Streptococcus pneumoniae serogroups and colony morphology: a look back.

From 1985 to 1987, Streptococcus pneumoniae isolates were collected from children under 5 years of age in the Asaro Valley, Papua New Guinea as part of a study on bacterial colonization and respiratory tract infections. Data on serogroup and colony morphology were collected to survey serogroups and associated colony morphologies present in the area and to assess whether colony morphology can be indicative of serogroup. In total, 5989 colonies were examined; serogroups 6, 10, 14, 15, 19, 23, 33, 34, 35 and nonserotypeable strains were the most common and accounted for 77% of all the colonies, with serogroups 6, 19 and 23 accounting for 48%. The majority of colonies displayed the typical draughtsman morphology, though serogroup 10 and non-serotypeable isolates most often displayed a raised colony morphology. Of the 15 mucoid colonies identified 73% were serotype 3, though only 29% of serotype 3 isolates were mucoid. Thus colony morphology is of limited value in identifying the pneumococcal serogroup/serotype apart from mucoid colonies, which are likely to be serotype 3.

Neisseria gonorrhoeae isolates from four centres in Papua New Guinea remain susceptible to amoxycillin-clavulanate therapy.

Antibiotic-resistant strains of Neisseria gonorrhoeae have the potential to undermine treatment and control of gonorrhoea, which remains a highly prevalent sexually transmitted infection (STI) in Papua New Guinea (PNG). The standard treatment regimen for gonorrhoea in PNG based on amoxycillin and clavulanic acid (amoxycillin-clavulanate) was introduced about 15 years ago and there is some concern that over time circulating strains may have developed resistance to this therapy. To investigate this, N. gonorrhoeae isolates (n = 52) were collected from STI clinics in geographically representative centres in PNG and tested for their in vitro susceptibility to a range of antibiotics. All 52 isolates tested were found susceptible to amoxycillin-clavulanate, despite 40% (n = 21) being penicillinase producers and thus resistant to penicillin. These findings indicate that amoxycillin-clavulanate therapy remains an effective treatment for gonococcal infections in PNG, and support the maintenance of the present standard treatment for gonorrhoea in PNG.

Chlamydia trachomatis infection and distribution of serovars in the Eastern Highlands Province, Papua New Guinea.

We have used nested polymerase chain reaction (PCR) and the PCR-based endonuclease digestion method to genotype Chlamydia trachomatis serovars in 460 infected individuals from the Eastern Highlands Province of Papua New Guinea. Our study groups comprised women who presented in labour to the Goroka Base Hospital, their newborn infants, symptomatic children who presented to the hospital's Outpatients Department and men and women from 15 randomly selected villages in the Asaro Valley. In this analysis, the major outer membrane protein (MOMP) gene, omp1, of C. trachomatis was amplified using DNA obtained from the endocervix of women, urine from men, and both the eye and nasopharynx of children. Amplified DNAs were digested concurrently using Alul and a combination of EcoRI, Hinl and Hpall restriction enzymes. The mixtures were separated on electrophoretic gels and the respective serovars designated on the basis of resolved digested DNA patterns. Our results, which were confirmed also by omp1 sequence data, show serovars D, E, F, G, H and L3 to be present in the studied communities. The overall relative frequencies of these serovars were 30%, 21%, 25%, 1%, 20% and 2% respectively, with serovars D, E, F and H accounting for 97% of these infections. Double infections among these principal serovars were also detected in all our study groups but at a low overall frequency of 3%. Serovar D was the major agent involved in the aetiology of chlamydial infection in both children and adults though serovar F was the most frequent in newborn infants. Serovar H was relatively less frequent in symptomatic children. No trachoma-related serovars were detected, confirming the rarity of this disease in Papua New Guinea. In contrast, although clinical cases of lymphogranuloma venereum have not been described in the country, the detection of serovar L3 in this study suggests that it may occur. However, the association of L3 also with childhood infection indicates that it may be causing the same pathology as the serovars D-K that are associated with non-ulcerative sexually transmitted infections.

Sex Workers' Sexual Health and Peer Education Project in Goroka, Eastern Highlands Province, Papua New Guinea.

