Category: education

Bacteria living in men’s penises could be promoting sexually transmitted infections

The debate about whether to circumcise or not continues to raise passions. The fact that male circumcision reduces acquisition of HIV from an infected partner has been proven by three randomised clinical trials. And male circumcision may also protect against other sexually transmitted infections.

One of the most powerful arguments against male circumcision is that it only addresses acquired infections in the male. A recent report in the Scientist that bacteria living under the foreskin can promote STI’s would help answer this critique.

Just as the vaginal microbiome differs among women and changes over time, the penis is home to a variety of bacteria that vary with age, sexual activities, and whether the man is circumcised, among other things. And it’s not just the skin that envelops the male sexual organ that’s inhabited by microbes: researchers continue to identify bacteria that dwell within the urogenital tract, a site once considered sterile in the absence of infection.

David Nelson and colleagues at Indiana University in Bloomington found evidence to suggest that the sexually transmitted pathogens in the urogenital tract were obtaining metabolites from other microbes. “There was a signature in the chlamydial genome that suggested this organism might be interacting with other microorganisms,” said Nelson. “That’s what initially piqued our interest. And when we went in and started to look, we found that there were a lot more [microbes] than we would have anticipated being there.”

The researchers found that some men pass urine containing a variety of lactobacilli and streptococci species, whereas others have more anaerobes, like Prevotella and Fusobacterium. In terms of overall composition, “we see a lot of parallels to the gut,” said Nelson, noting that there doesn’t seem to be a standout formula for a “healthy” urogenital tract. Commensal microbes within the urethra could make a man more susceptible to infection by supporting colonization by pathogens like Chlamydia, whereas bacteria that consume the environment’s nutrients could help prevent it. “We just don’t know at this point,” said Nelson.

To date, circumcision is the known largest influence on the composition of the penis microbiome. In a 2010 PLOS ONE paper, Lance Price of the Translational Genomics Research Institute in Phoenix, Arizona, and his colleagues showed that the bacteria that colonized the base of the penis’s tip, or glans, varied before and after circumcision. More specifically, the researchers found fewer anaerobic bacteria within six months after the men in a study were circumcised. Those findings have since been confirmed.

Definitely further studies in this field should be encouraged.

Sexual health of female sex worker in the UK

Female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs). Using routine STI surveillance data, McGrath-Lone et al  in an article published in the latest issue of Sexually Transmitted Infections investigated differences in sexual health between FSWs and other female attendees at sexual health (genitourinary medicine – GUM) clinics in England.

They reported on 2704 FSWs visiting to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London) in 2011. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (eg, gonorrhoea Odds Ratio: 2.76, p<0.001). Significantly migrant FSWs had better sexual health outcomes than UK-born FSWs (eg, period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease OR: 2.92, p<0.001).

They concluded that although FSWs in England have access to high-quality care through the GUM clinic network, there was evidence of geographical inequality in access to these services.

A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees.

Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population.

Bacterial vaginosis fact sheet update by CDC

Bacterial vaginosis (BV) is the commonest vaginal infection seen in women. The Centre of Disease Control (CDC) has recently updated its fact sheet on this common condition.

In summary 

BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. Having a new sex partner or multiple sex partners and douching can upset the balance of bacteria in the vagina and put women at increased risk for getting BV.

BV can cause some serious health risks, including:

Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;

If you are HIV positive, increasing your chance of passing HIV to your sex partner;

Making it more likely that you will deliver your baby too early if you have BV while pregnant;

Increasing your chance of getting other STDs, such as chlamydia and gonorrhoea.

These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.

Important new research on lymphogranuloma venereum (LGV) in gay men in the UK

Lymphogranuloma venereum (LGV), previously predominantly a tropical disease, re-emerged in Western Europe in 2003, and has arguably now regained endemic status in many countries. It remains largely contained within in a population of men who have sex with men (MSM) with high rates of other sexually transmitted infections (STIs) including HIV, though a first female case was reported in Sexually Transmitted Infections in 2012.

A recent series of papers in Sexually Transmitted Infections sheds further light on the risk factors for rectal LGV in men who have sex with men in the UK, the key symptoms and ways in which LGV presents to the clinician, and pitfalls in the currently recommended treatment and prevention strategies.

