Emerging sexually transmitted viral infections: 2. Review of Zika virus disease.

A sudden increase in the number of newborn infants with microcephaly in Brazil in 2015 brought Zika virus (ZIKV), a less-known infection, to public attention. The rapid increase in the number of cases across the Americas and the devastating complications of infection with ZIKV highlighted the gravity of the situation. Within a relatively short period of time, our knowledge of this infection has significantly increased. This includes the realisation that ZIKV can be sexually transmitted. The aim of the present article is to provide a concise summary on this novel sexually transmitted infection linked to human birth defects and Guillain-Barre Syndrome. According to World Health Organization, individuals living outside areas of ZIKV mosquito transmission where one or both partners have been exposed to ZIKV should abstain from sex or have sex with condoms for at least six months after the last day of possible exposure.

The prevalence of HIV among women with high-grade cervical smear abnormalities in Birmingham, United Kingdom: A prospective cohort study.

OBJECTIVE: The aim of the study was twofold: 1. To assess the acceptance for HIV screening in women attending Colposcopy clinic 2. To determine the prevalence of HIV in women presenting with high-grade cervical smear abnormalities. DESIGN: A prospective study. SETTING: Colposcopy clinic, Birmingham Women's Hospital, UK. POPULATION: Patients attending colposcopy clinic. MAIN OUTCOME MEASURES: To determine acceptance of HIV testing and prevalence in colposcopy patients with High-grade cervical smear abnormalities. RESULTS: Of the 252 patients who were offered the HIV test, 244(96.5%) accepted the test. None of 244 cases tested for HIV were found positive. CONCLUSIONS: HIV testing is feasible and acceptable in colposcopy clinics.

Comparison of doxycycline with azithromycin in treatment of pharyngeal chlamydia infection.

Recent data suggest that azithromycin may not be as effective as doxycycline in eradication of genital chlamydial infection. The aim of this study was to compare the eradication rate of pharyngeal Chlamydia trachomatis infection after treatment with azithromycin 1 g stat with that of doxycycline 100 mg twice a day for seven days. A prospective open-label observational study was conducted on patients with pharyngeal Chlamydia trachomatis diagnosed at Whittall Street Clinic, University Hospitals Birmingham, Birmingham, UK, between July 2012 and July 2013. We confirmed eradication of pharyngeal Chlamydia trachomatis with a negative test of cure. We treated all our patients with azithromycin 1 g stat until February 2013. At that stage, we offered doxycycline to patients with pharyngeal Chlamydia trachomatis A total of 398 patients (52 men, 346 women) were diagnosed with pharyngeal Chlamydia trachomatis during the study period. Of the 172 patients included in the final analysis, 78 were treated with azithromycin and 64 with doxycycline. Treatment failure was identified among 8/78 (10%) patients treated with azithromycin and 1/64 (2%) treated with doxycycline (absolute difference: 8 percentage points, 95% CI: 0-17%, p = 0.041). In our study, doxycycline 100 mg twice a day for seven days was associated with less treatment failure of oropharyngeal chlamydia compared with azithromycin 1 g stat Future randomised studies should investigate whether patients with pharyngeal Chlamydia trachomatis should be followed up with a test of cure when treated with azithromycin, or be treated with doxycycline.

The uptake of HIV and syphilis testing in a nurse-delivered service during Gay Pride events.

Novel HIV testing strategies may improve the uptake of the test. The aim of the present study was to investigate the uptake of HIV testing during Birmingham Pride events in 2009 and 2010. The project was a collaboration between Whittall Street Clinic and Healthy Gay Life. This was a nurse-delivered service that was offered for nine hours each day during the events (total of 36 hours in two years). The OraSure™ assay for HIV and syphilis testing was used. A total of 405 men visited our marquee during the 2009 (n = 201) and 2010 (n = 204) events. A total of 398 (98%) men accepted HIV testing during the events in 2009 and 2010. Six men (1.5%) were HIV-positive, an incidence of 37.7 cases per 10,000 persons perday. The uptake of syphilis testing was similarly high; 390 (96%) individuals agreed to be tested and one (0.5%) patient was diagnosed with syphilis. The uptake of HIV testing during the Pride event was high. Pride events provide a unique opportunity for testing undiagnosed HIV-infected patients. HIV testing should be provided in other cities during Pride events.

