Posts filed under ‘Infecciones de transmision sexual’

Sexually transmitted infections in older populations

Current Opinion in Infectious Diseases Feb 2013 V.26 N.1 P.80–85

Poynten, I. Marya; Grulich, Andrew E.a; Templeton, David J.a,b

aKirby Institute, University of New South Wales, Sydney

bRPA Sexual Health, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia

Correspondence to Dr Mary Poynten, Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia. Tel: +61 2 93850937; fax: +61 2 93850920; e-mail: mpoynten@kirby.unsw.edu.au

Purpose of review

People are living longer and healthier lives. In recent years, there has been a focus on recognition of ongoing sexual activity among older adults and leading from this, the potential for an increase in diagnoses of sexually transmitted infections (STIs). Data on STI rates, sexual behaviour and factors affecting susceptibility to STIs are discussed.

Recent findings

There is limited published literature in this field and few recent longitudinal studies of STI acquisition in people older than 50 years. Although there is evidence of an increase in incidence, STIs remain rare in older compared with younger populations. Compared with their heterosexual counterparts, older men who have sex with men are at higher risk of incident HIV and some other STIs. The HIV epidemic is ageing as a result of increasing life span and acquisition of HIV at older ages. Improved longevity, evolving societal norms and physiological changes may place older people at risk of HIV and other STIs.

Summary

Routine STI screening is not warranted in all older people. Education and prevention strategies for all people at greater risk of HIV, regardless of age are required. Age-appropriate interventions designed to impart knowledge and provide the requisite skills needed to reduce STI risk in older age would be beneficial.

FULL TEXT

http://journals.lww.com/co-infectiousdiseases/Fulltext/2013/02000/Sexually_transmitted_infections_in_older.12.aspx

PDF (CLIC PDF)

 

August 18, 2014 at 4:27 pm

Syphilitic Gumma

N Engl J of Medic Aug.14, 2014 V.371 P.667-667

IMAGES IN CLINICAL MEDICINE

 

  1. Cherniak and M. Silverman

A 45-year-old woman presented to an outreach clinic in rural Uganda with a 1-year history of a progressively enlarging ulcerated mass on the hard palate (Panel A). The mass had initially been painless but more recently had become painful and was causing difficulty in speaking and swallowing. She had received a diagnosis of cancer and was attempting to sell her home to pay for surgical resection. She had no history of syphilitic symptoms or treatment. The results on Treponema pallidum hemagglutination assay were positive for syphilis; nontreponemal testing was not locally available. Serologic analysis for human immunodeficiency virus was negative. Tertiary syphilis with an oral gumma was diagnosed. The patient was treated with three intramuscular injections of 2.4 million units of penicillin G benzathine at 1-week intervals. At follow-up 2 months after the end of treatment, there was resolution of the mass and symptoms (Panel B). In the oral cavity, gummas may occur as masses on the hard palate or tongue that frequently ulcerate….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMicm1313142

August 15, 2014 at 10:08 pm

Syphilis Predicts HIV Incidence Among Men and Transgender Women Who Have Sex With Men in a Preexposure Prophylaxis Trial

Clin Infect Dis 2014 June 16 

Marc M. Solomon1,2, Kenneth H. Mayer4,5, David V. Glidden2, Albert Y. Liu3, Vanessa M. McMahan1, Juan V. Guanira6, Suwat Chariyalertsak7, Telmo Fernandez8, and Robert M. Grant1,2 for the iPrEx Study Teama

+ Author Affiliations

1The Gladstone Institutes

2University of California

3Bridge HIV, San Francisco Department of Public Health, California

4Fenway Health, Beth Israel Deaconess Medical Center, Fenway Institute

5Harvard Medical School, Boston, Massachusetts

6Investigaciones Medicas en Salud, Lima, Peru

7Research Institute for Health Sciences and Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Thailand

8Fundacion Ecuatoriana Equidad, Guayaquil, Ecuador

Correspondence: Marc M. Solomon, MD, MPH, 1650 Owens St, 5th Floor, San Francisco, CA 94158 (marc.solomon@ucsf.edu).

Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association.

Methods

The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed.