Moreover, microbiological  characteristic of LGV repeaters using surveillance data has convinced Rönn and colleagues that behaviour alone does not explain reinfection, which they see as related to centrality in sexual networks.

Together these four articles add important information on the clinical presentation, epidemiology and treatment of LGV in MSM.

Project on the role of shame in failure to attend for STI and HIV testing shame approved for funding

The 2013 round of applications for funding has resulted in approval for the following pilot project:

Designing a Research project for understanding the role of stigma and shame in STI and HIV testing 

The project will be headed by Phil Hutchinson, Ph.D. (Man.), M.A. (Man.), B.A. (London), Senior Lecturer in Philosophy, Manchester Metropolitan University.

The aim of the preliminary project is to find the methodology to test the hypothesis: is shame one of the reasons for failing  to attend for STI and HIV testing. The project will be completed within six months involving setting up workshops with groups involved with both patient groups and those sexual health care.

HIV testing in the street: a useful tool for widening coverage

The March issue of the journal STI included an article by Sonia Fernandez-Balbuena and colleagues in Madrid which demonstrated that offering HIV testing on the street  may allow a significant number of hard-to reach populations to offer themselves for HIV testing.

Of 7552 persons in various Spanish cities who were asked to full a brief questionnaire and offered HIV testing 3517 participants (47%) were first-time testers. These included 24% of men who have sex with men , 56% of exclusively heterosexual men and 60% of women. 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM.

The authors concluded that their community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community.

In their view a decisive in decisive factor for almost two of every three persons who had never been tested. was the visibility of the programme.

Need and acceptability of human papillomavirus (HPV) vaccination in men

HPV vaccination of young women with the quadrivalent vaccine (HPV4) resulted in a dramatic fall in genital warts and cervical cancer rates. However rolling out a similar vaccination in young men has been hampered by arguments that  male HPV4 vaccination programmes exceed cost-effectiveness thresholds.

Unlike the USA and Australia, European countries do not include men in HPV vaccination programmes, instead focusing on achieving expanded coverage among women to promote herd immunity.

Yet there is  evidence that HPV4 vaccination offers substantial clinical benefits to men and is cost effective among men who have sex with men (MSM). MSM have largely been excluded from mathematical models. A recent study in the journal Sexually Transmitted Infections has shown that HPV related conditions such as anal/genital warts and rectal infections are likely to be profoundly underdiagnosed among MSM in most European cities. The paper concluded that there is an urgent need to improve sexual healthcare tailored to MSM at risk for STIs.

There is also the argument  for a gender-neutral (universal) approach to vaccination.

In the same issue of STI a meta-analysis shows that there are currently a number of obstacles to acceptability of HPV vaccination in  men. They concluded that Public health campaigns should aim to promote positive HPV vaccine attitudes and awareness about HPV risk in men. The paper recommended interventions to promote HPV vaccination for boys and to overcome  obstacles to HPV vaccine acceptability for men.

Bacterial vaginosis (BV): a common cause of vaginal discharge in need of more research

Bacterial vaginosis (BV) is a common condition in women presenting as a malodorous vaginal discharge. The  smell is often worse after sex and arround the menstrual period. Occasionally there is an associated  itching or burning sensation although most women with BV only have the discharge. BV can also be detected in women who are totally symptom free.

BV is caused by an imbalance of the normal vagina flora and its mechanism remain poorly understood. An updated review by the Centre for Disease Control (CDC), USA confirms a commonly observation that BV follows sexual intercourse with a new partner and multiple partners as well as vaginal douching.

BV, itself an benign though troublesome nuisance is associated with increased risk of a number of infections or conditions:

  • Having BV can increase a woman’s susceptibility to HIV infection if she is exposed to the HIV virus.

  • Having BV increases the chances that an HIV-infected woman can pass HIV to her sex partner.

  • Having BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion.

  • Having BV while pregnant may put a woman at increased risk for some complications of pregnancy, such as preterm delivery.

  • BV can increase a woman’s susceptibility to other STDs, such as herpes simplex virus (HSV),chlamydia, and gonorrhea.

  • The bacteria that cause BV can sometimes infect the uterus (womb) and fallopian tubes (tubes that carry eggs from the ovaries to the uterus). This type of infection is called pelvic inflammatory disease (PID).
  • Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds). Pregnant women who have had previous premature of low birth weight babies should be tested and treated for BV in third trimester regardless of symptoms.