Posts in ‘Public health’ category

Is antiretroviral treatment for HIV increasing the susceptibility to syphilis

Posted on 9th August 2017 by · No comments

Recently, the world has experienced a rapidly escalating outbreak of infectious syphilis primarily affecting men who have sex with men (MSM); many are taking highly active antiretroviral therapy (ARV) for HIV-1 infection.

Treatment with ARV reduces risk of infection (because of greatly reduced viral load) and near-normal life expectancy for those on treatment. The currently accepted hypothesis is that these factors result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 sexually transmitted infections, including gonorrhoea, chlamydia and syphilis.

However, syphilis incidence has increased more rapidly than other STDs. In a recent open access article in the journal Sexually Transmitted Infections, Reckart and colleagues hypothesise that ART itself  may alter the innate and acquired immune responses to Treponema pallidum, the bacterium causing infectious syphilis, and that this biological explanation plays an important role in the current syphilis epidemic.

In a leading article in the same journal, Susan Tuddenham and colleagues (only available to subscribers), find the hypothesis intriguing despite some flaws. They go on to suggest that further work is necessary to look at the mechanisms underlying the current syphilis epidemic.

In the same issue David Glidden et al point out that in the early double blind trials with pre-exposure prophylaxis (PrEP) no increase in syphilis was found between those taking PrEP and those taking placebo. These findings would suggest that short term exposure to ART has no effect on the acquired immune responses to Treponema pallidum.

Sexually transmitted infections: challenges ahead

Posted on 21st July 2017 by · No comments

A commissioned article in Lancet Infectious Diseases on July 9, 2017 highlights some of the major issues and challenges facing us in the growing global epidemic of sexually transmitted infections (STI). Authors Prof Mabhus Unemo et al summarise the key issues as follows:

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research.

In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control.

Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease.

The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials.

Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches.

STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control.

Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation.

Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.

Read full article on Lancet Infectious Diseases

Centenary of nationwide free access to sexual health clinics in England and Wales

Posted on 3rd February 2017 by · No comments

STI began in 1925 as the British Journal of Venereal Disease, and you can read early editions on the sti.bmj.com website. The very first issue covers skin complaints often mistaken for syphilis, the use of bismuth and malaria inoculation to treat syphilis, and the establishment of a network of clinics following a Royal Commission.1 It also discusses diathermy in the treatment of gonorrhoea!

A hundred years ago, we had no effective treatment for gonorrhoea, and it is sobering to realise we may soon be in the same position. The GRASP surveillance system which tracks antimicrobial resistance in England and Wales shows indications that we are not far from ceftriaxone treatment failures in a report by Town et al.2 In an age of nucleic acid based diagnostics, we need alternatives to culture for detecting resistance. A fascinating report by Graham et al reports that whole genome sequencing can be achieved with urine specimens, including the detection of markers associated with resistance.3 On a related note, this month’s editorial by Nigel Garrett reflects on the perhaps brief life of syndromic management.4
Read full article

 

PrEP introduction for adolescent girls and young women

Posted on 23rd August 2016 by · No comments

Pre-exposure prophylaxis PrEP use in the sexually active females prevents HIV acquisition.

The International AIDS Conference in Durban, South Africa, in July 2016, has renewed interest and momentum around HIV prevention. High and sustained HIV incidence rates—about 2 million people acquiring HIV every year for the past 5 years—highlight the need for new prevention technologies for populations at substantial risk of HIV.1 As many as 7000 new infections a week are occurring in the most vulnerable adolescent girls and young women in eastern and southern Africa.1 75% of young people in sub-Saharan Africa living with HIV are adolescent girls and young women age 15–24 years; AIDS is the leading cause of death for girls age 10–19 years in Africa.1 To date, prevention efforts have not had sufficient effect on risk of HIV in adolescent girls and young women.

Oral pre-exposure prophylaxis (PrEP)—the use of antiretroviral medications by HIV-negative people to avoid getting HIV—is a new biomedical intervention that has the potential to substantially reduce HIV acquisition in the people at greatest risk. Recent evidence suggests that PrEP was effective among several populations in reducing the risk of HIV infection by 70%.2 Less is known about the effectiveness of PrEP for young women,2 but the intervention could greatly increase the ability of adolescent girls and young women to protect themselves from HIV if they are able to access and use it effectively.

Read whole article

Access to Sexual Health Services for the Somali Community in Birmingham UK

Posted on 24th March 2016 by · No comments

The UK, hosts a large number of refugees from Somalia.

Somalis are absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Therefore, when decisions are being made in relation to addressing the needs of recently arrived refugees the needs of those who originate from Somalia may be neglected.

Somalis are known to have a high level of need but low uptake of health care services. This included sexual health.