We conducted a survey among female sex workers in Goroka, Eastern Highlands Province, Papua New Guinea to evaluate the frequency of sexually transmitted disease (STD) symptoms they suffered, their STD and HIV (human immunodeficiency virus) transmission knowledge and health-seeking behaviours, the forms that their HIV risk perception took, and the types and quantities of educational resources to which they had access and in fact used. This survey was a part of a larger study of sex workers that was carried out in two other cities, Lae, the capital of Morobe Province, and Port Moresby, the nation's capital. We interviewed 190 self-identified female sex workers who had been recruited between January 1999 and October 1999 through peer-mediated contacts. In an average one-week period, the women had intercourse with two customers, two to three times, and one boyfriend once or twice. In the surveyed group, 83% of the women had a history of symptomatic STDs and 73% had gone to an STD clinic for treatment. Of the women who used condoms at all, 7% used them each time they had sex with clients, but only 3% used them each time they had sex with steady partners. The remaining 93% of the women used condoms on some occasions or not at all. Most women (72%) knew about male-female transmission of HIV, but fewer cited other sexual and non-sexual modes of transmission. The majority of the women (71%) felt that they were of low or unknown risk of acquiring HIV infection. When asked where or to whom they would go when concerned about AIDS (acquired immune deficiency syndrome) or STDs, most women (93%) said that they would go to a health care provider. Evaluating the sex workers' understanding of STDs and HIV has been essential in designing education and intervention projects so as better to address the future morbidity and mortality associated with STDs and AIDS.

Forecasting the Population-Level Impact of Reductions in HIV Antiretroviral Therapy in Papua New Guinea.

Papua New Guinea (PNG) recently did not secure external funding for the continuation of its antiretroviral treatment (ART) programs meaning that supplies of HIV drugs for the estimated 38,000 people living with HIV in PNG could be completely depleted during 2010. Using a mathematical model of HIV transmission calibrated to available HIV epidemiology data from PNG, we evaluated the expected population-level impact of reductions in ART availability. If the number of people on ART falls to 10% of its current level, then there could be an approximately doubling in annual incidence and an additional 12,848 AIDS-related deaths (100.7% increase) over the next 5 years; if ART provision is halved, then annual incidence would increase by ~68%, and there would be an additional ~10,936 AIDS-related deaths (85.7% increase). These results highlight that maintenance of ART and associated services through external funding is essential for the health and well-being of HIV-positive people in PNG.

The prevalence of sexually transmitted infections in Papua New Guinea: a systematic review and meta-analysis.

BACKGROUND: The potential for an expanded HIV epidemic in Papua New Guinea (PNG) demands an effective, evidence-based and locally-appropriate national response. As sexually transmitted infections (STIs) may be important co-factors in HIV transmission nationally, it is timely to conduct a systematic review of STI prevalences to inform national policy on sexual health and HIV/STI prevention. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a systematic review and meta-analysis of HIV and STI prevalences in PNG, reported in peer-reviewed and non-peer-reviewed publications for the period 1950-2010. Prevalence estimates were stratified by study site (community or clinic-based), geographic area and socio-demographic characteristics. The search strategy identified 105 reports, of which 25 studies (10 community-based; 10 clinic-based; and 5 among self-identified female sex workers) reported STI prevalences and were included in the systematic review. High prevalences of chlamydia, gonorrhoea, syphilis and trichomonas were reported in all settings, particularly among female sex workers, where pooled estimates of 26.1%, 33.6%, 33.1% and 39.3% respectively were observed. Pooled HIV prevalence in community-based studies was 1.8% (95% CI:1.2-2.4) in men; 2.6% (95% CI:1.7-3.5) in women; and 11.8% (95% CI:5.8-17.7) among female sex workers. CONCLUSIONS/SIGNIFICANCE: The epidemiology of STIs and HIV in PNG shows considerable heterogeneity by geographical setting and sexual risk group. Prevalences from community-based studies in PNG were higher than in many other countries in the Asia-Pacific. A renewed focus on national STI/HIV surveillance priorities and systems for routine and periodic data collection will be essential to building effective culturally-relevant behavioural and biomedical STI/HIV prevention programs in PNG.

High prevalence of sexually transmitted infections among female sex workers in the eastern highlands province of Papua New Guinea: correlates and recommendations.