Prevalence of hepatitis in early syphilis among an HIV cohort.

To investigate the prevalence of syphilitic hepatitis among a group of HIV-infected patients we performed a cross-sectional observational study of consecutive HIV-infected patients with early syphilis attending University Hospital Birmingham between 1 January 2005 and 31 August 2008. The AIDS Clinical Trials Group grading for abnormal liver enzymes was used to identify hepatitis. A total of 62 HIV-infected patients were diagnosed with early syphilis during the study period. Twelve (19.3%) of them demonstrated abnormal liver enzymes consistent with syphilitic hepatitis involving raised levels of alanine aminotransferase, aspartate transaminase, alkaline phosphatase or gamma-glutamyl transferase (GGT). Grade 3 hepatotoxicity was observed among five patients. None of the patients with syphilitic hepatitis had grade IV hepatitis or abnormal bilirubin levels. Liver biopsy was not carried out in any of the patients, and following completion of treatment of syphilis all abnormal liver enzymes returned to normal levels after a median of 16 weeks. Exclusion of syphilis must be considered when investigating hepatic disease in HIV-infected patients.

Oropharyngeal gonorrhoea: rate of co-infection with sexually transmitted infection, antibiotic susceptibility and treatment outcome.

The aim of the present study is to investigate the rate of co-infections with other sexually transmitted infections (STIs), antibiotic susceptibility and management of oropharyngeal gonorrhoea diagnosed in a busy genitourinary medicine clinic. The method involved a retrospective study on consecutive patients diagnosed with oropharyngeal gonorrhoea. A total of 131 patients were diagnosed with oropharyngeal gonorrhoea over the study period. The median age of the infected patients was 28 (interquartile range: 22 to 35) years. Forty-one (31%) of patients were younger than 24 years. High rates of co-infection with urethral gonorrhoea (37%), rectal gonorrhoea (37%) or chlamydial infection (16%) were identified. Thirty patients (23%) had only oropharyngeal infection. Twenty-two (17%) patients' isolates showed resistance to at least one antibiotic. Antibiotic resistance among oropharyngeal gonococcal isolates was above 5% between 2000 and 2009. Test-of-cure (TOC) was carried out for only 63 (48%) of patients; none had positive culture. Among 46 isolates treated with cefixime 400 mg/stat, 27 (59%) had TOC; all were negative. Repeat TOC was not carried out for any of the patients. In conclusion, successful management of oropharyngeal gonorrhoea should comprise of counselling, partner notification and TOC after treatment with appropriate antibiotic regimen.

Audit on the success of partner notification for sexually transmitted infections in the West Midlands.

SUMMARY: The aim of this study is to investigate the success of partner notification (PN) among 13 genitourinary medicine centres in West Midlands. The West Midlands Audit Group conducted a regional audit between June and August 2007. Information on screening and management of patients with chlamydia, gonorrhoea, early syphilis and HIV were collected separately. Participating centres were asked to provide PN details for 10 index patients with each of chlamydia, gonorrhoea, early syphilis and HIV infections. For each index patient with chlamydia or gonorrhoea, 0.54 and 0.44 partners were screened, respectively. Among partners of patients with syphilis and HIV, 24% and 35% were screened, respectively. Only 9% of 311 screened partners were involved in casual partnerships with index patients. Acquisition of more robust targets for PN, better documentation, improved communication between genitourinary (GU) medicine centres, and provider referral may improve the performance of PN for Sexually transmitted infections.

The demographical and clinical features of patients reattending a genitourinary medicine clinic and the role of counselling on subsequent incidence of sexually transmitted infections.