Earlier STIRF funded a project which looked at issues and problems relating to access for sexual health services. The project is now completed and is presented in a meeting held on:

Date: April 27
Venue: Birmingham City University
Time: 16.00 – 18.00

Meeting on Sexual Health needs of Somali Community

Risks for pelvic inflammatory disease in students

Posted on 17th February 2016 by · No comments

In the latest issue of the Sexually Transmitted Infections, Phillip Hay and colleagues in the UK report on a prospective study of female students attending 11 universities and 9 further education colleges in London.

At the start, the students were asked to fill a questionnaire and provide a self taken vaginal sample for infection screening. After 12 months, they were assessed for pelvic inflammatory disease (PID), a condition that can lead to infertility and other complications.

PID was found in 1.6% of the particpants. Unsurprisingly the strongest predictor of PID was the presence of Chlamydia trachomatis at the first visit (relative risk (RR) 5.7).

However, adjusting for this, the authors reported that significant predictors of PID were ≥2 sexual partners (RR 4.0) or a new sexual partner during follow-up (RR 2.8), and age <20 years (RR 3.3). Somewhat surprisingly recruitment from a further education college rather than a university also increased the relative risk of PID 2.6 fold, perhaps reflecting different health protection behaviors (eg condom use) between the two groups.

The study concluded that in addition to known risk factors such as multiple or new partners in the last 12 months and younger age, attending a further education college rather than a university were risk factors for PID.

They recommended that sexual health education and screening programs could be targeted at these high-risk groups.

Report of gonorrhoea resistant to all antibiotics in UK

Posted on 31st December 2015 by · No comments

A highly drug-resistant gonorrhoea outbreak in the north of England has been identified.

Fifteen cases of “super-gonorrhoea” have been detected by Public Health England since March, the British Association for Sexual Health and HIV reported.

For an entertaining understanding of how microbes develop resistance see this short video

 

The perils of chemsex

Posted on 3rd December 2015 by · No comments

The term “Chemsex” is used in the United Kingdom to describe intentional sex under the influence of psychoactive drugs, mostly among men who have sex with men. The main drugs are mephedrone, γ-hydroxybutyrate (GHB), γ-butyrolactone (GBL), and crystallised methamphetamine. These drugs are often used in combination to facilitate sexual sessions lasting several hours or days with multiple sexual partners.

Mephedrone and crystal meth are physiological stimulants, increasing heart rate and blood pressure, as well as triggering euphoria and sexual arousal. GHB (and its precursor GBL) is a powerful psychological disinhibitor and also a mild anaesthetic.

Anecdotal reports and some small qualitative studies in the UK find that people engaging in chemsex report better sex, with these drugs reducing inhibitions and increasing pleasure.

Unfortunately use of chemsex can lead to mental health problems which can be permanent. Moreover Casual sex, particularly if under the influence of alcohol or drugs can lead to the acquisition of sexually transmitted infections and even such bugs as shigella, an infection causing severe bacillary dysentery and diarrhoea usually associated with travel to regions such as Indian subcontinent, North and East Africa and South America.

See trailer for Chemsex, a film ChemsexOfficial directed by William Fairman and Max Gogarty (a Peccadillo Pictures)  in the medical journal Lancet.

Sexually abused children should be offered HPV vaccination

Posted on 19th November 2015 by · 1 comment

Should children exposed to sexual abuse be offered human papillomavirus (HPV) vaccination alongside screening for sexually transmitted infections? A recent article in the Lancet argues for a yes answer.

The WHO defines childhood sexual abuse  as the involvement in sexual activity of a child under the age of 18 years who did not give informed consent or is not developmentally prepared.

The global prevalence of childhood sexual abuse is estimated to be 8–31% for girls and 3–17% for boys. The true figures are probably nearer the upper figure.

According to a review, parents were the perpetrators of about 45% of cases of childhood sexual abuse in the USA, and other relatives were responsible for a further 19%.  Others included figures of authority such as priests and teachers. Survivors of such abuse are often hesitant to report such incidents because of shame and fear of retribution. Thus, the incidence and prevalence of childhood sexual abuse is almost certainly underestimated. Read the rest of this post »

Invitation to workshop: role of stigma and shame in the access to sexual health clinics

Posted on 26th August 2015 by · No comments

A workshop on philosophical aspects of sexual health is being held at

Seminar Room 3.28, New Business School, Manchester Metropolitan University Manchester, United Kingdom

The workshop is run by Dr Phil Hutchinson and was part funded by a research grant from Sexually Transmitted Infections Research Foundation (STIRF). Project STIRF-026

Workshop 1: The Problem of Selection Bias in Biomedical & Public Health Research. Wednesday September 16

Workshop 2: Shame, Stigma and HIV. Thursday September 17

Venue: Seminar Room 3.28, New Business School, Manchester Metropolitan University, Manchester, UK

Mandatory registration: contact: marie.chollier@stu.mmu.ac.uk

Further information can be obtained from Phil Hutchinson p.hutchinson@mmu.ac.uk