Analysis of a Large Severe Acute Respiratory Syndrome Coronavirus 2 (Alpha) Outbreak in a Catalan Prison Using Conventional and Genomic Epidemiology.

Enforcing strict protocols that prevent transmission of airborne infections in prisons is challenging. We examine a large severe acute respiratory syndrome coronavirus 2 outbreak in a Catalan penitentiary center in February-April 2021, prior to vaccination deployment. The aim was to describe the evolution of the outbreak using classical and genomic epidemiology and the containment strategy applied. The outbreak was initially detected in 1 module but spread to 4, infecting 7 staff members and 140 incarcerated individuals, 6 of whom were hospitalized (4.4%). Genomic analysis confirmed a single origin (B.1.1.7). Contact tracing identified transmission vectors between modules and prevented further viral spread. In future similar scenarios, the control strategy described here may help limit transmission of airborne infections in correctional settings.

Sex and gender differences in hepatitis C virus risk, prevention, and cascade of care in people who inject drugs: systematic review and meta-analysis.

Background: People who inject drugs (PWID) are a priority population in HCV elimination programming. Overcoming sex and gender disparities in HCV risk, prevention, and the cascade of care is likely to be important to achieving this goal, but these have not yet been comprehensively reviewed. Methods: Systematic review and meta-analysis. We searched Pubmed, EMBASE and the Cochrane Database of Systematic Reviews 1 January 2012-22 January 2024 for studies of any design reporting sex or gender differences among PWID in at least one of: sharing of needles and/or syringes, incarceration history, injection while incarcerated, participation in opioid agonist treatment or needle and syringe programs, HCV testing, spontaneous HCV clearance, direct-acting antiviral (DAA) treatment initiation or completion, and sustained virological response (SVR). Assessment of study quality was based on selected aspects of study design. Additional data were requested from study authors. Data were extracted in duplicate and meta-analysed using random effects models. PROSPERO registration CRD42022342806. Findings: 9533 studies were identified and 92 studies were included. Compared to men, women were at greater risk for receptive needle and syringe sharing (past 6-12 months: risk ratio (RR) 1.12; 95% confidence interval (CI) 1.01-1.23; <6 months: RR 1.38; 95% CI 1.09-1.76), less likely to be incarcerated (lifetime RR 0.64; 95% CI 0.57-0.73) more likely to be tested for HCV infection (lifetime RR 1.07; 95% CI 1.01, 1.14), more likely to spontaneously clear infection (RR1.58; 95% CI 1.40-1.79), less likely to initiate DAA treatment (0.84; 95% CI 0.78-0.90), and more likely to attain SVR after completing DAA treatment (RR 1.02; 95% CI 1.01-1.04). Interpretation: There are important differences in HCV risk and cascade of care indicators among people who inject drugs that may impact the effectiveness of prevention and treatment programming. Developing and assessing the effectiveness of gender-specific and gender-responsive HCV interventions should be a priority in elimination programming. Funding: Réseau SIDA-MI du Québec.

Mathematical modeling of SARS-CoV-2 variant substitutions in European countries: transmission dynamics and epidemiological insights.

Background: Countries across Europe have faced similar evolutions of SARS-CoV-2 variants of concern, including the Alpha, Delta, and Omicron variants. Materials and methods: We used data from GISAID and applied a robust, automated mathematical substitution model to study the dynamics of COVID-19 variants in Europe over a period of more than 2 years, from late 2020 to early 2023. This model identifies variant substitution patterns and distinguishes between residual and dominant behavior. We used weekly sequencing data from 19 European countries to estimate the increase in transmissibility ( Δ ß ) between consecutive SARS-CoV-2 variants. In addition, we focused on large countries with separate regional outbreaks and complex scenarios of multiple competing variants. Results: Our model accurately reproduced the observed substitution patterns between the Alpha, Delta, and Omicron major variants. We estimated the daily variant prevalence and calculated Δ ß between variants, revealing that: ( i ) Δ ß increased progressively from the Alpha to the Omicron variant; ( i i ) Δ ß showed a high degree of variability within Omicron variants; ( i i i ) a higher Δ ß was associated with a later emergence of the variant within a country; ( i v ) a higher degree of immunization of the population against previous variants was associated with a higher Δ ß for the Delta variant; ( v ) larger countries exhibited smaller Δ ß , suggesting regionally diverse outbreaks within the same country; and finally ( v i ) the model reliably captures the dynamics of competing variants, even in complex scenarios. Conclusion: The use of mathematical models allows for precise and reliable estimation of daily cases of each variant. By quantifying Δ ß , we have tracked the spread of the different variants across Europe, highlighting a robust increase in transmissibility trend from Alpha to Omicron. Additionally, we have shown that the geographical characteristics of a country, as well as the timing of new variant entrances, can explain some of the observed differences in variant substitution dynamics across countries.

