Category: education

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.

What is in the May issue of STI

The latest issue of STI (Sexually Transmitted Infections) contains articles on increasing resistance of bacterial STI’s, a successful  educational interventions in South London to encourage HIV testing and data supporting the willingness by a substantial section of men who have sex with men to use pre-exposure prophylaxis for HIV.

particularly worrying is the emergence of a novel strategy by the gonococcus to avoid detection by the now widely used DNA amplification methods.

HIV treatment of infected partner reduces transmission in heterosexual couples

Based on results of randomised clinical trials the World Health Organization recommends antiretroviral drugs for all HIV infected adults in serodiscordant heterosexual relationships at all stages of the disease. But does this strategy work in real life situations?

A recent study published in the Lancet has for the first time reported that such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting.

New analyses from China look encouraging, say researchers. Between 2003 and 2011, uninfected partners of treated people were significantly less likely to seroconvert than uninfected partners of untreated people (1.3 infections/100 person years (95% CI 1.2 to 1.3) v 2.6 (2.4 to 2.8)). After adjustments, treatment of infected partners was associated with a 26% reduction in risk of transmission to uninfected partners (hazard ratio 0.74, 0.65 to 0.84).

The analyses compared around 24 000 treated couples with nearly 15 000 untreated couples registered in China’s national HIV epidemiology database.

It is hard to say whether treatment was entirely responsible for reducing transmission, because people who were treated were older, sicker, and may have had less sex, or less risky sex, than those who were not yet treated, says a linked comment by the Lancet

But the findings hint at a direct effect. Treated couples looked better protected, despite the relatively low CD4 counts (and presumably higher viral loads) necessary for treatment in China.

Treatment was associated with lower transmission when HIV had been acquired from a transfusion of blood products (50% of the treated couples) or heterosexual sex, but not when it had been acquired from injecting drugs.

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.

 

New HIV infection in UK in men who have sex with men exceeds heterosexual transmission after many years

Annual report of HIV infections in the United Kingdom in 2001 published by Health Protection Agency (HPA) show that for the first time in  many years newly diagnosed infections were higher in men who have sex with men (MSM) than transmission through heterosexual intercourse.

By the end of 2011, there were an estimated 96,000 (95% credible interval 90,800 – 102,500) people were living with HIV in the UK. Approximately one quarter (22,600, 24% [19%- 28%]) of these were undiagnosed and unaware of their infection. Fig 1

Fig 1. People infected with HIV at the end of 2011

 

This is an increase from the 91,500 people estimated to have been living with HIV by the end of 2010. The estimated prevalence of HIV in 2011 was 1.5 per 1,000 (1.5-1.6) population of all ages, 2.1 per 1,000 (1.9 – 2.3) men and 1.0 per 1,000 (1.0 – 1.1) women.

The rise in new diagnosis in MSM (Fig 2) is particularly worrying as nearly half the patients (47%) are diagnosed late when their immune system is already compromised increasing the chance of a fatal outcome within one year of diagnosis ten fold. These deaths are totally avoidable with the use of anti-viral therapy early in the infection.

 

Fig 2. New cases of HIV by exposure category

 

No increase in sexual behaviour in HPV vaccinated teenage girls in US

Since US public health officials began recommending in 2006 that young women be routinely vaccinated against HPV, many parents have hesitated over fears that doing so might give their children license to have sex. Research published on Monday in the journal Pediatrics and reported in the New York Times of October 15 may help ease those fears.

Using a sample of nearly 1,400 girls, the researchers found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated.

“We’re hopeful that once physicians see this, it will give them evidence that they can give to parents,” said Robert A. Bednarczyk, the lead author of the report and a clinical investigator with the Kaiser Permanente Center for Health Research Southeast, in Atlanta. “Hopefully when parents see this, it’ll be reassuring to them and we can start to overcome this barrier.”

HPV, the most common sexually transmitted virus in the United States, can cause cancers of the cervix, anus and parts of the throat. Federal health officials began recommending in 2006 that girls be vaccinated as early as age 11 and last year made a similar recommendation for preadolescent boys. The idea is to immunize boys and girls before they become sexually active to maximize the vaccine’s protective effects.

Data from the CDC showed that in 2011 nearly a third of children 14 to 19 years old are already infected with HPV. But despite the federal recommendations, vaccination rates around the country remain low, in part because of concerns about side effects as well as fears the vaccine could make adolescents less wary of casual sex. A study by Basu et al from Yale on parental attitudes toward the vaccine found that concern about promiscuity was the single biggest factor in the decision not to vaccinate.

HIV Infection Among Ethnic Minority and Migrant Men Who Have Sex With Men in Britain

A study by Jonathan Elford and colleagues published in in the journal Sexually Transmitted Infection has examined human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) from different ethnic and migrant groups living in Britain.

A diverse national sample of MSM living in Britain was recruited in 2007-8 through Web sites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey that included questions on HIV testing, HIV status, and sexual behaviour. A sample of just under 12,000 white British men were used as comparison

Results: Nine hundred and ninety-one ethnic minority MSM, 207 men born in Central or Eastern Europe (CEE), 136 men born in South or Central America, and 11,944 white British men were included in the analysis.

Self-reported HIV seropositivity was low for men of South Asian, Chinese, and “other Asian” ethnicity (range, 0.0%–5.8%) and for men born in Central or Eastern Europe (CEE 4.5%) but elevated for men born in South or Central America (18.7%), compared with white British men (13.1%) (P < 0.001).

Interestingly there were no significant differences between these groups in high-risk sexual behavior (P = 0.8). After adjusting for confounding factors in a multivariable model, substantial differences in the odds of HIV infection remained for South Asian and Chinese MSM as well as for migrants from CEE, but not for other groups, compared with white British men; for example, South Asian men, adjusted odds ratio 0.43, 95% confidence interval 0.23, 0.79, P = 0.007.

The authors concluded that despite marked differences in HIV between ethnic minority, key migrant, and white British MSM  there was no significant difference in high-risk sexual behaviour between the groups studied.

Their study highlights the importance of health promotion targeting MSM from all ethnic and migrant groups in Britain.

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.

Dramatic drop in health spending according to OECD

Growth in health spending slowed or fell in real terms in 2010 in almost all OECD countries, reversing a long-term trend of rapid increases, according to OECD Health Data 2012.

In real terms average health spending has declined by over 6% compared to the start of the millenium.

Overall health spending grew by nearly 5% per year in real terms in OECD countries over the period 2000-2009, but this was followed by zero growth in 2010. Preliminary figures for a limited number of countries suggest little or no growth in 2011. The halt in total health spending in 2010 was driven by a fall of 0.5% in public spending for health, following an increase of over 5% per year in 2008 and 2009.

While government health spending tended to be maintained at the start of the economic crisis, cuts in spending really began to take effect in 2010. This was particularly the case in the European countries hardest hit by the recession.