PrEP) use. Finally in this section, I am going to cover potential buffers on a socio-structural and motivational level. While gay discrimination as a phenomenon is widely documented, there is little research on the underlying mechanisms. Thus, in the second part of the talk, I am going to introduce potential psychological processes underlying anti-gay attitudes. Finally, I am going to argue that given medical advances in sexually transmitted infection (STI) and HIV research, the relevance of psychological factors increases to ensure the success of the medical approaches.
Oral Session Abstracts
O-01 Project to extend testing and improve care of sexually transmitted infection diseases (chlamydia and gonorrhea) at the emergency clinic
Veronica Widen Karlsson
Södersjukhuset AB, Sweden
Background: The emergency clinic has a large proportion of visitors below 30 years of age. This age group has shown to have multiple partners and multiple unprotected sexual intercourses. Statistics show that chlamydia and gonorrhea has the highest incidence in the age group 15 till 30 years of age.
Objectives: To improve the care of patients with suspected sexually transmitted infection (STI) at the emergency department and increasing the testing of the STI risk group ‘younger adults’.
Method: The emergency department offer STI testing to all the younger visitors with genital symptoms (group 1), those who are attending the clinic for other diseases (group 2) and those younger visitors who are accompanying other patients (group 3). All the journal notes concerning the STI testing, including the test results, are placed in a separate protected data base journal unit within the emergency department. Department of venereology organises training and information for the staff in order for the care chain to operate well, and they also follow-up test results, contact the patients for treatment, follow-up care and contact tracing.
Results and Conclusion: A total of 534 patients have been tested with an incidence of 6.1% positive tests for chlamydia and 0.74% for gonorrhea. Most positive samples come from group 1, but almost 25% come from group 2 or 3. The STI testing has risen from 2012 to 2014 with 52%. Offering STI tests to young adults at the emergency department is one way to reach this population. They test earlier than they otherwise would and thereby reduce the spread of the infections. The patients have been pleased with the way the care chain has worked and the emergency doctors are more keen to offer tests when they know they do not have to take responsibility for the positive results and the comprehensive contract tracing.
O-02 Natural course of Chlamydia trachomatis bacterial load in the time interval between screening and treatment in anogenital samples
Jeanne Dirks1, Genevieve van Liere2, Susanne Bogers1, Nicole Dukers-Muijrers2, Petra Wolffs1 and Christian Hoebe2
1MUMC+, Netherlands
2Public Health Service South Limburg, Netherlands
Background and Aim: Although Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide, little is known about its natural course, which can result in infertility or resolve spontaneously. We studied the natural course of the CT-load in the time interval between screening and returning for treatment.
Methods: A total of 285 CT-positives were included from a Dutch STI clinic with 40 anal-, 79 urine- and 191 vaginal infections. Patients were excluded if they used antibiotics in the month before or during the study period. Patients were 16–63 years, sampling interval was 3–28 days and it was 3–565 days since their last unsafe sexual contact (n = 45). Quantitative CT-PCR (ompA gene) was performed on two samples per location per patient; one diagnostic sample and one sample at treatment. CT-load differences within 1 log were considered stable load over time due to test-technical variability. Chi square test compared load category distribution between sample types (analyses presented per sample type).
Results: Majority of samples have a stable CT-load between screening and treatment (67.5%, 73.4% and 50.0% for vaginal-, urine and anal swabs; p = 0.6). CT-load increase was observed only in ± 11% (p = 0.6). No association between CT-load and sampling interval is observed. Time since last unsafe sexual contact is not associated with the CT-load course, as large variations are observed in CT-load at screening and over time. Furthermore, only stable CT-loads are seen in the first two weeks after the last unsafe sexual exposure.
Discussion:
1) Most patients visit the STI clinic when the CT infection is established or in its declining phase.
2) The number of days between screening and treatment did not correlate to CT-load change.
3) Within days of their last unsafe sexual contact, CT-load was sufficiently high to be detected with highly sensitive PCR. Perhaps waiting two weeks after unsafe sex before a CT test is unnecessary.
O-03 The ever-changing Chlamydia trachomatis and Neisseria gonorrhoeae test evaluation algorithms: the more things change, the more they remain the same
Alula Hadgu
CDC, Atlanta, GA, USA
The evaluation of new diagnostic tests in the absence of a gold-standard is a difficult and complex task. For many decades, the evaluation of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) tests was based on culture. However, for the last 20 years or so, this evaluation was based on three ad hoc algorithms. These include: (1) patient-infected-status algorithm (PISA), which is the currently FDA recommended method, (2) composite reference standards and (3) discrepant analysis. In this presentation, we demonstrate that all these overly simplistic approaches of estimating test sensitivity and specificity are biased, arbitrary and are not necessarily better than using a single imperfect test. In this work, we calculated the PISA-based estimates of two non-nucleic acid amplification tests (non-NAATs) from a study conducted in the north-western part of the U.S. and compared these estimates with the package insert PISA-based estimates of two NAATs for detecting CT. The PISA-based sensitivities of the culture, GenProbe, Aptima-Combo and the BD-ET tests were 98.6 (95% CI: 94.6–99.8), 88.7 (95% CI: 82.5–93.0), 94.2 (95% CI: 90.1–92.0) and 92.8 (95% CI: 86.8–96.7), respectively. Similarly, the PISA-based specificity estimates of these four tests were 99.0 (95% CI: 98.7–99.3), 99.5 (95% CI: 99.2–99.7), 97.6 (95% CI: 96.6–98.4) and 98.1 (95% CI: 97.3–98.8), respectively. These results demonstrate that culture has the ‘highest’ sensitivity, and the GenProbe test has the ‘highest’ specificity, indicating the currently recommended CT evaluation algorithm can result in biased and highly unusual inference. We will further demonstrate that even a coin test in the presence of conditional dependence can have a PISA-based sensitivity and specificity estimates of 69% and 72%, demonstrating, PISA, like discrepant analysis is a biased and misleading procedure.
O-04 Does lymphogranuloma venereum transmission in urogenital specimens of Chlamydia trachomatis-infected population in France in 2013 exist?
Arabella Touati1, Chantal Vernay-Vaisse2, Michel Janier3, Valentia Mage3, Isabelle le Hen2, Cécile Charlois2, Véronique Badier2, Philippe Dhotte2 and Bertille de Barbeyrac1
1National Reference Center for Chlamydia, France
2STI Center, France
3Hôpital Saint Louis, France
Background: In recent years, a very few cases of lymphogranuloma venereum (LGV) in heterosexuals in Europe have been reported. However, there is a lack of data concerning the epidemiology of LGV in this population in France.
Aims: To determine if there was evidence of LGV transmission in non-rectal specimens of Chlamydia trachomatis (CT)-infected population in France in 2013.
Methods: A total of 1803 CT-positive specimens (1767 urogenital and 37 throat swabs) were retrospectively analysed using LGV-specific real-time PCR. No rectal samples were included. The specimens were collected in 2013 at six sexually transmitted infections (STIs) screening centres in Paris, Marseille and Bordeaux, France. Demographic data, STI history, sexual behaviour in the last six months were recorded.
Results: We typed 1803 CT-positive specimens from 739 men and 1064 women. The mean age of these patients was 26 years for women and 30.7 years for men. Out of 1412 patients with documented sexual orientation, 98 were men who have sex with men (MSM), 22 were women who have sex with women and 1292 were heterosexuals. This was a high-risk population as shown by the following characteristics: 6% were co-infected with Neisseria gonorrhoeae, 11% had history of STI, 69.5% reported having had three or more casual partners in the last six months and 27.9% declared having had unsafe sex (defined as not always using a condom). We did not find any single case of LGV infection in women in particular and in heterosexuals in general. Interestingly, four samples from MSM were typed positive for LGV strain L2b (two urines, one throat and one genital ulceration).
Conclusions: Our study showed no evidence for spread of LGV infections in women, and heterosexuals in France in 2013. L2b strains seem to be restricted to the MSM population.
O-06 Detection of Mycoplasma genitalium and Chlamydia trachomatis in three different self-collected genital specimens in women
Bjartling Carina, Johnsson Annika and Persson Kenneth
Skane University, Sweden
Background: The optimal specimen for detection of Mycoplasma genitalium in women is not yet determined. Most studies have investigated clinician-collected vaginal swabs and found them to be more sensitive than cervical specimen or first-void urine (FVU) in M. genitalium detection. An increase in sensitivity for detection of both M. genitalium and Chlamydia trachomatis when adding FVU to clinician-collected cervical swab has also been reported. Only one study has reported on self-collected vaginal swabs showing them to be more sensitive than clinician-collected vaginal swabs.
Aim: To compare the performance of three different self-collected genital specimens for detection of M. genitalium and C. trachomatis.
Methods: Women visiting a sexual health clinic in Malmö, Sweden were invited. While screened for C. trachomatis, they provided three different genital specimens which were also tested for M. genitalium. Self-collected vaginal swab, self-collected vaginal swab in FVU and FVU only was compared, and the relative sensitivity was calculated.
Results: The prevalence of M. genitalium and C. trachomatis was 8.4% and 4.2%, respectively, among 2101 included women. In M. genitalium, the relative sensitivity for self-collected vaginal swab (84.7%) and self-collected vaginal swab in FVU (84.7%) was at the same level and significantly higher than in FVU (66.1%, p < 0.0001). In C. trachomatis, self-collected vaginal swab in FVU had a relative sensitivity of 96.6%, vaginal swab 95.5% and FVU 93.2% with no statistically significant difference between any of the specimens.
Conclusion: Self-collected vaginal swab and self-collected vaginal swab in FVU had the highest relative sensitivity in M. genitalium detection. Adding FVU to the vaginal swab specimen did not increase the sensitivity for M. genitalium.This result suggests a self-collected vaginal swab to be a proper and feasible choice for detection of M. genitalium in this population.
O-07 Prevalence of Mycoplasma genitalium in men with urethritis in a large hospital in Brussels, Belgium
Agnes Libois1, Marie Hallin1, Tania Crucitti2, Marc Delforge1 and Stéphane de Wit1
1CHU Saint-Pierre, Belgium
2Institute for Tropical Medecine, Belgium
Background:Mycoplasma genitalium (MG) is increasingly recognised as a genital pathogen and as a cause of urethritis. While resistance to azithromycin is known to increase, no FDA-approved test is yet available, and routine detection is currently not performed for MG in Belgium, where the prevalence of this pathogen is unknown.
Methods: An ‘in-house’ amplification assay detecting MG was performed on urine of men with complaints of urethritis presenting at the emergency unit or at the sexually transmitted disease clinic of our teaching hospital in Brussels. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were tested on the same samples using the Abbott RealTime CT/NG assay.
Results: A total of 194 men with urethritis were tested. Eighty-one percent were Caucasians. Median age was 30 years (IQR 26–38 years). Sixty-five percent were heterosexual, and 35% were men who have sex with men; 6.7% were HIV-infected. Prevalence of M. genitalium in men with urethritis was 8.8%. CT was detected in 19.7% men and NG in 23.3%. Twelve men had a coinfection: nine CT + NG, two MG + CT and one MG + CT + NG. In 55.7% of samples, no pathogen was found. All patients positive for at least one of the three pathogens tested had a urine leucocytes count ≥10 cells/µl, except two CT urethritis. Conversely, 95% of urine samples presenting a leucocytes count <10 cells/µl were negative for all the pathogens tested. Age, origin, sexual orientation or infection with another pathogen was not significantly associated with MG urethritis.
Conclusion:M. genitalium was identified in 8.8% of men with urethritis indicating that amplification assay detecting MG should be implemented in routine testing for those patients.
O-08 Prevalence of Mycoplasma genitalium antibiotic resistance markers in men enrolled in a multi-center clinical study
Damon Getman1, Alice Jiang1, Meghan O’donnell1 and Seth Cohen2
1Hologic, Bedford, MA, USA
2Occidental College, Los Angeles, CA, USA
Background/Objective: This study evaluated the prevalence of Mycoplasma genitalium (Mgen) 23s rRNA, gyrA and parC mutations associated with macrolide and fluoroquinolone resistance, among male urogenital specimens collected from symptomatic and asymptomatic subjects enrolled in a prospective multi-site US clinical study.
Methods: Aliquots from residual specimens obtained from symptomatic (urethritis) and asymptomatic men at ages 18–52 years, enrolled from seven diverse US clinical sites, including obstetrics and gynecology, family planning, public health and sexually transmitted disease clinics, were tested using a research-use-only transcription mediated amplification (TMA) assay for Mgen (Hologic, Inc.). First-catch urine or urethral swab specimens positive for Mgen by TMA were evaluated by reverse transcription-PCR and Sanger sequencing of Mgen 23s ribosomal RNA, or mRNA from parC and gyrA genes to identify the presence of macrolide and fluoroquinolone antibiotic resistance-associated mutations (MT-23s, MT-gyrA, MT-parC, respectively).
Results: Of 50 Mgen TMA-positive subjects, 21 (42%) harbored MT-23s mutations at position 2058 (A2058G, A2058C, A2058T) or position 2059 (A2059G). Of these 21, nine subjects (42.9%) were symptomatic. MT-23s mutations were more prevalent in subjects co-infected with Chlamydia (3/8, 37.5%) compared to subjects infected with Mgen alone (3/22, 13.6%). Of 15 subjects with gryA sequencing results, three (20%) had MT-gyrA, while nine of 25 (36%) had MT-parC. Finally, of nine subjects with 23s, gyrA and parC sequencing results, two (22.2%) had MT-23s and either MT-gyrA or MT-parC.
Conclusions: Mgen strains containing macrolide and fluoroquinolone resistance markers were highly prevalent in the urogenital tracts of this cohort of male US subjects. Identification of patients infected with Mgen strains resistant to both antibiotic classes raises concern for the advent of multi-drug-resistant M. genitalium.
O-09 Rate of azithromycin resistance in Mycoplasma genitalium in Barcelona (Spain)
Estrella Caballero1, Jørgen S Jensen2, Maria-Jesús Barberá3, Martí Vall-Mayans3, Maider Arando3 and Antonia Andreu1
2Microbiology and Infection Control, Statens Serum Institut, Denmark
3STI Unit Drassanes, Hospital Universitari Vall d’Hebron, Spain
Background:Mycoplasma genitalium (MG) is a cause of urethritis in men, and there is strong evidence that it is an important cause of cervicitis and pelvic inflammatory disease (PID) in women. By mutation, MG can develop resistance to azithromycin. High levels of macrolide resistance have been reported in some countries from Northern Europe.
Objective: To assess the rate of macrolide resistance in MG detected in Barcelona over one-year period.
Methods: A retrospective study was performed among 98 samples with a positive PCR test for MG (ANYPLEX II STI-7 V1-1, Seegene) between February 2013 and March 2014. Identification of macrolide resistance mutations, in domain V of the 23s rRNA gene, was studied by PyroMark sequencing.
Results: From the 98 MG-positives samples, 84 (86%) were amplified in the resistance mutation assay. Of them, 68 (81%) were from 57 men (52 in urethra/first-catch urine and five in rectum) and 16 (19%) from 16 women (eight in cervix and eight in vagina). Among the 73 patients with evaluable samples, 26 (36%) carried MG with macrolide resistance. In 15 cases, the A2059G mutation was identified and in 11, the A2058G mutation. Both mutations confer high-level azithromycin resistance. Macrolide-resistant MG was found in samples from 24 (42%) men (20 [38%] urethra/first-catch urine and four [80%] rectum) and in two (12.5%) from women.
Conclusions: This study shows that 36% of the patients had MG resistant to azithromycin, similar to North European countries. Men with rectal MG were highly likely to carry macrolide-resistant strains. The findings could have implications for the use of single dose of 1 g azithromycin as first-line treatment for non-gonococcal urethritis (NGU).
O-10 Reporting of non-consensual sex and domestic violence in a sexual health clinic – can we break the silence?
Rita Browne, Dina Rayamajhi, Emma Fletcher and Leanna Powell
Whittington Health, UK
Background: Increasing reports of sexual violence emphasises the need for clear pathways for management in our clinics.
Aim: To evaluate the frequency of reporting of previous non-consensual sex (NCS) or domestic violence (DV) in patients attending our clinic and subsequent management.
Methods: All patients were asked about previous NCS and DV during their consultation, and all who reported this between March 2013 and September 2014 were identified. Epidemiological and clinical data were collected from electronic patient records, inputted into an excel spreadsheet and analysed using an SPSS package.
Results: A total of 11,582 patients were seen for a new consultation of whom 316 (2.7%) reported NCS or DV; 245 (78%) were female. Ethnicity was varied; the majority heterosexual (93%) but 28% (20/71) of the males were men who have sex with men (MSM). The mean age was 30 years (range 17–65). Sixty-two percent (197) attended because of symptoms and 54% (171) had had a sexually transmitted infection (STI) in the past. Sixty-four percent (202) reported DV; 48% by known perpetrators (ex- or current partner) and in 12% it occurred <3 years prior. Fifty-five percent (174) reported NCS and by a known assailant in 51%; 18% <3 years prior. Nineteen percent reported both NCS and DV. Seventy-one (22%) had previously reported to the police or health care services. Fifty-nine percent reported no ongoing concern related to the previous violence, but 14% (43) had some support in clinic from staff trained in counselling. In 82, outcome was not documented. Nine patients were having external counselling. Ninety-eight percent had an STI screen, and 15% had an STI.
Discussion: A significant number of patients reported previous violence, and 14% had brief counselling support in clinic after disclosure. Only a minority had accessed help elsewhere. We feel we need to have a clear pathway for management of these patients and be more proactive about referring for counselling support when indicated.
O-11 Increasing rates and new genotypes of lymphogranuloma venereum among men having sex with men in Sweden
Jenny Isaksson1, Ola Carlsson1, Åsa Airell2, Susanne Strömdahl3, Göran Bratt4 and Björn Herrmann1
1Uppsala University Hospital, Sweden
2Karolinska University Hospital, Sweden
3Karolinska Institutet, Sweden
4South General Hospital, Sweden
Background: Lymphogranuloma venereum (LGV) has in the last decade been reported from several European countries among men having sex with men (MSM) but has previously only been found as sporadic cases in Sweden.
Aims: To investigate whether LGV is underdiagnosed among MSM in a Swedish high-risk population and to genotype all detected chlamydia cases during six months.
Methods: Samples from rectum, urine and throat were collected from MSM during six months at Venhälsan clinic and analysed by ProbeTec ET Chlamydia trachomatis (CT) DNA assay (BectonDickinson). C. trachomatis-positive samples were analysed for LGV by pmpH real-time PCR and subsequently genotyped by ompA and multilocus sequence typing (MLST). Obtained sequence types (STs) were compared to STs in the database http://mlstdb.bmc.uu.se.
Results and Discussion: In 2566 patients (7473 samples), 212 (8%) CT cases (250 positive samples) were detected. Fifteen (7%) CT-positive patients had LGV. The genovar distribution for ompA was G (26%), J (22%), D (22%), E (15%), L2 (9%) and L2b (3%). In 2006, L2b was the only LGV variant found in Sweden, while this study shows that different LGV strains now are widely spread in the MSM community. Four out of 15 LGV cases were not clinically or epidemiologically expected and would have been undetected without the present study. After sequencing, full MLST profile was achieved for 117 samples (47%) (rectum 66, throat 12, urine 40). MLST analysis resulted in 18 STs (based on five targets) or 20 STs when including ompA. The four most common STs (ST109 16%, ST52 15%, ST108 12%, ST58 12% = LGV) comprised 55% of all CT-cases and are strongly associated to MSM (97%–100% from MSM in previous studies). ST308 comprised 10% and has not been detected in Sweden previously.
Conclusion: LGV has increased in Sweden during the last decade among high risk-taking MSM. Intensified routine screening has been rewarding. Certain MLST STs are highly linked to MSM and predominate.
O-12 Examining the clinical utility of multiplex PCR testing for genital ulcer disease in two London sexual health services
Laurence Dufaur, Bonnie Darroch, Michael Rayment and Craig Tipple
Imperial College Healthcare NHS Trust, UK
Background: Multiplex PCR (mPCR) for Treponema pallidum (TP), herpes simplex (HSV) and Haemophilus ducreyi (HD) can help diagnose genital ulcer disease (GUD).
Aim: To evaluate the utility of reference laboratory mPCR testing in two London sexual health clinics.
Method: Retrospective review of GUD cases where mPCR requested (January 2010 – January 2014). Patient notes and local (HSV PCR, TP serology, dark ground microscopy [DGM]) and reference (mPCR) laboratory results were reviewed.
Results: Totally, 671 mPCR samples were collected from 636 patients. Overall, patients were 87.3% male (71.4% men who have sex with men [MSM] of which 50.3% HIV-1 infected) with a median age of 35 years. Clinical diagnoses were (n = 350): primary syphilis 29%; secondary syphilis 2%; genital herpes 56%; other 13%. For 285/671 (42.3%) samples, HSV or TP was positive. No samples were HD positive. Two hundred samples were HSV positive and were compared with in-house testing (where done):
mPCR
+ve (%)
−ve (%)
Total (%)
In-house
+ve (%)
134 (32.8)
11 (2.7)
145 (35.5)
−ve (%)
20 (4.9)
244 (59.7)
254 (64.5)
Total (%)
154 (37.7)
255 (62.3)
409 (100)
mPCR: multiplex PCR.
Of 88/636 (13.4%) patients with TP-positive ulcers, 83.0% had positive syphilis serology and 63.6% positive rapid plasma reagin (RPR). Compared with mPCR (n = 70), sensitivity and specificity of DGM was 53.1% (95% CI: 40.2–65.7) and 83.3% (95% CI: 36.1–97.2). For 77/109 (70.6%) patients, a syphilis diagnosis was made without or prior to mPCR result; for 22/109 (20.2%) mPCR confirmed diagnosis, but patients were treated presumptively. Ten of 109 (9.2%) patients were treated on basis of mPCR result alone. Mean days from mPCR sampling to report were 12.48 (SD 8.56). This reduced over time (14.7 days in 2010 and 7.4 in 2013). Overall cost of mPCR: £57,035.
Discussion: mPCR can diagnose both syphilitic and herpetic genital ulcers. HSV was the commonest cause of GUD and no HD was identified. mPCR has comparable sensitivity to in-house HSV PCR and greater sensitivity than DGM for TP identification but slow turnaround time (sampling to NHS lab report) may limit utility.
O-13 Timing of test of cure for anogenital Neisseria gonorrhoeae infections – a prospective cohort study using nucleic acid amplification tests
Carolien Wind1,2, Maarten Schim van der Loeff1,3, Magnus Unemo4, Rob Schuurman5, Alje van Dam6 and Henry de Vries1,2
1Public Health Service Amsterdam, Netherlands
2Academic Medical Center Amsterdam, Netherlands
3Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, Netherlands
4WHO Collaborating Centre for Gonorrhoea & Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Sweden
5University Medical Center Utrecht, Netherlands
6Onze Lieve Vrouwe Gasthuis General Hospital, Public Health Service Amsterdam, Netherlands
Introduction: The use of nucleic acid amplification tests (NAATs) to diagnose Neisseria gonorrhoeae (Ng) infections has rapidly replaced culture. This complicates performance of test of cure (TOC) to monitor treatment failure. As evidence for the timing of TOC using modern Ng NAATs is highly limited, we assessed the time to Ng-clearance when using modern NAATs.
Methods: We included patients attending the sexually transmitted infection (STI) clinic Amsterdam from March to October 2014 with anogenital Ng. We collected swabs or urine for RNA-based NAAT (Aptima Combo 2 assay [AC2], Hologic) and DNA-based NAAT (Cobas 4800 NG/CT assay [C4800], Roche). Treatment for Ng was ceftriaxone 500 mg. Upon treatment, patients self-collected daily samples for both NAATs for 28 days and recorded sexual contact in a diary. After 28 days, patients returned to the clinic with their samples, and we collected final samples for culture and NAAT. Clearance was defined as two consecutive negative results. Reinfection was defined as >2 positive results after clearance, with at least one result positive in both DNA and RNA-based NAAT. A blip was defined as a positive RNA or DNA result after clearance without reinfection.
Results: We included 77 patients of whom 62 completed the study. The median number of self-collected samples was 27. Anatomical locations were distributed evenly (urethra: 20, vagina: 21, rectum: 21). Twenty-three (37%) patients had a Chlamydia trachomatis co-infection. All patients cleared Ng during the study, and median time to clearance was two days (range: 1–9) for both NAATs. Ninety-five percnt of patients cleared before day 6 (AC2) and day 7 (C4800). Reinfection was observed in one patient. Blips occured in six (AC2) and 15 (C4800) patients, respectively.
Conclusion: With modern RNA- or DNA-based NAATs, a TOC of anogenital gonorrhea can be performed after seven to nine days. However, intermittent positive test results after clearance occurred in 10%–25% of patients.
O-14 Genetic characterisation of Neisseria gonorrhoeae strains with decreased susceptibility to cephalosporins
Judit Serra-Pladevall1, Sara Rodriguez2, Pere Armengol1, Maria Jesús Barbera1 and Antonia Andreu1
Background: The global spread of gonococcal strains with decreased susceptibility (DS) or resistance to extended-spectrum cephalosporins (ESCs) is a major public health problem, since gonorrhea may become an untreatable infection. Molecular characterisation is useful to prevent emergence and dissemination of antimicrobial resistance.
Aims: To study resistance determinants and molecular epidemiology of all strains of Neisseria gonorrhoeae (GC) with DS to ESCs isolated in our laboratory from January to December 2013.
Methods: Antimicrobial susceptibility was determined using E-test in GC II (Becton Dickison). From extracted DNA of the strains with DS to ESCs, four resistance determinants (penA, mtrR, penB and ponA) were amplified using conventional PCR and sequenced. Molecular epidemiological characterisation was performed using NG-MAST.
Results: Among the 339 GC isolated in 2013, 48 (14.2%) showed DS (minimum inhibitory concentration, MIC ≥ 0.125 µg/ml) to cefixime and/or ceftriaxone. Of them, 27 possessed the mosaic XXXIV penA allele and 13 the non-mosaic XXXVI penA allele with point mutation (A501T and/or S551L). All isolates except one contained mutations G101K and A102N/D in the penB gene, and 41 possessed a single-base-pair deletion in the 13-bp inverted repeat of the promoter region of mtrR. All isolates except one contained the mutation L421P in ponA gene. Nineteen NG of the 27 (70.4%) with mosaic XXXIV belong to genogroup 1407 and 10 of 13 (77%) with non-mosaic XXXVI to genogroup 2400.
Conclusions:
1. Three mutation patterns in penA were observed, being the most prevalent the mosaic XXXIV allele (56%), which has been associated to genogroup 1407 worldwide.
2. The second most prevalent was the non-mosaic XXXVI allele (23%) with two additional mutations, A501T and S551L.
3. The most prevalent genogroup was G1407 (41.7%) followed by G2400 (25%).
O-15 A legal perspective on HIV and sexually transmitted infection criminalisation: a tool to promote public health?
Ingrid Geray1 and Marie Chollier2
1UNESCO Chaire, France
2Manchester Metropolitan University, France
Recently, there has been an increased use of the law in relation to HIV, and new laws are also being introduced as part of national responses to HIV. In many countries, transmitting or exposing another person to HIV can be prosecuted under criminal law. This increase in legal appeal is at some point surprising as new treatments against HIV became effective, resulting in an undetectable viral load and a very low risk of transmission. HIV infection can be linked to a sexually transmitted chronic infection as well as infection with hepatitis B, herpes or human papillomavirus (HPV). Criminalising the transmission of a chronic condition is therefore questioning (1) individuals’ rights and responsibility and (2) public health policies and their efficiency. Exposure laws are primarily concerned with consent, while transmission laws are concerned with both consent and proof of transmission. This legal review exposes the different charges and number of convictions under which HIV and sexually transmitted infections (STIs’) transmission or exposure is brought:
(1) Either under specific (Germany) or under more generic criminal offences such as murder, manslaughter, attempted murder, assault, grievous bodily harm (GBH) or poisoning (UK, France).
(2) Either under Public Health Law (i.e. Australia, mandatory disclosure) or Criminal Law (often distinguishing intentional from ‘reckless’ – or even negligent – transmission of HIV).
Can the criminalisation promote public health outcomes and improve HIV prevention efforts?
Does criminalisation decrease stigma, or legalise it?
O-16 PCR-directed optimisation of the application and outcome of Neisseria gonorrhoeae culture
Petra Wolffs1, Nicole Dukers-Muijrers2, Lisette Houben1, Tanja Geelen1, Christian Hoebe1,2 and Inge van Loo1
1Maastricht University Medical Center, Netherlands
2Public Health Service South Limburg, Netherlands
Background: Culture of Neisseria gonorrhoeae (NG) is the gold standard for monitoring antimicrobial susceptibility of NG. Due to rising antimicrobial resistance, surveillance is prioritised by the WHO. The main challenge in assessing resistance is that NG culture is difficult, and the current high percentage of failed cultures results in high costs and a limited willingness to submit samples for culture.
Objective: To investigate factors influencing the positivity of NG culture and to evaluate whether quantitative PCR (qPCR) data could be effectively used to guide the application of culture.
Methods: Routine PCRs were performed on COBAS 4800 (Roche Diagnostics), and cultures were performed when requested. Routine diagnostic data obtained at MUMC between January 2012 and December 2014 were analysed using multivariate logistic regression analyses to assess the association between culture positivity and determinants. These included sample type, the PCR Ct value, time between PCR and culture sample, and basic patient characteristics, such as age and sex.
Results: We analysed 765 NG PCR-positive samples. Of these samples, in 333 cases, culture was performed of which 113 samples were culture positive (34%). Multivariate analysis showed that the PCR Ct value was the only variable independently significantly associated with culture positivity. Using a cut-off value of Ct 30, 34% of samples would be eligible for culture resulting in a positive culture in 62% of samples.
Conclusion: This study shows that when routinely obtained qPCR data are used to guide the application of NG culture, culture effectivity can be maximised.
O-17 Can Neisseria gonorrhoeae acquire, maintain and express an extended-spectrum β-lactamase gene?
Michelle Cole, Cathy Ison and Neil Woodford
PHE, UK
Background: Ceftriaxone is the last option for empiric monotherapy for the treatment of gonorrhoea. In recent years, chromosomally mediated resistance to ceftriaxone has emerged in Neisseria gonorrhoeae. Therefore, increasing doses of ceftriaxone, administered with azithromycin, are now recommended for effective treatment. Fortunately, extended-spectrum β-lactamases (ESBLs), which would render the last treatment option for monotherapy (ceftriaxone) unusable, have not been detected in N. gonorrhoeae.
Objectives: Can an ESBL gene be transferred into, maintained and expressed by N. gonorrhoeae?
Methods: Electroporation was used to transfer pEK204 (harbouring blaCTX-M-3 and blaTEM-1, 95 kp) extracted from a uropathogenic E. coli strain (ST-131) into various gonococcal strains. The blaCTX-M-3 gene from pEK204 was amplified with and without the open-reading frame and also with and without the gonococcal DNA uptake sequence incorporated into the PCR products. Electroporation and natural transformation was used to transform gonococci with the blaCTX-M-3 gene variants. All experiments were performed in triplicate with varying levels of cefotaxime selection.
Results: None of the electroporation and natural transformation experiments resulted in any transformants. All the controls, DH5-α E. coli as a recipient for pEK204 and the gonococcal penA for the blaCTX-M-3 experiments worked successfully.
Discussion: Previous electroporation of native gonococcal plasmids into N. gonorrhoeae was successful so electroporation was not a limiting factor. pEK204 is probably too large to be acquired by N. gonorrhoeae. Future work using TEM-ESBLs are required to establish if the unsuccessful blaCTX-M-3 transformations were due to a lack of recombination site. It is encouraging that N. gonorrhoeae was not able acquire and express this ESBL. Vigilance to detect the acquisition or emergence of an ESBL in N. gonorrhoeae is however essential.
O-18 E-learning course in sexually transmitted infections; utilising the potential of the electronic age
Usha Hartgill1, Morten Skoglund2 and Harald Moi1
1University of Oslo, Oslo University Hospital, Norway
2University of Oslo, Norway
Background: The electronic age has stimulated the evolution and development of novel forms of education including distance learning which allow educational resources to be accessed and utilised without limitations on localisation and at the convenience of the user.
Objectives: The University of Oslo has an active media department and as part of its ongoing work in the field, commissioned the development of an e-learning course on sexually transmitted infections (STI) which not only can be accessed by students at the university but will also be freely available on the Internet.
Methods and Results: This presentation describes the development of the course which includes an introduction with basic epidemiology of the commonest STI, how to take a sexual history including important considerations, the male and female genital examination and preparation of samples for microscopy. It also shows microscopy and interpretation of slides with emphasis on the importance of point-of-care testing and office diagnostics for STI. The course has interactive modules allowing concurrent feedback including a novel and innovative microscopy component.
Conclusion: Peer reviewed, web-based educational resources which are free at point of access can be a useful adjunct to traditional teaching allowing clinical education at an accepted standard both internationally and across disciplines and are becoming more and more widely used.
O-19 The effects of intra-anal imiquimod treatment on the virological, dysplastic and immune environment in HIV-infected men with high-grade squamous intraepithelial lesions
Ross Cranston1, Jonathan Baker2, Alexiy Nikiforov1, Laura Janocko1, Nabanita Biswas1 and Ian Mcgowan1
1University of Pittsburgh, Pittsburgh, PA, USA
2University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Background: Imiquimod, a Toll-like receptor 7 agonist, has been used to treat internal anal high-grade squamous intraepithelial lesions (HSIL). However, the virological and immunological consequences of imiquimod therapy have not been defined in HIV-infected individuals where there are theoretical concerns that use might be associated with increased HIV replication in anorectal tissues.
Aims: To evaluate the effect of standard dose imiquimod treatment for nine weeks on anal HSIL, human papillomavirus (HPV) detection, the anorectal immune environment and HIV detection in both anal and rectal tissue.
Methods: Ten HIV-infected PPTs with biopsy-proven internal anal HSIL were recruited. Samples were taken before (visit 1) and after (visit 2) treatment for anal HPV typing and histology, anal/rectal tissue cytokine expression and HIV quantification. The study was approved by the University of Pittsburgh Institutional Review Board.
Results: Nine evaluable PPTs (one PPT discontinued use due to a hemorrhoid flare) were all male, white, with average age of 39.2 (range 28–53) years and average CD4 T cell count of 480 (range 54–1182) cells/mm3; all were taking combined antiretroviral therapy and seven of nine had HIV RNA < 50 copies/ml. Rectal gonorrhea and chlamydia was excluded. Average doses of imiquimod used was 26 of 36 prescribed, and there was an average of 9.9 days from last dose to visit 2. Between visit 1 and 2, nine of 16 (56%) lesions improved from HSIL to low-grade SIL. There was no progression to cancer, and no change in number of HPV types or quantifiable cytokines detected, nor in anal or rectal tissue HIV RNA/DNA.
Conclusions: Standard dose intra-anal imiquimod showed efficacy for treatment of intra-anal HSIL. There was no evidence of immune activation in the tissue samples, and imiquimod therapy did not increase anorectal tissue HIV replication. These data provide support for further evaluation of imiquimod in the treatment of HPV-associated anal dysplasia.
O-20 Validation of the Denver HIV risk score for targeting HIV screening in Vancouver, British Columbia
Titilola Falasinnu1, Mark Gilbert2, Paul Gustafson1 and Jean Shoveller1
1University of British Columbia, Canada
2Ontario HIV Treatment Network, Canada
Background/Introduction: The Denver HIV risk score (DHRS) is a prediction rule developed for targeting HIV testing and validated in U.S. clinical settings (PMID: 22431561). The final model of the DHRS included age, gender, race/ethnicity, sex with a male, vaginal intercourse, receptive anal intercourse, injection drug use and past HIV testing.
Aim(s)/Objectives: We aimed to validate the DHRS in patients attending two publicly funded sexually transmitted infection (STI) clinics in Vancouver, British Columbia.
Methods: We validated the model using electronic records (2000–2012) from 47,175 clinic visits. Each visit was scored based on variables included in the DHRS. Visits were stratified into five risk groups according to their score: very low (<20), low (20–29), moderate (30–39), high (40–49) and very high (50). The model’s discrimination and calibration for predicting an HIV diagnosis were examined by area under the curve (AUC) and the Hosmer–Lemeshow (H-L) statistic. We examined the sensitivity and proportion of patients who would need to be screened at different cutoffs of the risk score.
Results: The prevalence of HIV infection was 0.46%. Validation demonstrated good performance: the AUC was 0.80 (95% CI: 0.79–0.81) and the H-L = 8.8, 8 df, p = 0.36. HIV prevalence within each risk groups was: 0%, 0.05%, 0.25%, 0.86% and 1.23%, respectively. HIV testing is recommended for scores of ≥40. The DHRS identified cases with a sensitivity of 96% and a fraction screened of 41%.
Discussion/Conclusion: The DHRS performed well in these STI clinic settings in Vancouver, accurately identifying individuals at increased HIV risk, and may be useful for providing individualised estimates of risk as part of routine HIV screening.
O-21 Anogenital warts and associated human papillomavirus type and variant distribution among HIV+ and HIV− men who have sex with men
Ville N Pimenoff1, Jenny Mccloskey2, Omar Clavero1, Xavier F Bosch1, Silvia de Sanjose1 and Ignacio G Bravo1
1Institut Catalá d´Oncología – Hospital Duran i Reynals, L´Hospitalet de Llobregat, Spain
2Royal Perth Hospital, Australia
Background: Anal warts are common in HIV+ individuals and among men who have sex with men (MSM). Condylomata, generally attributable to infection by low-risk human papillomaviruses (HPVs), are considered benign low-grade squamous intraepithelial lesions (LSILs). However, anal condylomata have occasionally been linked to high-grade SIL (HSIL) and to oncogenic, high-risk HPVs.
Objectives: Here, we describe the histopathology of anal SILs and of the associated HPV type and variant distribution in HIV+ and HIV− patients.
Methods: A total of 480 baseline and 167 recurrent formalin-fixed paraffin embedded (FFPE) anogenital wart (AGW) samples were collected from 302 patients. Baseline of 179 perianal and 145 anal warts were analysed among 243 patients (56 heterosexual women, 61 heterosexual men and 126 MSM, including 41 HIV+ MSM). Lesion histopathology, including p16/p53 biomarkers, and associated HPV types and variants were assessed.
Results: In total, 98.6% of AGWs showed the presence of HPV DNA. MSM showed a higher proportion of perianal/anal condylomata as HSILs compared to heterosexuals. HIV+ MSM (compared to HIV−) presented fourfold increased prevalence of perianal LSILs containing only oncogenic HPVs, while more than 64% of anal HSILs among MSM were only associated with low-risk HPVs. Histopathology revealed that 59.3% of the HSILs were flat lesions and 93.8% of these cases were p16 positive and associated with oncogenic HPVs. In contrast, 70.0% of condylomatous HSILs were exclusively associated with low-risk HPV. Recurrent AGWs with baseline HPV type detected were associated with the same HPV variant.
Conclusion: Perianal LSILs were commonly associated with oncogenic HPV types in HIV+ MSM, while anal HSILs associated only with low-risk HPV types were common in both MSM groups. Taken together, clinical diagnosis of condylomata in patients requiring surgical anal treatment cannot be assumed to be only benign low-risk HPV-associated low-grade lesions, particularly among MSM and HIV+ patients.
O-22 Reaching young men with prevention, care and treatment through scaling up voluntary medical male circumcision services in a high HIV prevalence province in KwaZulu-Natal, South Africa
Catherine Searle and Arthi Ramkissoon
Maternal, Adolescent and Child Health Systems (MatCH), South Africa
Background: Medical male circumcision (MMC) is effective in reducing heterosexually acquired HIV in males by ∼60%. UNAIDS/WHO recommend voluntary MMC (VMMC) as part of comprehensive HIV prevention in high HIV and low MMC prevalence areas.
Aims/Objectives: The aim was to assess how VMMC services can be scaled up to increase access to HIV services for males.
Methods: Routine data collected at VMMC services at high volume sites, outreach services and referred from primary health care clinics between April 2012 and October 2014 were reviewed to determine the profile of clients seeking services.
Results: During the period, 57,075 procedures were conducted at 104 sites in four districts. Sites included 13 hospitals, 11 community health centres, 57 clinics and 23 non-health facilities such as schools, prisons and community halls. Twenty-seven percent of clients circumcised were aged 10–14, 35% 15–19, 19% 20–24, 14% 25–34, 4% 35–49 and 1% 50 years and older. Ninety-five percent of males presenting at services were HIV negative, 3% HIV positive and 2% declined testing. Thirty-seven percent of clients arrived pre-screened for HIV, and 63% were screened on site. Demand for services fluctuated, ranging from 700 to 5006 procedures per month.
Discussion: Eighty-one percent of males accessing MMC services are <25 years old, and 95% are HIV negative, making MMC an effective strategy to reach males prior to HIV infection in high-prevalence settings. Expanding services to community health centres, clinics and non-medical settings such as schools has helped scale up services. Critical enablers to scale up included mobile services, dedicated demand creation staff, client transport and partnerships with the Department of Health. Careful allocation of human resources is needed to deal with fluctuating demand, with high volumes of clients accessing services in school holidays and the winter months.
O-23 Audit on HIV testing in patients with an indicator condition for HIV in primary care in Catalonia, Spain
Cristina Agustí Benito1, Alexandra Montoliu1, Juanjo Mascort2, Ricard Carrillo3, Jesús Almeda4, Maria Aragón4, Josep Maria Elorza4 and Jordi Casabona1
1CEEISCAT-Agència de Salut Pública de Catalunya, Spain
2Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Spain
3Societat Catalana de Medicina Familiar i Comunitària (CAMFiC), Spain
4IDIAP Jordi Gol, Spain
Background: Delayed presentation among new HIV diagnoses in Spain continues to be seen at high levels. To offer HIV testing based on indicator conditions (ICs) is a strategy used to increase the early detection of HIV. Identifying patients at risk of infection and offering them counselling and testing for HIV is the most important contribution to be made by general practitioners to improve early diagnosis of HIV.
Objective: To estimate the prevalence of HIV testing among patients diagnosed with an IC for HIV, attending to primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients.
Design: Cross-sectional and population-based study in all patients between 16 and 65 visited in PC in Catalonia between 2010 and 2012 diagnosed an IC.
Methods: Data from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP), were used in this audit. All participants between 16 and 65 years old registered in SIDIAP from January 2010 to December 2012 with a diagnosis of an IC, were screened to identify those with an HIV test within four months.
Results: Since 1 January 2010 and 31 August 2012, 71,709 episodes of one or more ICs diagnosed at the same consultation were observed; only 18,033 episodes (25.15%) got an HIV test within four months. The HIV infection prevalence among tested patients was 1.50%. Women (OR: 1.27, 95% CI: 1.22–1.32), patients 50 years old or older (OR: 1.97, 95% CI: 1.86–2.09) and patients presenting only one IC (OR: 2.28, 95% CI: 2.11–2.46) were most likely to not being tested for HIV.
Conclusions: The study showed important missed opportunities for HIV testing in PC in Catalonia. Urgent engagement of PC professionals to increase HIV testing and prevent late-stage diagnoses is required.
O-24 HIV avidity index used to identify recent HIV infections: the effect of antiretroviral treatment
Mariangela Raimondo1, Vincenza Regine1, Arnaldo Caruso2, Patrizia Bagnarelli3, Maria Rosaria Capobianchi4, Valeria Ghisetti5, Nadia Zanchetta6, Claudio Galli7 and Barbara Suligoi1
1Istituto Superiore di Sanità, Italy
2Spedali Civili di Brescia, Italy
3Università Politecnica delle Marche, Italy
4National Institute for Infectious Diseases "L. Spallanzani", Italy
5Amedeo di Savoia Hospital, Italy
6Luigi Sacco Hospital, Italy
7Abbott Diagnostics, Italy
Background: In 2013, in Europe, the largest proportion of newly diagnosed HIV infections was attributable to sexual contacts (74.3%), although late presenters accounted for almost half of these cases. To monitor more accurately the true HIV incidence, we used the avidity index (AI) of anti-HIV antibodies that discriminates recent infection (RI) (≤6 months from seroconversion) from established infection (EI) (>6 months from seroconversion) and analysed the effect of antiretroviral treatment (ART) initiation on AI.
Methods: We included 647 HIV-positive serum samples: 455 samples from 87 HIV-positive individuals (group A) with an estimated date of seroconversion; 192 samples from 192 individuals with AIDS or HIV infection with CD4 < 200 cells/μl (group B). All samples were assayed for AI using Architect HIV Ag/Ab Combo (Abbott). Samples with AI ≤ 0.80 were classified as RI, whereas those with AI > 0.80 as EI. The effect of ART on AI misclassification was evaluated calculating the false recent rate (FRR), defined as proportion of EIs misclassified as RI using AI.
Results: Of the 647 serum samples, 286 (44.2%) were collected after ART initiation; the FRR in those 286 samples was 32.5% compared to 10.9% among the 361 samples collected before ART initiation (p = 0.000). In group A, FRR was 13.2% and 53.5% before and after ART initiation, respectively. In group B, FRR was similar before and after ART initiation (7.1% and 4.6%, respectively; p > 0.05).
Conclusion: The impact of ART on AI misclassification is significant among serum samples collected before advanced immune depletion, probably attributable to a slower maturation of antibodies when HIV replication is reduced by ART. This effect is irrelevant in the advanced stage of disease.
O-25 An epidemiological analysis of men who have sex with men who are prescribed HIV post-exposure prophylaxis: implications for wider pre-exposure prophylaxis policy
Holly Mitchell, Martina Furegato, Gwenda Hughes, Nigel Field, Hamish Mohammed and Anthony Nardone
Public Heath England, UK
Background/Introduction: Post-exposure prophylaxis following sexual exposure (PEPSE) is a potential method of preventing HIV infection in certain circumstances. Initiation of PEPSE is recommended following receptive anal intercourse with a partner of known positive or unknown HIV status from a high-risk group.
Aim(s)/Objectives: To investigate the characteristics and risk profile of patients receiving PEPSE to determine whether this could inform development of pre-exposure prophylaxis (PrEP) policy for men who have sex with men (MSM).
Methods: Data from the Genitourinary Medicine Clinic Activity Dataset (GUMCADv2) were used to investigate the characteristics of patients receiving PEPSE. Associations with PEPSE use were assessed using multivariate logistic regression, and HIV incidence was derived using a Cox proportional hazards model adjusted for age and ethnicity.
Results: Between 2011 and 2013, 14,118 patients received PEPSE, of which 63% (8937) were MSM. Among MSM receiving PEPSE, 14% (1225) received more than one course (maximum 13 courses), 45% (4003) were aged 25–34 years and 75% (6732) were of white ethnicity. 2.0% were diagnosed with HIV between four and 16 months after receiving their last course of PEPSE. Compared to MSM controls not receiving PEPSE, MSM receiving PEPSE were significantly more likely to be of non-white ethnicity (adjusted OR = 1.28, 95% CI: 1.21–1.36), and to be diagnosed with HIV following a subsequent exposure (adjusted OR = 1.21, 95% CI: 1.04–1.42). HIV incidence was higher among those receiving PEPSE (adjusted hazard ratio = 1.18, 95% CI: 1.03–1.35).
Discussion/Conclusion: MSM prescribed PEPSE are at high risk of acquiring HIV infection following a subsequent exposure and may require intensive interventions to ensure course completion and reduce HIV risk behaviour. PrEP may be beneficial for high-risk MSM receiving PEPSE and also avoid the need for repeat PEPSE prescriptions.
O-26 Prevalence of non-volitional sex types and associated factors: a national sample of young men and women with and without same-sex activities
Nicole Dukers Muijrers1, Carlijn Somers1, Hanneke de Graaf2, Suzanne Meijer3 and Christian Hoebe1
1GGD Zuid Limburg, Netherlands
2Rutgers WPF, Netherlands
3Soa Aids Nederland, Netherlands
Background: Non-volitional sex (NVS) in young people continues to be a major public health problem with long-term negative health outcomes.
Aim: Compare NVS prevalence and associated factors between young men and women with and without same-sex sexual activities.
Methods: We obtained data from 10,401 young women and young men aged 12–25 years participating in a population study on sexual health, the Netherlands. We calculated and compared prevalence of six types of NVS between women who had sex with men (yWSM) or women (yWSW), and men who had sex with women (yMSW) or men (yMSM). In sexually experienced participants (n = 5986), logistic regression analyses were applied to assess associations with NVS types by assault or penetration. Analyses were weighted to represent the Dutch population.
