Category: Public health

Use of human papillomavirus (HPV) vaccine causes dramatic fall in genital warts

An important new study by a team of researchers working in a sexual health clinic in Melbourne, Australia has shown that 4 years after a government funded program of vaccinating girls and women aged 12-18 there was a dramatic decline in new cases of genital warts in heterosexual women and also of men with a new diagnosis of genital warts. Cases of genital warts attending the Melbourne Sexual Health Centre fell from 18.6% of all new diagnosis in women under 21 in 2007-2008  to 1.9% in 2010-2011. Interestingly there was a similar dramatic fall in new cases of genital warts in men under 21 over the same time period from 22.9% to 2.9%. The odds ratio per year for diagnosis of genital warts that was adjusted for number of sexual partners from July 2007 until June 2011 in women <21 years was 0.44 (95% CI 0.32 to 0.58) and in heterosexual men aged <21 was 0.42 (95% CI 0.31 to 0.60)  – a fall of over 55% in both sexes.

There was no drop in the incidence of new genital warts diagnosis in women aged over 30 or in men who have sex with men adding weight to the authors’ conclusions that the fall in new wart cases in younger men and women was a consequence of vaccination. It is argued that a reduction in new infections in young women had resulted in a reduced pool of infection and hence also caused a similar drop in their male sexual partners.

The Australian government was providing the vaccine free to all girls and women aged 12-18 from 2007 until the end of 2009. Since then free vaccine has been only offered girls aged 12-13.  The vaccine used in Australia contains antigens from HPV 6 and 11 which are the commonest HPV genotypes associated with genital warts as well as HPV 16 and 18 associated with cervical cancer.

Unfortunately the quadrivalent vaccine is not the one chosen for use by the Department of Health in the UK. A recent study which we reported earlier showed that the quadrivalent vaccine is more cost effective than the bivalent vaccine currently recommended for use in the UK.

 

WHO asks for 16 days of activism against gender violence

According to the World Health Organisation 1 in 4 women worldwide are physically or sexually abused during pregnancy, usually by her partner. The WHO multi-country study on women’s health and domestic violence against women has highlighted the extent of violence by intimate partners against women across a wide range of societies. WHO has asked for 16  days leading up to December 10, International Human Rights Day, for global activism to counter violence perpetuated against women.

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)

 

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.