Results

Of 2499 individuals, 360 (14.4%) had a positive rapid plasma reagin test at screening; 333 (92.5%) had a positive confirmatory test, which did not differ between the arms (FTC/TDF vs placebo, P = .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P = .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 person-years for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P < .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence.

Conclusions

In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.

PDF

http://cid.oxfordjournals.org/content/early/2014/07/16/cid.ciu450.full.pdf+html

July 19, 2014 at 10:26 am

Worsening Epidemic of HIV and Syphilis Among Men Who Have Sex With Men in Jiangsu Province, China

Clinical Infectious Diseases June 15, 2014 V.58 N.12 P.1753-1759

Hai-Tao Yang1,a, Weiming Tang2,a, Zhan-Pei Xiao3, Ning Jiang4, Tanmay Mahapatra2, Xi-Ping Huan1, Yue-Ping Yin4, Xiao-Liang Wang1, Xiang-Sheng Chen4, and Geng-Feng Fu1

1Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China

2Department of Epidemiology, School of Public Health, University of California, Los Angeles

3Henan Provincial Center for Disease Prevention and Control, Zhengzhou, Henan

4National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, Jiangsu, China

Correspondence: Geng-Feng Fu, PhD, Jiangsu Provincial Center for Disease Prevention and Control, A502, 172 Jiangsu Road, Gulou District, Nanjing, Jiangsu 210009, China (fugf@jscdc.cn).

Background

Epidemics of human immunodeficiency virus (HIV) and syphilis among men who have sex with men (MSM) are major public health concerns in most parts of China. A dearth of information regarding the current trend of HIV in this hard-to-reach population in several regions including Jiangsu, coupled with the reemergence of syphilis, calls for an effort to understand the dynamics of the dual epidemic in this province.

Methods

To estimate the occurrence and burden of these 2 sexually transmitted diseases and the distribution of their potential sociobehavioral correlates among MSM in Jiangsu, 2 cohort studies were conducted in Yangzhou and Changzhou cities.

Results

Among 839 participants, 48% were married, 51.7% had sex with women in the last 6 months, and 25.5% did not use condoms during their last anal intercourse. The observed incidence of HIV was 13.59 and 12.62 and that of syphilis was 7.33 and 13.25 per 100 person-years among the participants of Yangzhou and Changzhou, respectively. The baseline prevalence of HIV and syphilis was 16.0% and 29.9% in Yangzhou and 13.6% and 14.9% in Changzhou, respectively.

Conclusions

Considerably high incidence and prevalence of HIV and syphilis among participants and their potential bridging role in transmitting these infections to the general population in Yangzhou and Changzhou cities calls for urgent effective intervention strategies.

abstract

http://cid.oxfordjournals.org/content/58/12/1753.abstract

PDF

http://cid.oxfordjournals.org/content/58/12/1753.full.pdf+html

 

EDITORIAL Commentary

The Next Tsunami? HIV Spread in Asian Men Who Have Sex With Men

Kenneth H. Mayer

Harvard Medical School, Beth Israel Deaconess Medical Center, and The Fenway Institute, Fenway Health, Boston, Massachusetts

Correspondence: Kenneth Mayer, MD, The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 (khmayer@gmail.com).

Over the past few years, human immunodeficiency virus (HIV) incidence has appreciably decreased in several countries [1]. However, in many parts of the world, HIV is spreading increasing rapidly among men who have sex with men (MSM) [2]. This trend of the epidemic becoming increasingly concentrated among MSM has been particularly marked in several urban epicenters throughout Asia in recent years, and in the current issue of Clinical Infectious Diseases, Yang et al describe a worsening epidemic of HIV and syphilis among MSM in 2 cities in Jiangsu Province in eastern China [3] . The authors found that HIV prevalence initially ranged between 13.6% and 16%, with syphilis prevalence ranging between 14.9% and 29.9%, but subsequent annualized HIV incidence was >12.5%. These rates are extremely high, and portend a worsening HIV/AIDS epidemic among Chinese MSM. Similar findings have been noted in several other recent studies from China [4–9] and nearby countries [10, 11], and contribute to a growing worrisome body of literature suggesting that AIDS in Asia is disproportionately becoming an MSM epidemic. The rapid spread of HIV among Asian MSM is particularly concerning because the majority of the world’s population lives in Asia, with an increasing number of individuals living in urban epicenters. Some MSM have female, as well as male partners, and/or inject drugs, so transmission outside their core group is highly likely. The potential for amplified transmission in these densely …

abstract

http://cid.oxfordjournals.org/content/58/12/1760.extract

PDF

http://cid.oxfordjournals.org/content/58/12/1760.full.pdf+html

June 9, 2014 at 9:24 am

Sexually transmitted infections – Controversies and conundrums in screening, treatment and stigma