BACKGROUND: More than 200 female sex workers (FSWs) participating in commercial sex along the Highlands Highway of Papua New Guinea were identified in a previous survey. This has implications for the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) to areas and population groups serviced by the road. GOAL: The goal of this study was to estimate the prevalence of gonorrhea, chlamydia, syphilis, trichomoniasis, and HIV among FSWs in Goroka and Kainantu in the Eastern Highlands Province (EHP) and to identify correlates that could be considered in intervention and control. STUDY: Self-identified FSWs recruited through the Goroka Sex Workers Peer-Mediated Programme were invited to participate. All consenting FSWs underwent pretest counseling and provided sociodemographic and behavioral data using a structured questionnaire. The women were also asked to self-collect vaginal specimens and to provide peripheral blood to detect the respective STIs and HIV. RESULTS: Results were available for 211 FSWs. None of the women were positive for HIV. The overall estimated rates for gonorrhea, chlamydia, syphilis, and trichomoniasis were 21%, 19%, 24%, and 51%, respectively. Seventy-four percent were positive for at least 1 STI and 43% had multiple STI infections. High-risk sexual behaviors were found to be common among the women, including low and inconsistent use of condoms, with most of them attributing this to unavailability, dislike by or familiarity with clients, and being drunk and/or high on marijuana. CONCLUSIONS: STIs are prevalent among FSWs in Goroka and Kainantu in the EHP and are maintained by widespread high-risk sexual behaviors, including low use of condoms. Implications for their spread through the highway warrants increased efforts in intervention. Apart from a need to promote condom acceptance, distribution, and use, other high-risk sexual behavior and correlates identified in this study provide important considerations for intervention and control in this population.

High prevalence of Neisseria gonorrhoeae and multiple sexually transmitted diseases among rural women in the Eastern Highlands Province of Papua New Guinea, detected by polymerase chain reaction.

BACKGROUND: In a previous community-based study among rural women in the Eastern Highlands Province (EHP) of Papua New Guinea we determined that the prevalences of Trichomonas vaginalis infection, Chlamydia trachomatis infection, and syphilis were 46%, 26%, and 4%, respectively. Surprisingly, however, the prevalence of Neisseria gonorrhoeae infection was only 1%, which we considered low in consideration of the high prevalence of other sexually transmitted diseases (STDs). The aim of the current study was to reexamine samples that were collected in that survey and retest them with use of polymerase chain reaction (PCR). STUDY DESIGN: Using a cluster-sampling method, we surveyed 201 women aged 15 to 45 years in a population of approximately 19,000 people. In addition, 243 other women living in the same area who wished to be screened for STDs were included in the study. METHODS: Endocervical samples that were stored frozen at -80 degrees C were retested with multiplex PCR (M-PCR) for the detection of both N gonorrhoeae and C trachomatis and with a separate PCR for the detection of T vaginalis. RESULTS: A total of 373 samples that were still available were analyzed. The prevalences of T vaginalis, C trachomatis, and N gonorrhoeae infections were 42.6%, 26.5%, and 18.2%, respectively; 59.8% of the women had at least one STD, while 21.7% had mixed infections, 5.9% of them with all three pathogens. CONCLUSIONS: STDs are very common among rural women in the EHP of Papua New Guinea and often present as multiple infections.

Human immunodeficiency virus and other sexually transmitted infections among female sex workers in two major cities in Papua New Guinea.

BACKGROUND: Treatable sexually transmitted infections are very common in developing countries and quite often are inadequately treated or remain untreated despite the fact that they enhance the transmission of human immunodeficiency virus (HIV). GOAL: To estimate the prevalence of HIV, syphilis, chlamydial infection, gonorrhea, and trichomoniasis among female sex workers in Port Moresby and Lae, Papua New Guinea, and to collect data on associated behaviors. STUDY DESIGN: Self-identified female sex workers recruited through our peer-mediated sexually transmitted disease (STD)/HIV risk-reduction community outreach program were invited to participate in the study. Participants underwent pretest counseling, were interviewed, and were asked to self-collect vaginal swab specimens for the detection of STDs and to provide 10 mL of blood for HIV and syphilis testing. RESULTS: A total of 407 female sex workers, 207 in Port Moresby and 200 in Lae, were enrolled in the study. The overall prevalence rates of HIV, syphilis, genital chlamydial infection, gonorrhea, and trichomoniasis among these women were estimated to be 10%, 32%, 31%, 36%, and 33%, respectively. The sex workers in Port Moresby had a significantly higher HIV infection rate (17%) than those in Lae (3%) and a significantly lower trichomoniasis rate (21%) than those in Lae (44%). Mixed infections were common, occurring in 45% of the cases. Despite a high rate of symptoms, the rate of treatment-seeking was low. Condom use among the sex workers was very inconsistent; 85% reported that they did not use condoms at all times when having sex with their clients. Common reasons cited were dislike by clients, unavailability, alcohol use, and familiarity with a client. CONCLUSIONS: STDs are very common among female sex workers in Port Moresby and Lae and very often present as multiple infections. Despite STD/HIV awareness campaigns, unsafe sex-particularly irregular use of condoms-continues among sex workers and their clients. Barriers to safer sexual behavior need to be addressed, as do improvements in provision of STD services.