2015 European guidelines for the management of partners of persons with sexually transmitted infections.

BACKGROUND: Partner management is the process of identifying the contacts of a person infected by a sexually transmitted infection (STI) and referral to a health care provider for appropriate management. It represents a public health activity. METHODS: This guideline is produced by the IUSTI European Guideline Editorial Board and EDF Guideline Committee. RESULTS: It provides recommendations concerning the infections that require partner management, the lookback periods for this STI and the main steps to follow for partner management (offering support to patients, notifying partners, identification of contacts). Partner management is voluntary and needs to be performed with respect to human rights, social, cultural and religious behaviours. CONCLUSIONS: In European countries, there are different approaches to the partner management; some common type of actions can enhance the fight against STI.

Acute visual loss as a presenting manifestation of syphilis.

A heterosexual man with acquired syphilis had an uncommon presentation in the form of acute visual loss. The unusual clinical presentation and a high cerebrospinal fluid lymphocyte count led to delayed diagnosis and treatment. Recognition of uncommon presentation of syphilis in the current epidemic is essential for the interruption of transmission.

Preferences for partner notification method: variation in responses between respondents as index patients and contacts.

There have been very few studies focusing on what form of communication patients would find acceptable from a clinic. This study looks at the differences in preferences for various partner notification methods when the respondents were index patients compared with when they had to be contacted because a partner had a sexually transmitted infection (STI). There were 2544 respondents. When the clinic had to notify partners, respondents were more likely to report the method as good when a partner had an STI and they were being contacted compared with when the respondents had an infection and the partner was being contacted. The opposite was true for patient referral partner notification. Therefore, there are variations in the preferences of respondents for partner notification method, which depend on whether they see themselves as index patients or contacts.

An unexpected case of panuveitis.

We report a case of sight-threatening secondary syphilis with HIV co-infection where atypical pattern of skin manifestations resulted in a delay in making the correct diagnosis. However, despite marked visual loss by the time correct diagnosis was made, the patient responded well, albeit slowly, to a course of intravenous benzyl penicillin.

Why do those using illicit drugs have higher rates of sexually transmitted infection?

The study was designed to assess the association between drug use and gonorrhoea in a UK setting and determine whether any differences identified could be explained by variations in sexual behaviour. A case control analysis was undertaken in a population of men and women presenting to an inner city sexually transmitted diseases clinic. The results were analysed using a multivariate model incorporating demographic and behavioural factors potentially associated with acquiring gonorrhoea. Infection with gonorrhoea was found to be associated with illicit drug use (odds ratio 1.8, 1.2-2.8) and the association became non-significant after controlling for sexual behaviour factors. Moderate alcohol use (<5 units/week) was associated with acquiring gonorrhoea but heavier use was not. Patients who used illicit drugs had more casual partners and more foreign partners than those with no history of drug use, but an increased numbers of foreign partners were not associated with a higher prevalence of gonorrhoea. It was concluded that drug use is associated with gonorrhoea in a UK setting. Specific sexual behaviours reported by drug users may increase their risk of gonorrhoea and provide potential targets for behavioural interventions.

Comparison of outcomes of management of gonorrhoea by clinic-based test of cure with those by telephone follow-up.

We compared the outcomes in 278 patients managed with clinic-based test of cure (phase 1) for gonorrhoea with 271 patients managed with the new policy of telephone follow-up (phase 2). Almost 98% of the patients in both phases were treated within 28 days of diagnosis. Follow-up of the patients was significantly better with telephone follow-up (phase 2), with an increase in proportion of patients reviewed (76.1% compared with 59.7% in phase 1, P < 0.001). Yield of partner notification was 0.22 and 0.31 contacts per case of gonorrhoea within four weeks of treatment of the index case in phases 1 and 2, respectively.

2015 UK National Guideline on the management of non-gonococcal urethritis.

We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed.

2015 European guideline on the management of Chlamydia trachomatis infections.

Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).

Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'.

SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.

Boron-containing polyamines as DNA targeting agents for neutron capture therapy of brain tumors: synthesis and biological evaluation.

Three series of new boron-containing spermidine/spermine (SPD/SPM) analogues have been synthesized: N1- and N5-(4-carboranylbutyl) SPD/SPM derivatives (SPD-1, SPD-5, SPM-1, SPM-5); N1,N10-diethyl-N5-(4-carboranylbutyl)spermidine (DESPD-5), N1,N14-diethyl-N5-(4-carboranylbutyl)spermine (DESPM-5); and N5,N10-bis(4-carboranylbutyl)spermine (SPM-5,10). In vitro studies using rat F98 glioma cells have shown that these polyamines retain the ability to displace ethidium bromide from calf thymus DNA and are rapidly taken up by F98 glioma cells. However, their cytotoxicities, especially those with terminal N-substituted (SPD-1, SPM-1) boron compounds, are greater than those of SPD/SPM. Nevertheless, the groundwork has been created for a new class of boron-containing compounds that maybe useful for boron neutron capture therapy of tumors.