Results: NVS prevalence ranged from 1% to 61%, depending on type. Prevalence was higher for women (any: 40.6%) than men (any: 20.4%), and highest for yMSM and yWSW. Prevalences were highest in sexually active people, as shown in Table 1. NVS by assault or penetration were related to a range of socio-demographic, behavioural and social-network-related factors. Factors were comparable between men and women (regardless same-sex-experiences). NVS perpetrators were mostly (over 70%) known to the victim; one in four cases of NVS by penetration were accompanied by violence.
Conclusion: A substantial proportion of young men and women in the Netherlands have experienced NVS. Medical professionals, educators and caregivers should integrate services to continue to address NVS by targeting young people’s multifaceted risk profiles.
Women
yWSM
yWSW
Men
yMSW
yMSM
Assault
35.6%
35.5%
36.0%
22.9%
22.8%
24.1%
Penetration
20.3%
18.9%
32.2%
5.7%
4.8%
13.6%
Any NVS
55.9%
54.4%
68.2%
28.6%
27.5%
37.7%
NVS: non-volitional sex; yWSM: women who had sex with men; yWSW: women who had sex with women; yMSW: men who had sex with women; yMSM: men who had sex with men.
O-27 The anal human papillomavirus and dysplasia profile of patients with inflammatory bowel disease
Ross Cranston1, Miguel Regueiro1, Jana Hashash1, Jonathan Baker1, Joann Fultz2, Carly Mowrey1, Nicola Richardson-Harman3, Alexiy Nikiforov1, Laura Janocko1 and Ian Mcgowan1
1University of Pittsburgh, Pittsburgh, PA, USA
2Universty of Pittsburgh Medical Center, Pittsburgh, PA, USA
3Alpha StatConsult, Damascus, MD, USA
Background: Anal human papillomavirus (HPV) disease has not previously been evaluated in a population with inflammatory bowel disease (IBD).
Aims: To define the HPV viral, cytological and dysplastic environment of the anal canal in patients with IBD.
Methods: Fifty sexually active men and women with IBD were recruited. Assessments included an anal exam, anal and vaginal HPV testing, anal cytology and high-resolution anoscopy with biopsy of suspected dysplasia. The study was approved by the University of Pittsburgh Institutional Review Board.
Results: Twenty-five male and 21 female evaluable participants, 31 with Crohn’s disease (CD), 14 with ulcerative colitis (UC), one with undetermined colitis were predominantly white (91.3%), treatment experienced (76.1%), with an average age of 38.1 (range 22–66) years, and an average length of IBD diagnosis of 9.3 (range 1–33) years. Eighteen (39.1%) had an abnormal perianal exam, and three (6.5%) had an abnormal digital exam. Forty-one (89.1%) were diagnosed with anal HPV, 16 with single types and 25 with multiple types (range 2–5). HPV-16 was the most frequently detected (65.2%) with HPV types 11 and 45 the next most frequent in 17 (37.0%). Nineteen of 21 (90.5%) females had vaginal HPV detected. Overall, 21 (45.7%) had abnormal anal cytology. Thirty-three (71.7%) had at least one anal biopsy (nine had multiple), with dysplasia diagnosed in 28 (60.9%). High-grade squamous intraepithelial lesions (SIL) were diagnosed in four (8.7%) and low-grade SIL in 24 (43.5%). Principal component analysis demonstrated no striking difference in the variables examined between CD and UC cases.
Conclusions: The prevalence of anal HPV and anal dysplasia in this population is similar to HIV-positive men who have highest anal cancer incidence and may indicate a similar cancer risk phenotype. Further investigation is warranted to define the role of anal screening and preventative HPV vaccination in this population.
O-28 How does the management of pelvic inflammatory disease vary across Europe? A service evaluation for and on behalf of the European Collaborative Clinical Group
Omome Etomi1, Sabah Ahmed1, Dmitriy Kim2, Gilbert Donders3, Mikhail Gomberg2, Peter Greenhouse4, Jorgen Skov Jensen5, Phillipe Judlin6, Jonathan Ross7 and Rajul Patel8
1University of Southampton, UK
2Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Russian Federation
3Antwerp University Hospital, Belgium
4Bristol Sexual Health Centre, UK
5Statens Serum Institut, Denmark
6CHU de Nancy, France
7University Hospitals Birmingham, UK
8Royal South Hants Hospital, UK
Background: Pelvic inflammatory disease (PID) describes the broad spectrum of complex female upper genital tract infection. PID remains a significant cause of morbidity in women of childbearing age, and current guidelines encourage clinicians to maintain a high index of suspicion for diagnosis and low threshold for treatment. PID is often poly-microbial in nature with Chlamydia trachomatis and Neisseria gonorrhoeae as the leading bacterial causes. However, up to 70% of cases have an unclear aetiology. The aims of PID treatment are threefold: clinical cure, microbiological cure and prevention of long-term sequelae. With each subsequent episode of PID, risk of long-term sequelae development is increased. Therefore, prompt and accurate diagnosis coupled with adequate treatment is vital to prevent long-term morbidity.
Aims: To investigate the current management of PID amongst sexual health physicians across Europe, comparing their practice against the current European guidelines.
Methods: Interviews were conducted with a core group of European PID experts and a clinical scenario-based questionnaire developed. This final questionnaire was validated by the core group and then electronically circulated to members of the European Collaborative Clinical Group (ECCG); a network of sexual health specialists under the umbrella of IUSTI who conduct questionnaire-based research in Europe. The data are qualitative in nature and will be analysed using simple statistical methods.
Results: To date, responses have been received from most of the ECCG member countries. This study has found areas of controversy surrounding; choice of antibiotic therapy, the routine testing and treatment for Mycoplasma genitalium if found, the management surrounding intrauterine devices (IUDs) in situ and management of PID after treatment failure.
Conclusion: IUSTI should consider expanding and clarifying guidance on the above areas of controversy in its training programmes and next European guidelines.
O-29 Good sensitivity and specifity of Determine®-TP rapid test under real-life conditions, but limitations due to residual antibodies and test duration
Klaus Jansen1, Norbert Brockmeyer2, Heidrun Nitschke3, Michael Schumacher4, Susanne Kuttner-May5, Adriane Skaletz-Rorowski2, Dieter Muenstermann6, Andreas Lucht6, Anna Kraminer-Hagedorn6 and Hans Jochen Hagedorn6
1Robert Koch-Institute, Germany
2University Clinic, Germany
3Loca Public Health Authority, City of Cologne, Germany
Background: Use of rapid tests for syphilis is discussed controversially in Germany, due to additional costs while having standard serological syphilis diagnostic (SSSD) broadly and fast available and the inability to differentiate active infections and residual antibodies. We evaluated performance of Determine®-TP rapid test (Alere: TP-RT) under real-life conditions.
Methods: The local public health authority (LPHA) and an MSM-orientated counselling centre (MSM-CC) in Cologne, Germany, recruited clients stating risk for syphilis. Clients were not included in the study if prior syphilis was self-reported. TP-RT and SSSD (Architect® Syphilis TP CMIA (Abbott) were carried out on serum at German consultant laboratory for syphilis; positive results were confirmed according to guidelines. Samples of MSM-CC were tested by TP-RT also at MSM-CC. We calculated sensitivity and specifity of TP-RT using SSSD as gold standard and evaluated duration until display of positive results of TP-RT (at 15′, 30′, 60′, 120′, 24 h).
Results: Of 1046 samples of LPHA and 462 samples of MSM-CC, 8.9% resp. 6.7% were tested positive, thereof 74.2% resp. 58.1% due to residual antibodies. Overall sensitivity and specifity were 99.2% resp. 99.3% and differed concerning conditions of testing (Table 1). 97.8% of positive samples of LPHA showed positive TP-RT after 15’, 2.2% after 24 h; at MSM-CC, 100% showed positive TP-RT after 15’. False-negative TP-RT results were found only in case of residual antibodies.
Conclusion: TP-RT showed good sensitivity and specifity. The substantial proportion of samples showing positive TP-RT results not until after 24 h in combination with the high proportion of positive results due to residual antibodies despite respective anamnestic interviews questions the reasonableness of TP-RT, if SSSD is generally available.
All samples
Samples: LPHA
Samples: MSM-CC
TP-RT: consultant- laboratory
TP-RT: consultant- laboratory
TP-RT: MSM-CC
Sensitivity (95 CI)
99.2% (95.6%–100%)
100% (96.1%–100%)
96.8% (83.3%–99.9%)
93.5% (78.6%–99.2%)
Specifity (95 CI)
99.3% (98.7%–99.7%)
99.5% (89.8%–99.8%)
98.8% (97.3%–99.6%)
99.5% (98.3%–99.9%)
LPHA: local public health authority; TP-RT: TP rapid test; MSM-CC: MSM-orientated counselling centre.
O-30 Burden of human papillomavirus in anogenital and oropharyngeal cancers in men
Laia Alemany, Xavier Castellsagué, Xavier Bosch and Silvia de Sanjosé
Catalan Institute of Oncology, Spain
Background: Human papillomavirus (HPV) infection is one of the most frequent sexually transmitted infections. It has been firmly established as a central and necessary cause of invasive cervical cancer and aetiologically linked to other anogenital (vulva, vagina, anus and penis) and head and neck cancers, particularly oropharyngeal.
Aims: To estimate worldwide HPV prevalence and type distribution in anal, penile and oropharyngeal cancers in men.
Methods: Formalin-fixed paraffin embedded anal, penile and oropharyngeal cancer tissues were collected from pathology archives of collaborating centres worldwide. After centralised histopathological evaluation, HPV/DNA detection and genotyping was performed using SPF-10 PCR/DEIA/LiPA25 (version 1). Detection of HPV E6*I mRNA and p16INK4a was also performed.
Results: Cases finally tested for HPV/DNA were: 157 anal cancers, 1010 penile cancers and 884 oropharyngeal cancers. HPV/DNA prevalences were 85%, 33% and 22%, respectively. Most of the HPVs were identified as single infections in the cases. HPV-16 was the most frequent HPV type identified in all cancer sites, with a relative contribution among HPV/DNA-positive cases of 76% in anal cancers, 69% in penile cancers and 85% in oropharyngeal cancers. Further analyses considering other available information such as histological diagnosis, age at and year of diagnosis, geographical origin of samples; and other molecular markers will be presented at the meeting.
Conclusions: Considering the observed HPV contributions in the samples analysed, HPV-based prevention tools like HPV vaccination can be a useful measure for reducing the burden of anal, penile and oropharyngeal cancers in men.
Poster Abstracts
P001 Sexual behaviour in Israeli men: results from a representative study
Zohar Mor and Udi Davidovich
Ministry of Health, Israel
Background: Estimating the size of key risk-groups susceptible to HIV and sexually transmitted diseases (STD) is essential for establishment of interventions and budget allocation. Men who have sex with men (MSM) have compromised the key risk-group with the highest incidence of STD and HIV in Israel during the last 15 years, despite continuous interventions. This study aims to estimate, for the first time in Israel, the number of MSM in the Jewish male population in Israel and to appraise the HIV prevalence in this susceptible community.
Methods: This cross-sectional study included a random national representative sample of the Jewish population aged 18–44 years, who completed anonymous online questionnaires regarding their demographic details, as well as their sexual orientation and practices. The rate of MSM was then projected on the figures from the national civil census. The estimates of the HIV prevalence among MSM were based on the national HIV registry.
Results: The sample included 997 men, of whom 10.1% reported lifetime same-sex encounters, while 4.5% were self-identified as gay/bisexual. Based on the rate of responders who self-identified Jewish gays/bisexuals, it is estimated that there are 96,353 (95% CI: 85,714–97,884) Jewish gays/bisexuals aged 18–44 years in Israel, and 66,165 (95% CI: 65,675–66,643) are living in Tel-Aviv. Of all 671 Jewish men aged 18–44 years who were living with HIV/AIDS in Israel at the end of 2010 and reported same-sex practices, 611 (91.1%) were living in Tel-Aviv. It is therefore estimated that 0.7% (95% CI: 0.5–1.5) of all the Israeli Jewish gay/bisexual population aged 18–44 years are infected with HIV, and 1.0% (95% CI: 0.85–1.02) of all Jewish gays/bisexuals living in Tel-Aviv with similar ages are HIV-infected.
Conclusion: The rate of males who reported same-sex practices was higher than that those who self-identified as gay/bisexual (10.1% and 4.5%, respectively), while two of three were living in Tel-Aviv. The rate of HIV-infected MSM in Israel was 0.7%, while among Tel-Aviv MSM the rate was 1.0%. HIV infection rates among MSM were higher than the overall national HIV rate ( = 0.07%), but still lower than the definition of a ‘concentrated epidemic’ that was indicated by the WHO.
P002 Recreational drug use, sexual risk behaviour and risk of sexually transmitted infections in men who have sex with men using erectile dysfunction medications in Spain
Percy Fernández-Dávila1,2, Cinta Folch1, Laia Ferrer1, Raúl Soriano3, Mercedes Diez4 and Jordi Casabona1
1Centre de Estudis Epidemiològics sobre les ITS i SIDA de Catalunya, Spain
2Stop Sida, Spain
3Asociación Alaira, Spain
4Plan Nacional del Sida-DGSPCI/Centro Nacional de Epidemiología, Unidad de Epidemiología y Conductas de Riesgo, Spain
Background: Previous studies in many high-income countries reported associations between erectile dysfunction medications (EDM) (Viagra®, Cialis®, Levitra®) use and risk behaviours among men who have sex with men (MSM). Little is known about the extent and pattern of use of EDM by MSM in Spain.
Objective: To examine the relationships between EDM, recreational drugs, sexual risk behaviour and sexually transmitted infection (STI) in MSM.
Methods: The European MSM Internet Survey (EMIS) was implemented in 2010 in 38 European countries on websites for MSM and collected data on socio-demographics, drugs use, sexual behaviour and other variables. A logistic regression analysis was conducted to assess variables associated with EDM use in the previous 12 months. Final model was adjusted for some socio-demographic variables.
Results: A total of 13,111 respondents living in Spain completed the questionnaire. Thirteen percent of MSM reported using EDM. Users were more likely to: be 25–39 years old (aOR = 3.5, 95% CI: 2.6–4.7) and ≥ 40 years old (aOR = 14.4, CI: 10.7–19.3); report drug use in the previous 12 months: ecstasy/MDMA (aOR = 1.3, CI: 1.1–1.6), cocaine (aOR = 1.4, CI: 1.2–1.7), poppers (aOR = 1.6, CI: 1.4–1.9), mephedrone (aOR = 1.7, CI: 1.1–2.6) and GHB (aOR = 2.9, CI: 2.3–3.8); have unprotected anal intercourse with a non-steady partner (aOR = 1.3, CI: 1.1–1.5); visit a sex-focused venue: public sex venue (aOR = 1.2, CI: 1.1–1.4), private sex venue (aOR = 1.4, CI: 1.2–1.7) and sauna (aOR = 1.4, CI: 1.2–1.7); or having been diagnosed with gonorrhoea in the previous 12 months (aOR = 1.5, CI: 1.1–2), amongst others factors.
Conclusions: The use of EDM is associated with the use of many drugs (some of which interact dangerously with EDM), attendance at sex-focused venues (that provide opportunities for multiple sexual partners) and having sexual risk behaviours which expose MSM to STI acquisition. Comprehensive response to reduce the non-medical use of EDM and its consequences, as well as harm reduction of other drugs should be addressed to MSM.
P003 How easy is it to discuss party drug use in men who have sex with men? A clinic survey
Fionnuala Finnerty1, David Atefi1, Nicholas Pinto-Sander1 and Daniel Richardson2
1Royal Sussex County Hospital, UK
2Royal Sussex University Hosptal, UK
Background: Party drug use is associated with poor health outcomes particularly in men who have sex with men (MSM). We have shown high and increasing rates of party drug use in MSM locally including injecting drug use (Slamming).
Aims/Objectives: To ascertain staff confidence in discussing party drug use in MSM and to identify challenges and training needs.
Methods: We designed an eight-question electronic survey for health care professionals working in sexual health locally. The questions related to confidence and training required in asking MSM about party drug use.
Results: Ninety-three health care professionals completed the questionnaire (19 doctors, 26 nurses and 48 allied health care professionals including health advisers, health care assistants and pharmacists); 54/91(57%) of respondents felt happy with their current knowledge of party drug use in MSM, and 54/81(65%) of respondents had had specific training in party drug use. Ninety-two percent (75/81) of people felt that they would benefit from further training. Sixty percent of people felt confident discussing party drug use with MSM, 12% did not feel confident and 34% sometimes felt confident. People felt less confident discussing slamming – 40% (36) felt confident, 39% (34) felt sometimes confident and 21% (19) did not feel confident at all. Reported challenges included keeping up to date with new party drugs and legal highs and knowledge of the modes of administration. Small group teaching was the preferred mode of teaching.
Discussion and Conclusions: Even in centres where recreational drug use in MSM is high and staff receive training on drug use, it is an ever-changing landscape, and training needs to be regular and up to date preferably in a small group setting.
P004 Late seroconversions in a cohort of HIV risk-exposed individuals
Lorna Leal, Berta Torres, Agathe León, Alexy Inciarte, Constanza Lucero, Vicens Díaz-Brito, José María Gatell and Felipe García
Hospital Clínic de Barcelona, Spain
Introduction: Some patients who attend clinics to prevent HIV acquisition after an HIV risk exposure have a late seroconversion despite the counselling that the patients receive during the follow-up. The objective of this study is to assess the rate and the factors associated with a late HIV seroconversion.
Methods: Demographics, sexual behaviour, post-exposure prophylaxis (PEP) use and HIV test and sexually transmitted infections (STI) history were compared between patients with a late seroconversion and non-seroconverters patients matched by gender, age and date attending the clinic from a cohort of 3089 HIV uninfected patients attending a clinic due to an HIV risk exposure from 2003 to 2013.
Results and Discussion: Sixty-nine out of 3089 patients (2.2%) seroconverted after a median (IQR) of 18 (9–34) months since the last visit for sexual exposure. CD4 T cell count at HIV detection was significantly higher in those patients in whom HIV was detected earlier (527 vs. 421 cells/mm3 for patients with HIV diagnose before and after 18 months from the last visit in the clinic, p = 0.01). HIV seroconverters were predominantly male (96%) and men who have sex with men (MSM) (96%). No differences were observed between seroconverters and non-seroconverters regarding birth place (Spain 67% vs. 71%, p = 0.71), risk of exposure (high 16% vs. 20%, p = 0.66), hours from exposure to PEP prescription (17 vs. 16 h, p = 0.95), good adherence to PEP (91% vs. 96%, p = 0.4) and presence of co-infections at baseline (hepatitis A, B and C or syphilis). Conversely, the proportion of MSM (96% vs. 7%, p < 0.0001), sexual partner with known HIV infection (46% vs. 28%, p = 0.03), previous PEP (19% vs. 6%, p = 0.03), previous STI (54% vs. 16%, p < 0.0001) and previous HIV testing (58% vs. 41%, p = 0.04) was higher in seroconverters.
Conclusions: Late HIV seroconversions are usual between HIV exposed patients attending a clinic. Closer and longer follow-up and/or pre-exposure prophylaxis should be considered in MSM with sexual contacts with known HIV-infected patients and previous and repeated sexual exposure. These measures could prevent new infections or at least permit the diagnosis of HIV infection at earlier stages.
P005 Experimentals, bottoms, risk-reducers and clubbers: exploring diverse sexual practice in an Internet-active high-risk behaviour group of men who have sex with men in Sweden
Kristina Ingemarsdotter Persson1, Birger Forsberg2, Jakob Bergström1, Anna Thorson2, Ronny Tikkanen3 and Torsten Berglund1
1Public Health Agency of Sweden, Sweden
2Karolinska Institutet, Sweden
3Göteborgs Universitet, Sweden
Background: Unprotected anal intercourse (UAI) is known as the foremost determinant for transmission of HIV among men who have sex with men (MSM). Previous research has shown that HIV is not equally distributed among MSM. Knowledge about over-risks of HIV in subgroups of MSM who share risk-indicators can be used by preventive actors in order to better guide preventive interventions.
Aim: The objective of this study was to explore and identify subgroups of MSM at higher risk of HIV infection than others.
Methods: Data from the Swedish MSM health survey, MSM2013, were used, focusing on the respondents reporting having had UAI with casual partner(s) during the last 12 months (n = 714). Comparison of socio-demographics based on UAI with casual partner(s)-frequency was conducted. Weighted Latent Class Analysis (LCA) with covariates and distal outcomes was used to identify subgroups of MSM sharing the same characteristics.
Results: Men having had UAI with casual male partner(s) during the last 12 months differed from other sexually active men regarding several socio-demographics and perceived HIV status (proportion HIV+ 4.5% compared with 2.2%, p = 0.007). Four latent classes emerged based on similar within-group responses to survey questions on practices performed in relation to UAI with casual partner(s). The classes were assessed theoretically and practically meaningful and could be labelled based on qualitative differences. The class labelled Experimentals (latent class prevalence 0.16) appeared to differ most from the others when adding covariates and distal outcomes. No evidence for a causal connection between self-rated high preventive knowledge and taking part in less risky practices was found.
Conclusions: Subgroups of MSM may perceive risk in different ways based on similar sexual practice patterns. When designing preventive interventions, the varying needs of subgroups of MSM should be considered. Knowledge-intensive interventions may not be the best fitted for reducing HIV transmission.
P006 Reasons for and factors associated with early first sexual intercourse among adolescents in Norway – a cross-sectional study
Kirsten Gravningen1 and Henrik Schirmer2
1University Hospital of Northern Norway, UK
2Arctic University, Norway
Background: Circumstances related to first sexual intercourse (FSI) are associated with subsequent sexual health.
Aims: To examine reasons for and factors associated with early FSI (before age 15), including prevalent chlamydia infection, in a general adolescent population.
Methods: Analyses of data from a cross-sectional study among students in five high schools in Norway in 2009 (N = 1482) aged 15–20 years using web-questionnaires and Chlamydia trachomatis PCR-urine test results. Response rate 79%. We used logistic regression analysis.
Results: Thirty-one percent of girls and 20% of boys reported early FSI (p = 0.02). In multivariable analyses, FSI was associated with being a year 3 high school student (girls: adjusted odds ratio, aOR, 0.19, boys 0.32), university attainment (girls 1.76), same-/bi-sexual orientation (girls 2.07, p = 0.07), having known first sexual partner (FSP) >1 month before sex (boys 1.59), older FSP (boys 3.50), no substance use at FSI (girls 1.65, p = 0.06) and contraception non-use (boys 1.54, p = 0.06). The main reasons cited for early FSI were: curiosity (girls 85%, boys 82%), sexual arousal (69% vs. 93%, p < 0.001) and love (77% vs. 62%, p < 0.01). A minority reported: everyone else had done it (15%, 13%), my partner used pressure (10% vs. 2.9%, p = 0.03) and do not know (7.8%, 5.7%). More girls with early (vs. later) FSI reported partner pressure (10% vs. 5.5%, p = 0.08). In analyses adjusted for duration sexually active, early FSI was not associated with prevalent chlamydia.
Conclusion: Nordic girls continue to experience FSI at a younger age than boys. A large majority reported autonomous reasons for having had FSI with curiosity now equally common among both genders. Early FSI was associated with both protective and risk factors, including female non-consensuality and male non-contraception use. The protective effect of year 3 may be due to drop-out and vocational students leaving for apprenticeship after year 2. Sexual health education should provide youths with the required skills to have safe FSI.
P007 Is genital herpes simplex virus type 1 associated with risk-taking sexual behaviours?
Sogha Khawari1, Emily Clarke1, Rajul Patel1 and Omome Etomi2
1Solent NHS Trust, UK
2University of Southampton, Southampton, UK
Background: Herpes simplex virus type 1 (HSV-1) is now the primary cause of first-episode genital ulcers in the UK and in other European countries such as Sweden and Norway. Genital HSV-1 has previously been linked with early age of first sex and men-who-have-sex-with-men, but many studies examining risk-taking behaviour have examined HSV-1 and 2 together, and this issue has not been examined in detail. A diagnosis of genital herpes can be very distressing to patients, in part due to the stigma surrounding a sexually transmitted infection (STI) diagnosis in general.
Aim: To assess whether genital HSV-1 is associated with risk-taking sexual behaviours in comparison with HSV-2, chlamydia and asymptomatic patients with no STI diagnosis.
Methods: This NRES-approved questionnaire pilot study assessed 200 patients aged 16–30 years with a diagnosis of HSV-1, HSV-2, chlamydia or asymptomatic patients with no STI diagnosis attending a UK level 3 sexual health service. The detailed questionnaire assessed risk-taking behaviour and was based on NATSAL questions and other identified risk-taking behaviours.
Results: Data to date from 41 patients demonstrated that patients in the HSV-1 group had a mean age of first oral sex of 15 years (in comparison with 17 years in the HSV-2 group). However, mean age of first vaginal sex was 17 years (16 years in the HSV-2 group). Patients in the chlamydia group had a mean of eight sexual partners in the past year in comparison with four in the asymptomatic group, five in the HSV-1 group and two in the HSV-2 group.
Discussion: Provisional results from this pilot study suggest that the association between HSV-1 and risk-taking behaviour may be complex and that early age of first oral sex may be a particular risk factor. Further research is required in this area, as an improved understanding of the association between risk-taking behaviour and HSV-1 will be useful when counselling patients with a first diagnosis of genital HSV-1.
P008 High rates of repeat post-exposure prophylaxis and HIV incidence among men who have sex with men prescribed post-exposure prophylaxis in London, UK
Gary Whitlock, Jennifer Fearnley, Chris Mccormack and Alan Mcowan
NHS, UK
Background: There are limited outcome data for men who have sex with men (MSM) who have received HIV post-exposure prophylaxis (PEP).
Objective: To determine HIV incidence and repeat PEP use among MSM PEP recipients in London, UK.
Methods: Retrospective electronic case-note review of all MSM who were prescribed PEP between January and April 2013 at 56 Dean Street in London, UK.
Results: In total, 347 MSM received PEP between 1 January and 31 April 2013. Median age was 31 years. PEP indication was unprotected anal intercourse (receptive 87% and insertive 12%). Until April 2015, total follow-up was 385 person-years (mean 1.11 years/individual). There were 112 users (32%) who received repeat PEP. The total number of repeat PEP courses used was 271. Of repeat PEP users, the mean number of repeat PEP episodes was 2.4 per user. Eleven initiated Truvada for PrEP as part of the PROUD trial. Thirty-three MSM (9.5%) newly acquired HIV infection: the HIV-incidence was 8.4 per 100 person-years.
Conclusions: MSM who attend 56 Dean Street for PEP demonstrate high HIV incidence despite high repeat PEP use. For some, pre-exposure prophylaxis, once licensed, may be an acceptable way to minimise their HIV risk.
P009 Toxic habits and high-risk sexual behaviour in newly HIV-diagnosed coinfected with other sexually transmitted diseases
Mar Vera1, Carmen Rodríguez1, Jorge Alfredo Pérez2, Teresa Puerta1, Maria Villa1, Begoña Baza1, Maria Angel Valcarcel3, Lorenzo Eduardo Ayala3 and Jorge Del Romero1
1CS Sandoval, Spain
2Hospital Virgen de la Luz, Spain
3Hospital Clínico San Carlos, Madrid, Spain
Background: The reported incidence of Neisseria gonorrhoeae, Chlamydia trachomatis and Treponema pallidum has started to increase in many countries, primarily among men who have sex with men (MSM).
Objectives:
-The rate of other sexually transmitted diseases (STDs) in newly HIV-diagnosed MSM.
-The influence of drugs on the risk practices for STDs transmission.
Methods: Rectal, urethral and pharyngeal samples and syphilis serological tests were performed from HIV-diagnosed patients in an STD clinic in Madrid between 2007 and 2012. All patients were given a questionnaire to identify factors associated to high-risk sexual behaviour.
Results:
Between 2007 and 2012, 34,627 HIV serological tests and 1629 patients (1519 men, 83 women and 27 transgender) were diagnosed to HIV infection. The mean age was 33 years (range: 27–38), and 91.5% were MSM. 57.3% Spanish and 42.7% foreigners.
38.1% had other STDs at the time of HIV diagnosis: 23% gonorrhea, 50.1% syphilis and 30.6% chlamydia.
72.3% had a history of previous sexually transmitted diseases: 26.1% gonorrhea, 10.1% chlamydia and 26.9% syphilis.
76% had taken drugs in the last year: 60.4% alcohol, 35.7% cocaine and 31.2% poppers.
67.8% reported unprotected sex under the influence of drugs: 47.2% under alcohol influence, 33.5% under cocaine and 29.1% under poppers.
Conclusions:
1) A high rate of other STDs is observed in newly HIV-diagnosed MSM.
2) Most of the patients who were coinfected with other STDs reported unprotected sex under the influence of drugs.
3) High rates of coinfected emphasise the need for screening of other STDs in newly HIV-diagnosed MSM.
4) Alcohol and other recreational drugs are common among MSM and related to unprotected sex and transmission of HIV. This highlights the need for specific preventive programmes aimed at this group.
P010 20 years of bio-behavioural surveillance among men who have sex with men in Catalonia
Cinta Folch1,2, Laia Ferrer1,2, Victoria González2,3,4, Rafael Muñoz5 and Jordi Casabona1,2
1CEEISCAT – ASPC, Spain
2CIBERESP, Spain
3Microbiologia HUGTiP, Spain
4CEEISCAT, Spain
5Stop Sida, Spain
Objective: To summarise the main results of the behavioural surveillance surveys (BSS) among men who have sex with men (MSM) in Catalonia as well as to illustrate the applicability of these data.
Methodology: As part of the Integrated Information System for HIV/STIs Surveillance (SIVES) in Catalonia, a convenience sample of MSM was recruited biennially since 1995 in gay venues and among the membership of a community-based gay organisation. In 2008 and 2013, time-location sampling method was used to recruit MSM in gay venues in Barcelona. Oral fluid samples were collected to estimate HIV prevalence. Due to the different methodologies used, the analysis is presented separately: 1995–2006 and 2008–2013.
Results: Unprotected anal intercourse (UAI) with non-steady partners increased from 24% (1995) to 36% (2006), as well as the proportion who reported more than 10 non-steady partners in the last 12 months (from 45.2% to 62.8%). The use of poppers before or during sexual relationships increased significantly over the years (from 28.4% to 40.8%, respectively). Sexual risk behaviours remained stable between 2008 and 2013: UAI with non-steady partners in the last six months was reported by 36.0% and 37.7% of MSM. HIV prevalence increased from 14.2% in 1993 to 20.4% in 2006. No statistical differences were found in the HIV prevalence between 2008 and 2013 (17.0% and 14.2%, respectively). Data from BSS among MSM have been included in health promotion material and prevention activities by non-governmental organisations (NGOs) and have been used to harmonise indicators in order to facilitate comparisons across countries (GARP indicators).
Conclusions: It has been possible to maintain a coherent behavioural surveillance system among MSM on a long-term basis to describe trends, identify determinants of risk behaviours and to design and evaluate interventions. Our experience demonstrates the crucial role of NGOs working in the implementation and analysis of these studies.
P011 Sexual behaviour and HIV prevalence among men who have sex with men in Catalonia, Spain
Cinta Folch1,2, Laia Ferrer1,2, Alexandra Montoliu1,2, Victoria González2,3,4, Rafael Muñoz5 and Jordi Casabona1,2
1CEEISCAT – ASPC, Spain
2CIBERESP, Spain
3Microbiologia HUGTiP, Spain
4CEEISCAT, Spain
5Stop Sida, Spain
Objective: The objective of this communication is to report the main results of a bio-behavioural survey in Catalonia among men who have sex with men (MSM).
Methods: A cross-sectional survey was conducted in 2013 among MSM (SIALON II project). Time-location sampling was used to recruit men attending different venues in Barcelona city. Participants filled in a questionnaire (n = 402) and provided oral fluid samples to estimate HIV prevalence (n = 400). To adjust for unequal selection probabilities in the sample surveys, a weighted analysis has been used.
Results: Mean age was 37.2 years, and 58.7% were born in Spain (95% CI: 50.0–66.9). Overall, 91.1% (95% CI: 86.5–94.2) had ever been tested for HIV, and 63.6% (95% CI: 53.6–72.5) had been tested in the previous 12 months. HIV prevalence was 14.2% (95% CI: 10.0–19.8). Among HIV-positive MSM (n = 62), 30 cases had unknown HIV infection (48.4%), and 21 reported a negative test result within the previous 12 months (probable recent infection). Overall, 21.7% (95% CI: 15.0–30.2) of the respondents reported >10 sexual partners in the last six months, and the prevalence of unprotected anal intercourse among those with non-steady partners was 37.7% (95% CI: 31.2–44.6). Alcohol use during last anal sex was reported by 38.0% of the participants (95% CI: 29.8–46.9). Among the recreational drugs, the most prevalent were poppers 12.5% (95% CI: 7.9–19.2) and cannabis 13.2% (95% CI: 7.4–22.5).
Conclusions: Approximately half of the HIV infections among MSM attending gay venues in Barcelona remained undiagnosed, and a high proportion of them were probably recently acquired infections. Increasing frequency of HIV testing among MSM at higher risk is a critical first step for reducing the spread of HIV and linking HIV-positive individuals to appropriate medical care and services. Moreover, strategies to prevent HIV/sexually transmitted infections (STIs) and drug consumption should be reinforced among this population.
P013 Sexual behaviours among HIV-positive men and men receiving care at HIV voluntary counselling and testing site
Lukasz Lapinski1,2, Jacek Gasiorowski1,2 and Aleksandra Luszczynska3
1Wroclaw Medical University, Poland
2Centre for Prophylaxis and Treatment of Infectious Diseases and Drug Addiction, Wroclaw Healthcare Centre, Poland
3University of Social Sciences and Humanities, Poland
Background: Existing knowledge about the variation in sexual behaviour among men with HIV or other sexually transmitted diseases infected is limited.
Aims: The goal of the study was to assess sexual behaviour among patients of the HIV voluntary counselling and testing site (VTC) and among people living with HIV who received care in HIV clinics.
Methods: A total of 926 VTC patients (included new HIV- or syphilis-positive man and HIV- and syphilis-negative men) and 102 HIV-positive men in antiretroviral treatment were recruited in Centre for Prophylaxis and Treatment of Infectious Diseases and Drug Addiction (Poland). The mean age of VTC patients was 26.3 years (SD = 5.34) and HIV (+) men was 37.6 years (SD = 9.35).
Results: The findings indicated that (1) VTC HIV or syphilis-infected patients significantly often engaged in anal passive contacts than VTC HIV and syphilis-negative patients (18% vs. 16% vs. 8%); (2) 63.3% of HIV-positive men in antiretroviral treatment used condom always or often during anal sex with stable and casual partners, in the previous 12 months; (3) the number of stable relationships was equal in all groups; (4) the number of casual partners was higher among VTC syphilis-positive men who have sex with men (MSM) (9.1 ± 22.9) than VTC HIV-positive MSM (5.8 ± 10.9) and HIV-positive men in antiretroviral treatment (4.6 ± 1.1); VTC HIV and syphilis-negative men had 3.5 (SD = 5.6) partners and (5) 53.9% of HIV-positive men in antiretroviral treatment had sex after alcohol intake, 15.7% used narcotics and 29.4% poppers.
Conclusion: The results provide an insight into the complexity of sexual behaviours in studied population and can be used to develop STI secondary prevention programmes.
P014 Pregnant women’s attitudes about the use of a gel or a ring for the management of bacterial vaginosis during pregnancy
Marina Catallozzi1, Lauren Dapena Fraiz1, Katharine Hargreaves1, Gregory Zimet2, Shari Gelber3, Adam Ratner1, Lawrence Stanberry1 and Susan Rosenthal1
1Columbia University, New York, NY, USA
2Indiana University, Bloomington, IN, USA
3Weill Cornell Medical College, New York, NY, USA
Background: Bacterial vaginosis (BV) during pregnancy is linked to poor perinatal outcomes. Microbicides could be an option if women were willing to use them.
Aim: To understand pregnant women’s product preferences (ring vs. gel); likelihood of use for BV management under three conditions: prevention, high-risk prevention or treatment; and anticipated involvement of father of the baby (FOB).
Methods: Pregnant women (N = 196) were recruited from an obstetrics waiting room to complete an attitudinal survey about use (e.g. product preferences and specific barriers, likelihood of use across three different conditions and FOB involvement).
Results: Demographics: 68% under 30 years; 46% Hispanic and 20% African American; and 59% had an unplanned pregnancy. More women preferred the gel (67%); however, 72% had the same likelihood of use for prevention regardless of product. Women who chose the ring were less likely to think they would have trouble with ring insertion (p = 0.02); no other specific barriers were significant. Only 30% of women were likely to use for prevention; 76% for high-risk prevention; 82% for BV treatment while pregnant. Those with a planned pregnancy were more likely to use when at high risk (p = 0.04); no other relationships were significant. Anticipated FOB involvement in decision making was: 7% would need approval, 44% would ask his opinion and 37% would inform him of the decision. For use, 84% would ask the FOB to remind them and 62% would get help with insertion. Those under 30 years were more likely to ask the FOB for reminders (p < 0.01) and insertion help (p = 0.04). Those in a current relationship with the FOB (p < 0.01) were more likely to ask for reminders. African American women were less likely to have their partners help with insertion (p < 0.01).
Discussion: Pregnant women’s product preferences may be less critical than their risk perception. The role of the FOB may be vital since many would involve him in the decision making and adherence to use.
P015 Parent and adolescent attitudes about parental involvement in clinical research
Susan L Rosenthal1, Ariel M de Roche1, Marina Catallozzi1, Lisa Ipp2, Jane Chang2, Carmen Radecki Breitkopf3, Jenny Francis1 and Mei-Chen Hu1
1Columbia University Medical Center, New York, NY, USA
2Weill Cornell Medical Center, New York, NY, USA
3Mayo Clinic, Rochester, MN, USA
Background: Understanding parent/adolescent attitudes towards parental involvement (PI) during clinical trials may foster participation.
Aim: To determine if demographic, adolescent sexual history or family climate were related to attitudes regarding PI.
Methods: As part of a study on willingness to participate in a hypothetical microbicide study, adolescents (14–17 years) and their parents (N = 301 families) were interviewed separately including completion of subscales (cohesion, conflict, moral-religious emphasis, expressiveness, organisation and control) of the Family Environment Scale, and a PI scale.
Results: Adolescents were 62% female, 72% Hispanic, 53% 16–17 years, 65% had no sexual experience beyond kissing. Factor analysis on the PI scale yielded two factors: LEARN, reflecting gaining knowledge about test results/behaviours (four items summed) and PROCEDURE, reflecting enrollment/permissions (four items summed). A score of 4 indicates agreeing to PI on all four items. Adolescents had a significantly lower LEARN mean score (M = 2.97) than parents (M = 3.73, p < .01), and a significantly lower mean PROCEDURE score (M = 3.07) than parents (M = 3.74, p < .01), indicating that adolescents believed in less PI. Adolescents who were female and had sexual contact beyond kissing had lower LEARN scores than males and those with less sexual experience; parents who were non-Hispanic and reported less moral-religious emphasis had lower LEARN scores than those who were Hispanic and had higher moral-religious scores. Adolescents who were older and reported less moral-religious emphasis had lower PROCEDURE scores; there were no significant predictors for the parents’ PROCEDURE score. There was no significant correlation between adolescents and their own parents on the LEARN scale; there was for the PROCEDURE scale (r = .16, p < .01).
Conclusions: Parents wanted greater involvement in the research process. Recruitment/retention may be enhanced by managing these differing expectations.
P016 Parents’ willingness to have their adolescents participate in microbicide safety studies
Marina Catallozzi1, Ariel M de Roche1, Mei-Chen Hu1, Jenny Francis1, Jane Chang2, Lisa Ipp2, Carmen Radecki Breitkopf3 and Susan L Rosenthal1
1Columbia University Medical Center, New York, NY, USA
2Weill Cornell Medical Center, New York, NY, USA
3Mayo Clinic, Rochester, MN, USA
Background: Little is known about parents’ willingness to have their adolescent participate (PWTAP) in phase I microbicide clinical trials.
Objective: To understand demographic and family characteristics associated with PWTAP.
Methods: Parents of 14- to 17-year-old adolescents were presented a hypothetical phase I microbicide study. Parents were interviewed regarding demographics, six subscales (cohesion, conflict, moral-religious emphasis, expressiveness, organisation and control) of the Family Environment Scale (FES), parental involvement during clinical trials and willingness to participate. PWTAP was assessed with a six-point Likert scale (1–6), with a score of 6 indicating ‘strongly agree’ with participation.
Results: The parents (n = 301 families) were 71% Hispanic, 25% thought their adolescent had sexual contact beyond kissing and 27% reported previous research participation. Their adolescents were 62% female and 53% were 16–17 years old. The mean PWTAP score was 3.4 (SD = 2.0); a score of 3 represents mildly disagree and a score of 4 indicates mildly agree. Adolescent gender, parent Hispanic ethnicity, six subscales of the FES and parental involvement in the research process were not associated with PWTAP. Parents who had adolescents who were 16–17 as opposed to 14–15 years (F(1,298) = 8.6, p < 0.01) and those parents that believed or were not sure if their adolescent had sexual contact as opposed to those parents who thought their adolescent had not had sexual contact (F(1,297) = 5.4, p < 0.01) had higher PWTAP scores.
Conclusions: Parents were more willing to let their older adolescents and those who have had sexual experiences participate in a microbicide safety study. Other demographic characteristics or aspects of the family climate were not were predictive of PWTAP. Future qualitative research should examine parental decision-making processes in order to develop better predictive models.
P017 Genital nodular scabies: empirical treatment as first attitude
Andreea Anton
Colentina Clinical Hospital, Romania
Background: Scabies is a parasitic disease considered as sexually transmitted infection as it may spread by close contact. It is an important health community problem, with some groups having a greater risk of acquisition. Clinical features range from few classical/atypical lesions to crusted, making it more difficult to diagnose, especially when laboratory testing is limited.
Aim(s)/Objective(s): Because specific lesions are not always seen and non-specific lesions are present more often with excoriation, inflammation and secondary infection, cases can be missed, leading to misdiagnosis. Besides, the abuse of topical corticosteroids by the patient before presenting to the doctor can change the clinical aspect and reduce itch, which is an important element in supporting diagnosis.
Methods: We present the case of a 34-year-old homosexual man with moderate itchy papules and nodules, slightly excoriated on the scrotum, penile shaft and pubic area, in evolution for two months. He self-administered topical corticosteroids for two weeks with no improvement. His partner accused no symptoms. We performed microscopic examination of skin flakes obtained by scraping from multiple lesions which were negative. We had no possibility for detecting S. scabiei DNA from cutaneous scales based on amplification by PCR or ELISA. So we proceeded with benzylbenzoate for the patient and his partner. There was a great improvement short time after.
Conclusions: We have to admit that most times laboratory investigations in scabies are limited due to false-negative results or costs that are prohibitive (PCR, ELISA). Delay of treatment increases the risk of spread, so the best option is to start treatment immediately, empirical, even though the patient can have doubts on what basis the doctor prescribes without complementary investigations. Our patient hesitated at first to accept this option, but in the end, he was pleased with the result.
P018 Sexual violence, alcohol use, hormonal contraception and psychological distress is associated with normal body mass index in adolescent women
Jane Champion
The University of Texas at Austin, USA
Background: Primary care-based interventions for sexual health promotion and reduction of sexual risk behaviour, substance use, psychological distress, unintended pregnancy, violence, sexually transmitted infection (STI)/human immunodeficiency virus and obesity may reduce health disparities among ethnic minority adolescent women, a particularly vulnerable, at-risk population.
Aim: Assess psychosocial and situational factors associated with high sexual risk behaviour, substance use, STI acquisition, body mass index (BMI) and violence occurrence for sexual health promotion intervention development.
Methods: African American (n = 94, 16.8%) and Mexican American (n = 465, 83.2%) women (14–18 years) with sexual risk behaviour, STI or violence histories, recruited from metropolitan health clinics for participation in a clinical trial of behavioural interventions, completed semi-structured interviews at study entry with follow-up BMI assessments at six and 12 months.
Results: Overweight/obesity status did not vary by ethnicity (38.1% Mexican American, 37.2% African American). Reports at study entry of ever using alcohol or experiencing sexual violence were associated with and predicted significantly lower BMI at six-month follow-up. Reports at study entry of ever using alcohol, ever experiencing sexual violence and recent or current use of hormonal contraception was associated with and predicted significantly lower BMI at six-month follow-up. Higher psychological distress measured via the CES-D and SCLR-90 identified significantly lower (normal) BMI at six- and 12-month follow-ups.
Discussion: Normal BMI was associated with sexual violence, alcohol use, hormonal contraception and psychological distress. Implications include modification of sexual health promotion interventions to enhance efficacy for prevention of violence, substance use, unintended pregnancy, obesity and STI among ethnic minority adolescent women.
P019 A critical comparison of three diagnostic techniques used for the detection of Trichomonas vaginalis in patients attending a sexual health clinic
Mohd Sabri Abu Bakar, Emma Parker and Henna Jaleel
Southend University Hospital, UK
Background: The British Association of Sexual Health and HIV (BASHH) has recommended nucleic acid amplification tests (NAATs) as the gold standard method of Trichomonas vaginalis (TV) detection in 2014 guidelines.
Aims: To compare the efficacy of traditional wet mount microscopy (WMM), culture and transcription-mediated amplification (TMA) by Aptima assay for the detection of TV in our local population. Cost-effectiveness of TMA and staffing requirements will also be assessed.
Methods: All female patients with vaginal discharge, male contact patients and males with persistent urethritis were included. Aptima high vaginal/cervical swabs routinely tested for chlamydia or gonorrhoea by TMA were used for Aptima TV testing as were urines samples. All swabs and urine samples had WMM performed and cultured in modified diamonds media. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive value were calculated based on using TMA as the gold standard. Staff time was calculated from a Biomedical Scientist (BMS) band 6 salary. The statistical significance was measured using McNemars test.
Results: In total, 436 patients were recruited. Of these 64 were male and 372 were female. Eleven 11 were positive by at least one method, including one male. All TMA-positive patients (N = 11) were also positive by urine except for one. TMA is the most sensitive detection method compared to culture (p = 0.0124) and WMM (p = 0.0043). There is no significant difference in sensitivity between WMM and culture (p = 0.25). TMA 100% PPV suggested that the results were true positive. TMA is the quickest, 13 times quicker than culture and 7.5 times quicker than WMM, but it is the most expensive test at >£5 per test, culture £1–£5 and WMM < £1. TV positivity rate in the study was 2.52%, gonorrhea (1.36%) and chlamydia (5.48%).
Conclusions: TMA is the most sensitive test with fast turnaround time and also suitable for female urine samples. However, its use is limited due to cost and suitability for other samples, e.g. in male patients. Higher TV positivity rate in the local population may indicate that using less sensitive traditional methods may have underestimated its true prevalence.
P020 Chlamydia trachomatis genotype L2 infections in rectal, urethral and cervical samples
Teresa Puerta1, Mario Jose Rodriguez2, Blanca Menendez1, Oscar Ayerdi3, Mar Vera1, Petunia Clavo1, Carmen Rodriguez1, Juan Carlos Galan2 and Jorge Del Romero1
1Centro Sanitario Sandoval, Comunidad de Madrid, IdISSC, Spain
2Servicio de Microbiología, Hospital Ramón y Cajal, CIBERESP, IRYCIS, Spain
3Fundación Jiménez Díaz, Spain
Background: Last four years and ongoing outbreak of lymphogranuloma venereum (LGV) has been detected in men who have sex with men (MSM) across Europe. Acute proctitis is the most common symptom and is frequently associated with positive HIV serostatus.
Objective: To describe clinical and epidemiological characteristics of LGV cases detected in Madrid including less common locations as urethra and cervix.
Material and Methods: Between 2009 and 2013, 26,433 samples were processed for molecular detection of Chlamydia trachomatis (CT) by commercial methods (Abbott m2000rt). Anatomical locations of samples were rectum (6594), urethra (4843), cervix (9173) and pharynx (5820). L-genotypes detection, associated to LGV, was performed by and in-house real-time PCR. Positive results were confirmed by ompA gene sequencing.
Results: Overall, 2401 (9%) samples were positive for CT, from which 231/2401(9.6%) also were positive for L-geotypes including 204 (88.3%) from rectum, 21 (9%) from urethra, six (2.5%) from cervix and no one from pharynx. Relative to rectal location, 90% of the patients presented with acute proctitis, all of them were MSM, except one woman; from these, 82% were HIV positive, 42% not receiving highly active antiretroviral therapy (HAART) and more than 50% presented with concomitant sexually transmitted disease (STD). From urethral cases, 62% were MSM, 28.5% HIV positive and 14% unknown and 33% with concomitant STD, all of them presented with clinical symptoms except two that were included for contact study. Relative to cervical cases, no one was HIV positive, and all of them referred mild or no symptoms.