The aim of this study was to investigate the incidence of reinfection with sexually transmitted infection (STI) and its possible predicting factors among patients reattending a department of genitourinary (GU) medicine. The method included a retrospective study on consecutive patients re-screened for STI in a busy department of GU medicine between January 1996 and April 2005. Cox regression model was used to investigate the association of age, gender, sex group, previous STI, counselling for an STI on the last attendance, number of sexual partners in the previous attendance episode, condom use and the number for partners with whom they had unprotected sex, with STI at current screening. The results show that 302 consecutive patients with more than two attendance episodes were included in the study. Patients were mostly women (92%), younger than 35 years (80%) and heterosexual (98%). At baseline, 70 (23%) patients had STI. The incidence density of STI at the end of follow-up period was 15.69/100 person-years. Testing positive for an STI was associated with age younger than 25 years (hazard ratio 2.70 [95% confidence interval 1.70-4.57]; P = 0.000). In conclusion, our study confirmed the improvement in access to GU medicine services, encouragement of patients with an STI for re-screening on regular basis and use of novel STI counselling strategies, especially for younger patients may reduce the incidence of subsequent STI.

The outcome of treatment of early latent syphilis and syphilis with undetermined duration in HIV-infected and HIV-uninfected patients.

The aim of the study was to compare the outcome of syphilis treatment in HIV-infected and -uninfected patients. An observational study on patients diagnosed with early syphilis in three genitourinary clinics in the UK between January 2003 and June 2005 was conducted. Failure of the initial Venereal Disease Research Laboratory (test) (VDRL) titre to decrease four-fold within 12 months in the absence of history of re-infection was considered as treatment failure. During the study period, 190 HIV-uninfected and 129 HIV-infected patients were diagnosed, and 161 (84%) HIV-uninfected and 100 (77.5%) HIV-positive patients with diagnosis of syphilis who had 24 months follow-up syphilis serology results were included in the study (P = 0.10). There were 381 and 508 follow-up episodes for HIV-infected and -uninfected patients, respectively, within 24 months. One HIV-infected patient was diagnosed with neuro-syphilis. After 12 months, 102 (63%) HIV-uninfected and 76 (70%) HIV-infected patients were treated (P = 0.04). On Cox proportional hazard model, successful treatment after 12 months was associated with having VDRL titre more than 1:6 (hazard ratio [HR] 1.011; 95% confidence interval [CI], 1.004-1.019; P = 0.002). Those with negative immunoglobulin M enzyme immunoassay were less likely to have been successfully treated after 12 months (HR 0.676 [95% CI 0.518-0.883]; P = 0.004). HIV sero-status, age, sex group and treatment regimen were not associated with success of treatment. In conclusion, HIV sero-status did not play a role in the outcome of syphilis treatment. Treatment failure in a proportion of HIV-infected patients is due to a slower decline in VDRL titre rather than lack of response to treatment.

The features of patients attending walk-in compared with booked clinics for sexually transmitted infections.

Few data are available on the comparison of access of patients at risk of sexually transmitted infections (STIs) to different models of genitourinary (GU) medicine services. The aim of this study was to compare the characteristics and STIs results of patients attending walk-in clinics with those of patients attending booked-in clinics in a department of GU medicine. The study was carried out at the Department of GUM at Walsall Manor Hospital. This was a prospective study on consecutive new patients attending first come first served walk-in and booked clinics between 1 January and 1 April 2006. Patients' demography, sexual behaviour and results of screening for STIs were recorded. During the study period, 346 and 234 patients attended walk-in and booked clinics, respectively. Default rate for booked clinics was 27%. Significantly higher proportions of patients attending walk-in clinics were screened for an STI. All patients with HIV (n = 2) or with trichomonal (n = 4) infections attended walk-in clinics. In regression analysis, patients with genitourinary symptoms were more likely to attend walk-in clinics (odds ratio [OR]: 2.371; [95% confidence interval [CI]: 1.545-3.639; P = 0.0005). There was no difference between the prevalence of STIs among patients attending either service model. In conclusion, there was no significant difference between the proportion of patients with or at-risk of STIs who attended booked and walk-in clinics.