High Hepatitis B Prevalence and Vaccination Needs Among Transgender Women and Men Sex Workers in Barcelona, Spain.

Background: Transgender women sex workers (TWSWs) and men sex workers (MSWs) are especially vulnerable to acquiring hepatitis B virus (HBV) infection. We aimed to describe HBV prevalence (hepatitis B surface antigen [HBsAg] and core antibody [HBcAb]) and associated risk factors for HBV exposure (HBcAb), to assess vaccination status and risk factors for no prior vaccination, and to compare HBV prevalence and vaccination status between TWSWs and MSWs. Methods: The SexCohort study was advertised to TWSWs and MSWs through several communication channels. At cohort entry through 2 community-based organizations in Barcelona, the study population was screened for HBV and other sexually transmitted infections, and an epidemiological questionnaire was administered (n = 271). Results: Overall, 93.0% of participants were migrants, mostly from South and Central American countries. HBsAg prevalence was 1.9% (TWSWs, 2.4%; vs MSWs, 0.9%; P = .42), and previous exposure to HBV was 31.8% (TWSWs, 38.5%; vs MSWs, 20.8%; P = .002). Over 5 years of sex work (adjusted odds ratio [aOR], 9.35), prior exposure to Treponema pallidum (aOR, 3.49), and treatment with anxiolytic drugs (aOR, 3.23) were associated with HBV exposure. Overall, 33.7% of participants exhibited immunity from vaccination (TWSWs, 30.8%; vs MSWs, 38.61%; P < .001), while 34.4% were candidates to HBV vaccination (TWSWs, 30.8%; vs MSWs, 40.6%; P < .001). Never having been on pre-exposure prophylaxis for HIV (odds ratio [OR], 4.23) and non-Spanish origin (OR, 5.00) were associated with no prior HBV vaccination. Conclusions: There is a need to reinforce screening and vaccination programs aimed at TWSWs and MSWs as integrated services offered at the community centers commonly accessed by these populations.

Community-based screening enhances hepatitis B virus linkage to care among West African migrants in Spain.

BACKGROUND: Chronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain. METHODS: This was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed. RESULTS: In the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days. CONCLUSIONS: This community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care.

A large proportion of hepatitis B virus (HBV) infections occur within countries in sub-Saharan Africa. With recent increased migration from these countries to Catalonia Spain, the prevalence of HBV is greater in migrants than in host populations. However, migrants face additional barriers when trying to access care. We developed a community-based care pathway to provide migrants in Catalonia with access to HBV testing, post-test counseling, vaccinations, and appointments with specialists when needed. The results showed that this strategy was successful in increasing testing, linkage to care, and vaccination among at-risk migrant populations in Catalonia, Spain. It may be worthwhile implementing this strategy on a wider scale and with other at-risk populations to reduce HBV infections and improve outcomes.