Conclusions: Ongoing detection of CT L-genotypes on rectal samples, together with increased detection in other locations as urethra an cervix, confirms that LGV outbreak is completely established in Madrid, at least in MSM population with increased risk of affecting heterosexual ones. This scenario, with public health implications, justifies the implementation of surveillance and screening programmes mainly in high-risk populations.
P021 Epidemiology, clinical characteristics and late diagnosis of HIV infection in an STI Unit in Barcelona (Spain)
Lucía Miguel Escuder1, Estrella Caballero2, Maider Arando3, Pere Armengol3, Martí Vall3 and Maria Jesús Barberá3
3Sexually Transmitted Infections Unit, Drassanes-Hospital Universitari Vall d'Hebron, Spain
Background: Early diagnosis of HIV as well as other sexually transmitted infections (STIs) is one of the main objectives of STIs Units (STIU). In recent years, newly diagnosed HIV is increasing particularly among men who have sex with men (MSM), probably due in part to earlier diagnosis in this group.
Objectives: The aim of this study is to evaluate the epidemiological and clinical data, and delayed diagnosis in our STIU.
Methods: In this retrospective observational study, all newly diagnosed HIV infections during 2014 were included. Socio-demographic, epidemiological and clinical data were recorded. The frequency of late diagnosis (LD; CD4 < 350 cells/mm3) and advanced disease (AD; CD4 < 200 cells/mm3) were analysed.
Results: A total of 85 patients were diagnosed of HIV infection during 2014. Hundered percent were men (age median = 33) and most of them (85.9%) were MSM. Nearly half (52.9%) were diagnosed by a routine screening. Of these, 82.4% cases had a previous negative HIV serology (56.4% in the last year); 18.8% had acute symptomatic disease; 38.8% had acquired infection in the last year. CD4 median at diagnosis was 585 cells/mm3, with a median viral load of 80,000 copies/ml. Fifty-four percent (n = 46) had more than 500 CD4 at diagnosis. Only 11.8% of cases were considered LD and 4.7% AD (but four of them with <350 CD4 belonged are acute infections); none of them had an opportunistic disease. In 46 cases analysed (54.1%), 3.1% of total had some primary drug-resistance mutation (NNRTI), and 48.2% were HIV-1B subtype. Antiretroviral treatment (ART) was initiated in 47% of patients. Results are summarised in Table 1.
Conclusions: In our STIU, 16.5% had less than 350 CD4 at diagnosis, while the LD frequency in MSM in Spain is 40.6% and in Europe 34%. This study reveals the importance of STIU and routine screenings in MSM to increase the early diagnosis rate of HIV, with a clear impact in reducing transmission and morbi-mortality.
P022 A validation study of a clinical prediction rule for screening asymptomatic chlamydia and gonorrhoea infections among heterosexuals in British Columbia
Titilola Falasinnu1, Mark Gilbert2, Paul Gustafson1 and Jean Shoveller1
1University of British Columbia, Canada
2Ontario HIV Treatment Network, Canada
Background: One component of effective sexually transmitted infection (STI) control is ensuring those at highest risk of STIs have access to clinical services because terminating transmission in this group will prevent the most future cases.
Objectives: Here, we describe the results of a validation study of a clinical prediction rule for identifying individuals at increased risk for chlamydia and gonorrhoea (CT/GC) infection derived in Vancouver, British Columbia (BC) against a population of asymptomatic patients attending sexual health clinics in other geographical settings in BC.
Methods: We examined electronic records (2000–2012) from clinic visits at seven sexual health clinics in geographical locations outside Vancouver. The model’s calibration and discrimination were examined by the area under the curve (AUC) and the Hosmer–Lemeshow (H-L) statistic, respectively. We also examined the sensitivity and proportion of patients who would need to be screened at different cutoffs of the risk score.
Results: The prevalence of infection was 5.3% (n = 10,425) in the geographical validation population. The prediction rule showed good performance in this population (AUC, 0.69; H-L p = 0.26). Possible risk scores ranged from −2 to 27. We identified a risk score cutoff point of ≥8 that detected cases with a sensitivity of 86% by screening 63% of the geographical validation population.
Conclusion: The prediction rule showed good generalisability in STI clinics outside of Vancouver with improved discriminative performance when compared to temporal validation. The prediction rule has the potential for augmenting triaging services in STI clinics and enhancing targeted testing in population-based screening programmes.
P023 What is the link between recurrent herpes labialis and the acquisition of herpes simplex virus type 1 genital herpes?
Sergio Delmonte1, Elena Stroppiana2, Sabrina Rondoletti2, Anna Verrone2, Francesca Sidoti2, Giulia Ciccarese3, Cristina Costa2, Francesco Drago3, Ivano Dal Conte4 and Maria Laura Stella4
1AOU Città della Salute e della Scienza, Italy
2AOU Città della Salute e della Scienza di Torino, Italy
3Ospedale San Martino di Genova, Italy
4Ospedale Amedeo di Savoia, Italy
Background: Genital herpes (GH) caused by herpes simplex virus type 1 (HSV-1) infection is an increasing cause of consultation especially in younger populations, whereas recurrent herpes labialis (RHL) remains a very common disease. The decreasing incidence of primary HSV-1 infection during childhood, acquiring infection by sexual activity at a younger age and the increased frequency of oral sex are considered to be the major determinants. However, the role of RHL in the acquisition or manifestation of GH is not clear.
Objectives: To study the influence of a history of RHL and HSV-1 serology in acquiring GH among people attending STI units.
Methods: Between 2011 and 2014, patients with newly diagnosed GH attending STI Units in Turin and Genoa were enrolled. HSV PCR and specific HSV-1 serology at their first consultation were performed. Patients with PCR-confirmed HSV-1 GH were interviewed on their previous recurrent episodes of herpes labialis (at least three episodes in their life), and previous GH history.
Results: The study population was divided into three groups according to serologic results and medical history: seropositive patients with a history of RHL and GH (group 1), seropositive patients without any history of herpes labialis but with GH (group 2) and seronegative patients with GH (group 3). Totally, 142 patients with HSV-1 genital herpes were studied. Most patients (95%) did not report any history of RHL of which 65% had a negative serology for HSV-1 and 30% had a positive serology. Only 5% of patients reported a story of RHL.
Conclusions: Recurrent herpes labialis seems to protect from the acquisition of genital herpes by HSV-1, whereas HSV-1-positive serology status does not play any role in protection. Knowing this has an important implication in counselling: a history of RHL is highly protective for the acquisition of genital HSV-1 infection. Serology is of little help as it is when genital herpes is caused by HSV-2.
P024 Spread molluscum contagiosum revealing a congenital immune deficiency: dedicator of cytokinesis 8 deficiency gene
Introduction: Dedicator of cytokinesis 8 (DOCK8) deficiency is a rare inherited immune deficiency linked to autosomal recessive mutations of DOCK8 gene. It is characterised by recurrent bacterial and viral skin infections, susceptibility to cancers, lymphopenia and elevated serum IgE. DOCK8 deficiency is a combined immunodeficiency molecularly characterised in 2009.
Case Report: A 4-year-old child born to consanguineous parents suffers since the age of six months from eczema dermatitis superinfected by molluscum contagiosum spread all over the body. The evolution of the skin lesions was marked by the installation of a very itchy dry erythroderma and Staphylococcus aureus abscesses in the trunk and limbs. The patient also presented recurrent ENT infections and multiple food allergies. He also has failure to thrive at −4 SD and a leonine facies. Laboratory tests objectified lymphopenia (2000 cells/mm3), eosinophilia (21,000 cells/mm3) and hyper IgE (16,000 IU/ml). The analysis of lymphocyte populations by flow cytometry identified CD4 + and CD8 + lymphopenia. All these abnormalities guide to a combined immunodeficiency. Genomic multiplex ligation-dependent probe amplification (MLPA) analysis revealed a large homozygous deletion of DOCK8 gene from exon 6 to 20. The same mutation was identified in the heterozygous state in the mother. The child died from severe bacterial septicemia after one-year follow-up.
Discussion: The combined immune deficiency by DOCK8 deficiency is caused by homozygous deletions or heterozygous recessive that lead to the absence of DOCK8 protein and thus lymphopenia CD4 + and functional abnormalities of CD8 + T lymphocytes including a lack of antiviral cytokine production (TNFa, INFγ) and therefore increased neoplasia and susceptibility to severe cutaneous viral infections. The disease occurs in childhood with severe atopic dermatitis, upper and lower respiratory tract infections and recurrent viral and bacterial skin infections including extended herpes infections, warts (HPV), molluscum contagiosum and bacterial skin infections, including S. aureus, eosinophilia and elevated serum IgE.
Conclusion: Our case, added to the few described in the literature, reflects the large spectrum of mutations leading to this deficit and highlights the importance of regular monitoring of secondary infections and skin neoplasia risk.
P025 Effective treatment of lymphogranuloma venereum with 1 g azithromycin administered weekly for three weeks in HIV-infected population
Irene Fuertes de Vega, José Luis Blanco Arevalo, Jordi Bosch Mestres, Anna González Cordon, Esteban Martínez, Andrea Vergara Gómez, Teresa Estrach Panella, Josep Maria Gatell and Mercè Alsina Gibert
Hospital Clínic de Barcelona, Spain
Background: Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis serovar L 1-2-3. Doxycycline remains the regimen of choice for this infection. No controlled trials support the use of alternative treatment. Azithromycin (1 g orally once weekly for three weeks, prolonged azitromycin regimen, PAzR) is likely to be effective against this infection, but limited clinical data are available on this treatment. We decided to evaluate treatment with oral PAzR in patients presenting with.
Methods: We conducted a longitudinal prospective study between June 2010 and March 2015 including patients with any clinical suspicion of LGV. All patients received a dose of 1 g intramuscular ceftriaxone but were aleatorily assigned to receive, if LGV was detected at visit 1 (day + 7): (i) oral doxycycline 100 mg twice a day for 21 days or (ii) azithromycin 1 g orally once weekly for three weeks. Participants from azitromycin group were weekly microbiology assessed by real-time multiplex polymerase chain reaction (M-PCR) (visit 2, day + 14; visit 3, day + 21; visit 4/end of the study, day + 28).
Results: Ninety-one patients were included; 100% were men who have sex with men. Eighty-six patients (95%) were HIV-positive, and 68 patients (75%) had an undetectable viral load. Seventeen patients (19%) were simultaneously diagnosed with other STIs. Thirty-five patients were included in the doxycycline group and 53 in the PAzR-group. All patients who completed correct regimens, 34 to 35 and 51 to 53 in the doxicyclin and PAzR groups, respectively, were clinically responders. All but two – both in PAzR group and with a good clinical response – tested for M-PCR LGV, presented microbial cure during the treatment. No adverse events related to anyone of the treatments were reported.
Conclusions: Our findings point out that prolonged azithromycin regimen may be warranted for successful treatment of LGV in HIV-infected population.
P026 Nifuratel: an effective drug in bacterial vaginosis treatment
Mikhail Gomberg and NI Chernova
Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Russian Federation
Background: Bacterial vaginosis (BV) is the most common cause of abnormal discharge in women of childbearing age. The diagnosis is based on the Amsel criteria although a microbial spectrum analysis could be used. Atopobium vaginae (Av) has been reported to be associated with BV in around 80% of the cases. It may form biofilms together with Gardnerella vaginalis (Gv) and could be one of the causes of the therapeutic failures.
Aim(s)/Objective(s): The cure rate of BV, associated with Av, was assessed after oral or vaginal treatment with two different formulations of nifuratel.
Methods: Ninety-seven women with BV, diagnosed by Amsel criteria and/or the PCR kit (Florocenosis), were orally treated with nifuratel tablets 200 mg × three times daily for five days (total dose 600 mg, 53 patients, group 1), or with an intravaginal combination of nifuratel 500 mg and nystatin 200,000 IU, one suppository daily for eight days (44 patients, group 2). Tests on the cure rate, to assess the proportion of patients negative to Gv, Av and clue cells, were performed after the end of treatment.
Results: The eradication rate of BV in groups 1 and 2 was 96.2% (51/53) and 97.7%, (43/44), respectively. In both groups, the results were statistically significant compared to the baseline (p < 0.0001). All patients, in whom BV was diagnosed by Amsel criteria (41 in group 1 and 42 in group 2), were cured after treatment. Considering women, in whom BV was diagnosed by PCR kit, 10 out of 12 were cured from group 1 and one out of two from group 2, while three patients were lost to follow-up. Gv, clue cells and Av, when present at baseline, were eradicated in all cases.
Conclusion: The results suggest that nifuratel, when used either orally or intravaginally, is effective in BV. Av was eradicated in all patients treated.
P027 Reinfection risk behaviour in HIV-HCV coinfected in men who have sex with men
Nono Jennifer Igwe1, Renata Fialho2 and Martin Fisher3
1Brighton and Sussex Medical School, UK
2School of Psychology, University of Sussex, UK
3School of Psychology, University of Sussex, Sussex Partnership NHF Foundation Trust, UK
Background: An increase in sexually transmitted hepatitis C virus (HCV) has been observed in men who have sex with men (MSM). Little is known about the factors that contribute to HCV reinfection, and the aim of our study was explore the incidence of reinfection and sexual transmitted infections (STIs) diagnosed in those with and without reinfection.
Methods: Eligible participants were HIV-infected MSM, acutely infected with HCV (AHCV), from 2000 to 2014, who either sustained viral clearance through treatment or spontaneous clearance (SC) six months before the first HCV episode. Reinfection was defined as a genotype switch or newly detectable HCV viraemia six months or more post-treatment or SC. The number of sexual health screens and STIs were recorded for the two years prior to and after the first episode of HCV.
Results: We identified 82 HIV/HCV MSM, of whom 12% were reinfected. In the two years prior to AHCV, the total number of STIs was 145 (21% seen in those with subsequent reinfection), 13% at the time of AHCV and 25% two years thereafter. The mean number of STI screens two years before HCV infection was 2.89 compared with only 1.73 STI screens in the two years after (p = 0.000). The rate of SC at first-episode HCV was higher in those subsequently reinfected (50%) compared to those with a single episode (16%; p = 0.01).
Conclusion: These findings highlight that regular sexual health screening and risk-reduction strategies for those with acute HCV may play a role in reinfection. Rates of SC at first episode of HCV were higher in those who subsequently became reinfected, suggesting that either treatment confers protection or more likely that interferon-containing treatments may result in risk reduction.
P028 Pulsed dye laser versus Nd:YAG laser in the treatment of external genital wart: a comparative randomised clinical study
Shady Ibrahim
Al-Azhar University Hospitals, Egypt
Background: Genital warts are benign manifestations of human papillomavirus (HPV) that can cause discomfort and significant patient distress. To date, therapies for condylomata acuminata of the male genital are known for high recurrence rates and bothersome side effects.
Objective: To compare the clinical outcomes in the treatment of genital warts on the male external genitalia using pulsed dye laser (PDL) versus Neodymium:Yttrium Aluminum Garnet (Nd:YAG) laser.
Methods: The study included 32 male patients with multiple genital warts, from June 2013 to January 2015. In each patient, lesions were divided into two groups: group A was treated with Nd:YAG laser (spot size, 5 mm; energy, 80 J/cm2 and pulse duration, 20 ms). Group B was treated with PDL (spot size, 5 mm; energy, 15 J/cm2 and pulse duration, 0.5 ms). Laser sessions were applied every two weeks with maximum of three sessions. Clearance rate, recurrence rate and complications were evaluated and compared.
Results: The study included 32 male patients with a mean age of 29.6 ± 7.34 years. The cure rate was 76.25% with PDL-treated sites (group A) with significant difference from Nd:YAG laser treated sites (group B) (88.75%) (p < 0.005). Relapse was recorded in eight patients (25%) in group A compared with 13 patients (40.62%) in group B with no significant difference (p = 0.18). There was a significant difference between complication rates between both laser types which was higher in group B. The main complications with Nd:YAG included haematoma (28.12%), hyperpigmentation (21.8%) and hypopigmentation (34.3%). Pain score was significantly higher with Nd:YAG laser than PDL.
Conclusion: Both PDL and Nd:YAG laser are effective therapeutic modalities for genital warts, but there were higher cure rate and less recurrence rate with Nd:YAG laser. Additionally, Nd:YAG laser was more painful and showed higher susceptibility to complications compared to PDL.
P029 Leucocyte esterase urine tests in men who have sex with men with urethritis symptoms; the answer towards more efficient gonorrhoea antibiotic use?
Geneviève van Liere1,2, Amanja Verhaegh-Haasnoot1, Nicole Dukers-Muijrers1,2, Christian Hoebe1,2, Petra Wolffs2 and Marita Werner1
1Public Health Service South Limburg, Netherlands
2Maastricht University Medical Center (MUMC+), Netherlands
Background: Urethritis symptoms and discharge are known to be associated with urogenital Neisseria gonorrhoeae (NG) infection. Rapid diagnosis and adequate treatment are preferred to cure the symptoms and reduce the risk of transmission, especially in a high-risk population, i.e. men who have sex with men (MSM). Point-of-care tests, such as microscopy to detect or rule out NG, could be useful in this matter. Other point-of-care tests may be useful when microscopy is unavailable.
Objective: To determine the sensitivity of using leucocyte esterase (LE) urine tests for NG in symptomatic MSM.
Methods: Data from the sexually transmitted infection (STI) clinic South Limburg 2011–2013 were used to identify MSM presenting with urethritis symptoms. LE tests (negative, +, ++, +++) were performed, and MSM were tested for NG using nucleic acid amplification test (NAAT). MSM with a positive LE test were directly treated for NG, according to guidelines.
Results: A total of 135 MSM presented with urethritis symptoms; 20.9% (n = 23) reported discharge. Prevalence of urogenital NG was 12.6% (n = 17). The proportion NG positivity increased with higher number of leucocytes (LE + 3.7% [1/27], LE ++ 25.0% [4/16] and LE +++ 35.3% [12/34], p < 0.001). Overall sensitivity of the LE test was 100%, specificity was 49%; for LE test >+, this was 94% and 71%, respectively.
Conclusions: The LE test was 100% sensitive for urogenital NG and could be a valuable tool to rule out urogenital NG in a low resource setting, i.e. without direct microscopy available. Deferring from blind NG treatment of symptomatic MSM with a single + LE test may be recommended to avoid overtreatment (96%, 26/27). This could be useful in settings where there is a high treatment attendance, and NG would be treated according to NAAT result within a reasonable time.
P030 Patients with genital herpes infection have an educational deficit regarding how to prevent further transmission
Rhys Owens1, Emily Clarke2, Rajul Patel2 and Sogha Khawari1
1University of Southampton, UK
2Solent NHS trust, UK
Background: The IUSTI European guidelines state that patients receiving a diagnosis of genital herpes should receive clinician-led counselling. This is usually in the form of reassurance and information providence, covering numerous topics, during routine clinic appointments.
Aims: To assess patients’ perception of genital herpes counselling by clinicians and how informed patients feel about genital herpes. To assess patients’ knowledge of topics in herpes which IUSTI guidelines recommend information should be provided about.
Method: A total of 25 patients attending a level 3 UK sexual health service completed a survey assessing their perception of counselling quality and topics covered, and a knowledge assessment.
Results: Eighty-eight percent of patients felt that ‘not enough’ time was dedicated to the providence of counselling by clinicians and favoured further counselling in the areas of treatment options and psychological management. Knowledge assessment results demonstrated that only 27% of patients (10% of males) were aware that it is possible to transmit genital herpes when using a condom correctly, and only 35% were aware that the herpes virus can be transmitted from an individual that has not experienced symptoms. Forty-eight percent were either unaware or unsure about being able to transmit the herpes virus whilst not experiencing symptoms themselves.
Conclusion: Patients feel that they would benefit from further information providence regarding treatment options and the psychological impact of herpes simplex virus (HSV) infection. Whilst this is important at the time of diagnosis and aids adjustment, the educational deficit of patients regarding transmission risk and subclinical shedding needs to be addressed. Counselling should be seen as an ongoing process to patients who regularly attend sexual health clinics to help patients reduce their risk of further transmission.
P032 Topical cidofovir to treat high-grade anal intraepithelial neoplasia in HIV-infected patients (CIDAN12)
Elena Sendagorta1, Rosa Feltes1, Jose I Bernardino1, Jose A Perez-Molina2, Ander Mayor1, María Yllescas3, María J Beato1 and Pedro Herranz1
1Hospital Universitario La Paz, Spain
2Hospital Universitario Ramón y Cajal, Spain
3Fundación SEIMC-GESIDA, Spain
Background: Anal squamous intraepithelial neoplasia (anal HSIL) incidence is increased in HIV-infected patients, especially in men who have sex with men (MSM). There have been few prospective trials evaluating new therapeutic options for anal HSIL.
Objective: To evaluate the effect of topical cidofovir 1% cream for treatment of anal HSIL in HIV-positive individuals.
Methods: Unicentric pilot clinical trial including 15 HIV MSM diagnosed with anal HSIL by means of high-resolution anoscopy and biopsy. Patients received intranal cidofovir 1% cream three nights per week during four weeks. Assessment with high-resolution anoscopy (HRA) and biopsy was performed in all patients after completion of treatment at eight and 20 weeks. Complete response (CR) was defined as clinical and histological remission, and partial response (PR) as the evolution to low-grade SIL (LSIL) or the reduction of at least 50% of the area of HSIL. The primary endpoint of the study was the percentage of patients achieving a CR at eight weeks post-treatment.
Results: Baseline characteristics: median (IQR) age was 36 years (28.75–43.25), median (IQR) CD4+ count was 508.5 cells/mm3 (358–629.75) and viral load <50 copies/ml in 93.75%. At eight weeks, 10/15 patients (66%) achieved CR. At 20 weeks, seven of the 10 (70%) patients remained in CR, but 20% had a recurrence. Three patients with persistent HSIL at eight weeks improved at week 20 (one downgraded to LSIL [PR] and two CR). A reduction in the number of human papillomavirus (HPV)-viral genotypes was observed, from 5.2 to 2.73 at eight weeks (p = 0.002). No systemic adverse effects were observed; 81.25% had local adverse effects (pruritus, burning, pain), but no patient withdrew from the study.
Conclusions: Topical cidofovir 1% could be a therapeutic alternative in HIV-infected patients with high-grade anal intraepithelial neoplasia (AIN).
P033 Evaluation of female genital mutilation in a sexual health clinic
JH Leighton, CA Whitfield MA and MA Kingston VK Shafiq
NHS Trust, UK
Background: Female genital mutilation (FGM) is widely regarded as a form of child abuse. There is significant physical and psychological trauma with immediate sequelae including pain, bleeding and emotional distress, and subsequently the development of gynaecological and mental health problems. It is illegal to perform FGM in the UK or to send children abroad for the procedure, but there is evidence that this is occurring with no consequences for those responsible. Multi-agency guidelines were developed in 2014 to address this problem including national reporting for women who had undergone FGM.
Aims: We produced a policy to incorporate the required mandatory reporting, to ensure appropriate clinical assessment of women with FGM, and assess safeguarding concerns including the risk of girls in their families being subjected to it. A departmental assessment proforma and trust-wide clinical pathway were developed by a team of local safeguarding experts. These were adopted in November 2014, and we present an initial evaluation of this policy.
Methods: Retrospective case review.
Results: Nine women (median age 33 years) who had undergone FGM were assessed; all were black African. Eight were identified on examination; one volunteered the information, and one was unaware she had ‘been cut’. The procedure had been performed overseas in all before 11 years of age. Most had type 3 or 4 FGM, and four had developed gynaecological complications. Four were HIV positive; no other acute sexually transmitted infections were found. All women stated they were ‘against’ the practice and two required safeguarding referral.
Discussion: Sexual health services are ideally placed to identify those affected by FGM and to provide initial medical and safeguarding assessments and, when required, to refer on to others. We believe that our policy provides a pragmatic framework which effectively and safely assesses women with FGM and associated risk to related female children.
P034 Description of epidemiological, microbiological and behavioural characteristics of 101 patients infected with gonorrhea and diagnosed between 2009 and 2014 in a sexually trasmitted infection unit
Irene Fuertes de Vega, Carola Baliu Piqué, José Luis Blanco Arevalo, Jordi Bosch Mestres, Anna Gonzalez Cordon, Andrea Vergara Gómez, Francesc Marco and Merce Alsina Gibert
Hospital Clínic de Barcelona, Spain
Gonorrhea is a sexually transmitted infection with a high incidence and significant associated morbidity. This bacterium has been able to create resistance to all antibiotics prescribed for its treatment. However, nowadays in Europe, few data regarding risk factors associated with antibiotic-resistant Neisseria gonorrhoeae are available.
Objetives: To describe the epidemiological, microbiological and behavioural characteristics of patients infected with gonorrhea. Comparing these characteristics between patients infected with antimicrobial-resistant (AMR) gonorrhea to those with sensitive infection.
Methods: We reviewed data from 286 gonococcal isolates for which susceptibility study was available. Finally, we included 101 patients from whom epidemiological and behavioural data were available. Susceptibility to third-generation cephalosporins, quinolones, penicillin and spectinomycin was available for all samples, and susceptibility to macrolide was available for 46% of samples.
Results: Ninety-five percent of patients were male, and 60% were Spanish. Forty-two percent of patients were infected with HIV at the time of diagnosis. Thirty-eight percent of all samples showed no antimicrobial resistance (NAMR) for any of the antibiotic tested. Fifty-one percent showed ciprofloxacine resistance, 10% showed penicilline resistance, 9% showed third-generation cephalosporins resistance and 6% showed azithromycin resistance. No spectinomycin resistance was observed. Fifty-two percent patients with NAMR gonorrhoeae infection were HIV+ while the percentage of HIV+ was 37% in patients with AMR infections. AMR gonococcal infection was associated with heterosexual males (77%).
Conclusions: Ciprofloxacine, azythromicin and penicillin must not be used for treating gonorrhea in our patients. Isolates showing antibiotic resistance were associated with infection in heterosexuals and concurrent infection by other sexually transmitted infection (STI), especially by chlamydia. However, there were more HIV+ among patients with isolates that showed NAMR gonoccocal infection. Patients with AMR infection reported more sexual risk behaviours comparing with patients with NAMR infection. Patient with isolates that showed ciprofloxacin resistance were more likely to have been previously infected with other STI different from HIV.
P035 PelvoCheck® CT/NG: a new amplification assay for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in women
Angelika Stary, Martina Mück, Gudrun Heidler, Julia Hofstetter, Cornelia Zettl and Diyani Dewasurendra
Outpatient’s Centre for Diagnosis of Infectious Venereodermatological Diseases, Austria
Background: Detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women by using cervical and vaginal swabs tested with nucleic acid amplification tests (NAATs) is well established. In the present study, the Greiner Bio-One PelvoCheck® CT/NG, a microarray-based nucleic acid amplification assay, was evaluated for the detection of chlamydial and gonococcal infections in cervical and vaginal swabs sampled with the Greiner Bio-One PelvoCheck® Swab Collection Kit.
Methods: Of a total number of more than 700 women, the PelvoCheck® CT/NG was compared with the AC2 assay and the Abbott RealTime CT/NG analysing 228 cervical and 225 vaginal swabs. In addition, to increase the CT and NG prevalence, a subset of swabs were spiked with CT reference material (25 vaginal and 25 cervical) and NG reference material (46 cervical and 44 vaginal) mimicking the natural distribution in cervical and vaginal swabs. Furthermore, the suitability of the PelvoCheck® Swab Collection Kit for sampling of the cervical and vaginal swabs, and subsequent testing with, was verified.
Results: For CT, the negative and positive concordance of PelvoCheck® CT/NG and the AC2 assay for cervical swabs was 100% and 94.8%, respectively, and 100% and 92.7%, respectively, for vaginal specimens. For NG, a 100% overall agreement was demonstrated for all cervical and vaginal specimens. When comparing the PelvoCheck® CT/NG with the Abbott RealTime CT/NG, the corresponding concordant data for CT for cervical and vaginal swabs were 99.4% and 99.3% for negative results, and 97.3% and 98.7%, respectively, for positive results. For NG, an even higher agreement was observed for positive and negative results in all specimens.
Conclusion: The data of the comparison study of the Greiner Bio-One PelvoCheck® CT/NG with the AC2 and the Abbott RealTime PCR demonstrate that the new technology can be recommended for the diagnosis of both, chlamydial and gonococcal infections in women by using cervical or vaginal specimens.
P036 Efficacy of nifuratel in Trichomonas vaginalis treatment
Nadezhda Chernova1 and Mikhail Gomberg2
1Moscow State Medico-Stomotological University, Russian Federation
2Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Russian Federation
Background: Trichomoniasis (T) is the most prevalent non-viral sexually transmitted disease in women. Drugs of choice to treat T are 5-nitroimidazoles. There is a demand for alternative treatment especially in case of metronidazole-resistant Trichomonas vaginalis (Tv) infections. Nifuratel is a nitrofuranic drug with a proven activity against Tv and anaerobes.
Aim(s)/Objective(s): The eradication rate of Tv after systemic treatment with nifuratel was assessed in women with T and concomitant sexual infection diseases.
Methods: Thirty-one women with T, aged ≥18 years, were orally treated with nifuratel sugar-coated tablets 200 mg, 2 × three times daily (1200 mg/day) for five days, followed by 2 cpr two times daily (800 mg/day) for the next five days.
Results: The Tv eradication was achieved in 96.8% (30 out of 31) of patients (p < 0.0001 vs. baseline). Only one woman was still positive at the end of treatment.
Conclusion: Oral nifuratel is an effective alternative to nitroimidazoles in the treatment of T infection, and it is a valid approach in the treatment of mixed bacterial or fungal infections associated to T. vaginalis.
P037 Testing for rectal chlamydia and gonorrhea in women reported receptive anal intercourse
Mohamed Ghanem, Darren Cousins, Denise Migliorini and Lynn Riddell
NHFT, UK
Background: The prevalence of sexually transmitted infections (STIs) continues to increase in the UK. Women are at increased risk of acquiring and transmitting STIs. Infections in the rectum are under-diagnosed and are likely to account for continuing transmission.
Aims: To determine the prevalence of rectal chlamydia and gonorrhea in women who reported receptive anal intercourse (RAI) and to assess the value of testing for rectal chlamydia and gonorrhea in women practice RAI.
Methods: In 2012, the Northamptonshire Sexual Health Services introduced the routine offer of STI testing for rectal chlamydia and gonorrhea in women who practice RAI. The dual probe, Becton Dickinson viper assay, was used for rectal and vaginal specimens. We carried out a retrospective review of the medical records of all women tested for rectal chlamydia and gonorrhea from January 2014 to December 2014. The data collected included epidemiological characteristics, symptoms and swab results.
Results: Of 384 women with both rectal and vaginal tests, test results were positive in 21% for rectal chlamydia or gonorrhea and 20% for vaginal chlamydia or gonorrhea. Rectum was the only site of chlamydia and gonorrhea infection in seven and three women, respectively. Both women with only rectal gonorrhea had genital symptoms. Doxycycline was used in 81% of patients with rectal chlamydia. Test of cure was carried out in 26% of women with rectal infection, and two patients had positive chlamydia results despite been initially treated with doxycycline.
Conclusion: Women reported RAI have a high risk of vaginal and rectal chlamydia or gonorrhea infection. In absence of rectal chlamydia result, doxycycline should be considered as first line for treatment of positive/suspected vaginal chlamydia in this group of service users. More studies are required to assess the value of rectal gonorrhea testing in asymptomatic women reported RAI.
P038 Evaluation of equivocal syphilis serology in an inner city sexual health clinic
Helen Colver and Manjula Pammi
Nottingham City Hospital, UK
Background: Equivocal syphilis test results generate confusion for physicians and anxiety for patients. Such a result may be either a biological false positive (BFP), a sign of early infection or due to a waning immune response to previous syphilis. It is important for clinicians to recognise the implications of an equivocal syphilis result and to manage such a result appropriately.
Aims: To establish the characteristics of patients with equivocal syphilis results in an inner city sexual health clinic, and to investigate their clinical course and management.
Methods: A retrospective case note review was performed of all patents with equivocal syphilis results over a 12-month period (2013–2014) identified from the pathology database. Equivocal syphilis serology was defined as a treponemal enzyme immunoassay (EIA) test positive to any degree, with negative Treponema pallidum particle agglutination assay (TPPA) and rapid plasma reagin (RPR) tests.
Results: In total, 61 patients had at least one equivocal syphilis result during the period studied. Case notes were available for 54 of these patients, whose diagnoses are listed below.
Diagnosis
Male
Female
Total (%)
Yaws
1
0
1 (2%)
Past history of syphilis
19
1
20 (37%)
New syphilis
4
1
5 (9%)
BFP
17
11
28 (52%)
BFP: biological false positive.
Two of the five patients who subsequently developed positive syphilis serology had signs of primary syphilis at first presentation and the other three had risk factors for syphilis acquisition. Twelve (43%) patients in the BFP group had no identifiable risk factors for syphilis infection, and 10 (36%) had a possible cause for BFP including pregnancy and HIV infection. Sixteen of 28 (57%) had a repeat test at least 12 weeks after their initial sample to cover the window period suggested in the 2008 UK Syphilis Guidelines. None of the repeat tests were syphilis positive.
Conclusions: Patients with no features of early syphilis and at low risk of infection can be reassured that their equivocal result is likely to be a BFP, although they should be followed-up appropriately.
P039 The golden years: a study of co-morbidities in an HIV-positive ageing population
Kanchana Seneviratne and Manjula Pammi
Nottingham University Hospitals NHS Trust, UK
Background: Accelerated ageing in HIV is associated with co-morbidities emerging earlier despite antiretroviral therapy. Older individuals are at increased risk of cardiovascular disease (CVD), reduced bone mineral density (BMD) and drug interactions due to poly-pharmacy.
Aim: To assess the negative impact of ageing in older HIV-positive individuals with an emphasis on co-morbidities.
Method: HIV-positive individuals >44 years attending clinic over a six-month period were invited to complete a questionnaire. This was followed by a retrospective review of their case notes. Data were collected on demographics, medication, menopause, prostatic and erectile dysfunction symptoms. The 10-year CVD risk was calculated using Q risk and osteoporosis risk was calculated using the Frax score.
Results: Forty-nine of 53 (10 women, 39 men) >44-year-olds attending clinic in the six-month period of the study completed the questionnaire and had their notes reviewed. Median age was 52 years (range 45–71). Ninety percent were heterosexual, and 90% were black African. Twelve percent were using recreational drugs, and 20% had an AIDS diagnosis. Seventy-eight percent of women complained of peri-menopausal symptoms for which none were on hormone therapy. Forty-one percent of men described erectile dysfunction symptoms for which 25% were on medication. Forty-three percent (21) were 45–50 years (group 1), and 57%(28) were >50 years old (group 2). Mean years with HIV was 9 in group 1 and 12.6 in group 2, p > 0.05. Mean years on antiretrovirals was 6.6 in group 1 and 9.5 in group 2, p > 0.05. The 10-year CVD risk was 4.5 in group 1 versus 11 in group 2 (p < 0.05). The 10-year probability of fracture without BMD scan for major osteoporosis was 3.75 versus 4.92 (p < 0.05) and for hip fracture was 0.36 versus 0.81 (p < 0.05) for group 1 versus group 2, respectively.
Discussion: We found a significant increase in cardiovascular and BMD risk with advancing age. There is continued use of recreational drugs into old age which can impact on drug adherence and interactions. Closer attention needs to be paid to erectile dysfunction and peri-menopausal issues. A specialist multi-disciplinary clinic aimed at the >50 age group will aid in addressing these age-specific morbidities.
P040 An ultra-rapid PCR device for Chlamydia trachomatis and Neisseria gonorrhoeae: clinical evaluation with point-of-care application
Daniel Adlerstein1, Claire Ferrao1, Anna Dixon1, Justin Hardick2 and Charlotte Gaydos2
1Atlas Genetics Ltd., UK
2John Hopkins University, Baltimore, MD, USA
Background: We have developed a novel, rapid point-of-care (PoC) molecular system, io™, which comprises a fully integrated assay-specific cartridge and a reader with a turnaround time of 25 min. The cartridge implements a nucleic acid extraction, amplification using PCR and a multiplex electrochemical detection. An assay has been developed that can simultaneously detect two distinct targets in Neisseria gonorrhoeae (NG), with an internal control (IC) and has been designed to be compatible with a previously developed Chlamydia trachomatis (CT) assay.
Methods: Inclusivity was tested using eight WHO NG strains and 25 NG clinical isolates. Sixteen species, closely related to NG, were tested to ensure no cross-reactivity. Sixty clinical samples were extracted, purified and the eluted DNA used to reconstitute dried amplification reagents followed by ultra-rapid amplification. In the detection chamber, the amplification product is recognised by a target-specific probe labelled with an electrochemically active compound. The resulting double strand is cleaved by an exonuclease releasing the electrochemical label which is then detected by pulse voltammetry on screen printed electrodes.
Results: All WHO strains and clinical isolates were amplified and detected by the assay. The closely related species were not amplified or detected. For the clinical samples, a cut-off threshold for negative and positives was established. Five negative and two positive samples for NG were removed from the analysis due to mechanical failures. The assay detected 28/28 positives and 24/25 negative samples resulting in a specificity of 96% and sensitivity of 100%. The test was developed to be combined in a cartridge with a previously developed test for CT which was shown to have 98.1% sensitivity and 98% specificity.
Conclusions: The inclusivity and exclusivity results indicate the assay can detect a wide range of N. gonorrhoeae strains and that no cross-reactivity is observed with closely related species. The clinical sample data results show sensitive and specific detection of NG using multiplex PCR and electrochemical detection using elements of a fully integrated PoC system.
P041 Papillomaviruses of high carcinogenic risk in men with infertility and the impact of mixed viral infections (human papillomavirus and herpesvirus) in inflammatory diseases of reproductive tract in males
Mikhail Gomberg1, Vladimir Evdokimov1, Liubov Kurilo2, Alyona Lebedeva2, Vladimir Kovalyk3 and Alla Kushch4
1Centre of Dermatovenereology and Cosmetology, Russian Federation
2Medical and Genetic Research Center of Russian Academy of Medical Sciences, Russian Federation
3Clinical Hospital 84 of Federal Medical and Biological Agency, Russian Federation
4N. F. Gamaleya Federal Research Centre for Epidemiology and Microbiology Ministry of Health of Russian Federation, Russian Federation
Background: Human papillomaviruses (HPVs) and human herpesviruses (HHV) are very common. However, data on their role in development of inflammatory urogenital tract diseases (IUTD) and infertility in men are limited.
Aim: The aim of this study was to examine the prevalence of high carcinogenic risk HPV (HR HPV) in men with infertility and to assess the impact of mixed viral infections (HR HPV and HHV) in IUTD.
Methods: Totally, 94 males with infertility and IUTD were examined (87 with prostatitis and seven with urethritis and prostatitis). Altogether, 250 clinical samples were studied (ejaculates, urethral swabs and prostatic secretions). RT PCR was used for detection and quantification of viral DNA.
Results: HR HPVs were detected in 28.7%, and HHV (herpes simplex virus [HSV]-1/2, cytomegalovirus [CMV], Epstein-Barr virus [EBV] and HHV-6) – in 36.1% of males. In 37% of HR HPV-infected males, combination with EBV, HHV-6, or EBV + HHV-6 was found. HR HPV DNA was detected in 18.2%, 17.1% and in 24.1% of urethral swabs, ejaculates and prostatic secretions, respectively. In 11.9% patients, HR HPVs were detected in all three samples. Quantitative DNA analysis showed that HR HPV viral load in the majority of samples was relatively low, but in 46% of samples, viral DNA concentration exceeded the median over 100 times. The semen parameters in infected patients were significantly deteriorated as compared to uninfected men. Urethritis complicated with prostatitis was diagnosed in 3.4% patients with mono-HPV infection and in 40% patients with combined HR HPV + HHV infection (p = 0.012).
Conclusions: Mixed viral infections of the urogenital tract in infertile men have a negative impact on sperm parameters and are associated with a complicated course of IUTD. Quantitative analysis of HR HPV can be used as a useful indicator for monitoring HPV infection and its consequences.
P043 Coexistance of extragenital syphilitic chancre and secondary syphilis in a pregnant woman
Badri Talel, Zaouak Anissa, Mokni Mourad and Cherif Faika
La Rabta Hospital, Tunisia
Introduction: Syphilis is a well-known sexually transmitted infection. Chancre, a characteristic skin lesion of primary syphilis, usually occurs around the genital area. In at least 5% of patients, chancre occurs in other areas such as the lips. Herein, we report a case of extragenital syphilitic chancre occurring on the lower lip coexisting with secondary syphilis in a pregnant woman.
Case Report: A 17-year-old woman pregnant in the first trimester presented with an indolent ulcer on the lower lip since two months. In addition, she had multiple erythematous and non-pruritic macules located on the trunk since 15 days. She also had submandibular adenopathies. The diagnosis of primary and secondary syphilis was suspected. Treponema pallidum haemagglutination (TPHA) was positive at 1/1280, and human deficiency virus antibody was negative. The lip chancre healed after one intramuscular injection of benzathine penicillin G, 2.4 million units prescribed to the patient and her husband.
Discussion: Syphilis can be transmitted via many routes, but sexual contact is the major factor. The possibility of syphilis should be considered, and the patient should be asked about his or her sexual history. Extragenital chancres occur between 40% and 70% of the mouth with approximately one-fifth of them located on the lips as in our patient. Chancre on lips appears as erosion or ulceration covered by crust and clinically resembles impetigo, traumatic and herpes lesion. Treatment is the same as a non-pregnant woman and is based mainly on benzathin penicillin.
P044 Efficacy of treatment of genital warts with Veregen in daily practice
Sònia Beà Ardébol1, Montserrat Fernández Guarino2, José Ignacio Esquivias Gómez3, Marta Ruano Del Salado4, Guillermo Guhl Millán5, Elena Vargas Laguna6, Elena Sendagorta Cudós7, Carolina Garrido Gutiérrez8, Pedro Herranz Pinto7 and Juan Ballesteros Martín9
1Hospital Universitario Príncipe de Asturias, Spain
2Hospital Central de la Cruz Roja Española – San José y Santa Adela, Spain
3Hospital Universitario de Móstoles, Spain
4Hospital Universitario de Torrejón, Spain
5Hospital Universitario Clínico San Carlos, Spain
6Hospital Severo Ochoa, Spain
7Hospital Universitario La Paz, Spain
8Hospital Infanta Sofia, Spain
9Centro Sanitario Sandoval, Spain
Background: Since 2010, CDC guidelines recommend a new therapy for genital warts, consisting of sinecatechin ointment. According to pivotal studies, this treatment obtained a cure rate of around 53% (60% in women and 47% in men).
Objective: We conducted a multicentre prospective study in patients diagnosed with anogenital warts, who received treatment with the 10% sinecatechin ointment marketed in Spain for up to 16 weeks. We analysed the following parameters by sex: efficacy in lesion disappearance, considering whether it was a first clinical episode or recurrence after other treatments, side effects and degree of adherence to daily treatment application.
Methods: The study included 156 patients (91 men and 65 women) from 20 to 60 years of age, presenting warts on the penis, vulva, perianal area, groin, pubis, perineum and scrotum. Of these, 121 presented initial episodes, and 35 presented recurrences after other therapeutic options.
Results: The efficacy of the treatment was as follows: cure, defined as removal of all lesions, 46.8% (38.5% in men and 58.5% in women); significant improvement, meaning more than 50% reduction in number and extension of lesions, 62.2% (56.04% in males and 70.8% in females). In 66.9% of cases, no subjective symptoms related to the treatment’s application were reported, and mild pruritus is the most common symptom (10.25%); 68.6% presented no clinical signs, and mild erythema at the application site was the most common adverse effect, in 16% of cases. Only 45.5% of the patients correctly applied the medication, and 66% applied it more than 75% of the times indicated.
Conclusions: The efficacy obtained using the 10% sinecatechin ointment in daily practice is slightly lower than that obtained in the pivotal studies that supported its recommended use, most probably due to poor adherence to the indicated dosage. On the other hand, the safety profile of this treatment is similar to that obtained in the pivotal studies.
P046 Utility of type-specific herpes serological testing in an inner city sexual health clinic, Stoke-on-Trent, UK
Raeesa Chunara1 and Kieran Fernando2
1Royal Stoke University Hospital, UK
2Cobridge Sexual Health Centre, UK
Background: The British Association for Sexual Health and HIV (BASHH) has produced guidelines for the diagnosis and management of herpes simplex virus (HSV) including that in pregnancy. Diagnostic methods available include a lesional swab for HSV by polymerase chain reaction and an HSV type-specific serological test (TSST). As both HSV-1 and/or -2 may cause genital ulceration, the indication for undertaking a TSST should be carefully considered and in keeping with national guidance, particularly where there is a history of oropharyngeal infection and recurrent cold sores.
Aims: We aimed to assess whether our clinical practice with regard to the undertaking of HSV TSST is in keeping with national recommendations.
Methods: Retrospective (electronic) case note review of patients offered an HSV TSST between January 2012 and January 2015.
Results: A total of 21 patients were identified who had an HSV TSST undertaken. Of these, 16/21 (76%) were female and six of 21(24%) male. The mean age was 29 years. Sixty-four percent of patients had the HSV TSST performed in accordance with national guidance, and in 36% performed outside of the guidance.
Discussion and Conclusions: The commonest indication for undertaking an HSV TSST in our cohort was for asymptomatic pregnant ladies who were contacts of HSV. In patients who had TSST undertaken outside of national recommendations, the result did not alter their management. In conclusion, the HSV TSST should be undertaken in specific clinical scenarios in keeping with national guidance, and the result carefully interpreted and in clinical context, so as not to create patient anxiety. There should be clear documentation with regard to pre-existing HSV oral and genital history, in addition to that of the partner. Secondly, the rationale behind undertaking the TSST should also be clearly documented and the patient informed of the possible outcomes/interpretations of the test.
P047 Roche versus Qiagen: clinical evaluation of two automated amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae
Christian Noah1, Hans-Jürgen Stellbrink2, Hany Sahly1 and Gerrit Mohrmann1
1Labor Lademannbogen, Germany
2Infektionsmedizinisches Centrum Hamburg, Germany
Background: Nucleic acid amplification tests have become the standard procedure for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), which are the most common sexually transmitted pathogens worldwide.
Objective: To compare the artus CT/NG QS-RGQ Kit (Qiagen) with the Cobas 4800 CT/NG test (Roche Diagnostics) using clinical urogenital and non-urogenital samples.
Methods: Prospective analysis: 500 clinical samples routinely analysed using the Roche assay were retested with the Qiagen test. Two hundred urogenital samples were obtained from female (urine or vaginal/endocervical swabs) and 200 urogenital from male patients (urine or urethral swabs). In addition, 50 rectal and 50 throat swabs were included. Furthermore, a retrospective analysis was done including 50 CT- and 50 NG-positive specimens.
Results: Prospective analysis: 12.4% of the samples were positive for at least one pathogen: CT 7.4%, NG 5.8%, CT/NG 1.4%. The CT positivity rates were 4%, 10.5%, 16% and 0% in female and male urogenital samples, rectal and throat swabs, respectively. In the corresponding sample types, the NG positivity rates were 0%, 10.5%, 14% and 2%. The sensitivity of the Qiagen test was 100%. However, two urogenital swabs from female patients pre-tested negative exhibited weakly positive NG results which were not confirmed when retested. Retrospective analysis: all NG+ and CT+ samples were also positive in the Qiagen test. However, in one NG+ urethral swab, the Qiagen test recovered a CT co-infection (proven by an alternative assay) which was not recognised by the Roche test.
Conclusions: Both assays provide reliable results for the detection of CT and NG in urogenital and non-urogenital samples indicated by high concordance rates. False-negative results are rare. However, in clinically suspected cases, retesting of negative results with an alternative assay should be considered. In addition, weak positive results should be treated with caution, as the specificity may be questionable.
P049 Newly diagnosed HIV infection: evaluation of risk factors and coinfections with other sexually transmitted infections
Lucía Miguel Escuder1, Estrella Caballero2, Maider Arando3, Pere Armengol3, Martí Vall3 and Maria Jesús Barberá3
3Sexually Transmitted Infections Unit, Drassanes-Hospital Universitari Vall d'Hebron, Spain
Background: Nowadays in our environment, the main group of affected population by HIV infection is men who have sex with men (MSM); group of risk for other sexually transmitted infections (STIs) also.
Objectives: To analyse coinfection with other STIs at the time of HIV diagnosis, and evaluate the presence of these other STIs like risk marker to acquire HIV infection.
