Human intestinal spirochetosis, a sexually transmissible infection? Review of six cases from two sexually transmitted infection centres in Barcelona.

Human intestinal spirochetosis (HIS) is a possible cause of chronic diarrhoea and affects mainly men who have sex with men (MSM) and people living with HIV. Diagnosis is based on colon biopsy, where spirochetes can be observed on the luminal surface, especially with the Warthin-Starry stain or similar silver stains. We conducted a retrospective descriptive study of all HIS cases diagnosed in two sexually transmitted infections (STI) centres in Barcelona from 2009 until 2018. The medical histories were reviewed to gather epidemiological, clinical, and diagnostic variables. Six patients were diagnosed with HIS. All the individuals were MSM, with a median age of 31.5 years (interquartile range [IQR] 29.5;49.25) and half of them were living with HIV. Five patients reported condomless anal intercourse and 4 patients had practised oro-anal sex previously. Concomitantly, two of them had rectal gonorrhoea, one had rectal Chlamydia trachomatis and none of them had syphilis. The predominant clinical symptom was diarrhoea (5 patients). All cases were diagnosed by a Warthin-Starry stain on a colon biopsy specimen, and mild inflammatory changes were found in 5 cases. Five patients were treated with metronidazole and one with benzathine penicillin G. Treatment was successful in all the patients. HIS should be considered in patients with chronic diarrhoea who report risky sexual practices and/or concomitant STI. HIS may also be sexually transmitted according to the context.

Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients.

BACKGROUND: Since 2000, substantial increases in syphilis in men who have sex with men (MSM) have been reported in many cities. Condomless anal sex (CAS) is one of the factors, along with drugs for sex and sex in group. This study identified factors and clinical manifestations as well as Treponema pallidum (T.pallidum) strains that could be related to early syphilis in Barcelona. METHODS: This prospective study was conducted in a sexually transmitted infections unit in 2015. Epidemiological, behavioral, clinical and microbiological variables were collected in a structured form. Univariate and multivariate statistical analyses were performed focusing on HIV-positive patients. RESULTS: Overall, 274 cases were classified as having early syphilis (27.5% primary, 51.3% secondary, and 21.2% early latent syphilis). In all, 94% of participants were MSM and 36.3% were HIV-positive. The median number of sexual contacts in the last 12 months was 10; 72.5% practiced CAS, 50.6% had sex in group, and 54.7% consumed drugs. HIV-positive cases had more anonymous sex contacts (p = 0.041), CAS (p = 0.002), sex in group (p < 0.001) and drugs for sex (p < 0.001). In the multivariate analysis, previous syphilis (adjusted odds ratio [aOR] 4.81 [2.88-8.15]), previous Neisseria gonorrhoeae infection (aOR 3.8 [2.28-6.43]), and serosorting (aOR 20.4 [7.99-60.96]) were associated with having syphilis. Clinically, multiple chancres were present in 31% of cases with no differences on serostatus, but anal chancre was most common in HIV-positive patients (p = 0.049). Molecular typing did not conclusively explain clinical presentation in relation to specific T.pallidum strains. CONCLUSION: Control of syphilis remains a challenge. Similar to prior studies, HIV-positive patients were found to engage more often in sexual behaviors associated with syphilis than HIV-negative patients. Clinical manifestations were rather similar in both groups, although anal chancre was most common in HIV-positive patients. Various strain types of syphilis were found, but no clinical associations were identified.

Gay Circuit Parties in Barcelona and Their Impact on Gonorrhea Incidence.

This study explored the role of circuit parties on the incidence of gonorrhea among men who have sex with men (MSM) in Barcelona (Spain). Specifically, it aimed to detect cyclic peaks in the number of reported diagnoses of gonorrhea after gay circuit parties. We analyzed monthly cases of gonorrhea reported from January 2007 through December 2016 after the main annual gay circuit parties in Barcelona. We used the integer autoregressive model for time series with discrete values. The performance of the model was tested in heterosexual men and women, in whom the circuit parties could be expected to have no impact. A sensitivity analysis was conducted, changing post-event diagnosis windows to 1 week later/1 week before. In the study period, a total of 4182 of gonorrhea cases were detected, of which 74.8% (n = 2181) occurred in men who identified themselves as MSM. The average annual increase in gonorrhea cases reported among MSM was 32.57%. In an independent analysis of each gay circuit party, cases increased significantly in two of them. The results were also similar for same-sex practices among men only. On controlling for the increasing trend over the study period and the seasonal effect, an average of 1.16 gonorrhea cases in MSM (95% CI: 0.68, 1.64) were attributable to the celebration of one of the gay circuit parties considered. During the expected outbreak, an average of 13 gonorrhea cases were detected and between 5 and 13% were attributable to one of the circuit parties. In view of these findings, participants should consider seeking advice from their healthcare provider and practice safer sex using condoms to prevent sexually transmitted infections. Local public health services should be reinforced to ensure care for participants during and after gay circuit parties. More research is needed to design and implement preventive programs.