Usefulness of a novel multiplex real-time PCR assay for the diagnosis of sexually-transmitted infections / Utilidad de un nuevo ensayo de PCR multiplex para el diagnóstico de las infecciones de transmisión sexual

INTRODUCTION: Sexually transmitted infections (STI) are currently on the increase worldwide. New molecular tools have been developed in the past few years in order to improve their diagnosis. An evaluation was carried out using a new commercially available real-time PCR assay, Anyplex™ II STI-7 (Seegene, Seoul, Korea), which detects seven major pathogens in a single reaction - Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum - and compared with conventional methods performed in our laboratory. MATERIALS AND METHODS: Two different populations were included, and 267 specimens from different sites of infection (urines, endocervical swabs, rectal swabs, vaginal swabs, urethral swabs and one inguinal adenopathy) were processed for both methods. RESULTS: The parameters of clinical performance were calculated for C. trachomatis, N. gonorrhoeae, and T. vaginalis, and the assay achieved sensitivities (SE) from 93.94% to 100%, and specificities (SP) from 96.55% to 100%, with negative predictive values (NPV) from 93.33% to 98.85%, and positive predictive values (PPV) from 96.88% to 100%, with a very good agreement (kappa index from 0.88 to 1). CONCLUSIONS: Anyplex™ II STI-7 is a good tool for the reliable diagnosis of STI. Its ease of use and processing allows it to be incorporated into the day to day laboratory work

INTRODUCCIÓN: Las infecciones de transmisión sexual (ITS) son actualmente un problema de salud pública en todo el mundo debido al aumento que han experimentado en los últimos años que implica el desarrollo de nuevas herramientas moleculares para mejorar su diagnóstico. Se ha comparado el nuevo ensayo de PCR en tiempo real, Anyplex™ II STI-7 (Seegene, Seúl, Corea) que detecta los siete microorganismos implicados en las ITS - Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum - en una sola reacción, con los métodos convencionales utilizados en nuestro laboratorio. MÉTODOS: Se incluyeron dos tipos de poblaciones, obteniéndose 267 muestras de diferentes lugares de infección (orines, exudados endocervicales, frotis rectales, frotis vaginales, exudados uretrales y una adenopatía inguinal) que fueron procesadas por ambas metodologías. RESULTADOS: Las sensibilidades, especificidades y valores predictivos fueron analizados para C. trachomatis, N. gonorrhoeae y T. vaginalis, alcanzando sensibilidades (SE) de 93,94% a 100%, especificidades (SP) de 96,55% a 100%, valor predictivo negativo (NPV) entre 93,33% y el 98,85% y valores predictivos positivos (PPV) de 96.88% a 100% con muy buena correlación (índice kappa de 0.88 a 1). CONCLUSIONES: AnyplexTM II STI-7 es una buena herramienta para el diagnóstico seguro de las ITS. La facilidad de uso y procesamiento permite su incorporación en el trabajo del día a día del laboratorio

Comparison between two human papillomavirus genotyping assays targeting the L1 or E6/E7 region in cervical cancer biopsies

Introduction: Human papillomavirus (HPV) testing is increasingly used in cervical cancer prevention strategies, and a variety of HPV genotyping assays have been developed. We aimed to compare the performance of two HPV genotyping techniques in formalin-fixed paraffin-embedded (FFPE) tissue specimens from a series of invasive squamous cell carcinoma (SCC) cases. Methods Archival FFPE tissue blocks from 78 SCC cases were initially considered. DNA was extracted from dewaxed tissue sections and tested with the INNO-LiPA HPV Genotyping Extra assay (Innogenetics), and the F-HPV typing kit (Genomed) targeting the L1 and E6/E7 regions, respectively. Results The INNO-LiPA assay showed a higher sensitivity (98.6%) than the F-HPV assay (78.6%). A total of 12 (17.1%) biopsies showed multiple-type infections evidenced by at least one assay. Among the SCC cases tested, HPV16 and/or 18 were detected in 70% of the cases, and 18.4% of them had multiple infections with other high-risk types. Conclusions Our results suggest that the INNO-LiPA assay has a better performance than the F-HPV in FFPE specimens, probably due to its smaller amplicon size and the wider range of detectable HPV types. The prevalence of multiple infections could be higher than previously reported, as evidenced by the combination of the two assays (AU)

Introducción: La detección del virus del papiloma humano (VPH) es cada vez más utilizada en los algoritmos de prevención del cáncer cervical, y se ha desarrollado una gran variedad de ensayos para su detección y genotipado. Nuestro objetivo fue comparar dos técnicas de genotipado del VPH en muestras de tejido (..) (AU)