Methods: In this retrospective observational study, all newly diagnosed HIV infections during 2014 in our STI Unit were included. Presence of other STI at the time of HIV diagnosis and in the previous 12 months was analysed, and epidemiological and clinical data were recorded.
Results: A total of 85 patients were newly HIV diagnosed; 100% were men (age median = 33), and 43.5% were foreigners; 85.9% were MSM, and 24.7% had a sexual partner with known HIV infection in last year. Median of number of sexual partners in previous 12 months was 10 (1–100). Nearly half (49.2%; n = 42) had other STI at the time of HIV diagnosis, and 12 of them had two or more concomitant STIs. Syphilis was the most frequent (24% of total of patients in the study), secondary syphilis was the most frequent (33%). Neisseria gonorrhoeae (15.3%) and Chlamydia trachomatis (14.1%) infections follow in frequency. 23.5% has suffered other STI in previous 12 months with HIV-negative serology simultaneously. The median time between previous STI and HIV diagnosed was nine months (4–12 months). In 61.2%, risk exposure (anal sex without condom) in last 12 months was recorded at clinical history. Table 1 summarises epidemiological characteristics and coinfection.
Conclusions: This study reasserts the relevance of performing an HIV test when other STI is diagnosed; since 49% had other STI moreover at this moment. So, suffer an STI is a risk marker for HIV infection. Evaluation of new prevention strategies, like pre-exposure prophylaxis, should be directed to patients with risk factors or when an STI is diagnosed.
Epidemiological characteristics, coinfection with other STI (n = 85).
Risk exposure (<12 m):
Syphilis
24.7% (21)
Anal
61.2% (52)
Gonorrhoea
15.3% (13)
Oral
5.9% (5)
Chlamydia
14.1% (12)
Vaginal
1.2% (1)
LGV
1.2% (1)
Unknown
31.8% (27)
Acute HCV
2.4% (2)
New partner < 3 m:
HSV
1.2% (1)
Yes
48.2% (41)
Genital warts/HPV
9.4% (8)
No
15.3% (13)
Unknown
36.5% (31)
LGV: lymphogranuloma venereum; HCV: hepatitis C virus; HSV: herpes simplex virus; HPV: human papillomavirus.
P050 A case of lymphogranuloma venereum in Bulgaria
Gurpreet Variaah, Hristina Haidudova and Dimitar Gospodinov
Medical University – Pleven, Bulgaria
We present a case of a 61-year-old man who presented at our clinic with painful, fluctuant and ruptured lymph nodes in the left inguinal region. The disease began suddenly with fever (38°C), headache, oedema, erythema and pain in the left inguinal area two months ago. The patient denied history of multi-sexual partners and homosexual contacts but informed of an accidental sexual encounter with an unknown woman approximately two months ago. There was no evidence for trauma, animal contact or other infections. He did not report any urethral and rectal symptoms. The general practitioner (GP) assumed clinical diagnosis of tuberculosis and treated him with rifampicin for seven days without improvement and referred the patient to the surgical department, where an inguinal lymph node biopsy was done. The physical examination showed enlarged lymph nodes in the left inguinal area with several fistulas, blood and purulent secretions. No other clinical signs – skin rash, genital ulcers or ano-rectal lesions were visualised. Proctoscopy found no evidence for proctitis. Most other laboratory tests conducted were negative. The histopathology of the lymph node biopsy was non-specific for lymphogranuloma venereum (LGV) morphological features but highly suggestive – epithelioid cells granuloma with central necrosis and many giant cells within the lymph node tissue. The diagnosis was confirmed by the typical clinical picture and by the positive serum IgA and IgG Chlamydia trachomatis antibodies with very high titers of 1: 2048 with the indirect rapid solid phase enzyme immunoassay (EIA). The patient was successfully treated with clarithromycin 500 mg four times daily for 21 days and doxycycline 100 mg twice daily for 10 days. All the lesions disappeared within two months of therapy.
P051 Self-taking sexually transmitted infection screening in asymptomatic men who have sex with men in an HIV clinic in Dublin – outcomes and acceptability
Sile Dooley, Sandra Delamere, Hurley Caroline, Siobhan O’dea and Fiona Mulcahy
St James’s Hospital, Dublin, Ireland
Background: Asymptomatic self-taken sexually transmitted infection (STI) screening was successfully introduced among HIV-positive men in 2013. This facilitated a significant increase in STI screening in this patient cohort. As a result, there was an increased detection of STIs. An analysis was performed of the STI results over a three-month period in 2014, and following that, it was decided to assess patient acceptability of this initiative.
Aims/Objectives:
1. To establish the outcomes of increased STI screening
2. To determine patient’s acceptability of this method of STI screening
Method: All HIV-positive men were offered a self-taken STI screen at their clinic visit. Using electronic patient record (EPR), we determined how many HIV-positive men had STI screens performed and types of infection detected over a three-month period. A patient satisfaction questionnaire was administered to the first 100 men who have sex with men (MSM) patients who met the criteria and were willing to take part.
Results: From January 2014 to March 2014, 94 HIV-positive men had STI screens recorded as a procedure on EPR. All documented as asymptomatic, and the majority was MSM (94%). Eighteen percent (N = 17), all MSMs, had an STI. Rectal chlamydia (41%) and rectal gonorrhoea (23%) were the most common infections identified. Interestingly, of those documented as in a regular relationship (33%), 26% had an STI. Of those that were documented as not in a relationship (37%), 23% had an STI. Ninety-four percent of those diagnosed with an STI were referred to a health advisor for partner notification. Of the patients who completed the questionnaire on acceptability of screening, 90% admitted to being sexually active. Almost 70% stated a preference for self-taken screening as they found it private and less embarrassing (N = 50.5%) and easy to do (N = 49.2%).
Discussion: Self-taken STI screening has decreased barriers to screening, made the process more acceptable, increased uptake and increased detection of STIs.
P052 Managing gonorrhoea – are we meeting the BASHH standards?
Alyson Welsh and Alison Currie
NHS Lanarkshire, UK
Background: British Association of Sexual Health and HIV (BASHH) guidelines for management of gonorrhoea (NG) suggest the following auditable outcomes
• All patients should be recommended to have a test of cure (TOC).
• All patients should be screened for Chlamydia trachomatis or receive presumptive treatment.
• All patients should have partner notification (PN) carried out according to the published standards of the BASHH Clinical Standards Unit.
• All patients should receive first-line treatments or the reasons for not doing so documented.
We wanted to know if we were meeting these standards. We also wanted to see if we were performing culture swabs in order to monitor antibiotic resistance.
Methods: We conducted a retrospective case note review on all patients diagnosed with NG within our service from 1 January 2013 to 31 Deember 2013 inclusive. Twenty-three males (six men who have sex with men [MSM]) and 24 females were identified.
Results:
100% were also screened for C. trachomatis.
96% were recommended a TOC.
91% were seen regarding PN.
98% were given first-line treatment and if not, reasons were documented.
60% had a culture swab taken.
Conclusion: There is still room for improvement in four of the outcomes. PN is important to limit the spread of infection and to identify untreated cases. It is disappointing that only 60% of patients had a culture swab taken despite staff awareness on antibiotic resistance. Staff training is planned to address these issues. A re-audit is then planned.
P054 Anorectal lymphogranuloma venereum. Radiological, endoscopic and histological findings in an HIV patient
Juan Bosco Repiso-Jiménez, Teresa Fernández-Morano, Robin Rivera-Irigorin, Fernando Fernández-Sánchez, Teresa Fernández-Salguero, Raúl Quirós-López and Magdalena de Troya-Martín
Hospital Costa del Sol, Marbella, Spain
Background: The anorectal lymphogranuloma venereum (LGV) is an emerging disease in HIV-positive men who have sex with men (MsM). The L serovars of Chlamydia trachomatis (CT) invades genital submucosa and regional lymph nodes. They are main cause of classical type of LGV, practically eradicated in Occident. A new variant of LGV with anorectal involvement is becoming increasing and causing outbreaks in MsM communities since the HIV infection emergence. We report a new case of anorrectal LGV with radiological, endoscopic and histological findings.
Clinical Case: A 32-year-old HIV-positive male with history of receptive anal intercourse was referred to our clinic complaining of one-month evolution rectal tenesmus, bleeding and mucosal exudate in order to perform a proctoscopy. Previously, an MRI was performed with a radiological diagnosis of rectal cancer. According to patient’s sexual history, a microbiological testing for CT was performed and referred to gastroenterologist for rectal endoscopy. After a positive PCR test for CT, an antibiotic therapy with doxycycline 100 mg twice daily for a week was prescribed. We finally completed three weeks of doxycycline treatment after finding extensive rectal ulcers during endoscopy and due to dramatic symptoms improvement. The ulcer biopsy showed a lymphoplasmacytic infiltrate, cryptitis and epithelioid granulomas with PCR positivity for CT in tissue. Finally, we confirmed a serovar L2 CT by sequence analysis of ompA genotypes.
Discussion and Conclusions: The anorectal LGV causes severe ulcerative proctocolitis with pararectus lymphatic node involvement. Physicians can misdiagnose inflammatory bowel disease or rectal cancer. Without treatment, it is responsible for abscesses, anal fistulas and stenotic rectal. Anorectal swabs and PCR techniques for C. trachomatis along with endoscopy should be considered during investigation of proctocolitis in HIV-positive MsM in order to achieve early diagnosis of anorectal LGV and avoid complications.
P055 Misleading clinical features of secondary syphilis – case presentation
Vesta Kucinskiene1, Aiste Gineikiene1, Janina Stefanija Vasilaviciene2 and Daiva Staniene2
1Lithuanian University of Health Sciences, Medical Academy, Lithuania
2Kaunas Clinical Hospital, Lithuania
Background: Syphilis is a chronic sexually transmitted infection caused by Treponema pallidum subspecies pallidum. It is often a fascinating and perplexing infection, with protean clinical manifestations and both diagnostic and management ambiguities. The number of syphilis-infected persons in Lithuania ranged from 257 to 345 in the last five years.
Case Report: A 37-year-old man who had about 10 female sexual partners over the last three years presented to surgeon with phimosis and weeping rashes on penis. Antibiotics were prescribed to reduce an inflammation before circumcision. Almost at the same time, his current 36-year-old female sexual partner presented to the dermatovenereologist with rashes on the genital area. Physical examination revealed the presence of the eroded papules located on the trunk, genital area and small ulcers on the labia major, regional lymphadenopathy. Serological tests were positive: rapid plasma reagin (RPR) 1:32, Treponema pallidum haemagglutination (TPHA) 4 + . Her sexual partner was saved from the surgery because he was invited to consult dermatovenereologist also. Detailed examination of the man presented erythematous papules on the head and eroded papules on the trunk, genital area, also phimosis and ulcer under the foreskin on the penis. Serological tests: RPR 1:4, TPHA 3+. The coinfection with HIV was excluded. Oculist, cardiologist and neurologist consulted both patients, and disturbances in other systems were not detected. We initiated antibiotic therapy using penicillin intravenously every 3 h first day (3.2 mln. IU/day) and every 6 h later (4 mln. IU/day) up to a total dose of 51.2 mln. IU in 12 days. The lesions began to regress in the second day after the treatment was started.
Conclusion: Other specialists than dermatovenereologists should remember the treacherous clinical features of syphilis. It is recommended to perform serological syphilis tests before doing surgery on affected genital organs. The knowledge about syphilis should be increased among general practitioner’s (GP’s) and medical specialists in Lithuania.
P056 Lymphogranuloma venereum in a heterosexual, immunocompetent patient
Sarbu Maria Isabela1, Tampa Mircea2 and Georgescu Simona Roxana2
1“D. Victor Babes” Hospital, Romania
2“Carol Davila” University of Medicine and Pharmacy, Romania
Background: Lymphogranuloma venereum (LGV) is a sexually transmitted disease caused by Chlamydia trachomatis serovars L1–L3. It is endemic in Africa, India, South and Central America, and it is rare in developed countries, where it most often occurs in HIV-infected men who have sex with men (MSM).
Methods: We report the case of a 37-year-old male, Caucasian patient, from the urban area who addresses the dermatology department of our hospital for urethral discharge and bilateral enlargement of inguinal lymph nodes associated with erythematous, oedematous overlaying skin, which had occurred approximately 10 days before. The patient admits to having had unprotected intercourse with several partners during his stay in Morocco, two months before. His personal and family history was unremarkable. The physical examination was within normal range. On local examination, we noticed bilateral, tender masses located in the inguinal area, covered by erythematous, oedematous skin and a small, painless erosion on the prepuce.
Results: The patient tested negative for HIV, hepatitis B, hepatitis C, as well as syphilis. Gonococcal infection was also excluded. C. trachomatis serology was positive. The clinical suspicion of lymphogranuloma venereum was confirmed by PCR. The patient was treated with doxycycline 100 mg twice daily for three weeks and had a favourable evolution.
Conclusions: Lymphogranuloma venereum is rarely seen in practice in European countries and, when it does occur, it usually affects the HIV-infected MSM population. Taking an accurate anamnesis and sexual history is important in detecting these rare cases and preventing the disease from spreading.
P057 A case of psoriasis dramatically exacerbated after HIV infection
Diletta Bonciani and Marzia Caproni
University of Florence, Italy
A 50-year-old male, affected by psoriasis for 15 years, came to our clinic after a severe recurrence of the disease. He had always had mild psoriasis since the beginning with good response to topical therapies, such as corticosteroids and tacalcitol. At that time, he was HIV seronegative. At the visit, he presented erythematous plaque lesions all over the body, above all in the trunk, abdomen and legs. His face was spared, and the psoriasis area severity index (PASI) was 20. He has also itch, with visual analogue scale (VAS) pruritus 8. The patient was prescribed a two-month course of UVB phototherapy in addition to topical association of corticosteroid and tacalcitol. After two months, his disease was still severe, with a PASI score of 18. Due to the bad response to the therapy, we suspected a possible HIV infection; we tested him for HIV, and the test resulted positive with a CD4 count of 30 cells/mm3, so he started antiretroviral therapy and acitretin for psoriasis. At the follow-up after one month, he had a good clinical improvement of the lesions and itch with a PASI score 8 and VAS pruritus 2. Psoriasis might worsen or it might be detected for the first time following HIV infection or reverse, as in our case. It is particularly severe (usually affecting more than 50% of the body) and generally presents late in the course of the infection when CD4 cell counts are less than 200/µl, and the patient is not on antiretroviral therapy. Antiretrovirals can be beneficial and the eventual clearing of psoriasis is concomitant with a decrease in the HIV load; stopping antiretrovirals can lead to psoriasis exacerbation.
P058 Penile verrucous squamous cell carcinoma in patient with non-Hodgkin lymphoma and in association with human papillomavirus infection
Natasha Tsekova Traykovich, Marin Georgiev and Georgi Pehlivanov
University Hospital Alexandrovska, Bulgaria
Background: Verrucous squamous cell carcinoma (SCC), which was described in 1948 by Ackermann, was reported in 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%–16% of all penile SCC, and 33% of cases are associated with human papillomavirus (HPV) types 6 and 11. Lack of circumcision, poor hygiene, phimosis, tight prepuce and chronic infection are other important causative factors for penile verrucous SCC carcinoma.
Objective: 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 immunosuppressed due to the treatment of a non-Hodgkin lymphoma. There was no medication for the condylomata acumata for a long period of time, and consecutive destructive therapy was with unsatisfactory effect. 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 types 6, 8 and 16.
Results: The surgical excision and amputatio penis partialis in urology surgical department showed that there was no invasion of the tumour in corpora cavernosa and corpus spongiosum, and it was classified as T1NxMx. The patient remains under supervision of the dermatology and oncology specialists for eventual relapses.
P059 Buschke–Löwenstein tumour in association with high-risk human papillomavirus types
Dimitrina Nikolova1, Slaviana Galeva1, Hristo Stankov1 and Natasha Tsekova Traykovich2
1II SAGBAL Scheynovo Hospital, Bulgaria
2University Hospital Alexandrovska, Bulgaria
Background: 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 squamous cell carcinoma (SCC) occurring on anogenital mucosal surfaces where it is locally invasive but shows 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.
Objective: A 59-year-old female patient presented with large, exophytic, cauliflower-like tumour involving the vulva, perineum and perianal region with 13 years’ duration. The first lesions had been appeared on the vulva, and after three-year period of slow gradual enlargement, they covered perineum and perianal area. A yellowish discharge and erosions are observed. Colonoscopic examination showed that the mass reached linea dentata, and large invasion in anal sphincter was established.
Methods: Histologic examination of the tumour and rectal biopsy specimen presented well-differentiated SCC, as well as a marked mononuclear cell infiltrate and conspicuous koilocytosis. PCR for HPV DNA detected HPV types 6, 11, 16 and 58 from vulvar and anal area.
Conclusions: Surgical excision of BLT is therapy of choice. Vulvectomy followed by laser excision of anorectal involvement and temporary anus praeter ileostoma were performed. Multidisciplinary medical control is applied for eventual relapses.
P060 Giant condyloma acuminatum of Buschke Löwenstein treated with surgery
Pablo García Montero, Juan Bosco Repiso Jiménez, Teresa Fernández Morano, José Francisco Millán Cayetano, Carlos Hernández Ibáñez, Francisco Javier Del Boz González and Luz López Ortiz, Magdalena de Troya Martín
Hospital Costa del Sol, Marbella, Spain
Introduction: Buschke–Lõwenstein tumour (BLT) is a rare, slowly growing, locally destructive and infiltrative tumour associated with human papillomavirus (HPV) types 6, 11, 16 and 18. The disease significantly impairs quality of life of patients and without treatment the outcome is unfavourable.
Case Report: A 28-year-old woman from Eastern Europe, with no medical history, presented with anogenital warts of seven years of evolution, refractory to many different treatments (topical imiquimod, topical cidofovir, cryotherapy, etc). Clinical examination of the genital area revealed a locally destructive verrucous mass, associated with smaller satellite lesions. Histological examination confirmed condiloma acuminatum, and HPV types 6 and 11 were identified. Due to the large size of the lesion and the lack of efficacy of conservative treatments, it was decided to perform wide surgical excision under spinal anaesthesia. The histological study of the whole tumour ruled out malignancy, and no complications arose during post-operative period. Six months after, the patient leads a normal life in all aspects.
Commentary: The treatment of BLT is actually complex. Biopsy is mandatory to exclude malignant transformation into a squamous cell carcinoma. Many different treatments have been described; however, surgery seems to be the most appropriate option. Promoting healthy sexual behaviours and vaccination against HPV may reduce the incidence of this destructive and maiming tumour.
P061 Leukoderma syphiliticum: a rare presentation of syphilis in the 21st century
Vinay Keshavamurthy, Shraddha Uprety, Dipankar De, Sanjeev Handa and Uma Saikia
PGIMER, India
Background: Syphilis, also known as the ‘great imitator’ of skin diseases, is a multistage disease known for its protean manifestations.
Objective: To describe leukoderma as an uncommon presentation of secondary syphilis in a young man.
Case Report: A young man visited our clinic with hypopigmented lesions over the trunk since three to four months. They initially began as a crop of raised, erythematous lesions, which subsided with hypopigmented patches within one to two weeks. The patient had history of unprotected heterosexual intercourse about six to seven months prior, following which he had a painless ulcer on the penis, which spontaneously healed in about two to three weeks. Biopsy from lesional skin showed moderately dense dermal infiltrate composed mainly of plasma cells and lymphocytes with endothelial swelling causing partial luminal occlusion. Venereal Disease Research Laboratories (VDRL) and Treponema pallidum haemagglutination assay showed reactive titer of >1:16 (cut-off 1:8) and >1:80 (cut-off 1:80), respectively. Based on clinical, histological and serological features, the diagnosis of secondary syphilis was established, and the patient was treated with a single dose of benzathine penicillin 2.4 million units. On repeating the VDRL levels at three months follow-up visit, the titer was of 1:4.
Discussion: Secondary syphilis is a subtle disease with variable muco-cutaneous presentations. Skin rash, the common manifestations of secondary syphilis can rarely, leave behind depigmented patches on the back and sides of the neck, which have been classically described as ‘necklace of Venus’. Syphilitic leukoderma has been proposed to be a manifestation of secondary syphilis, which has been substantiated by a report demonstrating T. pallidum in lesional skin.
Conclusion: We report an uncommon manifestation of secondary syphilis. In accordance with the rising trend of syphilis, unusual manifestations of syphilis have to be kept in mind and ruled out especially in young sexually active population.
P062 Giant condyloma accuminata in an adolescent treated with a novel combination therapy
Vinay Keshavamurthy, Payal Chauhan, Geeti Khullar, Dipankar de and Sunil Dogra
PGIMER, India
Background: Condyloma accuminata is used to describe viral anogenital warts, commonly affecting sexually active adults. Some lesions may be resistant to treatment posing a therapeutic challenge.
Objective: To describe a case of therapy-resistant condyloma accuminata in an adolescent treated with a novel combination of Mw vaccine and isotretinoin.
Case Report: A 15-year-old male patient presented with foul smelling, exuberant cauliflower-like warty lesion over glans penis of six-month duration. He had received five sessions of cryotherapy followed by topical podophylltoxin for home application for six weeks with no improvement and further disease progression. He denied history of any sexual exposure. The diagnosis of condyloma accuminata was confirmed by histological and virological studies. Since the patient was resistant to conventional destructive modalities, he was treated with a combination treatment of Mw vaccine and oral isotretinoin 10 mg/day with psychological support. There was complete clearance of the lesion at 12 weeks follow-up after 10 Mw injections.
Discussion: Human papillomavirus (HPV), though predominantly transmitted by sexual contact, can rarely be transmitted both sexually and non-sexually. Several studies indicate that the origin of paediatric anogenital HPV infection often remains untraced, with no indication of sexual abuse. Topical vitamin A and oral retinoids have been found to be of benefit in treatment of cutaneous and cervical warts resistant to other conventional treatments. Retinoids have also been combined successfully with other treatment modalities like topical imiquimod, interferon-γ and radiofrequency ablation. Mw vaccine has been successfully used in management of anogenital warts with comparable efficacy of imiquimod.
Conclusion: This case was an unusual presentation of condyloma accuminata transmitted non-sexually in an adolescent boy, which was treated with a novel combination therapy of retinoids and immunotherapy.
P063 Congenital syphilis in an 8-year-old girl
Marta Koper, Agnieszka Beata Serwin, Małgorzata Szterling-Jaworowska, Małgorzata Dziużycka and Iwona Flisiak
Medical University of Bialystok, Poland
Background: According to 2014 European Guideline on management of syphilis, a presumed diagnosis of congenital syphilis can be made in a case of a child over one year of age and positive treponemal tests, in whom a sexual abuse was excluded.
Case Report: An 8-year-old girl was hospitalised in the department due to the following serological test for syphilis (STS), performed in February 2015: Venereal Disease Research Laboratories (VDRL) (±), FTA (+) 1/2600, FTA-ABS positive, Treponema pallidum haemagglutination (TPHA) (+++), IgM FTA-ABS negative, TPI 80%. The girl was asymptomatic, no internal organs’ involvement was found after several consultations and tests. A latent syphilis of unknown duration was diagnosed in both parents in May 2014 (the mother had positive STS results performed during prenatal visit in fourth pregnancy) with subsequent treatment with procaine penicillin; the woman had also a history of spontaneous abortion in her first pregnancy. There was no documentation of appropriate STS in mother’s earlier pregnancies. Parents were asked to perform immediately STS in their two children – 8-year-old and 3-year-old girls, but they visited our clinic as late as after nine months. The younger child had negative STS results. In the presented patient, after taking into consideration her personal history, family history of syphilis, physical examination (no internal organs’ involvement) as well as STS results and, after exclusion of a sexual abuse with high probability, a late congenital syphilis was diagnosed. The patient received treatment with procaine penicillin.
Conclusions: Screening for syphilis before 10th week of pregnancy, during the antenatal visit, is mandatory in Poland as a part of health-policy. However, the poor identification of cases of syphilis in pregnancy, the suboptimal notification and reporting system make antenatal syphilis control programme less effective than expected.
P065 The spectrum of malignancies seen in the last decade of HIV and highly active antiretroviral therapy
2Coventry and Warwickshire Partnership NHS Trust, UK
Background: Incidence of AIDS-defining malignancies (ADM) is reported as decreasing and non-AIDS-defining malignancies (NADM) as increasing in the highly active antiretroviral therapy (HAART) era. This decrease in ADM is attributed to early diagnoses and potent less toxic HAART. The increase in NADM is attributed to longer survival and ageing of patients.
Aim: To review recent malignancy trends, patient characteristics and survival observed in a HAART experienced era.
Method: A retrospective case note review of malignancies in HIV-positive individuals between 2004 and 2014 was conducted in two large HIV centres in the Midlands, UK.
Results: A total of 113 individuals with malignancy were identified. Mean age at malignancy was 44 years (range 20–81). Seventy-five percent were male, 47% Caucasian and 46% black African. Of the 18 with HIV for 10 years or more at the time of malignancy diagnosis, six were ADM (all non-Hodgkins lymphomas [NHL]). 10 had been on HAART for >10 years of whom four had ADM. Forty-two percent died, of whom 38% were new HIV diagnoses and 58% had a CD4 < 200. Sixty-three (56%) had ADM and 50 (44%) NADM. Thirty-seven NHL, 23 Kaposi sarcomas and three cervical cancers were identified as ADM. Twenty-two haematological, nine lung, five breast and four anal cancers were the top four NADM. Most malignancies occurred within five years of the HIV diagnosis (83% ADM, 58% NADM, p < 0.05). Survival worsened with increasing age in the ADM (88% survival in <30 years, 64% 31–40 years, 60% 41–50 years, 50% 51–60 years, 20% >60 years), while survival was between 47% and 57% throughout the age groups in the NADM, p < 0.01. Fifty-eight percent of ADM had an associated oncogenic virus compared to 18% of NADM, p < 0.01. One in three deaths occurred in ADM compared to one in two deaths in NADM.
Discussion: ADM are high even in those who have been on HAART for over 10 years. Therefore, ADM need to be considered and investigated in symptomatic individuals on HAART. The survival rate with NADM is poor at any age when co-infected with HIV.
P067 ‘Are we there yet’: concordance between nucleic acid testing and culture in Neisseria gonorrhoea infection in a suburban sexual health clinic
Martin Lechelt, Benny Cherian, Balakrishan Sudha and Richard Shen
NHS, UK
Background/Introduction:Neisseria gonorrhoea (NG) is the second most common bacterial sexually transmitted infection (STI) in humans. Nucleic acid amplification test (NAAT) is used widely for diagnosis of NG. These assays have high specificity and sensitivity in published studies, but discordance between assays and variable sensitivity/specificity with different manufacturers has been reported. The risk of false positive NG been diagnosed in areas of low NG prevalence can lead to diagnostic/management dilemmas for health care professionals.
Aim(s)/Objectives: Concordance NG NAAT testing against microscopy/culture and demographics of patients and contacts.
Methods: Data were analysed from 2012 to 2014. All samples tested for GC from our clinic were included in the study. We collected basic demographics, clinic documentations microscopy/culture and NAAT testing results using BD ProTec SDA.
Results: There were 221 patients included in the study; clinic population consisted of 87% Caucasians (64% heterosexual and 32% homosexual), age ranged 14–62 years. The NAAT-positive samples of which culture and microscopy was positive in 48% and 33%, respectively, and both in 29%. NAAT positive, culture and/or microscopy-negative samples (106) (47%) were associated with inconsistent condom usage (87%), pharyngeal samples (43%) in mainly men who have sex with men (MSM) (72%).
Discussion/Conclusion: This is a low-risk population in a low prevalence area for NG infection, and nearly 50% NAAT samples were not confirmed by a culture. The findings of this study reaffirm the utility of culture and the need for another gold standard other than culture for the NAAT-based diagnostic tests. Currently, clinical staffs are reliant on clinical/epidemiological factors to correlate NAAT test results to manage case/contacts.
P068 Secondary syphilis and luetic gastritis
Constantin Andreea Poliana
Muntenia Hospital, Romania
A 25-year-old patient was sent to our clinic for a skin rash from gastroenterology department where he had performed an upper gastrointestinal endoscopy for gastritis with non-specific symptoms: epigastric pain and discomfort. Before receiving the result from gastric biopsy, he was admitted to our service for a non-pruritic diffuse cutaneous rash distributed on the trunk and extremities in evolution for almost three months without constitutional symptoms and lymphadenopathy. He presented also some keratotic lesions located on the palms and soles diagnosed as warts at the gastroenterology department. According to the sexual and social history, the patient denied condom use, intravenous drug abuse, genital lesions and any history of sexually transmitted infections (STIs). After clinical examination, we raised the suspicion of secondary syphilis, and we recommended serologic tests for confirmation. Both treponemal and non-treponemal tests were positive for infection with Treponema pallidum. In the meantime, the patient received also the results from histologic examination, which confirmed luetic gastritis, and we started the antibiotic therapy according to the guidelines.
P069 Complete regression of giant genital warts in a liver transplant patient with sirolimus
Carolina Garrido Gutiérrez, Vicente M Leis Dosil, Ricardo Valverde Garrido and Rosa M Díaz Díaz
Introduction: Transplanted patients are subjected to immunosuppressive regimens to prevent rejection. This provokes, among other complications, the appearance of lesions caused by human papillomavirus (HPV), and these are often larger and more resistant to conventional therapies. Although the use of sirolimus is not approved in liver transplant, there is a wide variety of literature on its use, and at least one similar case reported in which sirolimus was used to treat giant resistant warts.
Case Report: This is a woman of 17 years with liver transplant for biliary atresia, who consulted for outgrowing lesions in the genital region since two months. In this moment, she was treated with mofetil mycophenolate, tacrolimus and methylprednisolone. Her physical exam showed abundant genital warts covering completely the major labia, and she also had similar lesions sparsed over the vulvar introitus and perineum. PCR revealed HPV-6 infection. We started a treatment with cycles of curettage and electrocoagulation plus topic imiquimod, but this resulted ineffective. We contacted Digestive System Service to suggest the possibility of initiating treatment with sirolimus. They decided to remove both mofetil mycophenolate and methylprednisolone, lower tacrolimus doses and start with sirolimus. One month later, lesions were stable, but in the following weeks, we observed a progressive decrease in size until they disappeared completely in three months.
Discussion: Sirolimus is a non-nephrotoxic immunosuppressive agent approved since 2001 for renal transplant which also has an antiproliferative activity. It has been used safely in liver transplant but remains unapproved for this indication because of occasional side effects. There are various published cases of recalcitrant warts in renal transplant with complete remission after starting treatment with sirolimus. However, given the results, we suggest to take in account the use of sirolimus in similar cases.
P072 A case of stillbirth congenital syphilis in Bulgaria
Gurpreet Variaah, Hristina Haidudova and Dimitar Gospodinov
Medical University – Pleven, Bulgaria
Congenital syphilis is a severe, disabling and often life-threatening infection seen in infants. A pregnant mother who has syphilis can spread the disease through the placenta to the unborn infant. Congenital syphilis is caused by the bacterium Treponema pallidum, which is passed from mother to child during fetal development or at birth. Nearly half of all children infected with syphilis while they are in the womb die shortly before or after birth. We present a case of a female stillbirth with severe congenital syphilis. The baby was born in the 28th week of gestation from a prostitute mother who suffered with a fresh and active secondary syphilis. The source of the infection in the mother was a foreigner. The stillborn weighed 1350 g and had pathognomic macro- and microscopic features of congenital syphilis. It was macerated and presented with hydrops fetalis, brachycephaly, flat face and occiput, horizontally slit eyes, low-lying big ears, cleft upper lip, short neck and subluxation of the left wrist. Pathological examination showed a large atrial septal defect type ‘ostium secundum’ with patent foramen ovale, generalised oedema, cyanosis of the internal organs and ascites in the abdominal cavity. Upon histopathological examination, lymphoplasmocytic infiltrates with focal necrotic areas, thickened vascular walls and vascular hyperemia were observed in the liver, adrenal glands, kidneys and the brain. In Giemsa staining, T. pallidum was not seen.
P073 Prevalence and genotype of human papillomavirus on anal and oral samples from patients with external anogenital warts in Portugal – the HERCOLES study
Carmen Lisboa1, Jacinta Azevedo2, Luis Azevedo3, Maria João Cunha4, Ângela Pista5 and Irene Santo2
1Hospital Centre of S. João, Portugal
2Health Center of Lapa, Portugal
3Medical University of Oporto (CIDES & CINTESIS), Portugal
4Sanofi Pasteur MSD – Portugal, Portugal
5National Institute of Health, Portugal
Background: The information about anal and oral human papillomavirus (HPV) infection and type distribution in patients with anogenital warts (AGWs) is scarce.
Objective: This observational and prospective epidemiological study aims to assess the frequency and distribution of specific HPV types in the anal canal and oral mucosa of patients with AGWs.
Methods: According to well-defined inclusion criteria, men and women with an incident clinical diagnosis of AGWs were recruited in seven Portuguese Clinical Research Centres between November 2012 and March 2014. Swab and cytobrush samples were collected from the AGWs and the anal canal and oral mucosa, respectively. HPV genotyping was performed by using CLART HPV-2 assay.
Results: From 141 women and 348 men (mean age of 34 years), 1631 valid samples were collected. All the patients included had HPV-positive AGWs. Anal and oral HPV DNA was detected in 87.4% (38.2% with multiple infections) and 15.6% (26% with multiple infections) patients, respectively. HPV-6 and 11 were the most common genotypes in AGWs, anal and oral mucosa. Concomitant HPV infections were present in 10.4% of the cases. HPV type agreement was 86.1% between perianal warts and anal canal infection, 86.5% between anal canal infection and AGWs, 71% between oral mucosa and AGWs and 55.7% between anal canal and oral mucosa.
Conclusions: Extragenital HPV infection is common in patients with AGWs. The HPV prevalence is higher in anal than in oral mucosa (p < 0.01) and in women’s than men’s anal canal (p < 0.01). Importantly, this study will improve our knowledge regarding AGWs, anal canal and oral mucosa HPV type frequency and raises awareness of concomitant external AGWs and anal and oral HPV infections.
P074 Molluscum contagiosum risk factors in adults
Gemma Martin-Ezquerra1, Pablo Garcia-Martinez1, Marta Banque1, Emili Masferrer1, Alba Alvarez-Abella2 and Ramon M Pujol1
1Hospital del Mar, Barcelona, Spain
2Capio Hospital General de Catalunya, Sant Cugat del Vallés, Spain
Objective: The objective of the present study is to describe the risk factors related to the acquisition of molluscum contagiosum (MC) in adults.
Methods: A case-control study was performed which included all consecutive adult patients with MC. The number and localisation of the lesions were recorded, and an extensive questionnaire was administered.
Results: One hundred and two consecutive patients with the diagnosis of MC and 109 controls were included. Fifty-one percent of patients were men, and the mean age was 32.9 years (range 18–81). The mean number of MC lesions was 10 (SD 10.5). Lesions were more often localised in the genital area (57.3%) followed by the head and neck in 16.5% of cases. Four patients (3.9%) were known to be co-infected with the HIV. The presence of MC in adults was significantly associated with a previous sexually transmitted infection (STI) (p = 0.04) or an illness of the genital area (p = 0.03), the presence of MC in the partner (p = 0.05) and the pool usage (p < 0.01). No differences could be related to men who have sex with men (MSM) sexual intercourses, the condom use, the presence of atopic dermatitis, the intimate contact with children, the habit of pubic hair removal or a past history of ITS in the partner. No relation could be detected between either the total number of sexual partners or the last year sexual contacts.
Conclusions: Some risk factors associated to the acquisition of MC favour that adult MC can be considered an STI. However, others not related to STI, seem also to be significant, as the pool usage.
P075 HIV prevalence among men who have sex with men diagnosed with a sexually transmitted infection in Italy, 1991–2013
Maria Cristina Salfa, Barbara Suligoi, Working Group, The Italian and STI Surveillance
Istituto Superiore di Sanità, Italy
Background: In recent years, sexually transmitted infections (STIs) have been increasing among men who have sex with men (MSM) in several industrialised countries. STI can be an indicator of HIV infection.
Objectives: To estimate the HIV prevalence among MSM diagnosed with STl, to assess socio-demographic and behavioural characteristics of HIV-positive MSM.
Methods: A retrospective study was conducted using data obtained from the Italian Sentinel STI Surveillance System (1991–2013). To assess independent associations between study variables and HIV positivity, a multivariate analysis was performed.
Results: A total of 13,610 MSM diagnosed with STI underwent HIV testing (83.6% of all MSM diagnosed with STI). The HIV prevalence was 21.3% (95% confidence interval [CI]: 20.6–22.0). The proportion of MSM tested for HIV decreased between 1991 (83.9%) and 2000 (67.4%), then increased reaching a maximum of 88.3% in 2007, and then remained approximately stable around 84.0%. An overall decreasing trend in the HIV prevalence was observed among MSM from 28.0% in 1991 to 10.8% in 2008, and then increasing until 2013 (25.0%). During 1991–2013, compared to heterosexuals, MSM showed a higher proportion of HIV-positive individuals (21.3% vs. 4.0%; p value < 0.001). Among HIV-positive MSM (No. 2904), 32.6% (95% CI: 30.9–34.4) were unaware of being HIV-positive. HIV positivity was significantly associated with age older than 25 years (OR: 3.3; 95% CI: 2.4–4.6), having had a previous STI (OR: 2.8; 95% CI: 2.4–3.3), having been diagnosed with an ulcerative STI (OR: 2.5; 95% CI: 2.0–3.1) and being migrant (OR: 1.6; 95% CI: 1.3–2.1).
Conclusions: These results showed an increase in the HIV prevalence among MSM with STI in more recent years. Compared to heterosexuals, HIV prevalence among MSM with STI was six times higher. Moreover, about 30% of MSM with STI ignored being HIV-infected. These findings stress the need for an active proposal of HIV testing among MSM with STI.
P076 Reach of sexually transmitted infection clinics by ethnic groups in the Netherlands
Louise van Oeffelen1, Hannelore Gotz2, Jim van Steenbergen3, Saskia van Leeuwen-Voerman4, Ans van Lier5, Maaike van Veen6, Birgit van Benthem1 and Ingrid van Den Broek1
1RIVM, Netherlands
2Public Health Service Rotterdam-Rijnmond, Netherlands
3Academic Center LUMC, Netherlands
4Public Health Services Haaglanden, Netherlands
5Public Health Services Region Utrecht, Netherlands
6Public Health Services Amsterdam, Netherlands
Background: In the Netherlands, ethnic minorities from sexually transmitted infection (STI) endemic countries are considered to be a high-risk group qualifying for STI clinic care free of charge. It is unknown to what extent they reach STI clinics.
Objectives: To investigate the difference in STI clinic consultation and positivity rate between ethnic minority groups and ethnic Dutch, and compare findings between the four largest cities.
Methods: Between 2011 and 2013, all STI clinic consultations in Amsterdam, Rotterdam, The Hague and Utrecht of persons aged 15–44 years in their place of living were selected from the national STI surveillance database. These were combined with numbers of inhabitants per ethnic group to calculate consultation rate as a proxy for coverage of the STI clinics in each city. Negative binomial regression (adjusted for age and sex) was used to compare the STI consultation and positivity rate between ethnic Dutch and ethnic minorities, and between ethnic groups living in Amsterdam, Rotterdam, The Hague and Utrecht.
Results: Ethnic minorities from Eastern Europe, Sub-Saharan Africa, Suriname, Netherlands Antilles/Aruba and Latin America have a higher consultation rate (range RR 1.26–2.21) than ethnic Dutch, whereas ethnic minorities from other European countries, Turkey, North Africa and Asia have a lower consultation rate (range RR 0.29–0.83). All ethnic minority groups have a higher positivity rate than ethnic Dutch (range RR 1.22–1.71). When comparing cities, consultation rate is markedly highest in Amsterdam and lowest in Utrecht among all ethnic groups (RR Amsterdam vs. Utrecht; range: 4.30–10.71). Positivity rate is more similar between cities.
Conclusion: There are substantial differences in the coverage of ethnic minorities between metropolitan STI clinics in the Netherlands. Although high positivity rates among ethnic minorities suggest that persons at higher risk reach STI clinics, focusing on ethnic groups with low consultation rates remains important.
P077 HIV testing in high-risk groups during sexually transmitted infection consultations in Dutch general practice
Ingrid van Den Broek1, Ivo Joore2, Daphne Reukers1, Ge Donker3, Eline Op de Coul1, Ard van Sighem4, Jan Prins2, Suzanne Geerlings2, Roos Barth2 and Jan van Bergen2,5
1RIVM, Netherlands
2Academic Medical Centre, University of Amsterdam, Netherlands
3NIVEL Centre for Health Services Research, Netherlands
4HIV Monitoring Foundation, Netherlands
5STI AIDS Netherlands, Netherlands
Background: About a quarter of HIV infections still remain undiagnosed in the Netherlands. General practitioners (GPs) provide a common entry point into sexually transmitted infection (STI) care for high- and low-risk populations. Prior research has shown that GPs often do not offer HIV testing, even during STI consultations in high-risk groups.
Objectives: We aimed to further investigate GPs’ HIV testing behaviour and contribution to diagnosing HIV infections in the Netherlands.
Methods: Routine consultation-based questionnaires during STI consultations provided data on HIV testing from 2008 to 2013 (45 sentinel practices from NIVEL Primary Care Database). Additional information on HIV testing pre- or post-consultation was requested from GP patient registers for men who have sex with men (MSM) and migrants originating from HIV-endemic regions for whom HIV testing was indicated, but not performed. Additionally, we analysed the profile of HIV-positive patients diagnosed by GPs, entering care between 2008 and 2013 (ATHENA national observational HIV cohort).
Results: In 60% of STI consultations in high-risk groups initially no HIV test was reported (535/891). GP registers from 164 of 233 selected consultations revealed that 44% of not-tested (64 of 146 traceable patients) had an HIV test in previous or follow-up consultations or at different STI-care facilities. Hence, about 38% of high-risk patients were not tested for HIV during or around the time of STI consultation. The main reasons for not testing were insignificant or ‘too’ recent risk of infection according to GPs or hesitation/reluctance of patients to be tested. One-third of HIV-positive patients in care were diagnosed in the general practice; these were on average older, more often MSM or migrant than patients tested for HIV in the sentinel network.
Conclusions: Over one-third of at-risk patients are not tested for HIV in general practice. Strategies to facilitate HIV testing in high-risk groups in general practice are needed to prevent missed testing opportunities.
P078 High prevalence and high incidence of co-infections with hepatitis B, hepatitis C and syphilis and low rate of effective vaccination against hepatitis B in HIV-positive men who have sex with men with known date of HIV-seroconversion in Germany
Klaus Jansen1, Michael Thamm1, Thomas Bock1, Ramona Scheufele1, Claudia Kuecherer1, Dieter Muenstermann2, Hans-Jochen Hagedorn2, Sila Ayguenduez1, Osamah Hamouda1 and Barbara Gunsenheimer-Bartmeyer1
1Robert Koch-Institute, Germany
2Labor Krone, Germany
Background: Men who have sex with men (MSM) are assumed to be at higher risk for co-infections with hepatitis B (HBV), hepatitis C (HCV) or syphilis. HIV infection and these co-infections can accelerate disease progression reciprocally. We evaluated prevalences and incidence rates (IRs) of these co-infections among MSM in the German HIV-seroconverter cohort study (GHSCS).
Methods: The GHSCS is an open, multicenter, prospective cohort study of HIV-infected persons with known or precisely estimated date of HIV-seroconversion. MSM were screened on yearly collected serum samples for anti-HBc, anti-HBs, HBs-AG, anti-HCV and syphilis antibodies. Samples with signs of acute/chronic HBV infection or HCV infection were confirmed by PCR. Prevalences were compared by Chi square test and Fischer’s exact test respectively. Lifetime prevalences and IR/100 person years (PY) were calculated.
Results: Overall, 5445 samples of 1843 MSM were screened, taken 1996–2012. Median age at HIV-seroconversion was 33 years. Prevalence of acute/chronic HBV was 1.7%, of cleared HBV 27.1%, of occult HBV infection 0.2%; 47.5% were effectively vaccinated against HBV. HCV prevalence was 8.2%. HCV-genotype 1 was most frequent (71.6%), followed by GT4 (19.2%), GT3 (6.8%) and GT2 (2.7%). Syphilis prevalence was 39.6%. Prevalences of any STI, cleared HBV and history of syphilis were significantly higher in higher age groups, HBV vaccination significantly lower (all p values < 0.01). 18.9% had triple- or quadruple STI coinfections. IRs were 2.51/100 PY for HBV, 1.54/100 PY for HCV and 4.06/100 PY for syphilis. HCV-IR was significantly higher in MSM with syphilis-coinfection and living in Berlin, independently; syphilis-IR was significantly higher for MSM living in Berlin.
Discussion: Despite extensive HBV vaccination campaigns for MSM in Germany, less than half of screened MSM were vaccinated effectively. A high proportion of MSM had a history of HBV infection. High rates of STI co-infections in HIV-positive MSM stress the need for more extensive and tailored campaigns for HBV vaccination and STI prevention for this group, especially for higher age groups.
P079 Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Spain
Laia Ferrer Serret1, Cinta Folch1, Percy Fernández-Dávila1, Josefina Belda2, Antonio Susperregui3, Adriana Morales4 and Jordi Casabona1
1CEEISCAT, Spain
2UPS-ITS, Spain
3ADHARA, Spain
4STOP SIDA, Spain
Background: There is a lack of data on pre-exposure prophylaxis (PrEP) effectiveness in real world especially in Spain.
Aim: To identify predictors of knowledge of PrEP and compare the epidemiological profile of men who have sex with men (MSM) based on their willingness to use PrEP in Spain.
Methods: A paper-and-pencil and online version of a questionnaire was administered among MSM in Spain between June 2013 and February 2014. The analysis included 866 MSM HIV-negatives aged ≥ 18 years. Simple and multiple relationships were assessed with χ2 and adjusted residual statistics respectively, and logistic regression was used to identify predictors.
Results: Overall, 29% of men knew PrEP, 57.6% intent to use it, 16.6% did not intent and 26% hesitated. Knowledge was independently associated with having the highest education level (ORa = 2.6; 95% CI: 1.2–5.6), identifying oneself as homosexual (ORa = 2.1; 95% CI: 1.3–3.3), having an HIV test last year (ORa = 1.8; 95% CI: 1.3–2.6), having heard about PEP (ORa = 6; 95% CI: 3.4–10.5), intending to use PrEP (ORa = 2; 95% CI: 1.3–3.1), being recruited in an HIV testing centre (voluntary counselling and testing [VCT]) (ORa = 2.0; 95% CI: 1.3–2.9) and being optimist with HIV treatment (ORa = 1.8; 95% CI: 1.2–2.7). Hesitating men were older than those who intent and not intent to use it (aged > 30 years: 65.9%, 56.2%, 53.3%, respectively); the proportion of men who knew about PrEP was lower among hesitating men in comparison with other groups (21.8%, 29.8%, 32.6%, respectively), and the proportion of men who knew about post-exposure prophylaxis (PEP) was higher among those who did not intent to use PrEP than those who intent to use it or hesitated (84.3%, 70.4%, 67.6%, respectively).
Conclusion: Knowledge of PrEP was not associated with sexual behaviours, and there were no differences on sexual behaviours of men according their willingness to use it. Having access to VCT centres was associated with knowledge of PrEP. Men knowing about PrEP had more doubts about its use. Maintaining regular contact with the VCT centres can be a key point to keep men informed; thus, they can make more reasoned decisions regarding their health.
P080 Exploring chlamydia testing activity and positivity in men over the age of 24 in England in 2014
Emma L Hollis, Ana K Harb, John M Saunders, Ali Talebi, JK Dunbar, Sarah C Woodhall and Catherine M Lowndes
Public Health England, UK
Background: The English National Chlamydia Screening Programme (NCSP) targets sexually active 15- to 24-year-old men and women. A nationally representative survey in 2010–2012 found a higher chlamydia prevalence in men aged 25–34 years compared to 16–19 years (not the case in females). This raises the question as to whether the current NCSP target age is appropriate for men.
Aim: To explore chlamydia testing, positivity (number positive/number tested) and diagnoses among men by age group in England.
Methods: The Chlamydia Testing Activity Dataset (CTAD) collects data on all publicly commissioned chlamydia tests in England. Data from January to December 2014 were analysed by gender and five-year age groups.
Results: Of the 3,769,082 tests reported in 2014, 34% were from men. 58.4% of tests in men and 52.4% of tests in women were in adults aged 25 years and over. Positivity in men was highest in 20- to 24-year-olds at 9.5% and remained over 5% for age groups up to 34. Positivity in women was highest in 15- to 19-year-olds but fell below 5% for age groups 25 and over. The distribution of diagnoses by age group varied by gender with 44.1% of diagnoses in men and 24.6% of diagnoses in women in adults aged 25 years and over.
