Category: Bacteria

Lancet issue on the state of global health

The Lancet has devoted an entire issue to various aspects of global health. The issue is available free for download.

An edited extract from the executive summary follows:

The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors.

The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury.

Thus non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide.

Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

 

STIRF: new projects approved

In this year’s funding round we received six applications. After sending them for external peer review by experts, the Scientific Committee approved two projects for funding in 2013 which was submitted to the Trustees.

Project 1: Chlamydia trachomatisis the most common sexually transmitted infection effecting young people in the UK. It infects one in ten of all women aged 15-25 and can cause serious long term complications such as pelvic inflammatory disease and infertility. According to the Health Protection Agency in 2011 in England and Wales 147,594 infections were diagnosed in 15 to 24 year olds.

Recent evidence for emergence of resistance to the commonly used antibotics used in eradicating chlamydia is very worrying. We are delighted to fund Emma Hathorn as part of a multi-centre study to evaluate the incidence of  chlamydia resistance in people attending a clinic for sexually transmitted infections.

Antimicrobial resistance in Chlamydia trachomatis: is it a reality? STIRF-022

 

Project 2: There is increasing focus on involving patients and what they perceive are their actual needs when delivering clinical services in the NHS. This is particularly important in the fast developing field of HIV where new management strategies and new treatments take place within the background of shrinking funding. These clearly call for new ways of delivering these services more efficiently as well as more effectively. It is with this in mind that STIRF decided to fund the nurse-led project by Lucy Land that is taking steps to objectively define these priorities as seen from the HIV-infected patients perspective.

Development of a weighting scale to evaluate the relative importance of items in a validated HIV patient satisfaction questionnaire. STIRF-020

This study aims to refine a questionnaire they developed and validated with the help of HIV-infected patients to find issues that are more important and therefore need to be prioritised in development of HIV services.

Thanks to all the researchers who submitted and to the reviewers who gave their valuable time for free.

Rising gonorrhoea antimicrobial resistance in Europe

A recent report by the European Centre for Disease Prevention and Control has highlighted the danger that rising antibiotic resistance may mean that soon gonorrhoea may become an untreatable disease in some parts of Europe.

According to the report the most worrying result is the increase in the percentage of isolates with decreased susceptibility to cefixime and the increase in the number of countries where this phenotype was identified between 2009 and 2010. [Fig 1]

 

Fig 1. European Centre for Disease Prevention and Control

Patient characteristics of isolates with decreased susceptibility did not differ greatly when compared to the overall population, except for age: patients with decreased susceptibility to cefixime were more likely to be older.

There is some evidence that the rates of ciprofloxacin and azithromycin resistance have both decreased since 2009. However they remain worringly high across Europe (53% and 7%, respectively).

Similar results for cefixime – which is the first line drug therapy in many centres – have been reported by the European gonococcal antimicrobial surveillance programme (Euro-GASP) – Fig 2

 

Cephalosporine resistance in gonococcal isolates 2009 – Euro-GASP

Sex workers collective show long-term health gains of self-empowerment

A parallel AIDS conference in Kolkota, India gave the rights an update on the success of the VAMP sex-workers colective – now in its 15th year reports, reports Andera Cornwall the Guardian.

They have shown an impressive ability to minimise risk of HIV and other sexually transmitted infections in sex workers.

Founded in 1997, Vamp now has more than 5,000 members. Weekly meetings bring the collective together to tackle a wide range of issues faced by members. Health work and advocacy for sex rights’ human rights are interwoven with Vamp’s everyday work in the densely populated alleyways in the red-light districts of Sangli and other towns in the region.

Vamp’s mission is to change society. Rather than treating sex workers as victims to be rescued or rehabilitated, it demonstrates the power of collective action as a force for women’s empowerment, mobilising sex workers to improve their working conditions, and claim rights and recognition. And they’re yielding results.

The report showed how self-empowerment and education can achieve high rates of safe sex in women at high risk of sexually transmitted infections and HIV. It is yet another reminder to that the most effective way to protect this vulnerable population is to help then self-organise and self-protect rather than to criminalise prostitution.

The latter, as many studies have shown, merely drives women into the hands of criminal gangs, or leads to risk-taking sexual practices and high rates of self-harm.

UK gonorrhoea rates increase by 25%

Although overall rates of sexually transmitted infections rose by 2%, there has been an increase of 25% in new infections by gonorrhoea reported to the UK Health Protection Agency (HPA) – the second increase in two years running. Gonorrhoea rates increased from 16,835 to 20,965.