Respuesta completa al tratamiento con doxiciclina en pacientes con infección por VIH-1 con proctitis por linfogranuloma venéreo / Lymphogranuloma venereum proctocolitis in men with HIV-1 infection

Objetivos Describir las características de una serie de 15 casos con proctitis por linfogranuloma venéreo (LGV) en varones con infección por VIH-1, valorando la respuesta al tratamiento con doxiciclina durante 21 días. Pacientes y métodos Estudio observacional que describe una serie de casos con LGV diagnosticados en la Unidad de VIH del Hospital Germans Trias i Pujol entre marzo del 2008 y abril del 2009.ResultadosSe incluyeron un total de 15 pacientes, todos ellos hombres y que mantenían relaciones sexuales con hombres (HSH), con infección por el VIH-1 y sintomatología de proctitis aguda/subaguda. En todos los casos se determinó Chlamydia trachomatis (C. trachomatis) en muestra rectal mediante técnica de PCR, que después del tratamiento con doxiciclina oral (100mg/12h) durante 21 días se negativizó. Por técnica de hibridación reversa se confirmó el serovar L2 en todas las muestras. Conclusiones El diagnóstico de la proctitis por LGV precisa de una elevada sospecha por parte del clínico, puesto que su presentación clínica es habitualmente inespecífica. El tratamiento con doxiciclina en el LGV erradica la C. trachomatis en pacientes VIH (AU)

Introduction We present a series of 15 cases with lymphogranuloma venereum (LGV) with the aim of evaluating the response to a 21-day oral course of doxycycline (100mg twice daily).Patients and methods It is an observational study where we describe a series of cases with LGV diagnosed in the Hospital Germans Trias i Pujol's HIV Unit between March 2008 and April 2009.ResultsAll our patients were HIV infected men who had sex with men with proctitis in 80% of the cases. In all of them Chlamydia trachomatis was determined by PCR on rectal swab specimens, with a negative result after 21 days of treatment with doxycycline. Serovar L2 was confirmed in all the specimens with the reverse hybridization technique. Discussion A high index of clinical suspicion is the mainstay to the early diagnosis of LGV since the clinical presentation remains unspecific. The treatment with doxycycline eradicates C. trachomatis in HIV patients with LGV (AU)

Prevalencia de la infección por C. trachomatis y N. gonhorroeae y determinantes para su adquisición en jóvenes y adultos-jóvenes en Cataluña / Prevalence and determining factors of acquiring C. trachomatis infection among adolescents and young adults in Catalonia

Objetivo Determinar la prevalencia de Chlamydia trachomatis (C. trachomatis) y Neisseria gonhorroeae (N. gonhorroeae) y los factores de riesgo para su adquisición en menores de 35 años, usuarios de centros de atención a la salud sexual de la provincia de Barcelona durante el año 2007.MètodosEstudio transversal de una muestra oportunista de 500 jóvenes y adultos-jóvenes de 16-35 años. Un total de 397 muestras endocervicales y 26 de orina fueron analizadas mediante PCR en tiempo real. Se utilizó un cuestionario estandarizado para recoger información clínica, epidemiológica y conductual. Se analizaron las diferencias significativas en el análisis descriptivo mediante Pearson's χ2 o Fisher's exact test. La asociación entre la infección por C. trachomatis y sus determinantes fueron examinados mediante el test Mantel-Haenszel y un modelo de regresión logística multivariante. Se calcularon las Odds ratio y los intervalos de confianza al 95%.ResultadosLa prevalencia global de C. trachomatis fue del 4%, significativamente más elevada en el grupo de menores de 25 años. La prevalencia de N. gonhorroeae fue del 0,2%. Los factores de riesgo independientes para la infección de C. trachomatis fueron: origen extranjero (OR: 3,74; IC 95%: 1,10-12,72), tener nueva pareja sexual < 3 meses (OR 3,91, IC 95%: 1,30-11,81) y el consumo de tabaco<12 meses (OR: 4,99, IC 95%: 1,34-18,59).Conclusiones Este es el primer estudio realizado en Cataluña, que muestra elevadas prevalencias de C. trachomatis en jóvenes, y que reafirma las tendencias encontradas en Europa. Sistematizar la monitorización de la infección por C. trachomatis en poblaciones centinela aportará información válida para valorar la pertinencia de proponer programas de cribado en nuestro entorno (AU)