Discussion: In 2014, the distribution of testing by age group was similar in men and women. However, the distribution of diagnoses and positivity by age group differed by gender. Diagnoses reported in men outside the NCSP target age group contribute a large proportion of the total diagnoses. The effect of extending the age range of screening on chlamydia prevalence and sequelae is unknown, but may warrant consideration. Other factors such as burden of infection, cost-effectiveness, efficiency and capacity of current services provided must also be considered when discussing extending screening and prevention efforts to men over 25.
P081 Identifying and interpreting spatial temporal variation in diagnoses of infectious syphilis amongst men, England: 2009 to 2013
Jakob Petersen1, Maurizio Gibin2, Bersabeh Sile3 and Ian Simms3
1University of Essex, UK
2Birkbeck College, Italy
3Public Health England, UK
Aim: Spatial variation has been a key feature of the epidemiology of syphilis since it re-emerged in 1997. Increasing incidence was characterised by outbreaks, infection quickly becoming endemic in London, Manchester and Brighton. Here, we explore the recent occurrence of spatial clusters and variations in the trajectory of local epidemics in relation to sexual orientation, demographic factors, stage of syphilis infection and HIV serostatus.
Methods: Kulldorff’s scan statistics (SaTScan) was used to distinguish endemic and temporary clusters using a two-stage analysis. Data were visualised using STATA and ArcGIS.
Results: For each year, endemic areas were found in London, Manchester, Brighton and Blackpool. Between 30% and 40% of all diagnoses (12,521) were found within an 11-km radius in central London. Of men diagnosed with syphilis in London, 80% were men who have sex with men. The annual incidence in London increased from 24 (23–26 95% CI) cases per 100,000 population in 2009 to 36 (34–38) in 2013. In comparison with clusters, endemic areas were characterised by: a significantly higher (p < 0.05) proportion of men who have sex with men (MSM) (83% compared to 73%), an increased HIV positivity (41% vs. 15%), age 35–44 (34% vs. 23%), lower proportion of patients born in the UK (50% vs. 81%) and a lower proportion of primary-stage infection (40% vs. 47%). Space-time clusters occurred in urban and rural areas, diagnoses fluctuating between one and 10 per month. Exponential increases in diagnoses resembling the point source outbreaks generally associated with gastroenteric infection were seen at two locations.
Discussion: Control of syphilis in endemic areas has proved elusive, and clusters, which are frequently focused on young heterosexuals, present unique intervention challenges. Investigating the diversity of local epidemics provides information that can be used to predict outbreak structure, plan and evaluate sexual health services, and guide public health investigation, hypothesis generation and research.
P082 High proportion of newly diagnosed HIV-positive men who have sex with men had previous HIV test in Germany – is testing used as prevention strategy?
Background: HIV testing has been a cornerstone of prevention for many years in Germany. Statutory reporting of newly diagnosed HIV infections (NDH) includes information of the last negative test. Hypothesising that HIV testing influences risk behaviour, the proportion of NDH with previous negative test should decrease over time. This study aimed to describe the proportion of men who have sex with men (MSM) with a previous negative HIV test within the last two years prior to NDH.
Methods: NDH of MSM, reported between 2005 and 2014, to the national HIV surveillance system were analysed. Among all NDH MSM with last negative test were determined. Recent infections were defined as NDH with a negative test ≤ 23 month prior to the HIV diagnosis. Chi square test was used for statistical analysis.
Results: Between 2005 and 2014, a total of 15,872 MSM were newly diagnosed with HIV in Germany. The majority of MSM was of German origin (85%), lived in cities >1 million inhabitants (33%) and was 30–39 years old (33%). Overall, the information of last negative test was reported for 8657 NDH among all transmission group categories. The highest proportion of NDH with information of last negative test was found in MSM (85%; 7356/8657), in contrast to heterosexual HIV transmission (11%; 989/8657) and injection drug user (IDU) (4%; 307/8657). 46.3% (7356/15,872) of all MSM with NDH reported a previous negative test. 23.4% (3709/15,872) of that group reported a last negative test ≤ 23 months. The proportion varied between 21% and 29%, but this proportion remained nearly stable with no trend over time (p = 0.61). The proportion of MSM 25–29 years old with recent infection increased from 19.3% to 25.2%, whereas the proportion of NDH without negative test remained stable at 15.8%.
Discussion: High proportion of NDH of MSM in the last 10 years had previous negative test. The unchanged high proportion of recent HIV infections with previous negative test indicates ongoing transmission despite of test seeking in that group. Therefore, our data do not support the hypothesis that HIV testing changes risk behaviour.
P083 Comparison of two approches for recent infections among newly diagnosed men who have sex with men using a recency test and the date of the reported last negative test in Germany (2011–2014)
Alexandra Hofmann, Andrea Hauser, Kerstin Schönerstedt-Zastrau, Claudia Santos-Hövener, Ruth Zimmermann, Norbert Bannert, Viviane Bremer, Claudia Kücherer and Barbara Bartmeyer
Robert Koch-Institut, Germany
Introduction: Monitoring of recent HIV infections is crucial to assess dynamics and changing patterns of the HIV epidemic. Testing for recent HIV infections (TRI) among newly diagnosed HIV infections (NDH) was implemented in routine surveillance in 2011 in Germany.
Objective: The aim of this analysis is to describe the proportion of recent HIV infections among men who have sex with men (MSM) by TRI and reported last negative HIV test.
Methods: Filter-dried serum spots (DSS) were collected of NDH cases, and TRI was performed using BED IgG-capture-ELISA (<140 days). Socio-demographic, clinical, laboratory data and the last negative test were collected via HIV-notification database for NDH cases and merged with TRI results. The proportion of recent infections among MSM with DSS was calculated with both methods. Odds ratio (OR), 95% confidence interval (95% CI) and Wilcoxon rank-sum test (Wilcoxon) were used for statistical analysis.
Results: Between January 2011 and December 2014, a total of 6916 NDH MSM cases were documented in the German HIV notification system. DSS were collected for 62% (4302/6916) of MSM. TRI identified 38% (1616/4302) of these as recent HIV infections. TRI as well as last negative test were available for 32% (n = 1378) of MSM and 20% (n = 282) of those had a negative test five months prior to HIV diagnosis. MSM with a last negative test less than five months ago were more likely to be diagnosed with a recent infection (OR: 4.8; 95% CI: 3.47–6.78). Time intervals between last negative HIV test and HIV diagnoses were significantly shorter in MSM with recent infection test result (n = 747) compared to those with long standing infections (n = 631) (median 8 vs. 17 month; p < 0.001 Wilcoxon).
Conclusions: Information about the last negative test by surveillance data and TRI are a good tool to assess HIV dynamics. MSM with a recent HIV infection seem to test more regularly and with shorter time intervals between tests than MSM with a longstanding HIV infection. This may indicate ongoing transmissions in that group and continued risk behaviour after test seeking.
P084 Preventing late diagnosis of HIV infection – exploring barriers for not accepting HIV testing in an integrated sexual health clinic
Charlotte Webster, Joseph Arumainayagam, Sashi Acharya and Shamala Chandramani
NHS, UK
Background: Whilst the availability of treatment transformed the outcome of individuals with HIV infection, there is still a significant avoidable morbidity and mortality relating to HIV infection in the UK. Audit by British HIV Association showed that among deaths of HIV patients in 2006, 24% were directly attributable to the diagnosis of HIV being made too late for effective treatment. Furthermore, it had been shown that many of these ‘late diagnosis’ had been seen previously by health care professionals. The national strategy for sexual health and HIV recommended that all sexual health clinics should offer HIV tests to all their patients.
Objective: We sought to establish the offered rates of HIV testing at the integrated sexual health clinic, determine the accepted rates of HIV testing and establish any barriers that may be preventing HIV tests being offered or accepted.
Method: Patients who attended between July and August 2014 were randomly selected. The inclusioin criteria were new and rebooked patients, walk-in and procedure clinic attendees. Those who attended HIV clinics and follow-up patients were excluded. Demographics including age, sexual orientation and ethnicity were recorded.
Results: Sixty male and 60 females were included, and of these, 94% were offered the test. Of those not offered, four attended for treatment of recurrent warts, one had a recent test and another for repeat prescription for contraceptive pill. Of those offered, 42% declined the test. No reason was recoreded in 33%, 27% had a recent test, 15% were in the window period, 10% percieved themselves not to be at risk and 6% came for contraception only.
Discussion: To increase uptake of testing, following measures were implemented: recording reason for declining made mandatory, periodic reminder to staff to offer testing to all patients, perform baseline test in all cases and testing information displayed widely in all waiting areas.
P085 Prevalence of Mycoplasma genitalium in France and comparison with Chlamydia trachomatis and Neisseria gonorrhoeae using transcription-mediated amplification assays
Anne Ebel, Céline Venard, Dominique Brunengo and Sandra Merlin
Biomnis, France
Background:Mycoplasma genitalium (MG) causes non-gonococcal urethritis in men and is associated with endometritis and cervicitis in women. Nucleic acid amplification tests (NAATs) are the preferred assays for the diagnosis of genital infections, because of their high sensitivity and suitability for various types of samples. In France, few data on prevalence of MG exist.
Objectives: Determine prevalence of MG together with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), in men and women with or without symptoms of sexually transmitted infections (STIs), undergoing CT and NG screening in France.
Methods: We analysed 3002 clinical samples (1015 first-void urines, 877 vaginal swabs, 677 cervical swabs, 175 urethral swabs and 258 samples from other origins), prospectively collected from 2 to 14 Jaunary 2015. A research-use-only transcription-mediated amplification (TMA) assay for MG (Hologic®) and the APTIMA® Combo 2 assay (AC2, Hologic) for CT and NG were used, respectively.
Results: In women (n = 2201), the prevalence of MG, CT and NG was 3.2%, 7.0% and 0.7%, respectively, and 5.0%, 8.3% and 4.5%, respectively, in men (n = 785). Highest prevalence was in the age range of 20–29 years for women and men for all MG, CT and NG infections. We found three co-infections with CT/NG/MG, 20 co-infections with CT/MG and seven with NG/MG. MG-positive clinical samples mostly originated from first-void urines (33%), vaginal (31%) and cervical (17%) specimens.
Discussion: The MG’s prevalence reported here is comparable with what was reported in earlier epidemiologic studies in France. The prevalence of MG was intermediate between the prevalence of CT and NG.
Conclusions: In this study, we determined prevalence of the three infections in women and men in all age groups and in relation to the specimen type. We demonstrated a good and easy-to-use performance in primary Aptima collection tubes for the TMA assays on the Tigris® instrument.
P086 Who is being diagnosed with bacterial sexually transmitted infections through partner notification? A comparison of persons diagnosed with chlamydia or gonorrhoea through partner notification and those diagnosed otherwise in genitourinary medicine clinics in England, 2013
John Were, Hamish Mohammed, Martina Furegato and Gwenda Hughes
Public Health England, UK
Background: Partner notification (PN) is an essential component of sexually transmitted infection (STI) control.
Objective: We compared the characteristics of persons diagnosed with chlamydia (CT) or gonorrhoea (GC) through PN and those diagnosed as ‘index patients’ at genitourinary medicine (GUM) clinics.
Methods: Using data from the GUM clinic activity dataset version 2 (GUMCADv2), England’s national STI surveillance system, associations between patient characteristics and being diagnosed through PN were assessed using univariate and multivariate regression. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are reported.
Results: In 2013, 47,927 persons attended a GUM clinic through PN for CT, and among these, 15,788 (33%) were diagnosed with CT, accounting for 18% of all CT diagnoses. On multivariate analysis (aOR[95% CI]), multiracial persons (vs. white persons; 1.22[1.03–1.46]) and those co-infected with another STI (3.33[2.79–3.98]) had higher odds of being diagnosed through PN, while lower odds were found among men who have sex with men (MSM) (0.33[0.26–0.41]) and women (vs. heterosexual men; 0.55[0.51–0.60]), Asian persons (vs. white persons; 0.72[0.55–0.96]) and those who previously attended through PN (0.57[0.37–0.86]). For GC, the number of persons attending through PN was 10,870, and among these, 3294 (30%) were diagnosed with GC, accounting for 13% of all GC diagnoses. MSM (1.29[1.16–1.45]) and women (vs. heterosexual men; 1.52[1.36–1.70]) and persons living outside London (1.11[1.01–1.21]) had higher odds of being diagnosed through PN, while lower odds were found in >50-year-olds (vs. 15- to 24-year-olds; 0.72[0.58–0.91]), those who previously attended through PN (0.18[1.17–0.20]), black (0.77[0.67–0.88]) and Asian persons (0.75[0.60–0.94]).
Conclusion: There are notable differences among persons diagnosed with CT and GC through PN and those diagnosed as ‘index patients’. These data can be used for targeted interventions to improve PN outcomes among select patient subgroups.
P087 Anal HPV infection among HIV-positive and negative sexually active men who have sex with men
Marina Drabeni1, Libera Clemente2, Gian Michele Moise1, Laura Bon2 and Francesco Fontana2
1Sexually Transmitted Infections Unit, A.A.S.2 Bassa Friulana-Isontina, Gorizia, Italy
Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infection and causally linked to the development of cervical, anal, penile and oropharyngeal cancers. Men who have sex with men (MSM) are at greatly increased risk for HPV infection across all age groups; for this reason, anal cancer rate results higher in MSM, especially in HIV-infected people.
Objective: To evaluate the prevalence and genotypes distribution of HPV anal infection in HIV-positive and negative MSM.
Methods: HPV anal swabs (ESwab-Copan®) were collected in 137 HIV-positive and 136 HIV-negative MSM referred to our centre from July 2014 to March 2015. HPV genotyping was conducted on all samples, to detect low- and high-risk (LH/HR) HPV types. The nucleic acids extraction was carried out with NucliSENS easyMAG (bioMerieux®) and genomic amplification with the real-time PCR detection AnyplexTM II HPV28 (Seegene®).
Results: Anal swabs were positive for one or more HPV types in 73% (100/137) of HIV-infected and in 72% (98/136) of HIV-uninfected MSM. The HPV genotype distribution in HIV-positive patients compared to that of negative group was different. The co-infection with multiple HR HPV genotypes (n ≥ 2) was found in 81% (81/100) among HIV-positive and in 61.2% (60/98) HIV-negative MSM (p < 0.01); multiple LH HPV were present in 60% (60/100) among HIV-positive and 44.9% (60/98) among HIV-negative MSM (p < 0.01). Particularly, HPV-16 or 18 were positive in 40% (40/100) and 26.5% (26/98) among HIV-infected and unifected population, respectively.
Conclusions: In our HIV-positive population, anal HPV co-infections were found significantly higher than in the HIV-negative one. The high prevalence of HPV infections in both groups confirms the importance to extend the HPV vaccine to all sexually active MSM.
P088 Does bacterial vaginosis predispose to Chlamydia trachomatis and Neisseria gonorrhoeae infection? A population-based case-control study among US Army females
Christian Bautista1, Eyako Wurapa1, Warren Sateren1, Sara Morris2, Bruce Hollingsworth2 and Jose Sanchez3
1WRAIR, Washington, DC, USA
2Lancaster University, UK
3AFHSC, Silver Spring, MD, USA
Background: Bacterial vaginosis (BV) is the most commonly diagnosed condition in patients with vaginitis and is commonly associated with multiple and new sexual partners, lack of condom use and douching. Limited epidemiologic data suggest that BV may constitute a risk factor for infection with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).
Objectives: To determine if antecedent BV is associated with subsequent CT and NG infection.
Methods: Between 2006 and 2012, service members with a first-time diagnosis (case) of CT or NG were identified from the Defense Medical Surveillance System. Using a nested case-control study design, 10 controls were matched to each CT/NG case on age (± 1 year). Odds ratios (OR) for preceding BV were estimated using conditional logistic regression.
Results: A total of 37,419 CT cases (371,490 controls) and 4987 NG cases (49,870 controls) were identified. The prevalence of antecedent BV before CT/NG diagnosis among CT cases and their controls was 4.3% and 2.5%, respectively. In contrast, it was 9.0% and 3.2%, respectively, for NG cases and their controls. Antecedent BV was associated with both CT infection (OR = 1.8, 95% CI = 1.7–1.9) and NG infection (OR = 3.0, 95% CI = 2.7–3.4). After controlling for race and ethnicity, these estimates remained similar (for CT: OR = 1.8, 95% CI = 1.7–1.9; for NG: OR = 3.0; 95% CI = 2.6–3.3).
Discussion: Antecedent BV was found to increase the risk of subsequent CT and NG infection; further prospective studies are necessary to investigate this association and related risk factors.
P089 Low prevalence of urethral lymphogranuloma venereum infections among homosexual men visiting the sexually transmitted infection clinic in Amsterdam, the Netherlands
Bart Versteeg1, Nynke de Vrieze2, Sylvia Bruisten1, Jannie van der Helm1 and Henry de Vries3
1GGD Amsterdam, Netherlands
2UMC Utrecht, Netherlands
3AMC, Netherlands
Several guidelines (BASHH, WHO/USTI and CDC) recommend routine screening for anorectal lymphogranuloma venereum (LGV) in men who have sex with men (MSM). None recommend screening of urethral LGV infections. However, urethral LGV infections might play an important role in the ongoing transmission of LGV infections among MSM. Therefore, our aim was to study the prevalence of urethral LGV among MSM visiting the sexually transmitted infection (STI) clinic in Amsterdam, the Netherlands. We prospectively collected all urethral Chlamydia trachomatis (Ct)-positive samples from MSM visiting the Amsterdam STI clinic between March 2014 and April 2015. Samples were typed using an in-house pmpH quantitative PCR (qPCR) to differentiate between LGV and non-LGV infections. During the inclusion period, 10,859 MSM were tested for urethral Ct infections of whom 368 (3.4%) tested chlamydia positive. Of these, 288 (62%) were negative for an LGV-type infection, 72 (19.6%) were inconclusive and eight (2.2%) samples were positive for an LGV-type infection. Overall, we found a prevalence of 0.07% (8/10,859) among MSM visiting the Amsterdam STI clinic. The observed prevalence of urethral LGV infections (0.07%) is far lower compared to the prevalence of anorectal LGV infections of 1.5% found among MSM visitors of the STI clinic. Despite the low prevalence, these infections would be missed in the current diagnostic algorithm and could subsequently contribute to the ongoing transmission of LGV infections. Routine screening of urethral LGV infections might not be feasible for all MSM; however, awareness, screening of partners and prompt treatment of LGV infections are crucial for the individual patient and prevent ongoing transmission and possible severe outcomes.
P091 Prevalence study of asymptomatic sexually transmitted infection among men who have sex with men in a non-clinical setting in Barcelona
Pep Coll1, Antonia Andreu2, Mireia Jané3, Michael Meulbroek4, Ines Cruz2, Rosa Mansilla3, Antonio Carrillo4, Antonio Cabas4, Ferran Pujol4 and Jorge Saz4
1IrsiCaixa, Spain
2Hospital Universitari Vall d’Hebron, Spain
3Agència de Salut Pública de Catalunya, Spain
4BCN Checkpoint, Projecte dels NOMS-Hispanosida, Spain
Background: Sexually transmitted infection (STI) incidence is increasing in men who have sex with men (MSM) in Catalonia. Between 2010 and 2011, there was a 13% increase of syphilis; 60% of cases were MSM. Little is known about asymptomatic STI. A cohort study in Barcelona (‘Check-ear’) showed about 15% of MSM having asymptomatic infections with Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) in rectum or penis. The Public Health Agency of Catalonia started a screening programme of CT and NG in an HIV testing and counselling (HTC) for MSM.
Objective: To evaluate the prevalence of asymptomatic CT and NG among MSM tested for HIV in the Community Centre BCN Checkpoint in Barcelona.
Methods: Since March 2015, clients attending the Centre for HIV testing are offered to test for CT and NG at three anatomic sites (urethral, rectal and pharyngeal). Inclusion criteria: more than 10 partners during the last six months and no consistent condom use. Overall, 600 MSM are expected to be screened by July 2015. Rectal and pharyngeal specimens placed in VICUM media (Deltalab), and first-catch urines are transported to the laboratory at 4°C. Real-time PCR using Anyplex® CT/NG real-time detection (v 3.1) Seegene are performed.
Results: At the date of April 17, 62 MSM have been recruited. Baseline prevalence of any STI is 16.1%. Per anatomic site, CT: rectal, 8.1%; urethral, 1.6% and pharyngeal, 0%; for NG: rectal, 1.6%; urethral, 0% and pharyngeal, 4.8%. Infections detected are treated at BCN Checkpoint.
Conclusions: This screening programme allows to improve the access to testing and to generate knowledge about the impact of STI among MSM. Preliminary results show a high prevalence of STI among MSM, consistent with the ‘Check-ear’ cohort. High prevalence in rectum stresses the need to include anal swap. This study will allow Public Health Agencies to assess and implement STI prevention strategies addressed to vulnerable groups.
P092 Chlamydia and gonorrhoea co-infection at urogenital, anorectal and oropharyngeal site in men who have sex with men and women
Geneviève van Liere1,2, Martijn van Rooijen3, Christian Hoebe1,2, Titia Heijman3, Henry de Vries4 and Nicole Dukers-Muijrers1,2
1Public Health Service South Limburg
2Maastricht University Medical Center (MUMC+), Netherlands
3Public Health Service of Amsterdam, Netherlands
4Public Health Service of Amsterdam, Academic Medical Center (AMC), University of Amsterdam, Centre for Infection and Immunology Amsterdam (CINIMA), Netherlands
Background:Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections at (extra)genital sites are common in men who have sex with men (MSM) and women. CT/NG infection can occur simultaneously at the same anatomic location within a person (co-infection). However, studies on the proportion and the overlap of CT/NG co-infection at three anatomic sites are scarce.
Methods: At two Dutch outpatient sexually transmitted infection (STI) clinics (2011–2012), all men who have sex with men (MSM) and high-risk women (hereafter women), >16 years, tested for anorectal and urogenital CT or NG, were selected, and tests for both CT and NG at the same anatomic location were included. The prevalence of CT/NG co-infection were calculated and compared between anatomic locations and sex using Chi square test.
Results: In MSM, overall prevalence of CT at any site was 11.4% (1081/9514); for NG, this was 9.0% (852/9514). Prevalence of urogenital CT/NG co-infection was 0.4% (36/9514); for anorectal infections, this was 1.4% (96/7079), and for oropharyngeal infections, this was 0.1% (6/9497) (p < 0.001). In women, overall prevalence of CT was 13.2% (1447/10,947); for NG, this was 2.3% (249/10,947). Prevalence of CT/NG co-infection was 0.6% (69/10,947), 0.4% (17/4456) and 0.2% (13/7209) (p < 0.001), respectively. Compared to women, MSM more often had co-infection overall (p < 0.001) and per anatomic location (p = 0.01, p ≤ 0.001 and p = 0.03, respectively). Of NG positives, up to 42% had co-infection with CT, of CT-positives, up to 14% had co-infection with NG (Table 1).
Conclusion: Overall prevalence of CT/NG co-infection was low in both MSM and women. However, when CT or NG positive, CT/NG infections varied between 4% and 42%. In MSM, anorectal co-infections were frequently diagnosed, as well as for women with anorectal NG. These results indicate the importance of CT testing in NG-positive MSM and women, and NG testing in CT-positive MSM and women.
MSM: men who have sex with men; CT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae.
p < 0.01; ***p < 0.001
P093 Chlamydia trachomatis infection in men in Germany, 2008–2014
Sandra Dudareva-Vizule, Katja Alt, Alexandra Hofmann, Klaus Jansen, Andrea Sailer, Karin Haar and Viviane Bremer
Department for Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany
Background: In Germany, infections with Chlamydia trachomatis (CT) are not notifiable. There is no screening policy for men. A nationwide, laboratory-based, voluntary sentinel conducting routine CT diagnostics was initiated in 2010 collecting data retro- (from 2008) and prospectively. We analysed information on CT test conducted in symptomatic men to identify trends in CT-diagnostic practices.
Methods: We included information on number of conducted tests, test result, age and specimen type from 15- to 59-year-old men from laboratories having data available for each year from 2008 to 2014. We calculated proportion of positive tests (PPT) for five-year age-groups and tested specimens and compared them with Chi square test. We estimated trends for counts with linear regression and trends for rates with Poisson regression.
Results: Results for 201,476 tests from 15 laboratories were included. Men aged 20–34 years were most frequently tested (54% of tests). PPT was higher among men aged 15–19 (15.7%), 20–24 (19.1%) and 25–29 (14.7%) years compared to men aged 30–34 (10.5%), 35–39 (8.6%), 40–44 (7.8%), 45–49 (6.7%), 50–54 (5.7%) and 55–59 (4.1%) years (p value < 0.0001). Tested specimens were unspecified swabs (48.7%) and urine (32.2%), semen (7.6%), urethral (5.4%), rectal (3.3%) and pharyngeal (2.1%) swabs. PPT was higher in rectal (13.2%) and unspecified swabs (13.8%) compared to urine (10.0%), urethral (9.2%) and pharyngeal (2.3%) swabs, and semen (1.9%) (p value < 0.001). Between 2008 and 2014, the number of tests increased from 16.324 to 36.851 tests per year (p value < 0.001). Overall, the PPT remained stable over time (p value = 0.171).
Conclusions: The proportion of young men testing positive for CT was high. Despite increased testing, PPT remained stable over time. Awareness campaigns for young men should be implemented. Given the high proportion of positive rectal swabs, we recommend risk-based testing for CT in men who have sex with men.
P094 HIV/AIDS and malignancies in Israel, 1981–2010
Zohar Mor1 and Micha Barchana2
1Ministry of Health, Israel
2Haifa University, Israel
Objectives: Antiretroviral therapy (ART) became available in Israel in 1996, improved survival of people living with HIV/AIDS (PLWHA) and decreased HIV-related morbidities. This study assess cancer incidence of all adult PLWHA in Israel by transmission routes before and after 1996.
Methods: This cohort study was based on cross-matching the national HIV/AIDS and cancer registries to identify PLWHA who were also diagnosed with cancer. All PLWHA were also cross-matched with the national civil census to define the date of death or leaving Israel. They were followed-up from date of reporting until cancer diagnosis, death, leaving Israel or 2010, whichever occurred first.
Results: Of all 5154 PLWHA who were followed-up for 36,296 person-years, 362 (7.0%) developed cancer (997.4 cases per 100,000 person-years). Higher hazard ratios to develop cancer were demonstrated among older PLWHA, Jews and intravenous drug users. Cancer incidence among PLWHA was higher in the pre-ART period than after 1997 (1232.0 and 846.7 cases per 100,000 person-years, respectively). The incidence of AIDS-defining cancers was higher than non-AIDS-defining cancers and higher in the pre-ART than the post-ART period (777.0 and 467.2 cases per 100,000 person-years, respectively), while incidence of non-AIDS-defining cancers showed the opposite trend (376.5 and 455.0 cases per 100,000 person-years, respectively). The incidence of AIDS and non-AIDS-defining cancers declined between the pre-ART and the post-ART period by 2.0 to 3.4 times. PLWHA had higher rate of malignancies than the general population. Cox proportional regression models showed that PLWHA who acquired the infection by homosexual transmission were at the greatest risk to develop cancers before 1996, while those who were infected by contaminated blood products were at highest risk after 1997.
Conclusion: Both AIDS- and non-AIDS-related cancers decreased after the introduction of ART, and their diagnoses were strongly associated with age. Yet, cancers remain an important prognostic factor in PLWHA, and initiation of age-related cancer screening and ART early in the course of HIV infection can sustain high levels of immune function and reduce malignancies. Additionally, programmes targeting smoking cessation and viruses’ vaccination should be promoted in the population of PLWHA.
P095 Rectal tests for chlamydia in men: an analysis of activity and positivity by service setting – England 2014
Emma L Hollis, John M Saunders, Sarah C Woodhall, JK Dunbar, Kate Folkard and Catherine M Lowndes
Public Health England, UK
Background: Sexual health services in England are offered in specialist (genitourinary medicine [GUM]) and non-specialist (non-GUM) settings. Non-specialist settings may not be able to offer a comprehensive service for men who have sex with men (MSM). Therefore, it is important to understand where MSM access testing to identify areas in need of robust referral pathways. The Chlamydia Testing Activity Dataset (CTAD) collects data on all publicly commissioned chlamydia tests in England. Although sexual orientation is not collected in CTAD, anatomical site of test is.
Aim: To describe rectal testing for chlamydia and positivity among MSM in GUM and non-GUM settings.
Methods: Routine data from CTAD for men aged >15 years from July to September 2014 were analysed. Aggregate data on MSM from the GUM Clinic Activity Dataset (GUMCADv2) which collects sexual orientation were used for validation.
Results: Overall, 338,912 tests were reported in this period, and of these, 32,256 were rectal samples from men. There was 95% concordance between MSM tests recorded in GUMCADv2 and male rectal tests in CTAD. The majority originated from a GUM setting (90.1% vs. 9.1% from non-GUM). Positivity of samples from GUM and non-GUM settings was similar, 6.9% versus 6.6%. A quarter (24.5%) of tests in non-GUM settings were in men under the age of 25 years (19.8% in GUM). Overall, positivity of rectal tests is slightly higher in over 25s compared to under 25s (7.0% vs. 6.3%).
Discussion: Rectal tests among men in CTAD were a suitable proxy to identify MSM within non-GUM services. However, the use of rectal test as a proxy for MSM will miss MSM who are not having a rectal test and is, therefore, an underestimate of MSM in non-GUM settings. The majority of rectal testing was done in GUM settings; however, positivity in GUM and non-GUM services was comparable suggesting that high-risk MSM were accessing services outside of GUM. Services must ensure local pathways link all MSM to testing for other sexually transmitted infections (STIs) including HIV.
P096 Sexually transmitted infections in over 50s: does older really mean wiser?
Dornubari Lebari and Emile Morgan
Bolton Centre for Sexual and Reproductive Health, UK
Background: Evidence shows increasing rates of sexually transmitted infections (STIs) in people aged 50 years or more.
Objectives: To investigate STIs diagnosed and HIV testing patterns in people aged 50 years and older, attending our sexual health clinic.
Methods: A retrospective coding and case note review of people aged 50 years or over attending the clinic over a five-year period. Patients presenting for specialist clinics, complex contraception and genital dermatology were excluded.
Results: A total of 772 patients, aged 50 years or more, attended the sexual health clinic between 2010 and 2014. There were more male attendees (59%) compared with females. The most common STI diagnoses were anogenital warts (up to 36%) and herpes simplex infection (up to 27%). HIV diagnosis was made in seven (1%) of those presenting for a sexual health screen. Overall, 30% refused or did not have an HIV test, although this proportion decreased to 17% over the five-year period.
Discussion: People aged 50 years or over do present to sexual health clinics. They are more likely to be diagnosed with chronic STIs such as genital warts or herpes simplex infection. However, there is lack of sexual health education and health programmes targeted towards this group. Until recently, there has been lack of research into sexual behaviours of people aged 50 years or over to help inform sexual health provision. The most recent National Survey of Sexual Attitudes and Lifestyles (NATSAL-3) is the first to include people older than 50 years of age.
P097 Exploring epididymitis diagnoses in hospitals and genitourinary medicine clinics as a possible outcome measure to evaluate chlamydia control programmes
Nastassya Chandra, Bersabeh Sile, John Saunders and Sarah Woodhall
Public Health England, UK
Background: Epididymitis, orchitis and epididymo-orchitis (hereafter EO) can be caused by a variety of infectious agents, including Chlamydia trachomatis (CT). Monitoring EO trends may therefore be useful in evaluating CT control efforts.
Objective: To describe patterns in EO diagnoses among men diagnosed in English hospitals and genitourinary medicine (GUM) clinics between 2009 and 2011, to appraise the use of EO as an outcome measure in different settings.
Methods: EO diagnoses among >14-year-old men were obtained from the Hospital Episodes Statistics dataset, reflecting diagnoses made in hospitals, and from a national surveillance dataset for diagnoses made in GUM clinics. Annual diagnosis rates (per relevant 100,000 population) were calculated by age group and setting. The proportion with a concurrent chlamydia diagnosis and, for hospital diagnoses, the proportion where EO was the primary diagnosis (i.e. main reason for admission) were determined.
Results: The age distribution of EO diagnosis rates varied by setting: in GUM clinics, the highest rates were among 20- to 24- and 25- to 34-year-olds (91 and 74 diagnoses/100,000, respectively); in hospitals, the highest rates were among >64-year-olds (61/100,000). In GUM clinics, 9.7% of diagnoses had a concurrent chlamydia diagnosis, versus 0.04% in hospital-diagnosed EO. In 82% of EO diagnoses in hospitals, EO was recorded as primary diagnosis on admission. This proportion decreased with increasing age (93% in 15- to 19-year-olds; 66% in >64-year-olds).
Conclusion: We found heterogeneity in EO diagnoses by setting. Our finding that the highest rates were in younger men in GUM clinics is consistent with sexually transmitted infection aetiology in this setting. That higher rates were found among older men in hospitals suggests a more mixed aetiology. EO trends in GUM clinics may therefore be more useful as an indicator for chlamydia-related complications. However, further understanding of referral pathways among younger men is warranted.
P098 Evolution of Chlamydia trachomatis prevalence in a sentinel population of young people ≤25 years, Catalonia, 2007–2014
Evelin Lopez Corbeto1, Victoria Gonzalez1, Rossie Lugo1, Jordi Casabona1 and CT/NG-ASSIR CT/NG-Presons Study Group
1Centre d’Estudis Epidemiològics Sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Spain
CT/NG-ASSIR CT/ NG-Presons Study Group, Barcelona, Spain
Background: Genital infection with Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) in many European countries. CT is a serious public health concern because, although the infection often causes no symptoms, it can have severe long-term consequences in a proportion of cases. The group of young people ≤25 years is the most affected. Accurate information about the prevalence is needed to assess national prevention and control measures.
Objectives: To know and monitor the CT prevalence between sentinel populations of sexually active young people ≤25 years and to determine the factors associated with infection.
Methods: Under the Integrated Surveillance System of Catalonia (SIVES), cross-sectional studies were carried out for detection of CT in urine samples and survey of behavioural data in two sentinel population of young people ≤25 years: young people who attended at primary care services (CT/NG ASSIR project population) in years 2007, 2010 and 2012 and young prisoners (CT/NG Prisons project population) in years 2008, 2011 and 2014.
Results: According to the sentinel population, CT prevalence in CT/NG ASSIR project population presented a growing trend (p = 0.268) with an increase of 37.6%. The prevalence in CT/NG prisons project population presented a significantly increasing trend (p = 0.034) with an increase of 24%. As for socio-demographic characteristics, sex: CT prevalence was not statistically different in men and women. Age: CT prevalence was significantly higher in the youngest 16–18 age group. Origin: CT prevalence was always been significantly higher in foreigners. Risk factors in the two populations were: younger age, foreign and no condom use. Having more than two pairs and having a new sexual partner were also risk factors in CT/NG ASSIR project population.
Conclusions: The prevalence found among young ≤25 years suggests that routine screening in this group would be recommended to allow both early treatment of asymptomatic infection and the prevention of long-term complications.
P099 Increasing sexually transmitted infection rates among men who have sex with men in Finland 2004–2014
Eija Hiltunen-Back1,2 and Hannu Kautiainen3
1Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Finland
2Infectious Disease Control Unit, National Institute for Health and Welfare, Finland
3Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Finland
Background: High-risk sexual behaviour is increasing in Europe, especially among men who have sex with men (MSM), attributing to rising rates of sexually transmitted infections (STIs) and HIV.
Aim: To analyse the prevalence and risk factors for bacterial STIs among MSM.
Methods: MSM attending the outpatient STI clinic in Helsinki were tested for Chlamydia trachomatis and Neisseria gonorrhoea (urine, anorectal and pharyngeal swab) using nucleic acid amplification test (NAAT) and sera for HIV and syphilis screening. Risk behaviour data were collected using a self-administered questionnaire.
Results: In 2004–2014, 58,509 men were screened for STIs, of whom 6550 (11.2%) were MSM with the mean age of 34.1 years. The proportion of MSM increased from 7.4% in 2004 to 16.7% in 2014 (p < 0.001). Every fourth were notified by an infected partner. Half of the men were asymptomatic. Most (68%) had had casual partners, and 22% had been infected abroad. Condom was not used by 67% of the men, and half had infected other partners. The number of sexual partners during the previous year was high, 16% reported >10 partners. Only 40% have been tested for STI/HIV during the previous year. STI was diagnosed in 1722 (26.3%) MSM, and the prevalence of all the bacterial infections has increased linearly (Table 1). In 2009–2014, 18 LGV cases were detected.
Year
Chlamydia %
Gonorrhoea %
Syphlis %
2004
5.8
5.6
2.4
2014
9.7
8.5
4.8
Age-adjusted RR (95% CI)
1.66 (1.07–2.59)
1.57 (0.99–2.49)
1.87 (0.94–3.72)
Conclusions: MSM should be a target for active STI screening and counselling to control the current epidemics. Easily reachable, low-threshold services and active partner notification are needed.
P100 Sexually transmitted infections surveillance through a primary care sentinel network, Catalonia, 2011–2014
Rossie Lugo Colon1, Nuria Vives1, Marti Vall2, Edith López-Grado2, Roger Codinachs3, Maria Jesús Barberà2, Joan Caylà4, Jordi Casabona1, José Luis Martínez1 and STI Surveillance Group, The Catalan Sentinel1
1Departament de Salut, Spain
2ICS, Spain
3EAP Vic, SL, Spain
4ASPB, Spain
Background: In Catalonia, sexually transmitted infection (STI) continues on the rise particularly among men who have sex with men (MSM). Data from complementary sentinel surveillance systems are useful to monitoring the epidemiology of non-individualised mandatory STI in Catalonia.
Objective: To describe the epidemiological profile of patients included in the sexually transmitted infections sentinel network (RITS).
Methods: Epidemiological and clinical data of main STI are collected in the RITS by sentinel collaborators of 58 centres (STI Units, Reproductive and Sexual Health Units and Family/General Primary Care). Demographic, clinical and behavioural data are recorded using a standardised questionnaire. Variables included in the analysis: sex, age, origin, diagnosis, year of diagnosis, previous STI < 12 m, HIV, concurrent STI, number of sex partners < 12 m, new sex partner < 3 m, condom use at last sex, risk exposure <12 m and contact tracing. Data were analysed using SPSS v.17.0.
Results: A total of 10,409 STI reports were recorded in the RITS (2011–2014). Mean age was 31.9 years, 55% men and 36% foreigners. STIs were: syphilis (33%), gonorrhoea (26%), chlamydia (13%), herpes (7%), lymphogranuloma venereum (LGV) (6%), genital warts (6%) and other STIs (8%). Sexual preference: 65% heterosexual and 33% MSM. Risk exposure: 11% drugs before sex, 5% sex abroad and 5% sex in sex venues. A 40% had a new sex partner, and 84% did not use condoms at last sex. Mean number of partners was 23 MSM and three heterosexuals. Overall, 12% had a previous STI (21% MSM) and 7% had concurrent diagnoses. HIV co-infection was 14%: 80% MSM with LGV, 39% MSM, 35% syphilis and 18% foreigners. A 36% were unaware of HIV status. Contact investigation over 70%: syphilis, chlamydia, LGV and gonorrhoea.
Conclusions: STI sentinel network provides data on enhanced surveillance and epidemiological profile of other STIs. Further analysis needs to be performed for MSM-VIH, partnership, concurrent/previous STI, HIV testing at diagnosis, contact tracing and health setting diferences.
P101 Housekeeping multilocus sequence typing and high-resolution multilocus sequence typing schemes show different clustering of Chlamydia trachomatis strains derived from men who have sex with men and heterosexuals
Bart Versteeg1, Sylvia Bruisten1, Arie van der Ende2 and Yvonne Pannekoek2
1GGD Amsterdam, Netherlands
2AMC, Netherlands
Despite intensive efforts, Chlamydia trachomatis (Ct) remains the most common bacterial sexually transmitted infection worldwide. To gain more insight into the epidemiology and transmission of Ct, several schemes of multilocus sequence typing (MLST) have been developed. We investigated the clustering of Ct strains using an MLST scheme based on seven housekeeping genes (MLST-7) and a high-resolution MLST based on six polymorphic genes, including ompA (MLST-6). For this study, the existing MLST-7 scheme was modified using a nested PCR which enabled testing of clinical samples. Samples from 100 Ct-infected men who have sex with men (MSM) and 100 heterosexual women were randomly selected from previous studies and sequenced. Both MLST schemes were analysed for cluster analysis and phylogenetic relationships. Full profiles were obtained for 175 samples; 84 (48%) were from MSM and 91 (52%) from heterosexual women. We detected 32 sequence types (STs) using the MLST-7 scheme and 78 STs using the hr-MLST-6 scheme. Cluster analysis using high-resolution MLST-6 data showed clear segregation between isolates from MSM and heterosexuals. However, cluster analysis using the housekeeping MLST-7 data did not show this segregation. The MLST-7 scheme was thus not able to discern closely related urogenital Ct strains over a short time-frame confirming that this scheme is more suitable for evolutionary studies. For short-term cluster analysis, the MLST-6 scheme is considered more suitable to study the epidemiology and transmission of Ct in various populations.
P102 The most common skin lesions in patients with HIV infection: 25 years of experience from an Infectious Diseases Unit
Anargyros Kouris, Kalliopi Armyra and Nikolaos Sypsas
Laiko Hospital, Greece
Background: Patients with HIV infection will develop skin lesions at some stage of their disease. The spectrum of cutaneous lesions is wide, while 56 entities have been described. Cutaneous disorders related with HIV/AIDS often weaken the patient, reduce self-esteem and lead to suicidal tendencies.
Objective: The aim of this study was documentation of all skin lesions in patients suffering from HIV-1 infection that were present on their first visit in the department.
Materials and Methods: This was a retrospective study among 200 HIV-1 patients who were followed-up in the Infectious Diseases Unit of the Pathophysiology Department of the Medical School of the University of Athens. Seventy of these patients had manifested some skin lesion on the time of their first visit in the department. The patients were monitored since 1987 and constituted an excellent group in order to determine the commonest skin manifestations among HIV-1 patients.
Results: It was noted that candidiasis of the mouth (43%) and sexually transmitted diseases (29%) – specifically genital warts and gonococcal infections – had the greatest prevalence among skin lesions concerning HIV-1 patients. Moreover, 28% of the patients of the study manifested more than one lesion simultaneously. Forty-three percent of the patients with skin lesions met the criteria of AIDS. In regard with the number of CD4 T lymphocytes, it was found that 43% of the patients had CD4 < 200/µl, 30% had CD4 200–499/µl and 27% had CD4 > 500/µl.
Conclusion: It must be emphasised that among the commonest skin lesions concerning HIV-1 patients documented in this study were candidiasis of the mouth mucosa and sexually transmitted diseases, specifically genital warts. In addition, it was shown that in a great percentage of HIV-1 patients, more than one skin diseases may be found simultaneously. It appears that skin diseases occur more frequently among patients with low CD4 T lymphocytes. From all the above, one can reach the conclusion that the role of an experienced dermatologist is very important in early diagnosis of HIV-1 infection.
P103 Prevalence of metabolic syndrome and level of serum testosterone among erectile dysfunction patients attending Kasr Alaini hospital
Islam Abuelkhair and Tarek Anis
Cairo University, Egypt
Background: The metabolic syndrome has received considerable attention in recent years due to its association with increasingly common pathophysiological states such as heart failure, type 2 diabetes mellitus and erectile dysfunction (ED). Metabolic syndrome is considered the main threat for public health in the 21st century.
Objective: To determine the influence of metabolic syndrome (MS) and serum testosterone in patients with ED and their possible association.
Methods: This cross-sectional study included 100 patients suffering from erectile dysfunction. Metabolic syndrome was diagnosed according to the criteria of both National Cholesterol Education Program (Adult Panel III, 2001) and International Diabetic Federation (IDF). After full history collection and examination, patients were subjected to the following work: evaluation by IIEF-5; measurement of waist circumference, weight, height, body mass index and blood pressure; laboratory assay of fasting blood glucose, triglycerides, HDL and total testosterone.
Results:
A – Prevalence of MS among erectile dysfunction patients was 35% according to NCEP ATP III and 42% according to IDF. Both NCEP ATP III criteria and IDF criteria appear to correlate with the degree of erectile dysfunction.
B – Diabetes, hypertension and waist circumference were the most common parameters of MS.
C – The presence of MS is associated with more severe erectile dysfunction.
D – Increase in the number of components of MS is associated with more severe forms of erectile dysfunction.
E – Total testosterone was significantly lower in MS patients.
Conclusion: Sexual health may be the portal to men’s health; recognising erectile dysfunction that is complicated by MS can help physicians to identify individuals who are candidates for lifestyle modification and appropriate treatment of underlying cardiovascular risk factors. Hypogonadism and erectile dysfunction are epidemiologically associated with and may predict MS.
P104 Opportunistic diseases in patients with HIV/AIDS: the results of 21 years
Serhat Uysal, Hüseyin Aytac Erdem and Deniz Gökengin
Ege University, Turkey
Aim: Acquired immune deficiency syndrome (AIDS) is a disease that affects millions of people worldwide. The number of reported cases in Turkey since 1985 has been around 8000, and a rapid increase has been noted for the last two years. The incidence of opportunistic infections increases at late stages of HIV infections causing significant morbidity and mortality. This is a retrospective study reviewing opportunistic diseases in HIV/AIDS over 21 years.
Materials and Methods: Patients who presented to Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine, Ege University were analysed retrospectively for opportunistic diseases according to the World Health Organization (WHO) and Centers for Disease Control (CDC) definitions, between January 1994 and January 2015.
Results: Medical records were accessible for 383 HIV-infected patients. Eighty-one had an opportunistic pathology. Some patients had multiple opportunistic pathologies simultaneously or at various time points. Opportunistic pathology groups were summarised in Table 1. In the malignancy group, non-Hodgkin’s lymphoma (eight; 2.1%), Kaposi’s sarcoma (four; 1%) and cervical carcinoma (three; 0.8%) were the most common opportunistic diseases. Tables 2 to 4 show viral, fungal and parasitic infections, respectively.
Conclusion: Despite the availability of highly active antiretroviral treatment, opportunistic diseases still complicate the course of HIV disease, especially in advanced HIV infection and in patients with virologic failure.
P105 Is the current Neisseria gonorrhoeae antimicrobial resistance testing in Germany sufficient to guide the treatment?
Sandra Dudareva-Vizule1, Anna Loenenbach1, Sergejs Nikisins2,3, Susanne Buder4, Klaus Jansen1, Andrea Sailer1, Eva Guhl4, Peter K Kohl4 and Viviane Bremer1
1Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
2Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
3European Public Health Microbiology Training (EUPHEM) Programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, Germany
4German Reference Laboratory for Gonococci, Department of Dermatology and Venerology, Vivantes Hospital Berlin, Germany
Background:Neisseria gonorrhoeae (NG) infections are not reportable in Germany, and only limited data on NG epidemiology and antimicrobial resistance (AMR) are available. The first-line therapy according to German guidelines includes ceftriaxone or cefixime together with azithromycin. If susceptible, cefixime, ciprofloxacin, ofloxacin or azithromycin can be used as a single medication. We established the Gonococcal Resistance Network to monitor the NG AMR and patterns of resistance testing in Germany to guide testing and treatment algorithms and targeted prevention strategies.
Methods: We recruited laboratories based on the geographical distribution and number of NG-isolates. From April 2014, prospective data on all performed NG AMR tests were collected. We described the reported samples by sex, age, tested antibiotics (ceftriaxone, cefixime, azithromycin, ciprofloxacin and penicillin), beta-lactamase and result interpretation standard.
Results: Between April and December 2014, we received information on 651 isolates tested in 19 laboratories. Altogether, 90.3% isolates were from men and 8.5% from women. Median age of tested men was 36 (IQR 29–49) and of women was 28 (IQR 22–41) years. Resistance to ceftriaxone was tested in 92.9%, cefixime in 88.2%, azithromycin in 87.4%, ciprofloxacin in 94.9%, penicillin in 94.6% and beta-lactamase in 46.2% of 651 isolates. In 73.1%, AMR testing results were interpreted by using European Committee on Antimicrobial Susceptibility Testing (EUCAST) and 26.9% by using Clinical and Laboratory Standards Institute (CLSI).
Conclusion: Not all NG AMR tests included recommended antibiotics. Since different standard for the interpretation of AMR are used, differences in the interpretation of the results, suboptimal therapy and thus further development of AMR are possible. To facilitate optimal response to development of NG AMR in Germany unified test-panel of antibiotics and interpretation standard should be used.