Current Opinion in Infect. Dis  Feb 2014  V.27  N.1 P.53–55

Rogstad, Karen

Sheffield Teaching Hospitals NHS Foundation Trust and Undergraduate Dean, University of Sheffield Medical School, Sheffield, UK

Correspondence to Karen Rogstad, Consultant in HIV and Sexual Health, Sheffield Teaching Hospitals, NHS Foundation Trust and Undergraduate Dean, University of Sheffield School of Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Tel: +44 114 271 1900; e-mail: Karen.rogstad@sth.nhs.uk

The five review topics in this issue highlight some of the key controversies in sexually transmitted infections (STIs), and their control.

The authors are from all corners of the world and work in different healthcare systems, but all have an awareness of the internationality of STIs, which do not conform to national boundaries.

A problem in one country can rapidly spread to other continents, requiring a world view of STI treatment and control, and international collaboration and support.

There are some major areas of concern: in men who have sex with men (MSM), there is a resurgent syphilis epidemic, hepatitis C in HIV-positive men has an annual incidence of transmission of 2–4% [1], and there is no decrease in HIV incidence in MSM; gonorrhoea has increased globally by 21% over 3 years [2] and multidrug, extensively drug-resistant and potentially untreatable

FULL TEXT

http://journals.lww.com/co-infectiousdiseases/Fulltext/2014/02000/Sexually_transmitted_infections___controversies.8.aspx

PDF (CLIC on PDF)

 

June 5, 2014 at 8:39 am

Primary and Secondary Syphilis — United States, 2005–2013

MMWR My 9, 2014 V.63 N.18 P.402-406

Monica E. Patton, MD1, John R. Su, MD2, Robert Nelson, MPH2, Hillard Weinstock, MD2

1EIS officer, CDC; 2Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC (Corresponding author: Monica Patton, mepatton@cdc.gov, 404-718-8648) 

In 2013, based on data reported as of April 28, 2014, the rate of reported primary and secondary syphilis in the United States was 5.3 cases per 100,000 population, more than double the lowest-ever rate of 2.1 in 2000.

To characterize the recent epidemiology of syphilis in the United States, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for cases of primary and secondary syphilis diagnosed during 2005–2013 with a focus on states that reported the sex of sex partners during 2009–2012 to describe reported syphilis among gay, bisexual, and other men who have sex with men (collectively referred to as MSM).

During 2005–2013, primary and secondary syphilis rates increased among men of all ages and races/ethnicities across all regions of the United States.

Recent years have shown an accelerated increase in the number of cases, with the largest increases occurring among MSM. Among women, rates increased during 2005–2008 and decreased during 2009–2013, with different trends among different racial/ethnic groups.

Racial/ethnic disparities in reported syphilis persisted during 2005–2013, likely reflecting social determinants of health, such as socioeconomic status, that might contribute to the burden of syphilis in a community (1).

These findings underscore the need for continued syphilis prevention measures among MSM….

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a4.htm?s_cid=mm6318a4_w

PDF (see p.402)

http://www.cdc.gov/mmwr/pdf/wk/mm6318.pdf

June 4, 2014 at 3:11 pm

Ciprofloxacin Resistance and Gonorrhea Incidence Rates in 17 Cities, United States, 1991–2006

Emerging Infectious Diseases April 2014 V.20 N.4

Harrell W. ChessonComments to Author , Robert D. Kirkcaldy, Thomas L. Gift, Kwame Owusu-Edusei, and Hillard S. Weinstock

Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Antimicrobial drug resistance can hinder gonorrhea prevention and control efforts.

In this study, we analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level.

We analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991–2006.

We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection.

These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance.

PDF

http://wwwnc.cdc.gov/eid/article/20/4/pdfs/13-1288.pdf

March 29, 2014 at 11:11 am

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