Distributions of nicotinic acetylcholine receptor alpha7 and beta2 subunits on cultured hippocampal neurons.

The hippocampus receives cholinergic afferents and expresses neuronal nicotinic acetylcholine receptors. In particular, the alpha7 and beta2 nicotinic subunits are highly expressed in the hippocampus. There has been controversy about the location, distribution and roles of neuronal nicotinic acetylcholine receptors [Role L. W. and Berg D. K. (1996) Neuron 16, 1077-1085; Wonnacott S. (1997) Trends Neurosci. 20, 92-98]. Using immunocytochemistry and patch-clamp techniques, we examined the density and distribution of nicotinic receptors on rat hippocampal neurons in primary tissue culture. The density and distribution of alpha7 subunits change with days in culture. Before 10 days in culture, alpha7 expression, monitored immunocytochemically, is low and nicotinic currents are small or absent. In older cultures, about two-thirds of the neurons express nicotinic currents, and alpha7 appears in small patches on the soma and out along the neuronal processes. These patches of alpha7 subunits on the surface of the neuronal processes often co-localize with the presynaptic marker, synaptotagmin. The other most common nicotinic subunit, beta2, stays confined mainly to the soma and proximal processes, and beta2 is distributed more uniformly and is not specifically localized at presynaptic areas. The two subunits, alpha7 and beta2, have different expression patterns on the surface of the cultured hippocampal neurons. Taken together with previous physiological studies, the results indicate that alpha7 subunits can be found at presynaptic terminals, and at these locations, these calcium-permeable channels may influence transmitter release.

Nicotinic modulation of glutamate and GABA synaptic transmission of hippocampal neurons.

Although the hippocampus expresses nicotinic acetylcholine receptors (nAChRs) and receives cholinergic innervation, the functional roles of these receptors are not completely understood. Our results indicated that presynaptic nAChRs mediated a calcium influx that enhanced the release of both glutamate and GABA. Fura-2 detection of calcium in single mossy fiber presynaptic terminals indicated that nAChRs directly mediated a calcium influx. In hippocampal neurons in primary culture, both spontaneous vesicular release and evoked release of glutamate and GABA were enhanced by nicotine. The nicotinic current displayed rapid desensitization kinetics, and the response to nicotine was inhibited by alpha-bungarotoxin and methyllcaconitine, suggesting that nAChRs containing the alpha 7 subunit mediated the effect. Modulation of synaptic activity by presynaptic calcium influx may represent a physiological role of acetylcholine in the brain, as well as a mechanism of action of nicotine.

Variations in desensitization of nicotinic acetylcholine receptors from hippocampus and midbrain dopamine areas.

This study addresses two issues arising from the desensitization of nicotinic acetylcholine receptors from the hippocampus, ventral tegmental area, and substantia nigra. First, biophysical studies can find potent and complete desensitization of nicotinic receptors; but in vivo studies often find that desensitization affecting a behavior is less than complete, or that desensitization is important over a different nicotine concentration range. Our results show that there can be significant differences in desensitization when comparing nearby neurons from the same area of the brain. Thus, nicotinic receptors on a minority of neurons may remain active and maintain a behavior under conditions that can produce significant desensitization. Second, agonist applications that are intended to active nicotinic receptors also cause desensitization. The prevailing conditions and the rate of agonist application and removal will control the degree of activation vs. desensitization. These and other factors regulate the efficacy of nicotinic agonists experimentally and physiologically.

Acute rheumatic fever in human immunodeficiency virus infection.

A 25-year-old homosexual man with a childhood history of rheumatic heart disease presented with painful joints, fever and chest pain. He was diagnosed as having acute rheumatic fever and was found to be HIV antibody-positive. His illness responded to conventional treatment but he had a persistently low CD4 lymphocyte count and was started on zidovudine. Interpretation of the significance of a low CD4 lymphocyte count is problematic in a patient with coincident rheumatic fever and HIV infection as both conditions can cause CD4 lymphopenia.

Evaluation of nitrogen utilization in patients receiving total parenteral nutrition.