P106 Use of antimicrobials when treating gonorrhoea: are they prescribed appropriately?
John Were, Katy Town, Hamish Mohammed, Helen Fifer, John Saunders, Stephanie Chrisholm and Gwenda Hughes
Public Health England, UK
Background: National gonorrhoea treatment guidelines recommend ceftriaxone with azithromycin as first-line therapy. In 2013, 86.5% of patients in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) were treated with the recommended therapy, but 3.9% were treated with doxycycline instead of azithromycin and the remainder with various different combinations of antimicrobials.
Objective: The objective of this analysis was to determine whether antimicrobials were being prescribed appropriately.
Methods: Using GRASP 2013 data, the characteristics of patients who were prescribed the recommended therapy were compared with those of patients who were prescribed other antimicrobial combinations, and associations were assessed using univariate and multivariate logistic regression.
Results: In 2013, of the 913 patients who were prescribed ceftriaxone and azithromycin, 45.9% were men who have sex with men (MSM), 20% were women and 34.1% were heterosexual men, while of the 45 patients who were prescribed ceftriaxone and doxycycline, 64.4% were MSM, 28.9% were women and 6.7% were heterosexual men (p = 0.001). Of those who were prescribed ceftriaxone and doxycycline, 22.2% were MSM with chlamydia co-infection and 17.7% were women with pelvic inflammatory disease (PID). On multivariate analysis, MSM co-infected with chlamydia (aOR: 3.4, 95% CI: 2.5–4.6; p = 0.001) and women diagnosed with gonococcal PID (OR: 144.8, 95% CI: 24.2–864.0; p < 0.001) were more likely to be prescribed ceftriaxone and doxycycline. Of the remaining patients, 2.1% were prescribed spectinomycin and azithromycin, 1.9% were prescribed cefixime and azithromycin and 0.8% were prescribed ciprofloxacin.
Conclusion: Less than a fifth of prescriptions for ceftriaxone with doxycycline were issued to treat gonococcal PID. Use of ceftriaxone with doxycycline may be preferred to treat MSM co-infected with chlamydia by some clinicians. However, as levels of tetracycline resistance in gonorrhoea are high, this may not provide the dual treatment coverage required.
P107 The growing epidemic of infectious syphilis in Barcelona 2003–2013
Maider Arando Lasagabaster, Pere Armengol, M Jesús Barberá and Marti Vall-Mayans
Background: Since 2000, an increase of syphilis is being observed in many European cities, especially in men who have sex with men (MSM). In Barcelona, at the sexually transmitted infection (STI) Unit Drassanes-Vall d’Hebron, an increase of up to 500% was detected in 2002–2003 compared with the period 1993–1997. Since then, a continuous increase of cases has been observed in the city. The aim of the study was to analyse the cases of infectious syphilis diagnosed over a period of 10 years (2003–2013) at that STI Unit in Barcelona.
Patients and Methods: Retrospective study of infectious syphilis cases diagnosed at the STI Unit Drassanes-Vall d’Hebron in Barcelona from 1 January 2003 to 31 December 2013. A structured revision of epidemiological and clinical data from medical records and a descriptive analysis of the most relevant variables were carried out.
Results: During the study period, a total of 1705 cases of infectious syphilis were diagnosed (37.5%, 48.5% and 14% primary, secondary and early latent syphilis, respectivley); 84% were diagnosed in MSM and 9% in bisexual and 7% in heterosexual men, only 2% were women. Overall, the mean age was 36 years, and 42% had had a previous STI. Autochthonous cases represented 57% compared with 43% of foreigners (p = 0.04). Coinfection with HIV was present in 30% of the cases. A progressive increase of syphilis cases was observed, from 68 cases diagnosed in 2003 to 278 in 2013, mainly affecting MSM (76.5% in 2003 from 92.4% in 2013). The proportion of coinfected cases with HIV was similar (32.7% vs. 36.5%).
Discussion: Without changes in clinical practice, the epidemic of syphilis in Barcelona follows a growing epidemic curve involving new cases and reinfections. Syphilis continues to affect MSM with high rates of HIV coinfection in the absence of effective interventions.
P108 Incidence of sexually transmitted infections among active duty service women pre- and post-human papillomavirus vaccination, 2005–2014
Michelle Hiser, Jose Sanchez and James Cummings
Armed Forces Health Surveillance Center, Silver Spring, MD, USA
Background: A commonly cited barrier for not receiving the human papillomavirus (HPV) vaccine and for low vaccination rates in the US is that vaccination could promote unsafe sexual activity among females by lowering the perceived risks of acquiring a sexually transmitted infection (STI).
Objectives: The principal aim of this study was to examine if HPV vaccination resulted in a change in STI rates among female service members. Our secondary objective was to ascertain if any changes in STI rates were associated with service-specific vaccination policies since its implementation in the US military in 2008.
Methods: Active duty service women aged 18–26 years who joined the military between 2005 and 2014 were included in the cohort. Crude STI rates between vaccinated and unvaccinated women were examined. In turn, demographic and socio-economic variables were compared between both groups using a nested design matching on age (± 1 year), branch of service, educational level, year of entry into service (± 1 year) and year of vaccination.
Results: We will present a comparison of STI rates pre- and post-HPV vaccination with rates among unvaccinated women. Additionally, we will assess associations with risk variables as well as HPV-specific genital warts incidence in this cohort.
Discussion/Conclusions: We hypothesise that HPV vaccination will not be associated with an increase in unsafe sexual behaviour; thus, STI rates will not be significantly different between the vaccinated and unvaccinated females. Additionally, we expect to see a decrease in genital warts incidence from pre-vaccination to post-vaccination in 2008.
P109 Prevalence of HIV/AIDS and syphilis, knowledge, practices of men who have sex with men in Asunción and Metropolitan Area, Paraguay, 2014
Gloria Aguilar1, Tania Samudio1, Anibal Kawabata1, Carlos Cano2, Gladys Estigarribia2, Gladys Lopez1, Liliana Gimenez1, Alma Barboza1 and Rolando Rolon1
1National Program of HIV/AIDS, Paraguay
2National University of Caaguazú, Paraguay
Background: A good sexual and reproductive health (SRH) implies the ability to have a satisfying and safe sex life and the possibility of obtaining information that will allow free and informed decision making and free of discrimination. In Paraguay, men who have sex with men (MSM) account for one in three men who are infected annually with HIV.
Objective: To determine the prevalence of HIV/syphilis of MSM and knowledge, practices of MSM, aged 15 years and older, in Asuncion and Metropolitan Area of Paraguay.
Methods: Designed as a descriptive epidemiological survey, transversal, linked anonymous prevalence and behaviour; sampling RDS. The lab consisted of rapid HIV and syphilis test, and specific tests such as Venereal Disease Research Laboratories (VDRL) and western blot.
Ethics: The confidentiality of respondents by encoding that does not allow identification of individuals participating in the study.
Results: Of the 668 MSM, 67.0% identified as gays and bisexuals. Condom use was 65.4% (95% CI: 60.9–69.9); 42.1% (95% CI: 37.0–47.2) has been tested for HIV in the last 12 months. Knowledge of prevention and HIV infection was 61.2% (95% CI: 56.3–66.1). HIV infection was 13.0% (95% CI: 10.1–15.9%). Syphilis infection was 10.3% (95% CI: 7.4–13.2).
Conclusion: A high percentage of respondents did not identify as gay, implying that is not manageable with standard prevention strategies. Condom use and access to HIV testing were low. The prevalence of HIV and syphilis was high. Promoting access to HIV testing and condom use remains a challenge for Paraguay.
P110 Sexual behaviour, sexually transmitted infection/HIV prevalence in men who have sex with men in Armenia
Samvel Grigoryan
National AIDS Center, Armenia
Background: Second-generation HIV surveillance has been conducted regularly in Armenia starting from the year of 2000. However, Integrated Biological and Behavioural Surveillance (IBBS) for combined assessment of HIV infection, sexually transmitted infections (STIs), risk behaviours factors and trends in the sentinel populations was conducted in 2010–2014. The following populations vulnerable to HIV/STIs were involved: people who inject drugs (PWID), sex workers (SW), men who have sex with men (MSM), prisoners, migrants and young people aged 15–24 years.
Aim(s)/Objective(s): The goal of IBBS among MSM was to assess HIV, hepatitis B, syphilis prevalence, identify behaviours driving HIV transmission and to assess the level of knowledge on HIV prevention.
Methods: IBBS is conducted biannually according to the Surveillance National Protocol. Respondent-driven sampling method was used to conduct the surveillance. The sample size for MSM is 300. RDSAT software was used for processing and analysing the data.
Results: The main results of the three last IBBS studies among MSM conducted by the same methodology are shown in Table 1.
Biomarkers and key indicators
2010
2012
2014
HIV prevalence
2.3%
2.6%
0.4%
Syphilis prevalence
1.3%
1.9%
1.8%
Hepatitis B prevalence
4.1%
0.6%
1.1%
Knowledge on HIV prevention
53%
54.3%
78.9%
Condom use at last sex with casual partners
77.8%
73.1%
87.4%
Consistent condom use with casual partners
54.6%
47%
69%
Consistent condom use with all sexual partners
37.9%
36.7%
35.4%
Conclusions: HIV prevalence among MSM has been persistently low, which is stipulated by high levels of HIV knowledge and of condom use with casual partners. However, considering the low level of condom use with regular partners, as well as the importance of this population in halting and reversing the HIV epidemic, there is a need to maintain HIV prevention activities among MSM, as well as activities on increasing access to HIV testing and counselling, encouraging MSM to undergo HIV test, ensuring further referral for HIV treatment and care.
P111 Syphilis and HIV recent epidemiology in Catalonia, 2008–2013: increasing trends among men who have sex with men
Nuria Vives1, Rossie Lugo1, Maider Arando2, Martí Vall2, Pere Armengol2, Maria Jesús Barberà2, Patricia Garcia de Olalla3 and Jordi Casabona1 and The Catalan HIV and STI Surveillance Group, The Catalan Sentinel STI Surveillance Group1
1CEEISCAT, Spain
2CAP Drassanes, Spain
3ASPB, Spain
Background: HIV infection continues to disproportionately affect men who have sex with men (MSM), and syphilis has also re-emerged in this group in the European Union.
Objective: The aims of this study were to analyse syphilis and HIV trends from 2008 to 2013 and provide a descriptive epidemiology of syphilis and HIV cases in Catalonia.
Methods: Syphilis cases and HIV cases reported between January 2008 and December 2013 to the Mandatory Notification Surveillance System were selected. For each disease, we calculated incidence using all reported cases per 100,000 population (total, sex), incidence among MSM (based on estimates of the proportion of 2.3% of men reporting sex with men in Spain by year 2009), and we performed a descriptive analysis for the years 2008–2013.
Results: Syphilis rate increased disproportionally in the MSM group with a 124% increase from 241.5 to 540.2 cases per 100,000 MSM. While HIV global rate remain stable, HIV rate increased among MSM from 457.8 (2008) to 519.9 (2013) cases per 100,000 (46% increase). Descriptive epidemiology of syphilis and HIV cases for the 2008–2013 periods is shown in Table 1.
Discussion/Conclusion: The continuing of sexually transmitted infection (STI) and HIV in MSM is a major public health challenge in our setting. Targeted control measures and improve monitoring of STI/HIV in this population need to be prioritised.
Syphilis
HIV
%
%
Sex
Male
85
83
Female
15
17
Age
<15
0
0
15–24
11
11
25–39
55
56
40–49
24
22
≥50
10
11
Origin
Spain
54
56
Foreign
46
45
Route of transmission
HSH
51
49
Heterosexual men
10
17
Hererosexual women
15
13
IDU
–
7
HIV coinfection
HSH
38
–
Heterosexual men
6
–
Heterosexual women
2
–
Total number of cases
3286
4762
P112 Epidemiology of genital herpes simplex virus type 1 in the UK has changed significantly in the last decade
Li Jin Ooi1, Emily Clarke2, Rajul Patel2 and Sulet Nyein1
1University of Southampton, UK
2Solent NHS Trust, UK
Background: A 2006–2008 study at our UK level 3 sexual health clinic reviewed age- and gender-specific incidence of first-episode genital herpes. It demonstrated that first-episode herpes was associated with herpes simplex virus type 1 (HSV-1) in 54.4% females and 32.3% males. Females were more likely to have HSV-1 than HSV-2 at ages 16–34 years, and males were more likely to have HSV-2 at all ages.
Aim: To investigate the demographic and disease characteristics of patients presenting to a UK level 3 sexual health clinic with first-episode genital herpes between 2011 and 2013, and to compare them to the 2006–2008 study.
Methods: A retrospective case note review was undertaken of all patients aged 16 years and older between 2011 and 2013 presenting to a level 3 UK sexual health service with a first presentation of genital herpes. Demographic and disease characteristics were reviewed.
Results: Over the three-year study period, 743 patients presented with first-episode genital herpes. Prevalence of HSV-1 was 48% and HSV-2 was 52%. More females (65%) presented with herpes than males (35%). First-episode genital herpes was associated with HSV-1 in 51.0% of females and 42.8% of males. Males and females aged 16–24 years were more likely to have HSV-1, and males and females at all other ages were more likely to have HSV-2. Of those presenting with first-episode HSV-1, 53.1% of females were at ages 16–24 years in 2006–2008, and this had increased to 64.0% by 2011–2013 (p = 0.02). HSV-1 presentations in females then fell significantly at ages 25–34 years from 30.1% of all HSV-1 presentations in 2006–2008 to 20.6% in 2011–2013 (p value 0.02).
Discussion: Clinicians should modify advice given to patients presenting with first-episode genital herpes whilst laboratory typing confirmation is awaited. Only patients under the age of 24 years should be advised that they are more likely to have HSV-1 than -2. Age of presentation with genital HSV-1 in females appears to be becoming earlier with 50% presenting by the age of 22 years.
P113 A need to improve partner notification in sexually transmitted infections in Barcelona
Patricia Garcia de Olalla, Pilar Gorrindo, Sonia Gil, Pere Simón, Eva Masdeu, Maria José Santomà, Miriam Ros and Joan A Caylà
Agència de Salut Pública de Barcelona, Spain
Background: Partner notification (PN) is the cornerstone of infectious disease control. An effective PN has been shown to be associated with a reduction in disease incidence. This study aims to review PN for several sexually transmitted infections (STIs) between 2012 and 2014 in Barcelona.
Methods: Syphilis (TP), gonorrhea (NG) and lymphogranuloma venereum (LGV) are mandatory notifiable infections, and PN is a requirement for health professionals. The Barcelona STI Surveillance System collects data provided by doctors. Clinicians complete a standard data collection form that includes questions about PN outcomes (number of partners, number of identified and locating partners). A descriptive analysis of the characteristics of the index cases was carried out. We also calculated the proportion of PN performed, the number of partners per interviewed index patients and the number of partners locating.
Results: A total of 1641 TP, 1119 NG and 175 LGV index patients (IP) were detected. The incidence rate of TP increased from 21/100,000 inhabitants in 2012 to 31/100,000 in 2014; from 22/100,000 to 34/100,000 in NG and from 3/100,000 to 5/100,000 in LGV. The proportion of men was 91%, 87% and 100% for TP, NG and LGV, respectively. The median age was 36 years for TP and LGV, and 32 years for NG. PN were offered to 47%, 48% and 39% of TP, NG and LGV IP, respectivly. The number of partners per interviewed IP was 4.6, 3.9 and 1.3 partners per IP of TP, NG and LGV, respectively. The proportion of located partners was 35% of TP partners, 39% of NG and 38% of LGV. Patient referral was the only used method to inform partners and was not possible to ensure if partners have been informed of their exposure, and whether they have truly been tested.
Conclusions: PN in Barcelona is suboptimal; it reaches a low percentage of partners. PN programme should be commissioned as a prioritised and essential part of sexual health services with appropriate funding for health advisers.
P114 Multiple sexually transmitted infections correspond with risky sexual behaviour
Hana Zákoucká1, Přemysl Procházka2 and Daniela Vaňousová3
1The National Institute of Public Health Prague, Czech Republic
3Dermatovenerological Clinic, 2nd Faculty of Medicine, Charles University Prague, Czech Republic
Background: An occurrence of sexually transmitted infections (STIs) is increasing worldwide. A situation in the Czech Republic is very similar. There is strong evidence of changes of a sexual behaviour during decade reflected in the occurrence of HIV infections, syphilis, gonorrhoea and also multiple coinfections of STIs. Czech surveillance data concernig syphilis and gonorrhoea are available since the year 1959, HIV data since 1985.
Objectives: In the Czech Republic, there is a longlasting increase of a man having sex with man (MSM) proportion in an annual numbers of HIV positive (44% in 2004 up to 72.4% in 2014) and syphilis cases (6% in 2004 up to 66% in 2012). Percentage of coinfections is also increasing. The situation is well described mainly in case of syphilis in HIV-positive patients (16% in 2007 up to25% in 2013). It is not exceptional to diagnose the multiple infection in one patient, even in one site (for example rectal infection of Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum and Treponema pallidum). The main reason is risky sexual behaviour – anonymous sexual contacts, rapid emotional flare-up in combination with unprotected sexual intercourse, underestimation of a role of an oral sex in a transmition of, mainly bacterial, STIs.
Conclusions: Precise diagnosis of the multiple infections is essential for a proper antibiotic treatment and also for an evidence-based preventive interventions focused on the most endangered population groups. It is still very needed to maitain public health education.
P116 Gonorrhoea in Denmark 2014: current surveillance systems underestimate the number. Active reminding increases clinical reporting substantially
Steen Hoffmann1, Susan Cowan1, Annette Hartvig Christiansen1 and Line Oestergaard2
1Statens Serum Institut, Denmark
2Department of Infectious Diseases, Aalborg University Hospital, Denmark
Background: In Denmark, reporting of gonorrhoea to the clinical notification system (CNS) is mandatory. Submitting of isolates from the departments of clinical microbiology (DCM) to the gonococcus reference laboratory (GRL) is voluntary. Reminders to notify are issued upon receiving isolates. The introduction of The Microbiology Data Bank (MiBa), which includes all test results from all DCMs, has enabled evaluation of the two surveillance systems.
Aim: The aim was to assess the agreement between these three data sources on the number of cases of gonorrhoea.
Methods: All MiBa data for tests for gonococci from 2014 were compared to CNS and GRL. This is possible because all Danish citizens have a unique identifier (Central Person Registry number; CPR) included in MiBa and GRL and partly in CNS.
Results: Totally, 1873 cases were tested positive by nucleic acid amplification test (NAAT) and/or culture, and 1111 cases were reported to CNS. Of these, 1146 cases were NAAT-positive, 474 of which were culture-positive; 473 were culture-negative, and 199 were not cultured. Seven cases were NAAT-negative, but culture-positive. There were 720 cases that had no NAAT, but a positive culture. From the total of 1201 positive cultures, 804 isolates were submitted to GRL. For culture-positive cases, the notification rate was 83% if an isolate had been submitted and 36% if it had not. It was 48% for NAAT-positive culture-negative cases, and 22% for NAAT-positive cases with no culture. Thirty cases were only reported to CNS. The total number of cases of gonorrhoea reported to CNS and/or GRL was 1247. After addition of 256 non-submitted isolates from non-reported cases, the number rose to 1503. After further addition of 400 non-reported NAAT-positive cases with no or negative culture, the estimate was 1903.
Conclusions: Current surveillance systems underestimate the number. The surveillance should be based on MiBa, ensuring complete data and enabling automatic requests for epidemiological data and isolates.
P117 Aetiologic agents of vaginitis in women attended in primary health care centres, in Barcelona
Antonia Andreu, Neus Vila, Judit Serra-Pladevall, Isabel Romero, Rosa Radua, Montserrat Romera, Merce Locutura and Carmen Ribera
Background: Vaginitis is a common cause of infection in women, and laboratory testing to determine its aetiology has to be warranted. The most common causes are bacterial vaginosis (VB), candidiasis and trichomoniasis. The prevalence of each one depends of the geographical area.
Aim: To assess the prevalence and the aetiologic agents of vaginitis in women attending primary care centres.
Methods: Vaginal exudates of 4630 women, from 15 to 55 years, who consulted for vaginal discomfort between October and December 2014, were studied. Diagnostic were performed by Gram stain, culture in blood agar and in CAT broth (for isolation of Trichomonas and enrichment of yeast). Yeast identification was done in cromogenic agar, and by Maldi-Toff.
Results: A vaginal pathogen was isolated in 2466 of the 4630 samples (53.3%) as follows: 1533 (33.1%) Candida, 642 (13.9%) VB, 18 (0.4%) Trichomonas vaginalis, 233 (5%) Candida plus VB, four (0.1%) Candida plus T. vaginalis and three (0.06%) VB plus T. vaginalis and 33 others (0.7%). The most frequent yeast was C. albicans: 1602 (90.5%), followed by C. glabrata: 50 (2.8%), C. parapsilosis: 45 (2.5%), Saccharomyces cerevisiae: nine (0.5%), C. tropicalis: seven (0.4%) and C. guilliermondii, C. lusitaniae and C. krusei: five, respectively (0.3%).
Conclusions:
1. In our area, vulvovaginal candidiasis is much more frequent than bacterial vaginosis, whereas trichomoniasis is very infrequent.
2. In a high percent of patients (46.7), a specific cause was not identified.
3. Laboratory diagnosis of the aetiology of vaginitis is mandatory, because empiric therapy based on clinical symptoms and physical examination gives to frequent misdiagnosis and inappropriate therapy.
P118 Reliable methods for detection of sexually transmited bacterial fastidious microorganisms
Gergana Manolova Plamenova, Vesela Raykova and Georgi Pehlivanov
Aleksandrovska Hospital, Sofia, Bulgaria
Introduction:Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium are sexually transmissible pathogens which may cause infections with subsequent seious complications. The aim of this study was to determine their prevalence in symptomatic and asymptomatic sexually active women.
Materials and Methods: Polymerase chain reaction (PCR) and standard methods were used for testing 135 female specimens.
Results: The registered prevalence with the PCR technique was 2.66% for N. gonorrhoeae, 0.79% for C. trachomatis, 13.08% for U. urealyticum, 2.66% for M. hominis and 0.73% for M. genitalium. Co-infetion was found in 16 specimens. The standard methods demonstrated lower sensitivity in finding the pathogens in comparison with the PCR.
Conclusions: For Bulgaria, there are few simultaneous studies for detection of N. gonorrhoeae, C. trachomatis and the genital mycoplasmas by PCR and standard methods. Our results are comparable with the yet annouced. N. gonorrhoeae was found to be more frequent infection than chlamydial. U. urealyticum and M. genitalium were found predominantly in symptomatic patients. Infection with M. hominis was registered only as co-infection of ureaplasma infection.
P119 Review of cancer diagnoses in HIV-infected patients in the UK
Susanna Currie, Justine Mellor, Jennifer Mccord, Jaqueline Houston and Ashish Sukthankar
Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, UK
Background: Since the advent of highly active antiretroviral therapy (HAART), there has been a decline in the number of AIDS-defining malignancies (ADM), yet the incidence of non-AIDS-defining malignancies (NADM) seems to be increasing.
Aims: To review the incidence of ADM and NADM in our clinic in 2014 and consider variables which may be associated with ADM and NADM.
Methods: Our department has nearly 1800 patients with HIV enrolled in care. We keep a cancer database which records all HIV-infected patients who develop cancer.
Results: Fifteen HIV-infected patients were diagnosed with cancer in 2014:
Discussion: There was an even distribution of ADM and NADM. The patients who developed ADM tended to be younger than those with NADM, more likely to be homosexual and white British, not on antiretrovirals (ARVs), with a lower CD4 and higher VL and having had HIV diagnosed more recently. The incidence of NADM in this population is 440 per 100,000. It is difficult to determine which population, without HIV infection, that this is best to compare with. Further research on a larger scale, over a longer period of time is required to prove the increasing trend of NADM and to establish a hypothesis for it.
P120 Syphilis in pregnant females in Bialystok, Poland, 2000–2014
Marta Koper, Małgorzata Dziużycka, Iwona Flisiak and Agnieszka Beata Serwin
Medical University of Bialystok, Poland
Background: In Poland, screening for syphilis should be performed before 10th week of pregnancy and repeated in 33rd–37th week, in case of individual or population risk of the infection. Despite this regulation, the number of cases of congenital syphilis is one of the highest in European Union.
Aim: To describe socio-demographic, clinical and epidemiological characteristics of pregnant females treated for syphilis in Bialystok, Poland in 2000–2014.
Methods: A retrospective analysis of the age, residency, gestational age, sexual history, concomitant sexually transmitted infections (STIs), outcome of pregnancy and adherence to follow-up visits was performed.
Results: Fifteen pregnant females were treated for syphilis in a study period, aged 19–35 years (mean age 27.3 years), among them, three foreigners; 60% were residents of urban areas. Five females were in their first pregnancy; three – in second and four – in third one. One-third of women had a history of spontaneous abortion and one – of an ectopic pregnancy. Average gestational age at the diagnosis of syphilis was 15.3 weeks (range: 7–40 weeks); in five women, the screening for syphilis was performed before 10th week. In majority of patients, an early asymptomatic syphilis was diagnosed. A husband or a steady partner was a source contact in 86.7% of cases. Concomitant STIs were detected in 46.7% of patients; no HIV co-infection was diagnosed. All females received treatment with penicillin, and a follow-up was completed in four of them (26.7%). In one girl, born in 2007, a late congenital syphilis was diagnosed.
Conclusions: Majority of patients were diagnosed and treated after 10th week of pregnancy, and a case of congenital syphilis was detected which suggests STIs antenatal care was suboptimal and should be improved.
P121 Haemophilus influenzae and parainfluenzae urethritis. Descriptive research of 48 patients
Andrea Combalia Escudero, Irene Fuertes de Vega, Jose Luis Blanco Arévalo, Sara Pedregosa Fauste, Andrea Vergara Gómez, Jordi Bosch Mestres and Mercè Alsina Gibert
Hospital Clínic de Barcelona, Spain
Background: Due to the increasing incidence of urethritis in our environment, we have many articles focusing on Chlamydia trachomatis and Neisseria gonorrhoeae infection. However, there are few current data on Haemophilus influenzae and parainfluenzae urethritis.
Objective: Retrospectively describe the epidemiology and clinical manifestations of patients diagnosed with H. influenzae and parainfluenzae urethritis and study their antibiotic susceptibility profile and their response to empirical treatment.
Methods: Data from all patients with positive urethral cultures for H. influenzae and parainfluenzae attending a Spanish tertiary care centre between 2010 and 2014 were collected. Specific cultures, direct smear and PCR were performed. A descriptive analysis was performed.
Results:Haemophilus spp was isolated in 48 urethral samples; 41 were positive for H. parainfluenzae (85.4%), six for H. influenzae (12.5%) and one for both (2%). Five patients (10.5%) were currently co-infected with other microorganisms. Eighty-four percent of patients reported symptoms, being dysuria and purulent urethral discharge the most common clinical presentation (60%). All subjects were sexually active male, with a mean age of 36 years. Regarding sexual orientation, 37.5% were men who had sex with men, 35.5% were heterosexual, 2% bisexual and 25% of patients did not provide this information. 37.5% were HIV positive, 31.2% negative and in the remaining 33.5% the serostatus was unknown. 81.2% reported unprotected sex three to 10 days before consultation, including oral sex. Only one sample (2%) showed resistance to cephalosporins.
Discussion:H. influenzae and parainfluenzae urethritis affects young males with a history of unprotected oral-genital sex. This infection usually presents with dysuria and purulent urethral discharge about a week after an unprotected intercourse. In our population, empirical antibiotic therapy is efficacious for most Haemophilus spp urethritis.
P122 Mycobacterial infections in patients with HIV/AIDS: the Ege University cohort
Hüseyin Aytac Erdem, Serhat Uysal, Ekin Ertem and Deniz Gökengin
Ege University, Turkey
Introduction: The incidence of tuberculosis in patients with HIV infection is approximately 29-fold higher compared to healthy subjects. Atypical mycobacteria can cause life-threatening infections, especially in immune-compromised patients. This is a retrospective study reviewing mycobacterial infections in HIV-infected patients over 21 years.
Materials and Methods: Patients who presented to the Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine, Ege University were analysed retrospectively for mycobacterial infections, between January 1994 and January 2015.
Results: Medical records were accessible for 383 HIV-infected patients. Twenty-one (87.5%) patients were male, and the mean age was 43 (22–68, ± 11.71) years. Twenty-four cases had a mycobacterial infection. Excluding eight patients with newly diagnosed mycobacterial infection, the average follow-up time was 31 (0–155, ± 44.01) months. At the time of diagnosed mycobacterial infection 18/24 (75%), patients were not using any antiretroviral therapy. The first four most common symptoms at admission were fever (83.3%), cough (33.3%), sputum (21%) and fatigue (16.7%). The number of CD4 T lymphocytes at admission was less than 350/mm3 in 13 patients. Mycobacterial species detected and the site of infection were shown in Tables 1 and 2, respectively. Six patients (25%) died in the hospital at early days of the treatment, and two patients (8.3%) died after discharge.
Conclusion: Mycobacterial infections are among the most common opportunistic infections in HIV-infected patients with serious consequences.
Mycobacterial species detected.
n
M. tuberculosis
19
M. lentiflavum
2
M. gordonae
1
M. avium
1
Not detected
1
Site of infection.
n
Pulmonary
16
Miliary spread
3
Central nervous system
2
Lymphadenitis
2
Peritoneum
1
P123 Trends in chlamydia diagnoses at two large sexual health clinics in Central London, UK from 2001–2013
Nataliya Brima1, Sarah Woodhall2, Danielle Mercey3, Richard Gilson1, Andrew Copas1, Gwenda Hughes2 and John Saunders2
1University College London, London, UK
2Public Health England, UK
3Mortimer Market Sexual Health Clinic, UK
Background/Aims: To describe trends over time in chlamydia testing and positivity among heterosexual men, men who have sex with men (MSM) and women.
Methods: Laboratory data for all new episode chlamydia tests performed between 2001 and 2013 were analysed. To assess changes in chlamydia positivity and testing logistic regression, Kruskal–Wallis and Chi square tests were used.
Results: Between 2001 and 2013, 369,392 individuals were tested for chlamydia, and the overall positivity was 6.2%. The median age of those tested was 28 years (IQR 23.8; 34.1), 68% were white, 22% were MSM, 29% men who had sex with women (MSW) and 51% women. There was a steady increase over time, with a particular increase in the last three years, in the number of individuals tested (21,367 in 2001 to 51,529 in 2013). This increase was observed in all groups. The distribution of MSM, MSW and women changed significantly from 47%, 18% and 35% in 2001 to 21%, 29% and 50% in 2013, respectively (p < 0.001). Positivity was significantly higher in under 25-year-olds compared to ≥25-year-olds (9.0% vs. 4.8%, p < 0.001), men compared to women (7.2% vs. 5.2%, p < 0.001) and in black ethnicity compared to white or other (8.6% vs. 5.6% and 6.5%, p < 0.001; respectively). Among < 25-year-olds, positivity decreased each year from 2001 but changed little in older individuals. Positivity among MSM increased from 4.8% to 8.2% between 2001 and 2013. There was little variation in the number tested or positivity by season or month.
Conclusions: There has been a large increase in the number of tests performed at our clinics over the last decade; positivity has increased in some population subgroups and decreased in others. Changes in numbers of tests and positivity may reflect changes in policy and practice, including improved access to services, the introduction of a national chlamydia screening programme and extragenital testing.
P124 Low rates of Trichomonas vaginalis in a UK sexually transmitted infection clinic population – new tests may only generate a modest improvement over light microscopy in some settings
Sulet Nyein1, Emily Clarke2, Sabah Ahmed1, Elizabeth Foley2, Claire Ossey2 and Rajul Patel2
1Southampton University, UK
2Royal South Hants Hospital, UK
Background:Trichomonas vaginalis (TV) is the most common sexually transmitted infection (STI) in Europe; the WHO estimates 24 million cases within the region. Recent studies show high rates of TV using new antigen detection technology compared to wet mount microscopy (WMM) and many guidelines recommend that antigen tests are used first line.
Aims: The study assessed benefit of the OSOM TV antigen detecting system amongst high-risk women in the Solent region. A parallel audit was carried out to assess sample collection, handling and WMM assessment for TV.
Methods: Women attending sexual health services with symptomatic vaginal discharge or of African/Caribbean ethnicity were tested for TV infection using the OSOM test and/or WWM. The time taken for the wet film to be examined by the clinician was monitored as part of the clinical audit.
Results: From preliminary data collected on 58 women, three patients were positive for TV by the OSOM test, of which one was detected by WMM. Only 6% of WMM was delayed beyond 10 min with the average time to examine WMM being 226 s.
Conclusion: The OSOM test showed greater sensitivity to detect TV than WMM. However, even when using the test in women at highest risk of having TV, we only found a prevalence of <6%. This is significantly lower than other rates in the literature. Services should be wary of assuming the utility of introducing TV antigen detection systems within their routine or high-risk populations. Current low rates by WMM may only be marginally improved by new systems.
P125 Minding the gap – an audit of anal sex histories and subsequent management
Katy Robyn Green1, Sarah Wade1, Lucy Hill2, Emily Clarke2 and Rajul Patel1,2
1University of Southampton, UK
2Solent NHS Trust, UK
Background: The National Survey of Sexual Attitudes and Lifestyles (NATSAL) data show higher than previously recorded occasions of anal sex amongst females (15.1%) in the UK. The UK sexual testing guidelines state that rectal swabs should be taken for Neisseria gonorrhoea (GC) and Chlamydia trachomatis (CT) in symptomatic women having anal sex, but if asymptomatic, the guidelines are less clear. IUSTI guidelines for CT and GC give no specific recommendations as to when to test extra-genital sites. The British Association for Sexual Health and HIV (BASHH) sexual history taking guidelines state that all females should be asked about sites of exposure from sexual practices as part of a standard consultation.
Aim: To audit whether anal sex histories are being recorded in Solent NHS trust Sexual Health departments and whether rates of anal sex correlate with NATSAL data. Are subsequent swabs being taken from appropriate sites as outlined by current BASHH guidelines? If there is a need to change current swab taking procedures, what would be the cost impact?
Method:
Phase 1: Review of 200 female patients’ sexual health clinic notes to check for anal sex documentation and anal sample taking.
Phase 2: 200 female patients will have sexual histories taken in sexual health clinics via paper questionnaires.
Results:
Phase 1: Results demonstrate 43% of asymptomatic patients did not have any documented history, compared to 14% of symptomatic patients. In total, 6% of patients reported anal intercourse, which is significantly less than the 15.1% reported in NATSAL.
Phase 2: Provisional results show 31% of women attending sexual health clinics have had anal sex in past year, which is more than twice the 15.1% national average reported in NATSAL.
Conclusion: Sexual health services seem to find confusion as to how to document sexual histories and appear not to be taking full anal sex histories. BASHH and IUSTI need to expand sexually transmitted infection (STI) testing guidelines to avoid confusion about testing.
P126 A novel model of care incorporating self-directed care and rapid results management successfully reaches high-risk men who have sex with men
Gary Whitlock1, Ruth Byrne2, Farhad Cooper2 and Alan Mcowan2
1NHS, UK
2Chelsea and Westminster Healthcare NHS Foundation Trust, UK
Background: Men who have sex with men (MSM) are at high risk of sexually transmitted infection (STI). Public Health England recommends that those MSM at greatest risk should test for STIs every three months. Working with a focus group of MSM, we designed an express screening service with the aim of preferentially attracting this group. Touchscreen sexual history taking, self-sampling, rapid diagnostics using Cepheid ® GeneXpert and automated results management were incorporated to create a cost-effective solution that increased capacity and was attractive to users. The service redesign reduced the ‘time to treatment’ by 190 h.
Objective: To identify whether the express service design was successful in attracting high-risk MSM.
Methods: The risk characteristics of MSM diagnosed with gonorrhoea and/or chlamydia during a two-month period were retrospectively analysed from patient entered touchscreen data. The overall probability of having a new partner during the reduced ‘time to treatment’ was estimated based on reported new partners in the last 12 weeks.
Results: In total, 431 cases of gonorrhoea and/or chlamydia were diagnosed
Gonorrhoea
Chlamydia
Both
Total
MSM
214
113
33
360 (84%)
Heterosexual
5
66
0
71 (16%)
MSM: men who have sex with men.
Eighty-four percent of infections were seen in MSM (360/431).
Thirty-four percent of MSM reported high-risk behaviour such as fisting/injecting/‘chem sex’ (122/360).
Thirteen percent of MSM were HIV positive (48/431).
The new model of care reduced time to treatment by 190 h.
This reduction in time to treatment was most beneficial in MSM as the overall probability of MSM having a new partner during this time was 0.26 compared to 0.1 for heterosexuals.
Discussion: The service model was highly effective at reaching high-risk MSM. Faster treatment had most potential to reduce onward transmission in MSM as they reported more frequent partner change.
P127 Lifetime sexually transmitted infection testing among heteroseuxal university students engaging in different levels of sexual risk taking
Amber Cragg, Audrey Steenbeek, Mark Asbridge, Pantelis Andreou and Donald Langille
Dalhousie University, Canada
Introduction: Individuals aged 15–29 years have the highest rates of diagnosed sexually transmitted infection (STI). Routine STI testing is recommended for sexually active individuals under 25 years. Despite being readily available to most Canadian university students, not all sexually active students access testing. This study examines correlates of STI testing among sexually active heterosexual university students.
Methods: A cross-sectional, Internet-based survey of undergraduate students at eight universities in Maritime Canada was carried out in 2012, gathering information on student demographics, sexual behaviours and use of sexual health services. We conducted a sex-stratified descriptive analysis of each covariate and of lifetime STI testing at three levels of STI risk. We performed simple and multiple logistic regressions to find factors associated with lifetime STI testing.
Results: Only 34% of the overall study population and 51% of those whose behaviours put them at higher risk for STI acquisition have ever been tested. Individuals at higher or moderate risk for STI were more likely to be tested than those at lower risk. In both sexes, older students, those forced to have sex of any kind while at university and those with more sexual health knowledge were more likely to be tested. Perceived risk was only associated with lifetime STI testing among females.
Conclusions: Individuals at higher risk for STI acquisition are more likely to be tested; however, STI testing rates remain low in Canadian university students. Health promotion may be more effective in increasing testing among this group when targeting younger students with campaigns designed to increase general sexual health knowledge.
P128 La Isla Bonita – designing services to meet the increasing needs of Spanish-speaking HIV patients in London
Malika Mohabeer Hart1, Lazara Dominguez Garcia1, Carlos Corredor2, Ivana Paccoud2, Marion Wadibia2 and Charlotte Cohen1
1Chelsea and Westminster Hospital NHS Trust, UK
2NAZ London, UK
Background: Recent epidemiological data suggest that one in eight men-who-have-sex-with-men (MSM) diagnosed with HIV in London during 2011 were born in Latin America. The recent global recession caused significant UK migration from South America and Spain, including people living with HIV. A dedicated clinic was initiated to provide a collaborative Spanish-speaking HIV service.
Aim(s)/Objectives(s): To evaluate key characteristics and needs of this cohort.
Methods: Retrospective clinical records review of Spanish-speaking patients seen from 2014 to April 2015. Socio-demographics, country of origin, nationality, HIV parameters and pre-existing diagnoses were collated. Quantitative and qualitative data are presented.
Results: Fifty-four patients were included of whom 91% were male (90% MSM, 6% bisexual). Mean transfer age was 35 years, ranging 23–57 years. Over half were born in Colombia (37%) or Spain (28%); however, 76% had Spanish nationality. Most (96%) spoke limited or no English. The majority (87%) of overseas transfers was from Spain. The majority (85%) was employed, but only 20% general practitioner-registered. Mean transfer CD4 count was 565 copies/ml; 85% were on HIV treatment of whom 90% had an undetectable HIV viral load. Over half (57%) had at least one other diagnosis, mental health issues affected 31% and 20% had a sexually transmitted infection. Year 2013/2014 saw an 82% rise in transfers compared to 2011/2012.
Conclusion: This complex HIV cohort requires high-level multidisciplinary support to ensure continued engagement with health care. Language, mental health and socio-economic difficulties create barriers. Dedicated Spanish-speaking services are essential to improve outcomes for this vulnerable and ethnically diverse population in the UK.
P129 Implementation of a sexually transmitted infections circuit in an urban primary health care centre
David Garcia-Hernandez, Santiago Lancho-Lancho, Maria Cecilia Casano-Carnicer, Agnes Salvador-Mateo, Kristyna Klevarova, Natalia Subirats-Duran, Laura Eroles-Mallolas, Judith Martinez-Tellez, Aina Piera-Salmeron and Ana Romagosa-Perez-Portabella
EAP Raval Nord (Institut Català de la Salut), Spain
Background and Aims: Sexually transmitted infections (STIs) currently represent a European public health problem. An STI circuit was accomplished in an urban primary health care centre (PHCC) in order to provide closer and global STI care, increase primary care professionals’ training and enhance collaboration between care levels.
Method: A descriptive study analysed the circuit and patients’ and doctors’ satisfaction. The circuit started in April 2014 by a general practitioner (GP), previously trained in STI, who performed a weekly STI consultation in the PHCC. All patients and contacts received treatment (if necessary), STI screening, follow-up and counselling; some were referred to other specialists. STI briefings were held bimonthly for the PHCC professionals. A satisfaction survey included four questions to these patients and two questions to the referring GPs, with possible score from 1 (dissatisfied) to 5 (highly satisfied).
Results: Until December 2014, 288 consultations (93 different patients) were performed (82% men, 51% foreigners, average age 34.78). The main diagnoses were: condyloma (50 cases), non-specific urethritis (10), herpes (10), chlamydia (eight), gonorrhoea (eight) and syphilis (seven). Ten patients were referred to specialised services. Regarding patient satisfaction, the mean scores of the answers were: information given (4.74/5), care provided (4.81), treatment-result (4.41) and the circuit in general (4.43). In terms of GP satisfaction, the mean scores of the responses were: learning about STI (4.75/5) and circuit usefulness (4.82).
Conclusions: Patient and care providers’ satisfaction was very high. The circuit could improve accessibility, GPs knowledge and coordination between specialists.
P130 Access to sexually transmitted disease services in the UK – a worsening picture
Vanessa Hayden1, Tim Prescott1, Gwenda Hughes2, Rajul Patel1 and Elizabeth Foley1
1Southampton University, UK
2Public Health England, UK
Background/Introduction: Since their inception, genito-urinary medicine (GUM) clinics in the UK have been open access, confidential and free. In 2010, the mandatory Department of Health target to see 100% of patients within 48 h was removed. Additionally, since April 2013, GUM services have been commissioned by local authorities rather than the NHS.
Aim(s)/Objectives: To assess the effect of the removal of targets and commissioning changes to the accessibility to GUM clinics for patients.
Methods: During November 2014, male and female researchers telephoned all UK GUM clinics posing as patients. Researchers contacted clinics twice: firstly presenting with symptoms consistent with an acute sexually transmitted disease (STD) and secondly requesting an appointment for an asymptomatic screen. Questionnaires were sent to lead clinicians to compare expectations with actual service provision. In addition, a third of clinics in the UK were visited by researchers posing as patients with urgent symptoms.
Results: Of 236 clinics contacted, 89% could accommodate symptomatic ‘patients’ within 48 h with 53% of these on a walk-in basis only. Suggested waiting times ranged between 20 min and 3 h. Twenty percent of asymptomatic ‘patients’ were unable to book an appointment and 58% of appointments were offered within 48 h. Eighty-six percent of asymptomatic ‘patients’ were offered either a walk-in service or appointment within 48 h. Clinic visits revealed that 97% of ‘patients’ could be seen at walk-in clinics, with 55% having waiting times of less than an hour. Data were analysed using SPSS v22.
Discussion/Conclusion: Although when telephoning clinics only 89% of urgent ‘patients’ could be accommodated within 48 h, lower than the British Association of Sexual Health and HIV (BASHH) recommendation of 98%, when clinics were visited in person, 97% of ‘patients’ could be accommodated. This suggests that despite difficulties in capacity, clinics are doing their utmost to try to see patients with urgent problems.
P131 Does Europe need specialist genital herpes clinics?
Sarah Wade1, Katy Green1, Emily Clarke1,2 and Rajul Patel1
1University of Southampton, UK
2Solent NHS Trust, UK
Background: Genital herpes prevalence is increasing in Europe, and counselling and treating patients appropriately at diagnosis can improve patients’ adjustment to the diagnosis. Across Europe, the mainstay for diagnosis, treatment and counselling for new herpes patients are sexual health clinics. In the UK, some sexual health clinics also offer specialist genital herpes clinics, but currently there are no data available about their effectiveness, outcomes or patient satisfaction.
Aims: To assess the need for a specialist genital herpes clinic when comparing to a general sexual health clinic at a UK level 3 sexual health service in patients with newly diagnosed genital herpes.
Methods: A total of 200 patients with a new diagnosis of genital herpes from 2011 to 2013 had their notes reviewed to determine their initial management, complicating factors and subsequent re-attendance with recurrence. Twenty patients who attended either a specialist or sexual health clinic with a new diagnosis of herpes were interviewed to determine satisfaction with the service, and the information the clinician had provided on counselling topics identified in the British Association of Sexual Health and HIV guidelines.
Results: Results demonstrate patients attending the specialist clinic were more likely to have complicating factors; 7% were pregnant, 13% anxious, 15% had additional illnesses and 5% engaged in risky sexual behaviour. In total, 42% of patients attending the specialist clinic had complications, as opposed to 25% in the sexual health clinic. Re-attendance with recurrence was 22% for specialist and 16% for general clinics, but patient satisfaction remained similar in both clinics.
Conclusions: Despite patients who attended specialist herpes clinics presenting with more complications, there was little difference in their outcomes between clinics. Specialist genital herpes clinics may therefore have the potential to provide a superior standard of well-informed care for patients with multiple complicating factors.
P132 Multiple nodules of the scrotum: what is the right diagnosis?
Mirjana Popadić
Clinic of Dermatovenerology, Serbia
Background: Multiple nodules of the scrotum are uncommonly reported and continue to provide a diagnostic challenge for physicians. Differential diagnosis includes benign conditions like epidermoid cysts, mesothelioma, lipoma, leiomyoma, fibroma, haemangioma and exceedingly rare primary malignant epithelial tumour – rhabdomyosarcoma. Their origin is controversial. Treatment is always surgical, but the best procedure is still to be determined.
Case Report: A 20-year-old male was admitted to the Clinic of Dermatovenereology because of numerous, painless nodules of the scrotum that started to appear about one year before his admission to the clinic. The sizes of nodules as well as the quantity were gradually increasing. The skin changes occurred only in the scrotum area, and no remote lesion was observed. The general condition of the patient was good. The clinical examination revealed the numerous, non-tender, elastic, freely movable, solitary and fusing nodules on the scrotal skin with diameter from 2 mm to about 1.5 cm. The overlying skin was normal in color and texture. No other abnormality was observed during the physical examination. Testicular tumour markers (alpha-fetoprotein, beta-chorionic gonadotropin and lactate dehydrogenase) and hormones were within the normal limits. One nodule was surgically removed and was given to a histopathological examination. Pathological diagnosis was epidermoid cyst of the scrotum.
Discussion: Clinical assessment, physical examination and an understanding of benign intrascrotal processes are key to making a diagnosis. Lesions that are suspicious for malignancy should prompt urological consultation and radiological imaging. Ultrasound aids in the diagnosis in instances of uncertainty. Ultimately, surgery may be necessary to make a histological diagnosis.
P133 Antimicrobial susceptibilities and multi-antigen sequence types (NG-MAST) of Neisseria gonorrhoeae isolated in Canada, 2011–2014
Irene Martin1, Pam Sawatzky1, Vanessa Allen2, Linda Hoang3, Brigitte Lefebvre4, Prenilla Naidu5, David Haldane6, Paul Vancaeseele7, Chris Archibald1 and Michael R Mulvey1
1Public Health Agency of Canada, Canada
2Public Health Ontario Laboratories, Canada
3BCCDC, Canada
4LSPQ, Canada
5Alberta Provincial Laboratory for Public Health, Canada
6Queen Elizabeth II Health Sciences Centre, Canada
7Cadham Provincial Laboratory, Canada
Objective:Neisseria gonorrhoeae have acquired resistance to many antimicrobials and developed decreased susceptibility to third-generation cephalosporins, limiting treatment options. Antimicrobial resistance profiles and molecular sequence types were determined for N. gonorrhoeae circulating in Canada.
