Author: Mohsen Shahmanesh

US Committee recommends HPV vaccine for men

Human papilloma virus (HPV) causes warts but also is the underlying cause of various cancers, particularly cervical cancer in women.  HPV vaccines are now available and recommended for young women to prevent cervical cancer, and in the case of quadrivalent vaccine also genital warts. [see our news item: Quadrivalent wart vaccine would prevent high cost of care for genital warts ] The vaccine is more effective if administered to children aged 11-12 years, before they become sexually active

Now a study published in the New England Journal of Medicine showed that the quadrivalent vaccine can prevent intraepithelial neoplasia, a precursor of anal cancer, in young gay men. anal intraepithelial neoplasia associated with the HPV types linked to cervical cancer (HPV 16 and 18) were reduced by 55% in the vaccinated group. Consequently the US Advisory Committee on Immunisation Practice has recommended the roll out of vaccination to all children aged 11-12, regardless of sex.

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Delay in diagnosis of HIV can cut 15 years off your life

Current treatment with antiviral drugs has changed a previously fatal disease into a chronic condition where those infected can expect to live a normal and healthy life for many years.

Forward projections from a number of large cohorts have, however, suggested that with current treatment regimens patients may still have a slightly shorter life expectancy than uninfected persons. This is because patients with HIV appear to experience diseases associated with aging such as heart attacks, diabetes and cancer at a younger age,

A recent study from a UK-based large cohort by May and colleagues confirm these projections with men expected to do worse than women. They estimated that for an average 20 year old man HIV decreases life expectancy by 18.1 years compared with 11.4 years for women. This may reflect life-style differences between the sexes (alcohol, smoking) but may also be because women of child-baring age are more likely to be diagnosed early during routine antenatal screening.

Their study showed that persons starting antiviral therapy with a low CD4 count of less than 100 – which is sign of severe immunological damage – rather than earlier (CD4 200-350) lose over 15 years of life. Currently guidelines recommend starting antiviral therapy when the CD4 falls at or below 350.

While there are problems with making accurate projections into the future this research further highlights the importance of routinely offering and testing for HIV at all clinical settings in order to identify the infection early and before any significant immunological damage has taken place.

See BMJ 2011:343-d6016

Doi:10.1136/bmj.d6016

Syphilis resistance to macrolide antibiotic increasing in London

Resistance to the second line treatment regimen for syphilis reported from a large London sexual health clinic is causing concern. Macrolide antibiotics are used as second line treatment for early syphilis which is caused by a bacterium Treponema pallidum, in patients allergic to penicillin. Fortunately penicillin resistance has never been reported in syphilis and penicillin remains an effective treatment against this disease worldwide. The problem arises in patients with penicillin allergy who for some reason (eg pregnancy) cannot be treated with tetracyclines, the best alternative therapy.

Accessibility of genitourinary services uneven across England

The majority of the population in England have good access to genitourinary (GUM) services with only 3% living more than 30 minutes travel away, report Beth Stuart and Andrew Hind. However accessibility is not uniform access the country and people in the South West and East of England have the worse access compared to the national average. This might be important from a pubic health perspective because a study from Southampton showed that only 2% of young people were prepared to travel more than 30 minutes to access sexual health services.

Quadrivalent wart vaccine would prevent high cost of care for genital warts

In a recent study by Desai et al published in the journal Sexually Transmitted infection it was estimated that the annual cost of treating genital warts in general practice and genitourinary clinics was approximately £16.8 million. Most of this is potentially preventable if the government chooses the quadrivalent Human Papilloma Virus (HPV) vaccine which includes HPV typed 6 and 11 which are the commonest cause of genital infections in addition to types 16 and 18 which are the main causes of cervical cancer. Unfortunately the Department of Health currently advocates vaccination with a vaccine containing types 16 and 18 only which would not protect against genital warts and is also more expensive.

Older swingers at risk of STI

Swingers – straight couples who regularly swap sexual partners at organised gatherings and clubs and indulge in group sex – have rates of sexually transmitted infections comparable with those of recognised high risk groups, reveals research published ahead of print in the journal Sexually Transmitted Infections.

Those who are over the age of 45 are particularly vulnerable, indicates the research, yet swingers are largely ignored by healthcare services, representing a “missed target,” say the authors.

Update on ongoing project funded by STIRF

An assessment of patients’ satisfaction with their HIV care

Project STIRF 012

People with HIV are living longer, healthier lives due to advances in treatments.  Their healthcare needs, therefore, have changed and doctors and nurses need to have the knowledge and skills to meet those needs.   The project funded by STIRF aims to find out what patients attending an HIV outpatient clinic want from the service and how well it is provided. The team started out by trying to find out whether there was an established way of measuring HIV patients satisfaction with there care and if a questionnaire already existed that could be used. Some of questionnaires which had been used in the past did not seem to be relevant to the patients today.

Since then the team have held focus groups with patients to ask them what questions they would like included and what would motivate them to fill in a questionnaire. Once the questionnaire has been tested on a small group of people, a larger survey will be conducted and the results analysed, to find out how happy HIV patients are with their outpatient service and what they would like to see changed. We hope to find the right tools so that a listening exercise can be turned into an effective plan of action.