An audit on the management of gonorrhoea at the Whittall Street Clinic, Birmingham, UK.

The aim of this study was to investigate the compliance of management of gonorrhoea with the national recommendations. The method used was a retrospective audit on consecutive cases of culturally proven gonorrhoea. In total, 131 men and 100 women were included. Four men and nine women were not treated with the appropriate antibiotic. Seven women had not received any treatment. Only 0.33 partners for each case of gonorrhoea were contacted. Uptake of HIV testing was 64%. Treatment failure was recorded among three of 33 patients with test of cure. Oro-pharyngeal swabs were obtained in 34% of the patients with a history of oral sex. In only three of the nine auditable standards targets were met. In conclusion, staff re-training, updated local protocols, routine offer of test of cure and methods to improve partner notification were implemented to improve the management of gonorrhoea.

The sensitivity of syphilis assays in detecting different stages of early syphilis.

Our aim was to determine the sensitivity of the Murex ICE enzyme immunoassay (EIA) as a screening test for early syphilis and to determine how many additional cases of infection were detected by performing additional tests when requested on clinical grounds. This was an observational study on consecutive patients diagnosed with syphilis in the Department of Genitourinary Medicine, Edinburgh between January 1st 2004 and April 1st 2005. Additional tests were performed on sera that gave a positive or equivocal EIA on screening as well as by clinical request on sera from contacts of syphilis, and those with clinical signs of syphilis. Additional tests included a Venereal Diseases Research Laboratory (VDRL) carbon antigen test, a Treponema pallidum particle agglutination (TPPA) test, INNO-LIA line immunoblot assay, and an EIA specific for anti-treponemal IgM.A total of 105 patients were diagnosed with syphilis: primary (50), secondary (26), early latent (8), and of unknown duration (21). The TPPA was the most sensitive test in primary syphilis and had a sensitivity of 96% (48/50), which was significantly higher (P <0.05) than the sensitivity of 84% (42/50) for the screening EIA: seven of the EIA negatives were detected by EIA-IgM, six by TPPA, five by immunoblot, and two by VDRL. EIA-IgM was negative in six primaries; all were positive by TPPA and immunoblot. We conclude that, in order to maximize the serological detection of primary syphilis a specific EIA-IgM test and a TPPA test should be performed whenever there is a clinical suspicion of primary infection. This is particularly important when an EIA such as Murex ICE is used as a single screening test as it is less sensitive than the TPPA in primary infection.

Comparison of time to undetectable HIV viral load in the first 16 weeks after the start of three and four antiretroviral regimens.

The aim of this paper is to compare the time to a viral load <50 copies/mL of three or four antiretroviral therapy (ART) regimens among ART naïve patients within the first 16 weeks after the start of treatment. A retrospective study was carried out on ART naïve patients who started HAART between 1 January 1999 and 1 January 2004. ART naïve patients with a viral load >5.3 log10 copies/mL at the time of treatment were routinely started on four ART regimens in one of the HIV centres in Edinburgh. These patients were compared with ART naïve patients with viral load >5.3 log10 copies/mL at the time of start of three ART regimens in the other centre within the study period. During the study period, of 93 ART naïve patients with a viral load >5.3 log10 copies/mL, 56 and 37 commenced four drug and three drug regimens, respectively. Patients in each group were matched for their age, prevalence of HCV, median age, and median viral load at the start of therapy; however, patients on three drug regimens had significantly lower CD4 counts (P<0.01). The median time to undetectable viral load was 13.5 weeks for three and four drug regimens (P>0.05). By the time of undetectable viral load, there was no difference in the CD4 count of patients on three or four drug regimens. Similar proportions of immunosuppressed patients on three and four ART regimens had undetectable viral load within the first 16 weeks of therapy.

Characteristics of younger and older men with urethral chlamydial infection.