Methods: Provincial public health laboratories submitted N. gonorrhoeae to the NML from 2011 to 2014. Denominator data for calculation of % resistance were collected from the provinces. Antimicrobial susceptibility to eight antimicrobials was performed using agar dilution as recommended by Clinical and Laboratory Standards Institute (CLSI). NG-MAST sequence typing was also performed on all isolates.
Results: A total of 5119 viable N. gonorrhoeae were submitted to and tested by the NML between 2011 and 2014. Decreased susceptibility to cefixime (minimum inhibitory concentrations, MIC ≥ 0.25 mg/l) was identified in 4.2% of isolates in 2011, decreasing to 1.7% in 2014. Decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/l) was identified in 6.2% of isolates in 2011, decreasing to 1.6% in 2014. Azithromycin resistance (MIC ≥ 2 mg/l) was identified in 0.4% of isolates in 2011 and increased to 3.4% in 2014. ST1407, associated with elevated cephalosporin MICs, was the most prevalent type in 2011 at 15.3%, decreasing to 2.0% by 2014. The most prevalent sequence type in 2014 was the tetracycline-resistant ST5985 at 14.6%; however, ST10451 which is closely related to ST1407 was identified in 10.1% of all isolates in 2014.
Conclusion: Continued surveillance of antimicrobial susceptibilities and sequence types of N. gonorrhoeae is necessary to inform treatment guidelines and mitigate the impact of antimicrobial resistance in gonorrhea.
P134 Using signal-to-cutoff ratios to improve reverse sequence algorithm for syphilis diagnosis; are all commercial kits equal?
4Institut national de santé publique du Québec, Canada
Aim(s)/Objective(s): Our study aimed at: (1) correlating the magnitude of signal-to-cutoff (S/CO) ratios with the rate of syphilis infection confirmation for six commercial kits used in Quebec in a reverse sequence algorithm and (2) for each kit, establish an S/CO value above which treponemal confirmation would not be required.
Methods: A total of 1970 serum samples, obtained between January 2014 and February 2015, from patients previously undiagnosed with syphilis were included in the study. The samples, all EIA/CLIA reactive and either rapid plasma reagin (RPR) non-reactive or reactive with a low titer RPR (1:1 to 1:4), were prospectively tested with Treponema pallidum particle agglutination assay (TPPA) and, if negative or inconclusive, with a line immunoassay (LIA). Syphilis infection confirmation was defined by a reactive TPPA or LIA.
Results: The 27 participating laboratories used one of the following commercial kits: Architect (n = 13), BioPlex (n = 1), syphilis EIA II (n = 6), Trepsure (n = 4), Immulite (n = 1) and Vitros (n = 2). The rate of syphilis infection confirmation and the proposed S/CO values above which a confirmation would no longer be needed for the Architect, Trepsure and Vitros kits are shown in Table 1. The proposed S/CO values were obtained using the Hosmer and Lemeshow goodness-of-fit test. No S/CO values could statistically be established for the Bioplex, the syphilis EIA II and the Immulite kits.
EIA/CLIA kit
Number of samples
Confirmed samples (%)
Proposed S/CO value
Samples that would no longer need confirmation (%)
Architect
472
272 (42)
15
109 (23)
Trepsure
226
140 (62)
22
49 (22)
Vitros
63
46 (73)
89
25 (40)
S/CO: signal-to-cutoff.
Conclusions: In our setting, reactive samples tested with the Architect, the Trepsure and the Vitros commercial kits having an S/CO above 15, 22 and 89, respectively, would not need extra confirmatory testing. Using these S/CO values for the Architect, Trepsure and Vitros kits could generate a potentially cost-effective reverse sequence algorithm obviating the need for confirmation in 22% to 40% of the samples.
P135 Evaluation of gonococcal resistance in Austria from 2010 to 2013
Angelika Stary1, Claudia Heller-Vitouch1, Maria Haller1, Michael Binder2, Alexandra Geusau3, Georg Stary3, Klemens Rappersberger4, Peter Komericki5 and Reinhard Höpfl6
1Outpatient’s Centre for Diagnosis of Infectious Venereodermatological Diseases, Austria
2Outpatient’s Clinic for Sexual Transmitted Diseases, Austria
3Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Austria
4Department of Dermatology and Venereology, Community Hospital Krankenanstalt Rudolfstiftung, Austria
5Department of Dermatology and Venereology, Medical University of Graz, Austria
6Department of Dermatology and Venereology, Medical University of Innsbruck, Austria
Background: The Austrian Society for Sexually Transmitted Diseases started a surveillance project in 2010 to evaluate the gonococcal resistance in Austria.
Methods: From 2010 to 2013, a national network of 40 centres was established to collect 3090 gonococcal isolates and the anamnestic data of the patients. Gonococcal resistance testing was performed by disc diffusion test, agardilution breakpoint technique, agardilution and E-test. The following antibiotics were tested: cefixime, ceftriaxone, penicillin, amoxicillin/clavulanic acid, ciprofloxacin, ofloxacin, azithromycin and tetracycline. Interpretation was calculated according the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.
Results: In Vienna, 2693 isolates were collected, whereas 397 strains were sent from the federal states. Of all collected isolates, 88.8% were genital, 4% pharyngeal and 5.3% rectal isolates, respectively. Gonococci were collected more often from men (59.8%) than from women; 4.5% of men reported homosexual contacts. A concurrent infection with Chlamydia trachomatis was observed in 14.5% of all patients. While 2010 all isolates displayed susceptibility to third-generation cephalosporins, in 2011 seven gonococcal strains (0.8%), in 2012 one isolate (0.1%) and in 2013 10 isolates (1.5%), respectively, were resistant to cefixime (minimum inhibitory concentration, MIC > 0.125 µg/ml). All isolates were still susceptible to ceftriaxone (MIC ≤ 0.125 µg/ml). Furthermore, an increase of MIC values for cefixime as well as for ceftriaxone was observed. Resistance to azithromycin increased from 1% in 2010 to 1.5% in 2011 and decreased to 0.9% in 2013. Resistance to quinolones was detected in 58% in 2010 rising to more than 75% in 2013, respectively.
Conclusion: Third-generation cephalosporins still represent the most appropriate drug for gonococcal therapy. However, during the four years of observation, an increase of resistance to cefixim was observed, while it was stable to azithromycin. Azithromycin is therefore suitable for alternative therapy especially in case of coinfection with C. trachomatis. Due to the increasing MIC values for cephalosporins, the evaluation of the resistance pattern of the respective gonococcal strain by culture performance is highly recommended.
P136 Diagnostic value of PCR in syphilis infection
Daniel Coutinho1, Filomena Azevedo2 and Carmen Lisboa2
1Centro Hospitalar do Baixo Vouga, EPE, Portugal
2Centro Hospitalar de São João, EPE, Portugal
Background: Syphilis is still a major epidemiologic issue, and the diagnosis remains complex due to the pleomorphic clinical presentations of the disease.
Objectives: The authors aim to evaluate the usefulness of polymerase chain reaction (PCR) in detecting Treponema pallidum (Tp) in diverse biological specimens, define its clinical value for the diagnosis of syphilis and determine the impact of concomitant human immunodeficiency virus (HIV) infection in these results.
Material/Methods: All patients with clinical manifestation consistent with syphilis and a specimen collected for the detection of Tp by PCR testing, attending the sexually transmitted infection (STI) clinic of Hospital de S.João, Porto, between December 2006 and July 2014 were included. Clinical and laboratory data were recorded. Ulcer swabs, swabs from suspicious secondary syphilis skin lesions and skin biopsy samples were included and analysed by real-time PCR. Suspicious secondary syphilis skin lesions were superficially scratched before a swab was performed.
Results: In total, 193 specimens were collected from 176 patients. Positive Tp PCR results were obtained in 48 samples. Of the 16 samples collected from patients with primary syphilis, 12 were PCR positive, yielding a sensitivity of 75.0% (95% CI: 47.6–92.6) and a specificity of 100% (95% CI: 96.6–100). In 40 samples from patients with secondary syphilis, 34 were PCR positive, yielding a sensitivity of 85.0% (95% CI: 70.2–94.3) and a specificity of 100% (95% CI: 96.6–100). In 31 samples from patients with late syphilis, only two were PCR positive. PCR test performance was independent of HIV status. The PCR test was able to diagnose syphilis in three cases that were initially seronegative (by non-treponemal test), two of them in HIV-positive patients with delayed syphilis seroconversion.
Conclusions:Tp PCR test is a fast and reliable method for the diagnosis of early syphilis. This may provide an earlier diagnosis of the disease and is a definitive method to diagnose syphilis in patients with false-negative serology.
P137 Comparison of Xpert® HPV (Cepheid) with Anyplex™ II HPV28 Detection (Seegene) for the detection of high-risk human papillomavirus in clinical samples
Francisco Emilio Aliaga Lozano1, Daniel Jaén Luchoro2, Antonio Bennasar Figueras2 and Miguel Angel Ruiz Veramendi1
1Clínica Rotger, Palma de Mallorca, Spain
2Universidad de las Islas Baleares, Spain
Introduction: The Xpert® HPV (GX-HPV) method detects and reports human papillomavirus (HPV) 16, 18 and 45 genotypes (without distinguishing between them) and other high-risk HPV; but without specifying the genotype. The Anyplex™ II HPV28 Detection (SG-HPV) detects and semi-quantifies 28 viral genotypes; comprising the 14 HR-HPV that detects GX-HPV and 14 additional genotypes, including low-risk HPV (LR-HPV).
Objectives: The aim of this work was a comparative study between SG-HPV and GX-HPV methodologies.
Methods: A total of 100 endocervical samples were used for the comparative study.
Results: The GX-HPV and SG-HPV systems were compared in terms of isolation of nucleic acids, number of samples per run, PCR controls, genotypes detected and protocol duration. The agreement percentage between both methods was 92.93% (92/99), with a kappa value of 0.85 (95% CI: 0.75–0.96). The disagreement affected to seven cases, three of them were in accordance with semi-quantification of SG-HPV (+), which corresponds to a positive value after 40 PCR cycles. Three cases would be solved with the same result between both methods if the user manually validates the test reviewing the amplification plot. A positive HPV-35 case not detected by the GX-HPV system was the only discordance.
Conclusions: The GX-HPV and SG-HPV methods have shown an excellent agreement and concordance. The GX-HPV method has proved to be very useful for the screening of HR-HPV because of its quickness and competitive cost, not requiring manual intervention in nucleic acid isolation prior to PCR. The SG-HPV system has proved to be very useful in cases where the experimental confirmation of the genotype involved for monitoring is needed, coinfections assessment and evaluation of other genotypes or other non-endocervical samples.
P138 Neisseria gonorrhoeae: situation of antibiotic resistance in Germany
Susanne Buder1, Sandra Dudareva-Vizule2, Andrea Sailer2, Anna Loenenbach2, Klaus Jansen2, Viviane Bremer2, Eva Guhl1 and Peter K Kohl1
1German Reference Laboratory for Gonococci, Germany
2Robert Koch Institute, Germany
Background: The development of antimicrobial resistance in Neisseria gonorrhoeae is a serious problem for treatment and control of gonorrhoea. Numerous formerly effective therapeutic agents are no longer appropriable. The third-generation cephalosporins are amongst the last agents to remain effective. Reduced susceptibility or resistance to these cephalosporins is increasingly common. There is a severe concern that multidrug-resistant N. gonorrhoeae strains will spread globally (MDR-NG).
Methods: In 2014, Gonococcal Resistance Network (GORENET), a new N. gonorrhoeae surveillance programme for Germany, was implemented as a non-selected collection from all regions of Germany. The isolates were tested for ceftriaxone, cefixime, azithromycin, ciprofloxacin and penicillin by E-test and interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) 4.0.
Results: Overall, 307 isolates were tested in 2014. These results were compared to antimicrobial resistance (AMR) data from German isolates tested in European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) in period 2010–2013. More than 11% of the isolates displayed resistance to azithromycin, which demonstrates a massive increase in comparison with Euro-GASP data from previous years. Nearly 2% of all isolates showed a decreased susceptibility or resistance to cefixime (minimum inhibitory concentration, MIC > 0.12 mg/l). These results are lower than in previous years, but still concerning. No resistance to ceftriaxone was detected in 2014. Rates of resistance to ciprofloxacin (>70%) and penicillin (30%) are very high across Germany.
Conclusions: In Germany, ceftriaxone is an appropriate treatment for gonorrhea at present. Resistance to azithromycin is increasingly common. Cefixime is no longer recommended as first-line therapy agent due to a higher number of isolates with decreased susceptibility or resistance. Rates of resistance to ciprofloxacin and penicillin are high across Germany. Intensified surveillance of antimicrobial resistance status of N. gonorrhoeae is mandatory.
P139 Real-time PCR and serology for the diagnosis of primary syphilis
Andrea Vergara Gómez, Marisa López, Jordi Bosch, María Rosa Albarracín, Míriam José Álvarez-Martínez, Irene Fuertes, Izaskun Alejo, José Luis Blanco, Mercè Alsina and Jordi Vila
Hospital Clínic de Barcelona, Spain
Background: Syphilis is caused by Treponema pallidum (TP). Serological tests are still the standard for laboratory diagnosis, but they are relatively insensitive for detecting the primary stage of syphilis, and positive serology can also be indicative of a past infection. PCR assays can be used to detect TP in samples from primary lesions.
Objective: To compare the results of a commercial real-time PCR (RealCycler THLV®, Progenie Molecular) for the detection of TP in the diagnosis of primary syphilis with the serology in these cases.
Methods: Results of a real-time PCR for the diagnostic of TP during a period of two years (January 2013 to December 2014) were analysed. Swabs from genital, rectal and oral ulcers were processed from patients with suspected sexually transmitted infections. Results were compared with the serological tests (Venereal Disease Research Laboratories [VDRL], IgG and IgM).
Results: In total, 342 samples out of 287 patients were analysed. Sixty-eight (19.9%) were positive for TP, corresponding to 65 episodes in 64 (22.3%) patients. The most common diagnosis was genital ulcer in 37 (56.9%) cases, followed by proctitis or rectal ulcer in 19 (29.2%) and oral ulcer in eight (12.3%). Syphilis serology was performed in 53 (81.5%) of these patients. The PCR allowed the diagnosis in 14 patients (26.4%) with primary syphilis in which serology was negative or not suggestive of recent syphilis. When PCR was negative, syphilis serology was performed in 135 (49.3%) cases: 76 (54.3%) had negative serology and 44 (32.6%) had a serology compatible with a past infection. In 18 (13.3%) cases, serology was suggestive of recent infection (VDRL > 1/32 and/or positive IgM) and medical charts were reviewed: 16 cases corresponded to treated, secondary or early latent syphilis, and only two cases were probably primary syphilis.
Conclusions: The real-time PCR allows us to diagnose primary syphilis quickly and reliably. Only using serological techniques, some cases could remain undiagnosed.
P140 Molecular events determining primary HIV infections
Nagy Karoly1, Kanizsai Szivia1, Ongradi Joseph1 and Aradi Janos2
1Semmelweis University, Hungary
2Debrecen Unversity, Hungary
Background: The initial molecular events of HIV infection, determined by gp120 and gp41 viral surface glycoproteins, and cellular receptors are with primary significance. Redox changes in these proteins are also required for successful HIV entry and infection. Redox processes active in viral entry could be potential target for treatment of HIV infection. Earlier we demonstrated significant in vitro anti-HIV effect of thiolated pyrimidine nucleotides (TPN) and derivatives. Our aim was to determine selective effect of these compounds on monolayer and suspension cells, non-infected and infected acutely by HIV-1.
Materials and Methods: Six chemically modified derivatives of TPNs were used in concentrations ranged 5–100 micromole. Compounds were added for 24 h or 48 h to H9 human lymphoid cells, and on HeLaCD4 + β-gal monolayer cells non-infected, or infected with HIV-1IIIB 30 min after adding compounds. Viral infectivity was demonstrated by syncytium induction assay on MT-4 T cells, and MAGI assay on HeLaCD4 + β-gal cells. Cytotoxicity was determined quantitatively by XTT assay, based on mitochondrial dehydrogenase activity in living cell.
Results: All but one compounds exhibited a certain degree of cytotoxicity. On HIV-infected cells, however, cytotoxicity was much more pronounced: on H9 cells, 23% to 50% and on HeLa cells, 47% to 72%. Cytotoxic effect was dose-dependent.
Conclusions: TPNs inhibit the glyceraldehyde-3-phosphate dehydrogenase (GAPDH), as they may interfere with the function of the essential – SH groups of CD4 cells and – SH groups in viral envelope. In our study, the compounds induced a selective cytotoxic effect on HIV-infected cells. HIV infection activate cells, and cellular components – including cell membrane lipid rafts – expressing increased number of – SH groups. Our compounds, especially Mod-2, may function as an effective, new generation entry inhibitor for HIV.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by OTKA 81367 Grant.
P141 A new recombinant strain of Chlamydia trachomatis in Bilbao, Spain
Billie Caceda, Maria Jose Sada, Mikele Macho, Jose Angel Alava, Valentín Esteban, Manuel Imaz and Ramón Cisterna
OSI-BILBAO, Spain
Background: Most cases of Chlamydia trachomatis (CT) occur in women aged 15–24 years and are asymptomatic, which facilitates the spread and is an excellent niche to generate more virulent recombinant strains.
Objective: Determine the prevalence of recombinant strains of CT in our population.
Methods: We analysed 212 samples positive for CT. Samples were rectal, endocervical, urethral, pharyngeal, chancre lesion, semen and conjunctival. All the specimens were diagnosed with CT by real-time PCR system (Roche Applied Science) and confirmed by real-time pmpH and ompA-PCR. For genotyping lymphogranuloma venereum (LGV), the pmpH gene (deletion based 36 pb) was used and for CT the ompA gene. MEGA v5.0 software was used as phylogenetic method.
Results: Overall, 134(63.2%) were men and 78(36.8%) women, with a median age of 31.7 years (range 16–65). The most common diagnosis was having a partner with CT (31.6%) and urethritis (28.7%), less common: proctitis (1.4%) and inflammatory pelvic disease (0.9%). Four different CT genotypes were identified: E an L2 were the most prevalent (33%) followed by F (22%) and J (11.1%), and we found one recombinant strain between LGV and urogenital CT (probably genotype G). This recombinant strain belongs to a male of 39 years old with persistent urethritis, and his partner positive for CT. The positive sample was urethral.
Conclusions: We found one recombinant strain between LGV and CT urogenital (probably genotype G). Molecular methods like PCR and sequencing by genes pmpH and ompA are necessary to diagnose CT; this can be followed by bioinformatics analyses, which identify if there are conserved clustered regions of genetic exchange and, determine the genotypes and the recombinant strains. We observe that recombination is a mechanism for strain emergence that causes significant disease pathology like in this patient: persistent urethritis despite treatment, so it should be considered a longer antibiotic regimen.
P142 Comparison of conventional and modified Amsel’s criteria with Nugent score and impact on PCR-based bacterial vaginosis infection status evaluation
Safedin Sajo Beqaj1, Joel Lebed2, Bonnie Smith3, Melissa Farrell3, Jane R Schwebke4, Charles A Rivers4, Paul Nyirjesy5, Thomas E Davis6, Deanna D Fuller6 and Kenneth Fife7
1Pathology Inc., Torrance, CA, USA
2PPSP, Philadelphia, PA, USA
3PPGC, Houston, TX, USA
4UAB, Birmingham, AL, USA
5Drexel University, Philadelphia, PA, USA
6Eskenazi, Indianapolis, IN, USA
7Indiana University, Bloomington, IN, USA
Background: The diagnosis of bacterial vaginosis (BV) is usually made with Amsel’s criteria, a clinical diagnostic practice performed at bedside, or by the gold-standard, Nugent score (NS). Amsel’s criteria (vaginal discharge, positive whiff test, pH > 4.5 and presence of clue cells) are a subjective method. At least three of these are necessary for BV diagnosis. PCR assays that directly detect BV flora may be more objective than Amsel’s criteria.
Aim/Objective: This study aims to determine the concordance of various Amsel’s criteria subsets with the Nugent score for the evaluation of BV status.
Methods: Vaginal specimens from women with symptoms of BV were collected for testing with the BD MAX™ QS Vaginal Panel. The combined reference method was composed of NS followed by Amsel’s criteria, applied only to specimens with intermediate NS. Positive (PPA) and negative (NPA) percent agreement were calculated regarding each Amsel’s criteria in comparison to NS. BD MAX™ QS Vaginal Panel results (a single BV positive or BV negative call based on assessment of multiple BV markers) were then compared to reference method to evaluate its performance for BV diagnosis.
Results: Based on the analysis of 445 specimens, Amsel’s criteria showed better sensitivity with positive NS when vaginal discharge was disregarded (81.0% vs. 75.5%, p = 0.0001), while specificity with NS only slightly decreased when vaginal discharge was excluded (86.0% vs. 88.4%, p = 0.125). In support for these results, the BD MAX™ QS Vaginal Panel performance results (sensitivity/specificity) were 93%/87% with the combined reference method with conventional Amsel’s criteria and 93%/90% when vaginal discharge results were excluded.
Conclusions: Higher concordance between NS and Amsel’s criteria was obtained by disregarding the vaginal discharge criterion.
P143 Serological testing for sexually transmitted diseases on dried blood spots: are results as reliable as for blood drawn by venous puncture?
Inge van Loo1, Nicole Dukers Muijers2, Rosalie Heuts1, Marianne van der Sande3 and Christian Hoebe2
1MUMC, Netherlands
2Public Health Service South Limburg, Netherlands
3National Institute for Public Health and the Environment, Netherlands
Background: Many people at high risk for sexually transmitted diseases (STDs), e.g. men who have sex with men (MSM), are not reached by current sexual health care systems. To facilitate testing without going to a health care system by, for instance, home-based testing, a method for self-collected blood sampling was evaluated. For this purpose, dried blood spots (DBS) are evaluated for serological screening of HIV, hepatitis B (HBV) and syphilis.
Aim: The aim of this study was to compare the results for screening for HIV, HBV and syphilis from DBS with blood drawn by venous puncture.
Methods: DBS were collected from MSM, visiting the sexually transmitted infection (STI) clinic in South Limburg and HIV-positive and HBV-positive patients, visiting the outpatient clinic of MUMC. Serological screening tests for HIV (HIV p24/antibody test, Roche), HBV (HBsag and anti HBcore, Roche) and syphilis (Treponema pallidum, Biokit 3.0) were performed on DBS and on blood drawn by venous puncture.
Results: Totally, 224 persons are included in the study. In 18% of the DBS, the quality of sampling was low and could therefore not be tested. Of the remaining samples, the sensitivity was 100% for HIV (n = 187), 90% for HBsAg (n = 196), 79% for anti-HBcore (n = 193) and 93% for syphilis (n = 183), with specificities of respectively, 100%, 99%, 99% and 99%.
Discussion and Conclusion: The goal was to validate a method that could enhance the accessibility for screening for STIs for persons who could not be reached by the current sexual health care systems. Instructions for taking the DBS require special attention, since the number of samples with low quality of the DBS was almost 20%. The samples with sufficient quality showed acceptable sensitivities and specificities for HIV, acute HBV (HBsAg) and syphilis for use in routine practice.
P144 A novel multiplex real-time PCR assay improves the syndromic diagnosis of sexually transmitted infections
Gema Fernandez, Elisa Martró, Victoria Gonzalez, Verónica Saludes, Elisabet Bascuñana, Clara Marcó, Belén Rivaya, Evelyn López, Lurdes Matas and Vicente Ausina
Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Background: Sexually transmitted infections (STIs) are currently on the rise worldwide. The development of new multiplex molecular tools is needed for a correct diagnosis.
Objectives: To evaluate a new real-time PCR assay, Anyplex™ II STI-7, which detects seven pathogens (Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis and M. genitalium) in a single reaction, in comparison with culture and Abbott RealTime PCR assay used for routine STIs diagnosis in our laboratory.
Material and Methods: A total of 267 specimens were retrospectively tested by the STI-7 assay, including individuals who seek medical attention at health centres and HIV-negative men who have sex with men (MSM). Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for each pathogen in comparison with our routine methods, real-time PCR for C. trachomatis and N. gonorrhoeae and culture for T. vaginalis, which were considered as gold standard.
Results: Among specimens with a positive result by Abbott CT/NG assay or culture, sensitivities, specificities were 94.68% and 99.10% for C. trachomatis, 93.94% and 100% for N. gonorrhoeae and 93.94 and 96.55 for T. vaginalis. M. hominis, M. genitalium, U. parvum or U. urealyticum was detected in 160 (59.93%) out of 267 specimens in single or in mixed infections.
Discussion: The Anyplex II STI-7 is a simple and reliable assay for the diagnosis of STIs able to improve our routine diagnostic methods. Additionally, the multiplex detection of several pathogens in one reaction is strongly recommended for multi-aetiological syndromes such as STIs, even in asymptomatic carriers and low prevalence populations.
P145 Clinical evaluation of the CT/NG QS-RGQ kit in genital swabs, urine and semen using the QIAsymphony RGQ in comparison to the Cobas® 4800 CT/NG test
Gian-Luigi Cartolano, Christelle Lamon, Vincent Napoly and Stephane Chnichilla
EYLAU-UNILABS, France
Background: EYLAU Laboratory speciality is in vitro fecondation (IVF). In our lab, the diagnosis of genital infections due to Chlamydia trachomatis (CT) and Nesseria gonorrhoea (NG) is based on Roche CT/NG test Cobas4800: 24,000 tests are performed each year, including semen samples.
Aims: To compare the Qiagen CT/NG PCR to the Roche CT/NG-Cobas 4800, and to observe the results of PCR when performed on semen samples.
Methods: A retrospective study based upon 463 clinical samples (male, n = 215 and female, n = 248) and a prospective study involving 329 clinical samples (male, n = 205 and female, n = 124) were performed to determine performance of the Qiagen PCR when compared to our gold standard (Roche).
Results: Specificity (99.6%) and sensitivity (97.2%) of the combined studies demonstrated an excellent performance of the QiagenCT/NG PCR method. We observed a very small number of discordant results (n = 18). Results obtained with the semen samples (n = 80) during the retrospective study showed the same results with 22 CT + in both methods.
Discussion: The discordant results can be explained with the following reasons: the samples had been stored at room temperature (Roche specification) which is not the Qiagen recommendation. Moreover, all the PCR were performed on a unique collecting media provided by Roche, which is not the one optimised for Qiagen PCR. These two points could lead to false-negative results with the Qiagen PCR. Results obtained on the semen samples confirm the fact that PCR is a good diagnosis method.
Conclusion: The CT/NG Qiagen PCR demonstrated a good performance for CT and NG diagnosis, with male and female samples. PCR for CT and NG diagnosis performed on semen samples with the two methods showed the same results.
P146 Gastroenteritis in an HIV-positive men who have sex with men: a rare case of Shigella sonnei bacteraemia
Charlotte Murkin, Rosie Briggs, Fionnuala Finnerty, Amanda Clarke and Daniel Richardson
BSUH NHS, UK
Aim: To present a rare and interesting case that highlights the importance of a detailed sexual history and the seriousness of diarrhoeal disease in patients with HIV.
Objectives: Raise awareness of important differentials, highlight the necessity of taking a detailed sexual history and emphasise the seriousness of Shigella bacteraemia in the HIV-positive individual.
Methods: Case presentation of a 45-year-old man who have sex with men (MSM) with HIV and hepatitis C co-infection who presented with a two-day history of diffuse diarrhoea and vomiting. On admission, Mr X was found to be febrile, hypotensive and tachycardic with a CRP of 241. His CD4 two months prior to infection was 711 with an undetectable viral load. He reported good adherence to his antiretroviral medication. He was being treated for active hepatitis C with ribavirin and weekly interferon at the time.
Results: Computed tomography (CT) scan on admission showed bowel wall thickening involving most of the small bowel. The differential was infection including abdominal tuberculosis as well as inflammatory and neoplastic causes. However, S. sonnei sensitive to ciprofloxacin was isolated in both blood and faecal cultures. Mr X was treated with a seven-day course of ciprofloxacin and made a good recovery. Mr X later reported oro-anal sexual contact as well as insertive and receptive anal intercourse a few days previously with a partner who reported similar gastrointestinal symptoms. He also reported unprotected intercourse with multiple partners at a sex party. He was negative for all other sexually transmitted infections (STIs) at the time of admission.
Discussion: This case highlights the importance of taking a detailed sexual history. Increased incidence of Shigella outbreaks have been described in association the sexual practices of MSM. However, locally S. flexneri is more common and S. sonneii bacteraemia is very rare. Shigella diarrhoea seems to be more serious in HIV-positive patients, and this may be due to increased risk factors or more symptomatic disease.
P147 Detection of markers associated with resistance in Neisseria gonorrhoeae directly from clinical samples
Johan Melendez1, Justin Hardick2, Chris Geddes1 and Charlotte Gaydos2
1University of Maryland, Baltimore County, Baltimore, MD, USA
2Johns Hopkins Medical Institutions, Baltimore, MD, USA
Background: The thread of multi-drug-resistant Neisseria gonorrhoeae (GC) is a global health concern. The use of nucleic acid amplifications test (NAAT) does not allow for susceptibility testing limiting antimicrobial stewardship and surveillance programmes. There is an urgent need for detection of antimicrobial resistance markers directly for clinical samples including NAAT-derived samples.
Objective: To determine the feasibility of conducting molecular testing for susceptibility markers in GC samples submitted to the Johns Hopkins Center for point-of-care tests for sexually transmitted diseases.
Methods: As part of an ongoing study, 30 GC-positive samples (vaginal swabs and NAAT samples) have been analysed by real-time PCR for markers associated with resistance to penicillin, fluoroquinolones and cephalosporins.
Results: Of the 30 GC-positive samples, four of 30 (13.3%) had mutations in the GyrA and/or ParC genes, which are associated with decreased susceptibility to fluoroquinolones. None of the samples had the plasmid associated with penicillinase-producing N. gonorrhoeae (PPNG) or the PenA mosaic responsible for decreased susceptibility to cephalosporins. Preliminary results suggest that either genital swabs or NAAT-derived samples can be used for direct detection of resistance markers.
Conclusions: In this small cohort, we have detected markers associated with resistance to quinolones, but no PPNG or markers associated with decreased susceptibility to cephalosporins. Successful detection of markers from NAAT samples suggests that a single sample can be used for detection of GC and resistance markers. Additional studies are ongoing.
P148 Multidrug-resistant Mycoplasma genitalium in a monogamous men who have sex with men couple
Michelle Hanlon1 and Jørgen Skov Jensen2
1Olafiaklinikken, Oslo University Hospital, Norway
2Statens Serum Institut, Copenhagen, Denmark
Background:Mycoplasma genitalium (MG) macrolide and quinolone resistance is increasingly reported but not routinely tested for.
Objective: We report a case of multidrug-resistant MG in a monogamous men who have sex with men (MSM) couple, (fourth and fifth cases at our clinic in the past six months).
Methods: This couple was referred to the sexually transmitted infection (STI) clinic in February 2015. A detailed history and examination was performed together with MG screening and subsequent genetic mutation analysis of the 23s rRNA gene (macrolide resistance) and the parC gene (quinolone resistance).
Results: A Chinese MSM developed urethritis in October 2012. He had recently commenced a monogamous sexual relationship. The couple attended their general practitioner for STI screening together, and MG was detected in the patient (urethra) and his partner (anus). Despite being treated simultaneously and abstinence from sex, both experienced treatment failure following doxycycline (seven days) and azithromycin (five days). Both subsequently received moxifloxacin. Test of cure results five weeks later were discordant. The patient was followed-up until a negative test of cure was ultimately achieved later that year. The patient later re-presented with urethritis. Both patient and partner then tested positive for MG (urine and anus, respectively). A macrolide resistance mutation was found in the 23s rRNA gene, and a mutation in the parC gene leading to a S83I amino acid substitution associated with moxifloxacin resistance was detected.
Discussion: Multidrug-resistant MG in an increasingly common and challenging clinical entity. Test of cure results were, at times, discordant probably reflecting false-negative laboratory tests. We recommend concurrent treatment of regular sexual partner(s) irrespective of partners’ results, particularly when treating with third and fourth line therapy.
P149 What is the significance of isolated positive syphilis enzyme immunoassay results in HIV-negative patients attending the sexually transmitted infection clinic?
Nicola Thorley, Michael Adebayo, Miruna David, Erasmus Smit and Keith Radcliffe
NHS, UK
Background: According to clinic policy, patients are routinely screened for syphilis using enzyme immunoassay (EIA) total antibody. Positive EIA results are confirmed with a Treponema pallidum particle agglutination test (TPPA) and the rapid plasma reagin test (RPR). An unconfirmed positive treponemal EIA (EIA positive, TPPA negative and RPR negative) presents a clinical challenge to distinguish early syphilis infection from a false-positive result. Unconfirmed positive EIA cases are referred for syphilis line assay (Liatek) and also recalled for repeat full syphilis serology.
Aims/Objectives: We aimed to establish the proportion of HIV-negative cases with an unconfirmed EIA result, to ascertain the proportion of these cases that received Liatek and repeat syphilis serology testing and to review the clinical outcomes.
Methods: We performed a retrospective audit of our electronic patient record for HIV-negative patients who attended the clinic between 1 January 2013 and 31 December 2013 and had an unconfirmed positive treponemal EIA result. Baseline demographics, risk factors, clinical presentation and previous history of syphilis treatment were recorded.
Results: It was found that 0.35% (80/22,687) HIV-negative patients who had syphilis serology performed had an unconfirmed positive treponemal EIA result. Eighty-eight percent (70/80) received a Liatek test. Repeat syphilis serology was performed in 84% (67/80) cases, but no additional cases of early or latent syphilis were identified. After exclusion of 21 patients with verified previously treated syphilis, 18% (9/49) unconfirmed EIA positive cases were confirmed on Liatek testing, supporting a diagnosis of latent syphilis.
Discussion: Unconfirmed EIA was not attributable to early syphilis in any cases. The results of repeat syphilis serology did not inform the management of these cases, but the Liatek assay is of more value as a confirmatory treponemal test.
P150 Evaluation of a new assay for the diagnosis of HIV
Carmen Rodriguez, Almudena Lillo and Jorge Del Romero
Centro Sanitario Sandoval, IdISSC, Spain
Objective: To evaluate a new immunoassay of fourth-generation BioPlex®2200 HIV Ag-Ab, for the diagnosis of HIV infection.
Material and Methods: The study was conducted in a clinic for sexually transmitted infections in Madrid. A total of 172 consecutive serum samples with a cutoff greater than reading limit were analysed by an immunoassay of fourth generation (Architect, Abbott Diagnostics) and underwent confirmation by western blot (WB) (Biorad). Following our diagnostic algorithm, all the positive samples on the immunoassay and WB negative or indeterminate underwent plasma viral load, on suspicion of primary infection. BioPlex®2200 HIV Ag-Ab method is an immunoassay that incorporates highly conserved sequences of synthetic peptides and recombinant HIV-1 (group M and O) and HIV-2, and monoclonal antibodies specific for the HIV-1 p24 antigen. The assay design allows detection and identification of individual form of antibodies to HIV-1, HIV-2 and also of p24 antigen HIV-1.
Results: The 172 samples that had previously tested positive on Architect were analysed on BioPlex®2200. Of these, 161 were positive in Architect and positive in WB, and all of them were positive for HIV-1 in BioPlex®2200. A sample was negative in WB and was also negative in BioPlex®2200. Ten positive samples in the Architect presented WB indeterminate. From those, eight were positive in BioPlex® 2200 for HIV-1, one was positive for HIV-2 and one was negative, which underwent plasma viral load was confirmed undetectable. Later, a new sample of this patient was also negative in Abbott and WB.
Conclusion: The results obtained with the assay BioPlex®2200 HIV Ag-Ab have coincided with the other two techniques that we use in routine (Architect and WB). The sensitivity and specificity shown by the new method was very good, especially at the stage of primary infection, and it is a valid option for early diagnosis of HIV.
P151 Evaluation of a nucleic acid amplification test assay for diagnostic of C. trachomatis serotypes D-K infections in a primary care laboratory
Anabel Fernández Navarro1, Cèlia Guardià Llobet2, Rosa Tenllado Giménez3, Neus Sánchez Luengo3 and Maria Antonia Llopis Díaz3
1ISC, Spain
2ICS, Spain
3Institut Català de la Salut, Spain
Background: In Catalonia, Chlamydia trachomatis infection by serotypes D-K has a prevalence of 6%–7% in 15- to 24-year-old population (2012). Clinical practice guidelines recommend nucleic acid detection techniques (NAATs) as diagnostic methodology because of their high sensitivity (88%–95%) and specificity (95%–98%). Until 2013, in our laboratory, we used an enzyme immunoassay test, and in 2014, we changed to an NAAT.
Objective: To evaluate possible differences using antigen detection and NAAT in diagnosis of chlamydial infections in our aim population.
Methods: Retrospective comparison in the positivity incidence for chlamydial infection between 2013, using an immunoassay for detection of chlamydial antigens (QuickVue), and 2014, using an NAAT assay (Xpert CT/NG).
Results: Between January and October 2013, we performed 1269 chlamydial antigen detections from 1195 women (endocervical samples) and 74 men (urethral samples), with an average age of 29.2 years and a global positivity rate of 4.4%. There were 511 members of that population (40.3%) who were 15–24 years old, and we found a positivity rate of 5.9% among them. Between January and October 2014, we performed 2080 CT/NG assays from 1934 women (endocervical samples) and 146 men (urethral and urine samples), with an average age of 30.6 years and a positivity rate of 9.4%. Of these, 764 (36.7%) were between 15 and 24 years old, with an average positivity rate of 14.7%.
Discussion and Conclusions: We have a greater number of women than men because our aim population is Reproductive and Sexual Health Care Centres patients. In 2014, we found more chlamydial infections using an NAAT than in 2013 using antigen detection, which could be explained because NAAT has a higher sensitivity. As advantages, this NAAT assay detects N. gonorrhoeae infections as well as C. trachomatis, is quick and easy to perform, avoids subjective interpretation and allows using urine samples in men, easier to collect than urethral samples.
P152 Prevalence of sexually transmitted infections using multiplex real-time PCR in Korean nationwide reference laboratory
Kyoung Ho Roh, Hyoeun Shim and Sunhwa Lee
Seegene Medical Foundation, Korea, Republic Of
Background: Sexually transmitted infection (STI) is a public health concern. Treating symptomatic STI patients and active monitoring to asymptomatic health care examiner could decrease disease burden. Also, prevalence of STI is carefully followed-up by hospital-based laboratories and nationwide reference laboratories. We use sensitive and validated real-time PCR assay for reporting clinically important STI prevalence rate during 2014–2015.
Methods: Seegene Medical Foundation (SMF) had nationwide specimen collection and transport system in Korea. More than 4000 clinics sent genital and/or urinary specimens everyday, and the results were reported next working day. From 1 November 2014 to 31 March 2015, 7921 samples (3152 male and 4769 female) were tested and analysed in SMF using Anyplex II STI-7 (Seegene, Seoul, Korea). This multiplex real-time PCR (Anyplex II STI-7) could detect seven STI causing pathogens, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in one PCR tube.
Results: During five months of study period, overall prevalence rates of C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, M. hominis, U. urealyticum and U. parvum were 9.1%, 3.0%, 1.4%, 5.9%, 15.5%, 18.1% and 41.6%, respectively. C. trachomatis and N. gonorrhoeae concurrent infection rate was 0.8%. The concurrent infection rate in male was five times higher than those in female (1.6% vs. 0.3%). T. vaginalis was the least possible pathogen in Korea. However, higher prevalence rate of U. parvum was noted.
Conclusions: Multiplex real-time PCR shows robust and outstanding results in study times. It could be a cost-effective and rapid diagnostic tool for the detection of multiple STI organisms and sometimes used for routine health check up procedures. These results have a limitation because these data are from mostly symptomatic patients, but detail medical history could not review. In clinical reference laboratory, high throughput multiplex PCR is convenient, and epidemiologic data provide useful information to clinicians.
P153 Limited clinical benefits of endocervical microscopy when the use of nucleic acid testing for N. gonorrhoea is standard practice in symptomatic women
Darren Cousins, Robyn Cutforth, Mohamed Ghanem and Lynn Riddell
NHFT, UK
Background: National guidance recommends endocervical microscopy in symptomatic women attending sexual health services. The use of nucleic acid testing for Neisseria gonorrhoea (NGC) testing is now standard practice. The pressure on clinics to see more patients means there is pressure to simplify the patient journey, and we investigate whether endocervical microscopy is beneficial to the medical care of the patient.
Methods: Retrospective case note review of women attending sexual health services in a district general service in England. Demographics data collected include other diagnoses, risk behaviours along with endocervical microscopy results.
Results: In the time period, 273 patients had endocervical microscopy performed. Two patients had Gram-negative intracellular diplococci suggesting NGC, and this was confirmed by nucleic acid amplification test (NAAT) and culture testing as per national guidance. Both were due to be treated in clinic already as contacts of proven cases of NGC. Another six patients were confirmed contacts of NGC but had negative microscopy and tests, but were treated in line with national guidelines. Thirty patients demonstrated pus cells on microscopy. One of these had a positive NAAT for NGC and two had inhibited NAAT testing. Three of these patients were treated for pelvic inflammatory disease on clinical suspicion but had negative tests for NGC. Other cervical pathology visualised in five women with pus cells included Nabolian cysts and ectropions. No patients in the study were sex workers.
Conclusion: The suspicion of Gram-negative intracellular diplococci on endocervical microscopy did not change clinical practice as the cases demonstrated would have been treated in clinic due to their clinical history as contacts. The authors would question the validity of including endocervical microscopy in routine clinical practice in similar settings.
P154 Use of BD dual-probe chlamydia and gonorrhoea testing in men living with HIV in a large district general cohort
Denise Migliorini1, Darren Cousins2, Lynn Riddell1 and Mohamed Ghanem1
1NHFT, UK
2Summers Unit, UK
Background: In our HIV service, men historically screened for sexually transmitted infections (STIs) less than women, perhaps due to pathways requiring genital examination and clinician taken swab tests. This investigation compares the uptake of screening before and after the introduction of dual-probe nucleic acid testing for chlamydia and gonorrhoea.
Methods: Retrospective case note review of men attending the HIV service between 2009 and 2013; two years before and two years after introduction the dual probe. Data collected include sexual orientation, results of STI screens.
Results: Overall, 620 HIV-positive men were identified in the service within the time period. Sixty-two patients were tested in the two years prior to dual-probe testing, and 100 were tested after the introduction of with dual-probe nucleic acid techniques, demonstrating a 61% increase after the introduction of the dual probe. All tests were taken by clinician prior to the introduction of dual-probe testing, whereas 108 (74% of total) were self-taken afterwards. There was a 63% increase in STI testing in men who have sex with other men (MSM) in the cohort (n = 257), from 33 (26%) to 54 (40%). In heterosexual men, testing increased by 59%, from 29 to 46. There was also a 59% increase in testing heterosexual men. Positive chlamydia or gonorrhoea results were reported in 11 tests prior to dual-probe testing, but nine after the introduction of dual-probe testing. MSM patients were overrepresented in the positive results representing eight of 11 (72%) and seven of nine (78%) of the infections diagnosed.
Conclusion: STI testing increased dramatically with the introduction of dual-probe testing and the option of self-taken tests in asymptomatic patients, although fewer infections were diagnosed perhaps demonstrating more testing in lower risk groups. The incidence of chlamydia and gonorrhoea in MSM was double that of heterosexual men in our cohort, underlying national recommendations for screening.
P155 Sexually transmitted infections among men who have sex with men: prevalence, locations and challenges for molecular assays
Kristi Plaas1, Liina Eelmets1, Kaspar Ratnik1, Jaak Jänes1, Kristi Rüütel2 and Paul Naaber1
1synlab Eesti, Estonia
2National Institute for Health Development, Estonia
Background: It is known that men who have sex with men (MSMs) have more likely high prevalence of sexually transmitted infections (STIs) especially in extra-genital location.
Aim: To evaluate the prevalence of the most common STIs in genital and extra-genital sites of Estonian MSMs.
Methods: First-void urine (FVU), rectal swab (RE) and throat swab (TH) were collected via Internet-based self-testing during August 2014 to February 2015 from 233 Estonian MSM patients. All materials were tested in synlab Eesti for Chlamydia trachomatis (CT), C. trachomatis LGV (LGV), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) by nucleic acid amplification testing (NAAT) on Luminex xMAP® platform using in-house protocol. In NG and CT assays, both chromosomal and plasmid targets were applied.
Results: We found CT significantly more frequently from RE (4.7%) than in TH (0.9%, p = 0.01), in FVU was prevalence 2.6%. LGV type was not found. MG was significantly more common in FVU and RE (both 2.6%) than in TH (0%, p = 0.01). TV was found only in TH (10.3%) and not in FVU and RE (p < 0.001). NG (positive for both genetic markers) was the most frequent in TH (14.2%) as compared with RE (4.3%) and FVU (1.3%, for both p < 0.001). In RE, prevalence of NG was also more common than in FVU (p < 0.05). One RE (0.4%) and 24 TH (10.3%) samples were positive only for NG plasmid marker. This is significantly higher than generally among genital samples sent to lab routinely (0.016%, p < 0.001).
Conclusion: Whereas in FVU of MSMs the prevalence of STI pathogens was not significantly different from general STI patients’ genital samples, we found very high prevalence of NG and TV in MSMs’ throat. In several cases, TH sample was positive only for NG plasmid marker. This can indicate to the very low NG count in TH or frequent prevalence of this marker in other closely related species colonising MSMs’ throat.
P156 Acceptability and effectiveness of two partners’ notification strategies of new HIV cases
Silvia Martín Valle1, Patricia García de Olalla2, Emma Molas3, María Jesús Barberá4, Hernando Knobel3, Elia Díez2 and Juan Antonio Caylà2
1Agencia de Salud Pública de Barcelona, Spain
2Public Health, Spain
3Centre Forum de l´Hospital del Mar, Barcelona, Spain
4UITS Drassanes, Spain
Background: Partner notification of people infected with HIV is a key strategy for promoting diagnosis and early treatment.
Objective: This study aims to assess the acceptability and effectiveness of two HIV partners’ notification strategies.
Methods: HIV cases diagnosed between January 2012 and June 2013 at two health care settings in Barcelona were invited to participate in the study. A public health nurse (PHN) interviewed and collected epidemiological data from index cases (IC) and offered them to choose between two partner notification strategies: patient referreal who informed personally partners about their exposure and recommended HIV testing and notification by the provider referreal, who called by phone to a list facilitated by the IC. Acceptability of participation was the proportion of cases who provided partner information dividing by the total of IC contacted. Partner’s acceptability was the proportion of them who underwent testing out of the total who got the recommendation. The effectiveness of each strategy was estimated through the proportion of newly diagnosed partners by the total number of partners tested for HIV.
Result: Out of the 125 index cases contacted, 108 (86%) agreed to provide information about partners. A total of 199 partners were identified. Patient notification strategy was chosen by a 78% of the participants. The patient contacted 153 partners, 100 were tested and 21 (21%) were newly HIV diagnosed. Among the 53 partners who were not tested, 36 knew already their seropositivity and 17 refused to take the test. Provider notification strategy was chosen by a 22% of the participants. The provider contacted 46 partners, 41 were tested, five (12%) were newly HIV diagnosed and five partners already knew their HIV seropositivity. The overall effectiveness of the two strategies was 18.4%
Discussion: The acceptability of the study was high. While patient referreal notification was the preferred strategy, the acceptability of the couples was higher in the provider notification strategy, which partially compensates the effectiveness difference. Partner notification programmes should include both notification strategies.
P157 Rethinking migration! Switzerland renews its HIV/sexually transmitted infection prevention framework among migrants and sex workers
Steven Derendinger, Roger Staub and Stefan Enggist
Federal Office of Public Health, Switzerland
Background: For many years, the Swiss National HIV/AIDS Program and the 2011 Swiss National HIV/IST Program have considered people originated from high HIV prevalence lands, namely Sub-Saharan African countries, and sex workers as two distinct target groups. Despite the international acknowledgement that the HIV epidemic has developed considerably in the last decade in Eastern European countries and Russia, the latters have never been included into projects targeting migrants in Switzerland. Besides, synergies between migration and sex work HIV prevention programmes have never been exploited though most sex workers (female sex worker [FSW], men who have sex with men [MSW] and transgenders) are migrants in Switzerland.
Aim/Objective: A new framework is developed. It considers migration and HIV/sexually transmitted infection (STI) prevention holistically and enables new synergies among projects targeting sex workers, men having sex with men, transgender people, injecting drug users and migrants.