Other significant increases in sexually transmitted infections were in infectious syphilis (10%; 2,650 to 2,915) and genital herpes (5%; 29,794 to 31,154).

In contrast there was only a 1% rise in genital warts, perhaps reflecting the effectiveness of the vaccination programme. Diagnoses of genital warts cases in women aged 15-19 actually fell by 14% (11,251 to 9,700).

The greatest increase in sexually transmitted infections was in men who have sex with men and in heterosexual men and women aged 15-24. The high rates of infection reported in girls aged 15-19 is particularly worrying.

According to Professor Cathy Ison, director of sexually transmitted bacterial reference laboratory, the appearance of resistant strains for which no single antibiotic is effective is particularly worrying. This opens the prospect of having to use combination therapy in the future.

Research on effective behavioural change therefore remains a top priority.

Invitation to apply for research funds

We have entered a new round of invitation to apply for research funds. We are particularly interested in providing initial funding in projects that may allow young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.

We invite applications from researchers in the East and West Midland, the North East and North West Regions on projects relating to sexually transmitted diseases and HIV. All projects will be initially screened by the Scientific Committee of STIRF and those considered suitable will be sent for peer review by experts in the field. We encourage applications for

The following fields of research will be considerd in relation to STIs and HIV

  • Epidemiology of HIV and other sexually transmitted diseases
  • Health care delivery including views of clients
  • Issues relating to deprived or marginalised communities.
  • Pathophysiology of diseases and syndromes
  • Inter-relationship between diseases
  • Treatment modalities
  • Complications of treatment and co-morbidities

Applications should not exceed £50,000 in the first year. Depending on satisfactory reports a further £25,000 may be available for the second year. Joint funding with other grant giving bodies will be considered.

Further information and guidance on how to apply can be found on

How to Apply for Research funds

 

New ways of getting treatment to sexual partners of patients infected with chamydia or gonorrhoea

Treating a sexually transmitted infection in a person is incomplete without treating te sexual partner and thus closing the loop. Current forms of partner notification (PN) are not particularly successful with less than one half of sexual partners attending sexual health (genitourinary medicine) clinics.

A recent study by Claudia Escourt and her colleagues has looked at the feasibility of two different approaches to PN. One was to set up a hotine for the partner to phone a health care worker in the sexual health clinic and after appropriate consultation to collect their treatments either at the sexual health clinic and the secone was for the partner go to a a designated pharmacy and obtain treatment from a trained pharmacist. The partners were also asked to provide urine for chlamydia testing and to attend the sexual health clinic at a time of their own convenience for syphilis and HIV testing.

The preliminary results were encouraging and showed that both systems were acceptable to clients and increased uptake of treatment from 36% to 59% in the case of the clinic hotline and 66% in case of pharmacy.

The only drawback of either strategy was that almost none of the partners accessed HIV or syphilis testing at a later date.

STIRF funds new research on chlamydia and gonorrhoea

Chlamydia and gonorrhoea are the most common treatable bacterial sexually transmitted infections diagnosed within theUnited Kingdom. Most sexual health clinics now use Nucleic Acid Amplification based Tests (NAATs), which test for DNA sequences particular to the organism in question, to diagnose these infections.

These tests are highly sensitive and specific but can remain positive for a while after the infection is successfully treated with antibiotics. This is because NAAT tests, unlike bacterial culture, do not distinguish between live and dead organisms. This means that if individuals are retested too soon after completing treatment, their test result will still be positive from the initial treated infection. We do not know for how long this will be the case, making interpretation of repeat tests difficult.

This is particularly important in clinical practice, where where a test of cure is recommended, such as in pregnancy and after gonorrhoea. The research will allow better interpretation of test of cure results, thereby avoiding the need to retreat individuals and their partners with antibiotics unnecessarily.

The proposed project will follow up individuals known to have chlamydia or gonorrhoea who have been treated as per national guidelines and then retested every week (using NAAT tests) for the initial infection until this is no longer detected. Non-compliance and possible re-infection will be ruled out through structured questionnaires during the follow up period.

This is a collaborative study in conjunction with centres in London. STIRF will be funding the part of the study to be performed in Manchester.

Title of project: Testing for chlamydia and gonorrhoea: persistence of a positive test result after successful treatment.

Lead researcher:   Dr Gabriel Schembri

Place of Research: Manchester Centre for Sexual Health, Manchester Royal Infirmary.

Collaborating Centres: Sexual health centres in London

Proposed Duration of Study: One year

Funding from STIRF: £27,000 (subject to satisfactory report at six months)

 

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.