Outbreak of intestinal amoebiasis among men who have sex with men, Barcelona (Spain), October 2016 and January 2017.

Entamoeba histolytica has been recently recognised as an emerging sexually transmissible pathogen in men who have sex with men (MSM), causing sporadic outbreaks in countries where it is not endemic. Here we report two closed clusters of invasive amoebiasis occurring in Barcelona, Spain, in October 2016 (four cases) and in January 2017 (four cases).

El chancro del viernes por la tarde / No disponible

Se presenta un caso clínico de un varón con una úlcera anal y adenopatía inguinal, procediéndose a la discusión del diagnostico diferencial ante imposibilidad inicial de realizar serologías urgentes en circunstancias reales debido a la hora y el día. La evolución de la misma ilustra la interacción que hay entre el VIH y sífilis, además de manifestar la necesidad de realizar el cribado de otras infecciones de transmisión sexual (AU)

We report a case of a man with an anal ulcer and an inguinal adenopathy, proceeding to the discussion of differential diagnosis due to initial inability to perform urgent serology because of the circumstances of the time and day we visited the patient. The case illustrates the interaction between HIV and syphilis, and in addition expreses the need for screening for other sexually transmitted infections (AU)

[Reemergence of infectious syphilis among homosexual men and HIV coinfection in Barcelona, 2002-2003]. / Reemergencia de la sífilis infecciosa en varones homosexuales y coinfección por el virus de la inmunodeficiencia humana en Barcelona, 2002-2003.

BACKGROUND AND OBJECTIVES: An increase in syphilis infections since the mid 1990s has been documented, especially in homosexual men, in different European and North American cities. We intended to describe the characteristics of newly diagnosed cases of syphilis at the Sexually Transmitted Infections Unit of Barcelona in 2002 and 2003. PATIENTS AND METHOD: Descriptive analysis of cases with infectious syphilis and multivariate analysis of factors associated with HIV coinfection. RESULTS: 102 cases were diagnosed with infectious syphilis, 98 males (88 homosexual men). HIV coinfection was present in 34% of cases. Predictive factors of HIV coinfection were age > 30 years (p = 0.003) and having a HIV positive partner (p = 0.044). Clinically, there were no differences between cases coinfected or not with HIV. CONCLUSIONS: There has been a recent increase of syphilis in Barcelona, especially among some core groups of homosexual men with high rates of HIV coinfection.

Reemergencia de la sífilis infecciosa en varones homosexuales y coinfección por el virus de la inmunodeficiencia humana en Barcelona, 2002-2003 / Reemergence of infectious syphilis among homosexual men and HIV coinfection in Barcelona, 2002-2003

Fundamento y objetivos: Se ha documentado un incremento de casos de sífilis infecciosa desde mediados de 1990, sobre todo en varones homosexuales, en distintas ciudades europeas y norteamericanas. El objetivo de este trabajo es describir las características de los nuevos casos de sífilis infecciosa diagnosticados en la Unidad de Infecciones de Transmisión Sexual de Barcelona en 2002 y 2003. Pacientes y método: Análisis descriptivo de los diagnósticos de sífilis infecciosa y análisis multivariante de los factores asociados a la coinfección por el virus de la inmunodeficiencia humana (VIH). Resultados: Se diagnosticó 102 casos de sífilis infecciosa, de los que 98 eran varones (88 de ellos homosexuales). En el 34% de los casos los individuos estaban coinfectados por el VIH. Los factores predictores de coinfección fueron la edad superior a 30 años (p = 0,003) y tener pareja infectada por el VIH (p = 0,044). Clínicamente no hubo diferencias entre los casos según la coinfección VIH. Conclusiones: En Barcelona también se ha detectado un incremento reciente de casos de sífilis infecciosa, especialmente en determinados grupos nucleares de varones homosexuales con elevadas tasas de coinfección por el VIH

Background and objectives: An increase in syphilis infections since the mid 1990s has been documented, especially in homosexual men, in different Europen and North American cities. We intended to describe the characteristics of newly diagnosed cases of syphilis at the Sexually Transmitted Infections Unit of Barcelona in 2002 and 2003. Patients and method: Descriptive analysis of cases with infectious syphilis and multivariate analysis of factors associated with HIV coinfection. Results: 102 cases were diagnosed with infectious syphilis, 98 males (88 homosexual men). HIV coinfection was present in 34% of cases. Predictive factors of HIV coinfection were age >30 years (p = 0.003) and having a HIV positive partner (p = 0.044). Clinically, there were no differences between cases coinfected or not with HIV. Conclusions: There has been a recent increase of syphilis in Barcelona, especially among some core groups of homosexual men with high rates of HIV coinfection