Methods: Experts from several non-governmental organisations (NGOs) were invited to work on the development of a new HIV/STI prevention framework. In March 2015, the SFOPH organised a national HIV/STI forum to present the new framework and collect support from professionals and activists.
Results: The framework is composed of four principal goals and three action fields targeting respectively human and sexual rights, HIV/STI prevention and contraception, counselling, testing and treatment. The framework determines primary vulnerability factors to HIV/STI and factors that strengthen the vulnerability to HIV/STI (such as economic, social or psychological determinants).
Discussion: The new framework allows a comprehensive approach of HIV/STI prevention among migrants. The vulnerability factors enable the distinction between the migrants belonging to the general population and those needing particular programmes.
P158 The importance of a broad spectrum approach for screening of sexually transmitted infections in community-based voluntary counselling and testing centres
Mitja Lenart, Bojan Cigan and Miha Lobnik
DIC Legebitra, Slovenia
Background: Due to focusing prevention strategies on HIV/AIDS, the importance and impact of other sexually transmited infections (STIs) has become underestimated. A community-based voluntary counselling and testing centre (CBVCT) in Slovenia that offers free testing for HIV, syphilis, hepatitis B, oral gonorrhea and free hepatitis A and B vaccinations for the population of men who have sex with men (MSM) has noticed a high prevalence of STIs besides HIV. We presume that most of these infecions would go undiagnosed if the CBVCT centre focused only on HIV testing.
Aims: To ilustrate the importance of a broad testing specter for all STIs in CBVCTs and/or various other testing clinics.
Methods: Venous blood and oral swab sample collection in a Slovenian CBVCT centre that offers testing once per week at the primary location and twice per month at other locations such as dance clubs, faculties, community centres, etc. The testing programme is focused on the MSM population in the capital of Ljubljana, with occasional testing venues in other regions of Slovenia.
Syphilis test implementation date: 1 January 2012.
Oral gonorrhea implementation date: 1 June 2012.
Conclusion: While HIV testing should still be a cruicial part of prevention and provides a powerful motivator for testing, screening for other STIs is also recommended where finances and human resources are available. By regularly screening for other STIs, treatement can be started at an early age of the infection, which lowers the rate of further infections. Venous blood sample collection proved to be an efficient testing method.
P159 HIV/sexually transmitted infection prevention campaign in Switzerland: LOVE LIFE – no regrets
Roger Staub, Steven Derendinger, Sirkka Mullis and Norina Schwendener
Swiss Federal Office of Public Health, Switzerland
Background: Since 1987, the Swiss Federal Office of Public Health (SFOPH) and its partners have informed the Swiss population on HIV. In 2004, the campaign LOVE LIFE is created and focuses on sexual health. Since 2011, LOVE LIFE has included the prevention of other sexually transmittable infections (STIs) and has added a third safer sex rule: ‘In case of itchiness, stinging or discharge, go and see a doctor’ in addition to the well-known rules ‘1. Intercourse always with a condom and 2. No sperm or blood in the mouth’.
Aim/Objective: The recent campaign ‘LOVE LIFE – no regrets’ highlights a positive attitude towards life where everyone enjoys a pleasurable life and a self-determined sexuality without regrets. HIV becomes once again a relevant concern that is taken seriously.
Methods: The Swiss population is invited to participate in the campaign by committing to a short manifesto. The website is promoted through social media. The hashtag #LoveLifeNoRegrets offers a new alternative to commit in the campaign.
Results: By the end of 2014, approximatively 170,000 people claimed their commitment to the manifesto. A total of 270,000 people visited the website, and the LOVE LIFE spot was seen over one million times. This represents roughly 18% of the sexually active Swiss population. In that sense, the campaign managed to make HIV and safer sex a central topic.
Discussion: In 2015, the primary HIV symptoms (PHI) constitute the new focus of the campaign. The third safer sex rule is completed as follows: ‘Consult your doctor immediately if you experience flu-like symptoms following unprotected sex’. Higher awareness of PHI symptoms empowers people to seek quickly voluntary counselling and testing (VCT) after unprotected sex and enables very early HIV diagnosis.
P161 Extent of HIV/sexually transmitted infection prevention programmes reaching men who have sex with men attending the gay meeting venues in Stockholm, Sweden
Inga Velicko1,2, Achilleas Tsoumanis1, Torsten Berglund1, Maria Axelsson1 and Sharon Kühlmann-Berenzon1
1Public Health Agency of Sweden, Sweden
2Karolinska Institutet, Sweden
Background: Sweden took part in the SIALON-2 study with the objective to estimate HIV prevalence among men who have sex with men (MSM), to measure the extent of preventive programmes, and to provide outreach testing and prevention activities at gay meeting venues.
Methods: Between May and August 2013, MSM were recruited at gay venues in Stockholm using time-location sampling (TLS). Individuals answered anonymously a questionnaire and provided an oral fluid sample for HIV antibody testing, analysed at the laboratory. A logistic regression model was fitted to HIV testing during the last 12 months. All analyses were weighted according to TLS methodology and are presented with 95% confidence intervals (CIs).
Results: Based on 366 MSM, HIV prevalence was estimated at 2.4% (95% CI: 1.1–5.2). In terms of prevention activities, 92% (95% CI: 85.8–97.4) knew where to get tested for HIV and 78% (95% CI: 70.9–85.3%) had received free condoms during the last year. During the last 12 months, 58% (95% CI: 48.8–67.6) were tested for HIV and 61% (95% CI: 51.7–70.4%) for STI.
Factors significantly associated with not testing for HIV during the last 12 months among Swedish residents were: 25 years and older with odds ratio (OR) 1.53 (95% CI: 0.96–2.47), unaware where to get tested (OR = 5.79, 95% CI: 0.87–38.46) compared to those who knew and self-unreported HIV status (OR = 3.83, 95% CI: 1.22–12.0) compared to HIV-negative MSM.
A group of 28 individuals reported never have tested for HIV. Most of them (23/28), nevertheless, knew where to test, and 13/21 reported using a condom with non-steady partners in the last six months.
Conclusions: HIV prevalence among MSM attending gay venues was low. Results suggest that more frequent HIV testing should be encouraged among older MSM and those unaware of their HIV status. More information on where to get tested should be circulated in gay venues as well as testing opportunities should be expanded to reach those never tested, e.g. through outreach testing.
P162 Exploring perceptions of motivational factors and barriers for HIV testing among men who have sex with men in Sweden
Kristina Ingemarsdotter Persson1, Torsten Berglund2, Anna Thorson1, Ronny Tikkanen3, Jakob Bergström2 and Birger Forsberg1
1Karolinska Institutet, Sweden
2Public Health Agency of Sweden, Sweden
3Göteborgs Universitet, Sweden
Background: Previous studies suggest that the perception of ‘having been at risk’ and the sense of benefiting from testing may promote HIV testing among men who have sex with men (MSM). Fear, worries and structural barriers related to the test service are considered hinders for testing.
Aim: The objective of this study was to explore Swedish MSMs’ perceptions of motivational factors and barriers for HIV testing.
Methods: Data from a Swedish cross-sectional stratified web community MSM health survey, MSM2013, were analysed. For the men tested during the last 12 months, measures on motivators for getting HIV tested were analysed. Measures on barriers for HIV test were analysed for those never tested, or tested more than five years ago.
Results: Three out of four men had tested for HIV (n = 1602) out of which 43.1% (95% CI: 40.6–45.5) were tested during the last 12 months. MSM-tailored clinics were the most common test site reported by over a third of the men. Metropolitan residing men and homosexually identified men had tested at such a site more often than others.
A quarter of the men (n = 626), 23.6% (95% CI: 21.7–25.6) reported never having tested for HIV. Young men, men residing outside metropolitan areas and bisexually identified men reported having been tested less often than others.
The most common reasons specified for most recent HIV test were: testing regularly (43.2%, 95% CI: 39.4–45.3), health check/screening (18.3%, 95% CI: 16.1–20.5) and commencing a new relationship (16.8%, 95% CI: 14.6–19.0). The most common barriers among those never tested were: ‘haven’t taken risks’ (57.3%, 95% CI: 52.6–62), ‘haven’t thought of it’ (43.2%, 95% CI: 38.5–47.9) and being in a monogamous relationship with an HIV-negative partner (16.2%, 95% CI: 12.9–19.4). Younger men, 15–25 years old, reported barriers related to fear and worries and not having access to a test site more often than older men.
Conclusions: MSM-tailored test services including counselling are not available for all MSM. Particularly younger MSM could benefit from youth-friendly information and low-threshold services in order to establish an HIV test routine, getting hepatitis/human papillomavirus (HPV) vaccines and safer sex counselling.
P163 An audit of testing and vaccination for hepatitis B in men-who-have-sex-with-men who attend the sexually transmitted infection clinic
Nicola Poole1, Nicola Thorley2 and Keith Radcliffe2
1University of Birmingham, UK
2UHB, UK
Background: Hepatitis B infection, a major global health problem, can result in chronic liver disease, cirrhosis and hepatocellular carcinoma. Men-who-have-sex-with-men (MSM) are at increased risk hepatitis B acquisition; national guidance advises that they should be screened and offered pre-exposure vaccination. According to clinic policy, all MSM not known to be immune to hepatitis B should receive serological testing and be administered the first dose of vaccination at initial attendance.
Aims: Based on national British Association of Sexual Health and HIV (BASHH) guidelines and standards, aims (targets) were to ascertain whether MSM not known to be immune to hepatitis B:
1. Received serological testing at initial attendance (>90%)
2. Were managed according to clinic policy if serology was positive (>90%)
3. Received the first vaccination dose at initial attendance (>90%)
4. Completed the vaccination course (three doses) within six months of initial attendance (>50%)
An additional aim was to establish reasons for non-adherence to clinic policy.
Methods: Retrospective audit of electronic patient records for the period 1 January – 30 June 2013 inclusive. Totally, 258 patients were included.
Results: Seventy-one percent received serological testing at initial attendance. Seventy-five percent were managed according to clinic policy if serology was positive. Fifty-two percent received the first vaccination dose at initial attendance. Forty-six percent completed the vaccination course (three doses) within six months of initial attendance.
Discussion: Overall, audit standards were not met, and the proportion of cases for which a reason for non-adherence to policy was not documented was high. A significant number of patients either declined serology or vaccination or failed to attend follow-up, and in some cases, clinicians requested and awaited confirmation of immunity (i.e. HBsAb titre) rather than screening and vaccinating at the initial appointment. We have recommended several patient and clinician-orientated measures which may improve these outcomes and propose to re-audit at 12 months in order assess their effectiveness.
P164 ‘If you brand it they will come’: delivering services for men who have sex with men through contraception and sexual health clinics in areas of social deprivation
Vaughan Statham
NHS Lothian, UK
Background: A comprehensive HIV men who have sex with men (MSM) needs assessment (Scottish Government 2014) indicated that late HIV diagnosis and infrequent or no HIV testing were associated with social deprivation, being a bisexual MSM or aged under 25 years and with a syndemic of interlinked social and behavioural risk factors. Established outreach services for MSM, delivered by the ROAM Team, a subspecialist NHS service were well evaluated but served an affluent and largely older city centre population. Eleven local contraception and sexual health (CASH) clinics are generic and developed from services for women in socially deprived localities.
Aims: To comprehensively redesign MSM services to deliver care through local CASH clinics in areas of deprivation.
To evaluate service user’s sexual behaviours, other risk factors and demographics to explore whether men attending are representative of the group identified by the needs assessment.
Methods: Literature review of current MSM community clinic models, development of a service redesign proposal to meet the needs assessment recommendations and creation of an identifiable brand ‘m-test’ for clinical testing services for asymptomatic MSM. Pilot the clinical service in one local clinic.
Results:
Pre ‘m-test’
Post ‘m-test’
Period
April 2013– March 2014
August 2014– March 2015
12 months
8 months
Male attendees
97
101
MSM attendees
10
40
New to service
1
21
Return
6
7
Rebook
3
12
Diagnoses of MSM attendees
Rectal chlamydia
0
5
Pharyngeal chlamydia
0
1
Infectious syphilis
0
2
MSM: men who have sex with men.
Discussion/Conclusion: The m-test brand and service model successfully attracts MSM at high risk of HIV infection who have not previously accessed services.
P165 Predictors of pap screening rates among female university students in Maritime Canada
Audrey Steenbeek, Amber Cragg, Donald Langille, Mark Asbridge and Pantelis Andreou
Dalhousie University, Canada
Background: In Canada, the human papillomavirus (HPV) is highly prevalent; approximately 75%–80% of young adults will contract HPV, increasing risk for genital warts and cervical cancer. PAP screening is effective in detecting pre-cancerous cells (dysplasia), and despite it being free/available to most Canadian university students, many do not access it. Little is known about predictors of HPV screening among this population.
Aims: Characterising university students likely to be tested, to improve PAP screening.
Methods: Data come from the Maritime Undergraduate Student Sexual Health Services Survey (2012), a cross-sectional, anonymous, online survey of Canadian undergraduate students at eight universities (n = 10,361). This analysis focused on sexual health of, and health services use by (n = 4007) female students, weighted for demographics, imputed for missing values and limited to ages 19–29 (recommended screening age) years. We performed descriptive analysis and simple/multiple logistic regression analyses on factors associated with screening among vaginally sexually active females.
Results: In unadjusted analyses, students at higher/moderate risk of HPV had significantly higher odds of ever having been screened than lower risk; 22% of sexually active females had never been screened. In multivariable models, those that were older, Caucasian, non-heterosexual, less religious, residing with a romantic partner, and those who had more sexual health knowledge and perceived their friends as having liberal attitudes had higher odds of ever been tested. Those with more attitudinal barriers to help seeking were less likely to ever been tested. Perceived risk of HPV was not associated with testing.
Conclusion Those at most risk of HPV were more likely ever tested, yet with 22% never tested, it is unlikely recommendations are being met. Efforts aimed at reducing barriers to help seeking and targeting residences may improve PAP screening in this population.
P166 The practice of anal sex among the the female sex workers in the Northeast part of India
Ashimav Deb Sharma
Self sponsored, India
Background: Unprotected anal sex is associated with higher risk of transmission of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). This is due to the delicate nature of the rectal mucosa and anal sphincter. Any form of trauma to rectal mucosa in the receptive partner provides opportunity for the transmission of HIV/STI. The risk is more if the receptive partner is female.
Aim: The aim of this study was to observe the prevalence and factors associated with anal sex practices among female sex workers (FSWs) in the Northeast part of India.
Methods: A total 64 FSWs were interviewed with a questionnaire to collect information regarding the respondents’ knowledge and their practices related to anal sex as well as related socio-economic factors.
Results: Sixty-one (95.3%) FSWs reported having ever engaged in anal sex. None of them had urged their male partner to use condom during anal intercourse. Seventy-five percent (48 cases) of FSWs were aware of HIV/AIDS. Only 4.6% FSWs (three cases) were aware of the fact that unprotected anal sex has the higher risk of HIV transmission. Nine FSWs were found to have anal fissure, 11 FSWs were found to have hemorrhoids and 15 had both and one had rectal prolapse – all these conditions developed after being engaged in this profession.
Discussion and Conclusion: This study showed the practice of anal sex is quite common among FSWs, but their knowledge of HIV transmission risk associated with anal sex is very low. This is an alarming situation. It is important for HIV prevention programmes to focus not only on vaginal sex but also on risk associated with anal sex.
P167 Virgin sexual health service-wide first audit: offer and uptake of HIV testing
Protap Gupta and Kate Horn
Virgin Care, UK
Background: Antiretroviral therapy made a dramatic improvement in life expectancy of HIV-positive patients. Late diagnosis is the major cause of HIV-related death. It is recommended that all patients attending sexual health services be offered HIV testing. At Virgin Care, we are committed to follow the recommendation as outlined in our own standards of care document.
Aim(s)/Objectives:
To measure performance of our services against Virgin standards for offer and uptake of HIV testing.
To assess the feasibility of Virgin sexual health service-wide audit.
To find more information of reasons for not offering and not accepting HIV test.
Methods: The audit period was May 2014. An online survey tool, approved by Virgin Care as information governance compliant, was used to collect data. All service leads were asked to review 20 consecutive new/re-book patients seen in May 2014 and submit one form for each patient.
Results: Response rate was 100%. Just over 91% of all patients were offered and approximately 76% accepted the test. Virgin Care standards at the time of the audit were: offer – 100% and acceptance – 60%. The audit showed that about 25% patients did not accept the test. Reasons for non-acceptance were analysed and discussed at the quarterly national professional network meeting where best practice was shared.
Discussion/Conclusion: Virgin-wide audit is feasible. Documentation should be improved. Patients who refuse the test should have further explanation of reasons for and advantages of HIV testing. Re-audit in one year.
P169 Herpes simplex neonatorum
Ivan Bogdanov1, Zdravka Demerdjieva1, Anna Bogdanova2 and Nikolai Tsankov1
1Tokuda Hospital Sofia, Bulgaria
2Harris Birthright Research Centre – King’s College Hospital, UK
Background: Herpes simplex neonatorum is a rare condition, most often associated with herpes simplex virus 2 (HSV-2), whereas only several cases of infants with herpes simplex virus 1 (HSV-1) infection are found in the literature.
Objective: We report the case of both HSV-1 and HSV-2 infection in term-born child and a mother with history of itching and burning vulvar lesions.
Methods: At the ninth day after birth, the infant presented with vesicles and blisters disseminated over the upper extremities and later on the neck, buttox and lower extremities. Soon after the appearence of the skin leasions, wheezings and a poor general condition with nutritional perturbations appeared. On the basis of the mother’s medical history and the skin lesions, treatment with oral acyclovir 20 mg/kg q.p.d. was established before the Tzanck test and the serological findings (positive for IgG against both HSV-1 and HSV-2) had confirmed the neonatal infection.
Results: Because of the early clinical diagnosis, the immediate treatment led to success and complete healing of the infant despite the extensive skin involvement associated with rapidly progressing viral pneumonia.
Conclusion: Although primary HSV-1 and HSV-2 infections during pregnancy are rare, genital lesions even without general symptoms can lead to neonatal infection and should therefore be taken seriously. Prompt recognition and treatment of primary maternal infection is of great importance for the unremarkable fetal outcome.
P170 The 2014–2015 European collaborative clinical group report on the European management of partner notification
Sabah Ahmed1, Omome Etomi1, Ben Brooks1, Dmitriy Kim2, Rak Nandwani3, Mikhail Gomberg2, Ceri Evans4, George Sorin Tiplica5, Emily Clarke4 and Rajul Patel4
1Southampton, UK
2Moscow, Russian Federation
3Glasgow Hospital, UK
4NHS Hospital, UK
5Colentina Hospital, Romania
Background: Partner notification (PN) is a public health service in which sexual partners of individuals with sexually transmitted infections (STIs) are informed of their exposure and are offered testing, treatment and support services. Previously, there has been substantial variation in PN across Europe due a number of factors including a lack of financial resources and a variation in look-back periods. In 2013, the European guideline on PN was published in an attempt to bring consistency across the European region.
Aims: The study aimed to evaluate the current PN policies amongst sexual health physicians across Europe against the current European guidelines.
Methods: European experts in the field of PN were interviewed about controversies in management, and a clinical scenario-based questionnaire was developed. The final questionnaire was disseminated to 120 sexual health physicians across 38 countries, who are members of the European Collaborative Clinical Group (ECCG), established to conduct questionnaire-based research across the European region.
Results: Responses from the majority of ECCG countries have been received. There is a wide variation in PN practice across Europe, with differing legal and clinical requirements. Interim results shows a lack of consensus in the look-back period for Chlamydia trachomatis, as well as a disagreement in the management strategy when providing information to contacts attending for treatment. Furthermore, data indicate that provider referral is the preferred choice of management despite research supporting patient referral to be the most effective.
Conclusion: The practice of PN is unique to sexual health professionals and is a core element of sexual health practice. However, PN varies widely across Europe and is not always in line with current European guidelines. There is a need for ongoing Europe-wide education to avoid reinfection of the index case. IUSTI should consider to further support PN services to ensure good sexual health.
P172 Shame, stigma and chronic sexually transmitted infections: a review
Marie Chollier1 and Ingrid Geray2
1Manchester Metropolitan University, UK
2UNESCO Chaire, France
Since antiretroviral treatment (ART), HIV switched from a death sentence to a life sentence. Living with HIV being now a chronic condition did not unfortunately lead to the decrease of stigma and shame. It rather seemed to reframe states’ responses and policies, public health interventions and people’s attitudes and beliefs regarding not only HIV but sexually transmitted infections (STIs) in general. This review focuses on three levels of psychosocial impediments to STIs’ screening and patients’ follow-up.
1. The social environment and its characteristics organise and promote local responses to STIs in terms of legal treatment, health care access and organisation. It also provides general explicit and implicit rooted sets of stereotypes and attitudes. Regarding screening habits, potential social determinants related to social perception (stereotypes) and/or experiences and to level of knowledge have been identified.
2. Health care professionals are not exempted from stereotyping and stigmatising attitudes. As professionals’ attitudes negative perception may have an impact on routine testing attendance and treatment adherence, the patient/health care professional relation is a new field of interest.
3. Eventually, people living with STIs experiencing shame/stigma prevalence increases and might lead them to develop psychiatric symptoms.
Translational epidemiology seems able to include psychosocial factors, as an ecological approach setting the basis for comprehensive continuing professional development and tailored intervention in line with international standards and local specificities.
P173 Cost-effectiveness of different strategies for the treatment of gonorrhoea infections: one or two antibiotics?
Maria Xiridou1, Anna Lugner1, Henry de Vries2,3, Jan van Bergen4,5, Hannelore Gotz6,7, Birgit van Benthem1, Jacco Wallinga1 and Marianne van der Sande1,8
1National Institute of Public Health & Environment, Netherlands
2Public Health Service Amsterdam, Netherlands
3Academic Medical Centrer Amsterdam, Netherlands
4SOA/AIDS, Netherlands
5University of Amsterdam, Netherlands
6Public Health Service Rotterdam Rijnmond, Netherlands
7Erasmus Medical Center Rotterdam, Netherlands
8University Medical Centre Utrecht, Netherlands
Background: In response to the rising threat of gonococcal resistance to first-line antibiotics for gonorrhoea, European sexually transmitted infection (STI) Guidelines recommend dual antimicrobial therapy. Nevertheless, some countries, including the Netherlands, still recommend monotherapy for gonorrhoea.
Objective: To investigate the cost-effectiveness of dual therapy with ceftriaxone and azithromycin, compared to monotherapy with ceftriaxone, for gonococcal infections among men who have sex with men (MSM) in the Netherlands.
Methods: We developed a deterministic transmission model for the spread of gonorrhoea among MSM and calculated the numbers of new gonorrhoea infections and the use of health care facilities (doctor/clinic consultations, tests and antibiotic doses) with monotherapy and with dual therapy, for a 50-year time frame. From these numbers, we calculated the incremental costs and quality-adjusted life-years of dual therapy compared to monotherapy.
Results: Initially, there are no strains resistant to the first-line antibiotic(s); the two treatment strategies are equally effective in controlling transmission, but dual therapy is more expensive, due to higher antibiotic use. In a time frame of 10–20 years, dual therapy would not be cost-effective. Compared to monotherapy, dual therapy can delay the spread of antimicrobial resistance by at least 15 years, but it may be cost-effective only in the long run. With more frequent screening among asymptomatic high-risk MSM, dual therapy could be more cost-effective, compared to monotherapy.
Conclusions: Dual therapy can considerably delay the spread of antimicrobial resistance, but initially it is neither cost-saving nor cost-effective, compared to monotherapy. With a long time frame, however, dual therapy could be cost-effective compared to monotherapy.
P174 A clinician-led model of response to domestic abuse within an acute trust
Katrina Stegmann1, Fiona Charuy1, Nick Hale1, Liz Barnshaw1, Rhiannon Everett1, Peta Sissons2, Sally Jackson2, Jade Levell2 and CE Cohen1
1Chelsea and Westminster NHS Hospital Trust, UK
2Standing Together Against Domestic Violence, UK
Background: UK guidelines recommend health services train staff to ask about domestic abuse (DA). The WHO estimate one in three women experience either intimate partner or sexual violence in their lifetime, and the Crime Survey for England and Wales found young women most disproportionately affected. It is a complex issue impacting health significantly. Our Trust designed a clinician-led model of response comprising: tailored training, upskilled links, confidential social information (CSI) documentation log, online-resources, supervision and referral pathways embedded within safeguarding policy frameworks.
Aims/Objectives: To evaluate initial outcomes for DA survivors.
Methods: Retrospective review of DA survivor CSI logs, 1 April 2013 – 31 October 2014.
Results: In total, 300 survivors were identified, most female: 232 (77%). Ages ranged from newborn to 84 years, median 27. Twenty (7%) were HIV+ve and 60 (20%) were young aged 16–25 years. Of 20 males aged > 16 years, 17 (85%) were men-who-have-sex-with-men. Of 300 perpetrators recorded, 275 (92%) were male, 190 (63%) current/ex-partner, 58 (19%) parent/step-parent and 21(7%) disclosed >1 abuser. CSI logs were documented hospital-wide, most in: maternity 104 (35%), sexual health 64 (21%) and emergency 54 (18%). Prior DA was disclosed by 190 (63%) and 180 (60%) had hospital contact in the year prior. Nearly half the cases; 132 (44%) documented children were at risk. Physical abuse was reported by 206 (69%), verbal 123 (41%) and emotional 102 (34%). Sexual abuse was reported by 24 (8%) overall and 19 (30%) survivors identified in sexual health. It was found that 151 (50%) survivors had ≥1 high-risk features; 106 (36%) were pregnant, 54 (18%) disclosed escalating/severe abuse, e.g. strangulation. Most disclosures (260.87%) resulted in a safeguarding intervention with: social care (190.63%), police (99.33%), mental health (40.13%), general practitioner (GP) (38.13%) and DA agencies (37.12%).
Discussion and/or Conclusions: Our clinician-led initiative has led to increasing recognition of DA within patients, highlighting the feasibility of hospital interventions following disclosures to safeguard survivors. This model could act as a standard for other organisations to consider.
P176 You’ve got to speed it up! Using enhanced partner notification and data collection for a fast and effective way to monitor gonorrhoea trends at an urban sexual health clinic
Megan Crofts1, Lily Telisinghe2, Michael Clarke1, Nathan Speare1, Paul North2, Elizabeth Tempest2, Norah O’brien2, Maya Gobin2, Louise Bishop2 and Helen Wheeler1
1NHS, UK
2Pubiic Health, UK
Background: Enhanced partner notification (PN) is performed on all gonorrhoea cases attending the sexual health clinic. This includes how the index case met their partner(s), meeting location and how they intend to notify partner(s). In 2013, sexual health advisors noted an increase in gonorrhoea cases attending the sexual health clinic and alerted the Public Health team to investigate a possible outbreak.
Aims/Objectives: To describe an unexpected increase in gonorrhoea diagnoses at the clinic.
Methods: Anonymised patient data and in-depth partner notification records were analysed to describe gonorrhoea cases, during the period 2010–2013.
Results: Gonorrhoea reports revealed a rise in cases from 2010 to 2013 (1.4% in 2010 to 2.3% in 2013; p ≤ 0.001). This was seen in men who have sex with men (MSM) (40%–60%) with a decrease in cases in heterosexuals (61% in 2010 to 40% in 2013). Among MSM, the predominant site of infection was the pharynx (increasing 43%–63%); and increasingly, multiple-site infection (12%–35%) was recorded. Overall, patients were increasingly of white ethnicity (73% in 2010 to 84% in 2013). An increase was also noted in those who were known HIV positive (1.2%–5.3%; p = 0.16). Increasingly, patients are meeting partners online (38.8%).
Year
Tested positive for gonorrhoea
Total tested
p value
No n (%)
Yes n (%)
2010
11,789 (98.6)
164 (1.4)
11,953 (100.0)
<0.001 For trend <0.001
2011
12,277 (98.5)
189 (1.5)
12,466 (100.0)
2012
12,838 (98.2)
232 (1.8)
13,070 (100.0)
2013
13,564 (97.7)
321 (2.3)
13,885 (100.0)
Total
50,468 (98.2)
906 (1.8)
51,374 (100.0)
Conclusions: Enhanced PN enabled a timely response to this outbreak, which was largely driven by white MSM, meeting partners online. Early identification of rising rates of infection enabled health promotion to be focussed on specific messages such as asymptomatic carriage and the need for regular testing. Our clinic-specific monitoring may help minimise outbreaks in future by individualising health promotion, facilitating partner notification and targeting key online sites to alert users to outbreaks.
P178 Gonorrhoea in Brighton: a description of epidemiology, antimicrobial resistance and implications for public health interventions
Lauren Amor1, Fiona Cresswell2, Joanna Peters2, Angela Dunne2, Gillian Dean2 and John Paul2
1BSUH, BSMS, UK
2BSUH, PHE, UK
Background: Gonorrhoea constitutes a public health problem due to rising incidence and antimicrobial resistance. Understanding local drivers of infection, level of knowledge and preferred method of education is important for planning public health interventions.
Aims:
1. Describe demographics, lifestyle factors and antimicrobial resistance locally.
2. Assess subjective knowledge of gonorrhoea and preferred means of further education in infected individuals.
Methods: A prospective study recruited 149 individuals with gonorrhoea. Participants completed a questionnaire, samples were routinely analysed and cultures are undergoing whole genome sequencing. Data were analysed using SPSS.
Results: Demographics: average age 33.6 years, 7.4% female, 91.3% white, 80% men who have sex with men (MSM) and 35.9% of MSM were HIV-positive. MSM had significantly greater number of sexual partners in the three months prior to diagnosis than heterosexuals (eight vs. four, p = 0.01). 71.6% reported visiting a sauna, sex party or the Internet to find partners. Compared with HIV-negative MSM HIV-positive MSM reported the more sex under the influence of drugs (39.1% vs. 36.4%), greater number of previous sexually transmitted infections (STIs), particularly syphilis (55% vs. 9.1%) and were more likely to not use condoms (60% vs. 25%, p = 0.01). 66.9% of cases were culture-positive. Resistance to >1 antibiotic class was greatest in HIV-positive MSM (34.8%). Genotypic data are under analysis. Subjective knowledge about gonorrhoea increased with age. Preference of educational tools varied with age and sexual orientation. MSM prefer websites, posters in bars/clubs and directly from face-to-face interactions with health care workers.
Conclusion: Condom avoidance, frequent partner change and sex under the influence of drugs were common in both HIV-positive and negative MSM. Effective interventions targeting MSMs are needed. Web-based information, face-to-face communication or written information in bars and clubs is the preferred choice by this group.
P179 Investigating genital Chlamydia trachomatis in sex workers checked on Chilean sexual health care units
Erica Castro Inostroza
Universidad San Sebastián, Chile
Introduction:Chlamydia trachomatis (CT) is one of the most prevalent sexually transmitted infections (STIs) worldwide. Currently, there are no studies in Chile relating the presence of CT in sex workers to their occupation.
Objective: To evaluate epidemiological aspects of genital C. trachomatis infection in sex workers who are checked in the sexual health care units of Chilean hospitals.
Method: This is an analytical cross-sectional study. A survey was conducted on all subjects. CT identification was done by nested PCR targeting the ompA gene on endocervical, urethral and anal swabs and on urine samples. Positive samples were genotypified through restriction fragment length polymorphism (RFLP).
Results: In total, 162 sex workers (148 women and 14 men) from different regions of Chile participated in this study. 16.2% of them (10/162) presented the microorganism in the genital area, with all of them being women. CT-positive people’s average age was 33 years. Ninety percent of them stated to be heterosexual. All CT-positive workers drank alcohol and, paradoxically, used prophylactics. Found genotypes were H/I/J (30%), D (20%), E (20%) and F (10%). Twenty percent of the samples were not identified.
Conclusion: There are certain habits in the studied population’s socio-cultural and sexual profiles that would be associated to the presence of CT. This warrants intervention policies.
Funding: The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research funded by Project FONIS N° SA12I2251, Conicyt.
P180 Chlamydia control in Europe has strengthened – how much did the European Centre for Disease Prevention and Control guidance (2009) move prevention forward in the European Union/European Economic Area?
Otilia Sfetcu, Gianfranco Spiteri and Andrew Amato-Gauci
ECDC, Sweden
Background: More than three million chlamydia cases were reported in European Union/European Economic Area (EU/EEA) between 2004 and 2013, on a background of heterogeneous national prevention and control activities. In 2009, European Centre for Disease Prevention and Control (ECDC) published chlamydia control in Europe guidance, aiming to support the policy-making process in Member States. Five years after publication, ECDC evaluated the guidance’s impact on policy and explored areas for revision.
Methods: Two ECDC surveys (2007 and 2012) described national chlamydia prevention and control activities. Questions in the 2012 survey investigated awareness and specific use of guidance. Scientific evidence for prevention interventions efficacy was updated through systematic literature reviews. An expert focus group reviewed the results and identified areas for guidance revision.
Results: In 2012, fewer countries reported no organised activities compared to 2007 (20% [6/28] vs. 45% [11/27]). Combinations of case management, partner notification and opportunistic testing were reported by 46% (13/28) in 2012, up from 22% (6/27) in 2007. Eleven of 25 countries (44%) used the guidance for: writing new policy/strategy (n = 5), raising awareness for chlamydia (n = 4), improving surveillance (n = 4), obtaining funding (n = 2) or reviewing existing control frameworks (n = 2). Gaps in evidence remain for the risk of complications following chlamydia infection and for the effectiveness of control interventions at population level.
Conclusion: Chlamydia control activities strengthened in EU/EEA Member States and the ECDC guidance reportedly influenced for policy changes in some countries. The guidance is being revised to better serve/inform policy making, implementation and evaluation of control strategies. Priority areas for prevention remain: primary prevention, case management and partner notification.
P182 Does Mycoplasma genitalium cause proctitis? A case report
Fionnuala Finnerty and Daniel Richardson
Royal Sussex County Hospital, UK
A 19-year-old men who have sex with men (MSM) attended with a two-week history of rectal bleeding, anal pain, discharge and tenesmus. He had a past medical history of psoriasis. He was treated for rectal chlamydia with 100 mg doxycycline BD for one week for the previous four weeks. His last sexual contact was six weeks previously: unprotected receptive anal intercourse with a known male partner. He had no lymphadenopathy, no rash and no evidence of oral ulceration. On proctoscopy, he had erythematous mucosa and multiple small discrete ulcers in the rectum. He had a viral PCR for herpes simplex virus (HSV); HIV, hepatitis and syphilis serology and a multiplex realtime PCR from the rectal ulcer. He had triple site swabs for chlamydia and gonorrhoea, and the rectal swab was sent for lymphogranuloma venereum (LGV) testing. The differential diagnosis at the time was LGV, HSV, syphilis and gonorrhoea, and he was treated with a further course of 100 mg BD doxycycline for seven days and 400 mg acyclovir TDS for five days, but his symptoms did not resolve. His triple swabs were negative for chlamydia and gonorrhoea. HIV, syphilis and hepatitis serology was also negative. Multiplex PCR was positive for Mycoplasma genitalium and negative for syphilis, chlamydia and HSV. He was subsequently treated with a prolonged course of azithromycin (1 g stat and 250 mg BD for four days), and his symptoms completely resolved. In summary, this 19-year-old man had proctitis (with a positive rectal mycoplasma PCR) which resolved on a prolonged course of azithromycin. Asymptomatic rectal mycoplasma is well described, but symptomatic disease is not well reported.
P183 Sexually transmitted infections in military personnel in the country of Georgia
Tamar Akhvlediani1, Ketevan Mdivani2, Maia Ispireli2, Tinatin Meskhishvili2, Medea Betashvili3, Mikeljon Nikolich4, Christian Bautista4, Robert Rivard5 and Eric Garges4
1USAMRU G, Georgia, USA
2Mil Hospital, Georgia, USA
3MoD Georgia, Georgia, USA
4WRAIR, Washington, DC, USA
5USAMRIID, USA
Background: There is minimal information available about the prevalent pathogens, transmission and acquisition of sexually transmitted infections (STIs) in Georgia. There are recognised behavioural risk factors common to military personnel that facilitate acquisition and transmission of these infections. In many countries, the military has been identified as a high-risk group with rates among military personnel two to five times higher than civilian populations.
Objectives: The objective of this study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and identify potential risk factors associated with these bacterial infections in military personnel in Georgia.
Methods: Male military volenteers referred at the Gori Military Hospital with signs and symptoms of urethritis were offered participation in the study. After obtaining informed consent, a standard clinical and epidemiological assessment questionnaire was conducted. Urethal swabs were collected for bacterial culture and antibiotic sensitivity, and urine samples were taken for nucleic acid amplification testing (NAAT) to detect C. trachomatis and N. gonorrhoeae.
Results: From August 2013 to December 2014, 100 patients were enrolled. The mean age was 26 years; 92 patients reported sexual activity influenced by alcohol, and 32 patients were previously treated for STI. Only four patients received antibiotics before coming to the hospital. The most common symptom was urethral discharge (100%). Eleven patients were culture-positive for N. gonorrhoeae. By NAAT testing, 25 patients were positive for N. gonorrhoeae and 22 for C. trachomatis. Six patients were positive for both bacterial pathogens.
Conclusions: This ongoing study reveals a high prevalence of both N. gonorrhoeae and C. trachomatis in Georgian military personnel. Additional studies are necessary to test for a broader spectrum of pathogens to better describe the epidemiology of STIs and determine antibiotic resistance profiles in both military and civilian populations of Georgia.
P184 A three-year review of changing trends at a central London clinic for sex workers
Rosemarie Turner, David Payne, Sara Day and Ann Sullivan
Chelsea and Westminster Hospital, UK
Background: SWISH (sex workers into sexual health) has run in partnership between a central London sexual health clinic and the Terrence Higgins Trust (THT) since 2008. This is a free walk-in service offering testing for sexually transmitted infections, pregnancy tests, contraception, treatments for sexually transmitted infections (STIs) and hepatitis B vaccinations. THT offers free massage, counselling, advocacy services and condoms.
Aims: To identify changes in the proportion of men, women and trans* patients as well as STI rates.
Methods: A service evaluation of patients using patient notes.
Results: The number of men has increased annually; however, the rate of men has been steadily declining. Despite the increase in women and trans* patients attending, male patients were accountable for the most STIs each year. Chlamydia and gonorrhoea remain the most common STIs amongst male patients, though syphilis has been increasing amongst all patients.
Discussion: The reasons why the rate of women has increased should be explored; possibilities include staff are now trained to provide contraception or recommendations. Overall, the service remains popular with men, women and trans* patients.
P185 Anaemia status among care support and treatment clients due to antiretroviral treatment: a cross-sectional study
Anindia Reina Yolanda, Pande Mirah Dwi Anggreni, Muhammad Faisal Putro Utomo, Made Ayu Widyaningsih, Edwind Rakatama Fahlevie and Arya Khrisna Manggala
Udayana University, Indonesia
Background: The availability of anti-retroviral therapy (ART) has resulted in prolonged life and improved quality of life among people living with HIV and AIDS (PLWHA). The cause of HIV progress to AIDS may be caused by anaemia. Anaemia may happen due to autoimmune destruction of red blood cell (RBC) and also as an adverse effect of ART, such as zidovudine (AZT). This regimen is known to cause anaemia within three months after initial treatment.
Aims: The research was done to see anaemia type mostly suffered by PLWHA and its risk factors.
Method: A cross-sectional study with a total of 110 care support and treatment (CST) clients was conducted in Bali Province. Samples were consecutively selected from voluntary counselling and testing (VCT)/CST clinic at Sanglah General Hospital. Data were collected by extracting it from the medical records using extraction form. Data were then analysed using univariate analysis.
Result: Our study found a high proportion of anaemia (21.4%) among CST clients and mostly occurs in women. Our study showed that the dominant type of anaemia among PLWHA is normo-chromic normo-cytic and hypo-chromic micro-cytic. The ART regimens mainly consumed by those with anaemia is AZT/3TC/NVP.
Conclusion: Most PLWHA with anaemia suffered from the hypo-chromic micro-cytic type. This type of anaemia usually appears as a sign of iron deficiency and took long period to develop. Therefore, we can conclude that the anaemia is chronic and suspected as a risk factor HIV progressivity to AIDS. Another factor is the use of AZT/3TC/NVP, which is believed causing anaemia.
P186 Sexual networking: does targeting online sexually transmitted infection booking appointments to men who have sex with men on Grindr improve access to sexually transmitted infection testing services?
Richard West and David Daniels
West Middlesex University Hospital, UK
Background: Seventy-five percent of men who have sex with men (MSM) using online geo-location social networking applications report having sex with a partner they met online. Assessing risk and improving access to sexually transmitted infection (STI) and HIV testing services for this cohort may reduce undiagnosed infections and onward transmission.
Objectives: To improve access to asymptomatic STI and HIV testing services for MSM using online social networking applications by trialling a targeted online booking service, and to compare this group to MSM accessing services by conventional means.
Methods: We undertook a five-day marketing campaign on MSM geo-location application ‘Grindr’ allowing patients to directly book a genitourinary medicine (GUM) appointment from their smartphone. At appointment, history including last HIV test and last unprotected anal sex was taken. Comparisons to the same number of routine MSM, randomly selected from attendances prior to the service launch, were made.
Results: Fifty-five patients booked an appointment online, 34 attended. Comparisons to 34 randomly selected routine MSM attending for asymptomatic STI testing are made in Table 1. Patients booking via the online application were less likely to have engaged in testing services when using previous hepatitis B vaccination or previous HIV test as a marker of clinical engagement.
Reported history from online bookings and routine MSM.
Comparison
Online recruited patients
Routine patients
New to service
94%
18%
Previous hepatitis B vaccination
65%
85%
Reporting unprotected anal intercourse since last HIV test
71%
59%
Reported never previously testing for HIV
24%
6%
Discussion: Online marketing allowing direct access to GUM appointments proved effective at attracting new service users, who were less likely to have previously engaged with STI testing services. Expansion of online marketing and appointment booking via social network applications should be considered by testing services to improve public health outcomes.
P188 Sexual risk behaviours and sexually transmitted infection testing among female Aboriginal university students in the maritime provinces of Canada
Donald Langille, Audrey Steenbeek, Kevin Wilson, Amber Cragg and Mark Asbridge
Dalhousie University, Canada
Background: Young Aboriginal Canadians are at increased risk of negative sexual health outcomes, including risk of sexually transmitted infections (STIs). We examined associations between Aboriginal ethnicity and sexual risk behaviours and Aboriginal ethnicity and lifetime STI testing among young sexually active female university students in the Maritime Provinces of Canada.
Methods: A secondary analysis of online survey data of sexually active female undergraduate university students under 30 years of age (N = 5010) from eight post-secondary institutions located in the Maritime Provinces of eastern Canada was carried out. Students were asked about their ethnic backgrounds, sexual risk behaviours and use of health services. Logistic regression was used to compare Aboriginal to Caucasian students in terms of sexual risk behaviours and ever having been tested for STI while controlling for appropriate covariates.
Results: Overall, 67.2% of Aboriginal respondents did not use a condom at last vaginal intercourse compared with 43.1% of Caucasian students; 72.7% versus 46.6%, respectively, had ever been tested for STI. Comparable numbers had had more than one partner in the previous year (36.1% vs. 38.0%, respectively). In adjusted analyses, Aboriginal students were more likely not to have used a condom at last intercourse than their Caucasian peers (OR: 2.37; 95% CI: 1.34–4.18). They were also more likely to have ever been tested for STIs during their lifetimes (OR: 2.95; 95% CI: 1.11–7.82).
Conclusions: Aboriginal ethnicity is associated with decreased condom use and increased STI testing among female university students in the Maritime Provinces of Canada. Aboriginal students appear to recognise that they are at increased risk of STI and undertake appropriate testing more frequently. Health service providers working with university students should be aware of the lack of barrier protection seen in this group and promote such protection to Aboriginal women to the fullest possible extent.
P189 ‘Normal’ or ‘dirty’? The changing experiences of care and support among men who have sex with men diagnosed with HIV
Pamela Bruton1, Tanvi Rai1, Chris Higgs2, Jane Rowlands2 and Helen Ward1
1Imperial College London, UK
2Chelsea and Westminster NHS Trust, UK
Background: The development of effective and streamlined HIV therapies has transformed the treatment of patients following diagnosis. Clinical care is simplified and normalised with fewer appointments and less holistic support.
Objective: We explore how the experience of diagnosis, care and support has changed for men who have sex with men (MSM).
Methods: In-depth interviews with 34 HIV-positive MSM from two clinics in London. Participants were purposively selected from four ‘HIV generations’, based on antiretroviral therapy development – those diagnosed pre-1996, 1997–2005, 2006–2012 and since 2013. Framework was used to analyse the data.
Results: Men diagnosed in earlier generations described greater access to professional and non-statutory support in the period after diagnosis. Compared to later generations, they felt they had opportunities to ‘tell their story’ and seek support. Those diagnosed more recently perceived a lack of time and space within the clinical setting to share their stories, though all described a period of adjustment of differing lengths of time which included different points in their journey when they ‘faced mortality’. Simultaneously, support from within the MSM community appears to have diminished. Indeed many men are reluctant to test or disclose their status in the face of persistent stigma where terms such as ‘dirty’ are used to describe those with HIV, with some parallels to the stigma around homosexuality that many had already experienced.
Year
Total number of patients
Number of male patients
STIs in male patients
Number of female patients
STIs in female patients
Number of trans* patients
STIs in trans* patients
2012
Total 96
M 58 (60%)
M 28 (16%)
F 25 (26%)
W 2 (8%)
T 13 (14%)
T 4 (31%)
2013
Total 98
M 56 (57%)
M 20 (36%)
F 32 (33%)
W 2 (6%)
T 10 (10%)
T 2 (6%)
2014
Total 108
M 49 (45%)
M 13 (12%)
F 42 (39%)
W 6 (6%)
T 17 (16%)
T 3 (3%)
STI: sexually transmitted infection.
Discussion: In the efforts towards ‘normalising’ HIV, clinical care is becoming more remote or ‘virtual’, and people are encouraged to take more responsibility. This approach underestimates the evolving social politics of HIV within the MSM community and how interaction between these two phenomena impacts on testing behaviour and the care pathways following a positive diagnosis.
P190 Contributions of a true master to the field of sexually transmitted disease: Professor Philippe Ricord
Mauro Ramos Cunha
Secretaria de Saúde de Porto Alegre, Brasil
Background: The study of the history of medicine is generally a neglected area of medical knowledge. In the specific case of sexually transmitted diseases (STDs), it can provide an evolutionary understanding of clinical, laboratory and therapeutic practices. It can also bring understanding for socio-political, moral and ethical concepts, known to be evolving over time. This work presents the contributions made by Professor Philippe Ricord for the advance of the field.
Objectives: To present aspects of Ricord’s history of life, professional activity and, with particular interest, methodological considerations on his classical work, which made possible the distinction of gonorrhea and syphilis. Traditionally, these two diseases were considered as manifestations of the same infection. This erroneous unicist concept persisted in medical writings since the 16th century.
Methods: Literature review of computerised sources of the history of medicine and a manual search of documents in the Biblioteque de Histoire de la Santé, Université Paris Descartes. Methodological appraisal of aspects of his paper ‘Traité pratique des maladies vénériennes: ou Recherches et critiques sur experimental appliquée à l'étude de ces maladies, suivies d'un résumé thérapeutique et d'un formulaire Special’ (1838).
Results: The present review reinforces the innovative feature of his contributions. It also points out his importance as a teacher, his visionary ethical concerns and his prolific relationships with students and colleagues. His classic work, even containing inaccurate concepts in the light of current knowledge, was of paramount importance to the field of STDs.
Conclusion: Further knowledge of the life and work of Ricord has at the present time important messages for medical practice, either in the clinic, in teaching or in research.
Author Index
Abu Bakar Mohd Sabri, P019
Abuelkhair Islam, P103
Acharya Sashi, P084
Adebayo Michael, P149
Adlerstein Daniel, P040
Aguilar Gloria, P109
Agustí Benito Cristina, O-23
Ahmed Sabah, O-28, P124, P170
Airell Åsa, O-11
Akhvlediani Tamar, P183
Alava Jose Angel, P141
Albarracín María Rosa, P139
Alejo Izaskun, P139
Alemany Laia, O-30
Aliaga Lozano Francisco Emilio, P137
Allen Vanessa, P133
Almeda Jesús, O-23
Alsina Gibert Mercè, P025, P034, P121, P139
Alt Katja, P093
Alvarez-Abella Alba, P074
Álvarez-Martínez Míriam José, P139
Amato-Gauci Andrew, S16, S20, P180
Amor Lauren, P178
And the Catalan HIV And STI Surveillance Group The Catalan Sentinel STI Surveillance Group, P111