Objective To determine the prevalence of Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonhorroeae) infections and the risk factors for acquiring them in individuals under 35 years-old attending sexual health clinics in Barcelona province in 2006.MethodsCross-sectional study of a convenience sample of 500 adolescents and young adults aged between 16 and 35 years. A total of 423 samples were analysed using real-time PCR. A standardised questionnaire was used to collect clinical, epidemiological, and behavioural data on the participants. Significant differences were analysed in the descriptive study using Pearson's (2. The association between C. trachomatis infection and its determining factors was analysed using the Mantel-Haenszel test and a multivariate logistic regression model. Results The overall prevalence of C. trachomatis was 4%, and was significantly higher in those under 25 years of age. The overall prevalence of N. gonhorroeae was 0.2%. The independent risk factors for infection by C. trachomatis were as follows: foreign origin (OR: 3.74; CI 95%: 1.10-12.72), having had a sexual partner in the last 3 months (OR 3.91; CI 95%: 1.30-11.81), and tobacco use the last 12 months (OR: 4.99; CI 95%: 1.34-18.59).Conclusions This is the first study performed in Catalonia that shows high prevalence of C. trachomatis in young people, thus confirming trends in the rest of Europe. Systematic monitoring of C. trachomatis infection in sentinel populations will provide valid information allowing us to assess the relevance of proposing targeted screening programs in our setting (AU)

Carga viral del virus de Epstein-Barr como marcador diagnóstico de linfoma en pacientes infectados por el VIH / Plasma Epstein-Barr viral load measurement as a diagnostic marker of lymphoma in HIV-infected patients

Background and objectives: To assess the use of the Epstein-Barr virus (EBV) viral load as a marker for lymphoma diagnosis in HIV-infected patients. We also aimed to identify the relationship between EBV viral load in plasma and the presence of EBV in lymphoma cells.Patients and methods: Retrospective observational study of two HIV-infected populations: one of patients diagnosed with lymphoma and a control group. Thirty-nine patients with AIDS-related lymphoma (ARL) (32 non-Hodgkin's and 7 Hodgkin's lymphomas) and 134 HIV-positive individuals without neoplasia or opportunistic infections were studied. Blood samples were collected before lymphoma treatment in ARL patients. EBV viral load was measured in plasma by real-time quantitative PCR and the presence of EBV-EBER mRNA in lymphoma tumor was investigated by in situ hybridization. Results: Patients with ARL had higher EBV viral loads than those without lymphoma: 24,180.5 (±73,387.6)copies/mL versus 2.6 (±21.6)copies/mL (p<0.001). HIV-infected patients without lymphoma had negative or very low EBV load values. Among ARL patients, no correlation was found between EBV viral loads and CD4+ lymphocyte counts or between EBV and HIV RNA loads, or any other clinical or biological parameter. Cases with an EBV-EBER-positive lymphoma had higher EBV viral loads than those with EBER-negative tumors.Conclusions: EBV viral load is a useful marker of lymphoma in HIV-infected patients, and may be a useful tool for early diagnosis and treatment (AU)