This study examined some characteristics of male clinic attenders with urethral chlamydial infection. The prevalence of urethral chlamydial infection among heterosexual men (men who have sex with women [MSW]) was 446 (17%) of 2684 men. Men aged 16-34 years were more likely to have chlamydiae than older men with only casual partners (chi2 = 16.08; P = 0.001). Infected younger men with casual partners had more partners than uninfected men (median 2.0 [interquartile range [IQR] 1.0] versus 1.0 [IQR 1.0]) (P<0.05). However, this was not true of older men (median number of partners 1.0 [IQR 1.0] versus 1.0 [IQR 1.0]) (P>0.05). Consistent condom use by younger but not by older men was associated with a lower prevalence of chlamydial infection compared with those whose use of condoms was inconsistent (chi2 = 19.75; P<0.001). Our results suggest that chlamydia testing should be offered to any MSW, irrespective of his age, who has had a new partner.

A rapid method for identifying high-risk patients consenting for HIV testing: introducing The Edinburgh Risk Assessment Table for HIV testing.

Lack of time for conducting standard HIV pre-test counselling has been reported as a barrier to HIV testing. Use of a risk assessment table will identify high-risk patients to whom pre-test counselling may be limited. The aim of this study is to investigate the performance of a Risk Assessment Table for HIV testing designed in the Department of Genitourinary (GU) Medicine, Edinburgh. A prospective study was carried out on patients attending the Department of GU Medicine, Edinburgh between June 30th 2002 and July 1st 2003, who consented to HIV testing. Patients with any risk factor had standard pre-and post-test counselling. Those without any risk factor were tested and provided with leaflets on HIV testing.A total of 3337 patients were tested in the study period and 727 (22%) had risk factor for HIV infection. Twenty-nine patients (0.9%) were HIV-infected. The Risk Assessment Table failed to identify two infected patients. Routine use of the Risk Assessment Table saves time of the medical staff by only providing pre-test counselling to high-risk patients.

Non-chlamydial non-gonococcal urethritis or undiagnosed chlamydial urethritis?

The aim of this study is to investigate the prevalence of sexually transmitted infections (STI) in the partners of men with non-chlamydial, non-gonococcal urethritis (NCNGU). Observational study of the sexual partners of men with NCNGU diagnosed in the Department of Genitourinary Medicine, Edinburgh between 1 June 2002 and 31 December 2003. The diagnosis of chlamydial infection was based on ligase chain reaction (LCx) between June 2002 and March 2003, and on polymerase chain reaction (PCR) thereafter. Gonococcal infection was diagnosed with culture method.Sexual partners of 99 (25%) of the 403 heterosexual men diagnosed with NCNGU were screened. Chlamydial infection was detected in 19 (19%) of the female sexual partners. Higher proportion of female partners of symptomatic men (15/51) had chlamydial infection compared with that of partners of asymptomatic men (4/48) (P < 0.005).NCNGU may be related to false-negative results of chlamydial diagnostic tests. Screening and treatment of sexual partners of men with NCNGU is therefore necessary.

The uptake of HIV testing among patients with chlamydial or gonococcal infections attending a genitourinary medicine clinic.

Bacterial sexually transmitted infections (STIs) may be markers of high-risk sexual activity. Counselling for these infections provides an opportunity for promoting HIV testing. The aim of the present study was to compare the uptake of HIV testing between patients with gonorrhoea or chlamydial infections and those without a bacterial STI. A study on patients screened for chlamydial or gonococcal infections in the Department of Genitourinary (GU) Medicine, Edinburgh between 1 July 2002 and 30 June 2003. The overall uptake of HIV testing among patients screened for chlamydial and gonococcal infections was 2263 (37%) of 6184 and 2012 (44%) of 4583, respectively (P < 0.0002). Uptake of HIV testing was significantly higher among uninfected patients: for chlamydial infection, 17% of 1857 infected patients versus 45% of 4327 uninfected patients (P < 0.0002); and for gonococcal infection, 24% of 256 infected patients versus 45% of 4327 uninfected patients (P < 0.0002). The policy of pre-test counselling needs to be redesigned in order to improve the uptake of HIV testing among patients with high-risk sexual activity.