Enfermedades de transmisión sexual. Evaluación de los objetivos del Plan de Salud de Cataluña para el año 2000 / Sexually transmitted diseases. Evaluation of the objectives of the Health Plan for Catalonia for the year 2000

Fundamento y objetivo: Las enfermedades de transmisión sexual (ETS) fueron uno de los problemas prioritarios de salud incluidos en el Plan de Salud de Cataluña en 1991. Se fijaron como objetivos de salud para el año 2000 la reducción de la incidencia de la sífilis en un 30%; la reducción de la incidencia de la gonococia en un 25%; la reducción de la proporción de gonococia causada por cepas de Neisseria gonorrhoeae productoras de ß-lactamasa en un 50%; la eliminación de la oftalmía del recién nacido y de la sífilis congénita, y la reducción de la incidencia de otras enfermedades de transmisión sexual en un 20%. El objetivo de este trabajo es evaluar hasta qué punto se han alcanzado los objetivos. Población y método: Los indicadores de la evolución de la morbilidad de las ETS utilizados para la evaluación de los objetivos propuestos en el Plan de Salud han sido los siguientes: tasas de incidencia de sífilis, gonococia, oftalmía del recién nacido, sífilis congénita y otras ETS, y proporción de gonococia causada por cepas de N. gonorrhoeae productoras de ß-lactamasa registradas durante el período 1989-2000. Resultados: La evolución de las tasas de incidencia de la sífilis y de la gonococia indica, respectivamente, una disminución del 78% (de 7,1 a 1,5 por 100.000 habitantes) y del 95% (de 78,9 a 3,6 por 100.000 habitantes) durante este período de 12 años, en la primera parte del cual ya se alcanzaron los dos primeros objetivos formulados. La proporción de gonococia causada por cepas de gonococo productoras de ß-lactamasa que alcanzaba el 20,4% en 1989 se ha situado por debajo del objetivo del 10% (el 6,1% en 2000), lo que significa una disminución del 70%. El objetivo propuesto de eliminación de la oftalmía del recién nacido no se ha alcanzado a pesar de la importante disminución de su tasa de incidencia. La eliminación de la sífilis congénita se alcanzó en 1995 y este objetivo se mantiene hasta la actualidad. La tasa de incidencia de la rúbrica de otras ETS muestra una reducción del 42% entre 1989 y 2000, por lo que el objetivo se considera alcanzado. Conclusiones: A excepción del objetivo «Del año 1989 al 2000 deberá eliminarse la oftalmía del recién nacido», todos los objetivos se han logrado, y con anterioridad al año 2000. Durante el período 1989-2000 se han desarrollado diversas estrategias en el ámbito de la prevención y control de las ETS que pueden haber contribuido a reducir la incidencia de las ETS objeto de evaluación y a que los indicadores se encuentren en los niveles actuales (AU)

Background and objective: Nowadays sexually transmitted diseases (STDs) are a priority health problem. Therefore, they were included in the Framework Document for the Development of the Health Plan for Catalonia for the year 2000. Several health objectives were fixed: 30% reduction of siphylis incidence, 25% reduction of gonorhea incidence, 50% reduction of infections caused by ß-lactamase producer strains of N. gonorrheae, the oftalmia neonatorum and congenital siphylis eradication and 20% reduction of other STDs. We have analyzed whether this aims have been accomplished or not. Subjects and method: In order to evaluate the objectives, we have use these indicators: gonorhea, siphylis, oftalmia neonatorum, congenital siphylis and other STDs incidence rates and the percentage of gonorhea caused by ß-lactamase producer strains of N. gonorrheae ocurred during the 1989-2000 period. Results: Siphylis incidence rate decreased from 7.1 to 1.5 (78%) and gonorhea incidence rate sunk from 78.9 to 3.6 (95%) in 12 months. Furthermore, these objectives were successful in the early stages of the study period. In addition, the percentage of gonorhea caused by ß-lactamase producer strains of N. gonorrheae fell from 20.4% in 1989 to 6.1% in 2000 (70% reduction). Oftalmia neonatorum have not been eradicated yet but its incidence showed a marked downward trend. Congenital siphylis eradication was achieved in 1995 and this objective remains unchanged. Other STDs incidence rates showed a 42% reduction. Conclusions: All the predicted objectives were achieved except the neoftalmia neonatorum eradication. Several new preventive strategies have been developed during the study period and this may play a role in the actual situation of these indicators (AU)