Fundamento y objetivo: Evaluar el uso de la carga viral del virus de Epstein-Barr (VEB) como marcador para el diagnóstico de linfomas en pacientes infectados por el VIH. Identificar la relación entre la carga viral de VEB en plasma y la presencia del virus en las células del linfoma. Pacientes y método:Estudio observacional retrospectivo de dos poblaciones de pacientes VIH: una de pacientes diagnosticados de linfoma y un grupo control. Se estudiaron 39 pacientes con linfoma asociado a infección por el VIH (32 linfomas no hodgkinianos y 7 de Hodgkin) y 134 individuos con infección por el VIH sin neoplasia ni infecciones oportunistas. Las muestras de plasma de los pacientes con linfoma fueron obtenidas en el momento del diagnóstico. La carga viral en plasma del VEB fue realizada mediante una PCR cuantitativa en tiempo real y la presencia de RNAm VEB-EBER en los tumores fue investigada por hibridación in situ. Resultados: Los pacientes con linfoma asociado a infección por el VIH tenían cargas virales de VEB más elevadas que los pacientes sin linfoma: 24.180,5 (±73.387,6)copias/ml frente a 26 (±21,6)copias/ml (p<0,001). Los pacientes con infección por el VIH sin linfoma presentaron carga viral muy baja o negativa. En los pacientes con linfoma no se halló correlación entre la carga viral del VEB y el recuento de linfocitos CD4+ ni la carga viral de VIH, ni con otros parámetros clínicos o biológicos. Los casos de linfomas VEB-EBER-positivos tuvieron una carga viral de VEB más elevada que la de los linfomas EBER negativos. Conclusiones:En pacientes infectados por el VIH la carga viral del VEB es un marcador de linfoma, potencialmente útil para el diagnóstico y tratamiento precoz

Diferencias en las características sociales, conductas de riesgo y prevalencia de infección por el virus de la inmunodeficiencia humana e infecciones de transmisión sexual entre trabajadoras del sexo españolas e inmigrantes en Cataluña / Social characteristics, risk behaviours and differences in the prevalence of HIV/sexually transmitted infections between Spanish and inmigrant female sex workers in Catalonia, Spain

Fundamento y objetivo: describir y comparar las características sociales, las conductas de riesgo y la prevalencia de infección por el virus de la inmunodeficiencia humana (VIH), Chlamydia trachomatis y Neisseria gonorrhoeae en mujeres trabajadoras del sexo (TS) según país de procedencia. Material y método: estudio transversal realizado en Cataluña en 2005 en una muestra de conveniencia de mujeres TS, mediante un cuestionario anónimo. Se recogieron muestras de fluido oral y orina para determinar la prevalencia de infección por el VIH y de C. trachomatis/N. gonorrhoeae, respectivamente. Resultados: de las 400 mujeres, un 10,8% eran españolas, un 30,7% latinoamericanas, un 32,5% del Este de Europa y un 26% africanas. El 95,5% usaba siempre el preservativo en las relaciones vaginales con clientes y el 12,4% con las parejas estables. La prevalencia de infección por el VIH fue del 1,8%, la de C. trachomatis del 5,5% y la de N. gonorrhoeae del 0,5%. Las españolas eran las que más se habían inyectado drogas (9,3%) y las que habían usado menos el preservativo con los clientes (un 85,7% de uso constante) (p<0,05). Sólo se observaron diferencias en la prevalencia de infección por el VIH (un 9,3% en españolas; p<0,01). Conclusiones: insistir en el uso constante del preservativo con los clientes y las parejas estables es una estrategia de prevención que debe mantenerse. Las TS españolas requieren especial atención, ya que usan menos el preservativo y presentan la mayor prevalencia de infección por el VIH (AU)

Background and objective: To describe and compare the social characteristics, human immunodeficiency virus (HIV), Chlamydia trachomatis and Neisseria gonorrhoae prevalences, and risk behaviours among immigrant female sex workers (FSW) according to their geographical area of origin. Material and method: Cross-sectional study in an opportunistic sample of FSW in Catalonia in 2005 using an anonymous questionnaire. Oral fluid and urine samples were collected to determine the prevalence of HIV and C. trachomatis/N. gonorrhoeae, respectively. Results: Four hundred women participated in the study; 10.8% from Spain, 32.5% from Eastern Europe, 30.7% from Latin America, and 26% from Africa. The majority of them (95.5%) always used condoms during vaginal intercourse with clients, but only 12.4% with steady partners. Overall HIV, C. trachomatis and N. gonorrhoeae prevalences were 1.8%, 5.5% and 0.6%, respectively. Spanish women injected drugs more frequently (9.3%), and used condoms less commonly (85.7% used condoms consistently) (p<0.05). We observed differences in HIV prevalence only (9.3% among Spanish FSW; p<0.01). Conclusions: To insist on consistent condom use with clients and steady partners has to become a prevention strategy. Spanish FSW need special attention because they reported less use of condoms and highest HIV prevalences (AU)