This two phase study evaluates nitrogen utilization by the body as a function of fixed caloric intake but different nitrogen loads. Nitrogen use by the body was estimated from measures of nitrogen balance, net protein utilization, and urea accumulation rate. Phase 1 of this study included 411 measurements of nitrogen use in 120 patients assigned, according to clinical condition, to receive one of the four following therapies: dextrose (D) 25%, amino acids (CAA) 4.25% (Group 1); D 35%, CAA 4.25% (Group 2); D 25%, CAA 21.3% (Group 3); or D 35%, CAA 21.3% (Group 4). Forty patients in Phase 2 were assigned in a randomized, prospective, double blind manner, to receive one of the following regimens; D 35%, CAA 2.75% (Group 5); D 25%, CAA 2.75% (Group 6); D 35%, CAA 4.25% (Group 7); or D 25%, CAA 4.25% (Group 8). In Phase 1, positive nitrogen balance was achieved with the exception of Group 3 where neither the estimated caloric nor nitrogen needs of the patients were met. It appeared that protein utilization was maximal in patients receiving the therapy of highest calorie:nitrogen ratio (Group 4). Phase 2 patients achieved positive nitrogen balance to the same extent (p greater than 0.05) and although net protein utilization improved from 53 to 71%/d as the calorie:nitrogen ratio was increased, the differences were not significant (p greater than 0.05). There was a significant improvement in total iron binding capacity in Phase 2 patients (p less than 0.01) that was most prominent at the lower concentrations of amino acids (high cal:n ratio) (Groups 5 and 6). Smaller amounts of nitrogen appear adequate in producing a positive nitrogen balance and may be better utilized in hospitalized patients if the patients' caloric requirements are achieved.

Antiviral treatment of genital herpes.

A review of the randomized, controlled trials in the literature on the treatment of genital herpes infection with aciclovir, famciclovir and valaciclovir. Common clinical questions encountered by physicians, such as the effect of antivirals on symptoms, healing, aborting attacks and subsequent recurrences, are addressed. There is very little comparative data between the three licensed drugs but the little data that there is shows no difference in efficacy, tolerability and toxicity between aciclovir, valaciclovir or famciclovir when taken orally. Choice of therapy would then depend on convenience of dosing and cost.

HIV infection in the Caribbean.

The Caribbean is a multi-ethnic region with many different cultural differences. The majority of the population is of African descent, but there are also other ethnic groups present such as Indians, Chinese, Syrians and Europeans. The Caribbean region is influenced by countries such as the USA, Great Britain, France and Holland. The countries of the Caribbean have a serious problem with HIV infection and AIDS. The epidemiology of HIV infection in this region, is different from most other parts of the world in that the mode of spread does not easily fit into any of the three WHO patterns. This review shows that the infection initially started in the homosexual/bisexual community, but since then, it has moved to the heterosexual population and this form of contact is now the main mode of transmission of the virus. The Governments of the Caribbean countries have realized the extent of the problem and have taken measures to try to control the epidemic.

PIP: The Caribbean is a multi-ethnic region of great cultural diversity presently experiencing a serious problem with HIV infection and AIDS. Some of the countries have among the highest annual incidence rates of HIV infection and AIDS in the world. The number of AIDS cases reported keeps rising each year in most Caribbean countries, although the rate of increase is lower than when the epidemic first started. The epidemiology of HIV infection in the Caribbean differs from that of most other parts of the world because the mode of spread does not easily fit into any of the three World Health Organization patterns. This review shows that while HIV infection was initially observed among homosexuals and bisexuals, intercourse between heterosexuals has now become the main mode of HIV transmission in the region. This review further finds that HIV infection and AIDS in the Caribbean affects mainly young to middle-aged adults. Infected males outnumber females, but the gap is narrowing, while the Caribbean has no IV drug abuse problem except for in Bermuda and Puerto Rico. The governments of the Caribbean have realized the extent of the problem and have taken measures to try to control the epidemic. The paper considers the history of the epidemic; its epidemiology in terms of sources, prevalence, age, sex, and risk behaviors; HIV seroprevalence in populations such as homosexual and bisexual men, female prostitutes, intravenous drug users, blood donors, and antenatal clinics; trends; and geographical factors in Trinidad and Tobago, Bahamas, Puerto Rico, Bermuda, Haiti, Dominican Republic, St. Lucia, Cuba, and Guyana. The authors also note the effectiveness of the draconian Cuban policy in controlling the spread of HIV and AIDS, but stress that its severe nature may also drive cases underground, thus leading to an overall understating of the dimensions of the AIDS epidemic in the country.

Haematospermia.

Haematospermia, blood in the ejaculate, is a symptom which provokes great anxiety in patients due to fears of malignant or sexually transmitted disease. However, there is no evidence from the published literature to associate it with any serious pathology. The large series of cases indicate that investigation is unproductive and that patients do not develop serious disease even after prolonged follow-up. Patients presenting with haematospermia warrant a full physical examination, including rectal examination, but in the absence of physical signs they should then be strongly reassured. Further investigation is unnecessary. Coexistent urological symptoms should be investigated appropriately.