Sexual Contact as Risk Factor for Campylobacter Infection, Denmark.

Campylobacteriosis is a disease of worldwide importance, but aspects of its transmission dynamics, particularly risk factors, are still poorly understood. We used data from a matched case-control study of 4,269 men who have sex with men (MSM) and 26,215 controls, combined with national surveillance data on Campylobacter spp., Salmonella spp., and Shigella spp., to calculate matched odds ratios (mORs) for infection among MSM and controls. MSM had higher odds of Campylobacter (mOR 14, 95% CI 10-21) and Shigella (mOR 74, 95% CI 27-203) infections, but not Salmonella (mOR 0.2, 95% CI 0-13), and were less likely than controls to have acquired Campylobacter infection abroad (χ2 = 21; p<0.001). Our results confirm that sexual contact is a risk factor for campylobacteriosis and also suggest explanations for unique features of Campylobacter epidemiology. These findings provide a baseline for updating infection risk guidelines to the general population.

High linkage to care in a community-based rapid HIV testing and counseling project among men who have sex with men in Copenhagen.

INTRODUCTION: The aim of the study was to evaluate a community-based human immunodeficiency virus (HIV) testing program for its capacity to reach men who have sex with men (MSM) and successfully refer HIV-positive patients to treatment. METHODS: A walk-in clinic placed in the heart of the Copenhagen MSM community provided sexually transmitted infection counseling and rapid HIV testing. In addition, syphilis testing and hepatitis B vaccination were offered. The clinic was staffed with specially trained, predominantly non-health care personnel, and services were anonymous and free of charge. RESULTS: A total of 3012 HIV tests with concomitant counseling were performed between 2008 and 2012. The median age of users was 33 years (range, 16-73 years), 18% were non-Danish citizens, and 12% reported that this was their first HIV test. Thirty-eight individuals tested positive; however, 1 was found to be false positive by routine confirmatory testing. The remaining 37 users were true positive. All but 1 user was successfully linked to care at an infectious disease department and achieved full viral suppression after a median of 8 months (interquartile range, 5-19 months). The 37 positive patients accounted for 11% of all newly diagnosed HIV cases among MSM in Copenhagen in the period covered. Patients diagnosed in Checkpoint were younger than other newly diagnosed MSM, but had similar median CD4 counts at the time of diagnosis (420 [interquartile range, 260-590]). Seventy-six MSM (3%) were found syphilis positive in rapid testing and referred for confirmatory testing. Furthermore, 264 MSM completed a 3-shot hepatitis B vaccination program. CONCLUSIONS: Easily accessible, community walk-in clinics and targeted testing in high-risk settings are convenient for populations of MSM less likely to seek out the established health care system. Checkpoint diagnosed 37 new HIV cases, posed no barrier to successful linkage to care, was noninferior in quickly reducing community viral load, was cost-effective, reached younger MSM, and proved an ideal platform for trying out new interventions and test forms, which conventional health care providers have not yet embraced.

Risk of HIV or second syphilis infection in Danish men with newly acquired syphilis in the period 2000-2010.

OBJECTIVES: Risk of subsequent diagnosis of HIV in persons diagnosed with newly acquired syphilis, and syphilis in HIV-infected persons, are of interest as these infections are markers of unsafe sex. METHODS: From a nationwide register, all Danish men aged >16 years diagnosed with syphilis in the period 2000-2010 (n=1217) were identified, and subsequently data on HIV status was extracted from the Danish HIV Cohort Study. We used Kaplan-Meier analysis to estimate the 5-year risk of HIV and second syphilis infection, and Cox regression to determine incidence rate ratios (IRR). RESULTS: The 5-year risk of HIV diagnosis was 9.8% (95% CI 7.0% to 12.6%). Those with a second diagnosis of syphilis had a higher risk of being diagnosed with HIV (IRR=3.1, 95% CI 1.2 to 8.0). The 5-year risk for a second diagnosis of syphilis was 14.8% (95% CI 12.1% to 17.4%) and HIV-infected persons had a higher risk of a second syphilis diagnosis (IRR=4.0, 95% CI 2.8 to 5.9). Sixty-five percent of the persons were men having sex with men (MSM). Thirty-four percent of the HIV-infected persons had viral load >1000 copies/ml at time of syphilis diagnosis. CONCLUSIONS: The substantial risks of syphilis and HIV infection in men diagnosed with one of these sexually transmitted diseases indicate a high frequency of unsafe sex in the Danish MSM population. As one-third of the HIV-infected persons diagnosed with syphilis had high viral loads, our data support initiation of antiretroviral therapy in all HIV-infected MSM to reduce HIV transmission.

[Ingestion of button batteries. Epidemiology, clinical signs and therapeutic recommendations]. / Indtagelse af minibatterier. Epidemiologi, klinik og forslag til behandling.

The frequency of ingested button batteries is about 10 per million population per year, and one in every 1,000 battery ingestions causes serious injuries. Most of the patients are children. Seven to 20% develop transient symptoms, owing to irritation or superficial corrosion of the gastrointestinal tract. The severe lesions are almost always confined to the oesophagus. Toxic effects from the battery contents are unimportant. Batteries lodged in the oesophagus may not cause initial symptoms, and it is recommended that when ingestion is suspected patients should be examined by fluoroscopy. Batteries in the oesophagus should be removed promptly by endoscopy, those distal to the oesophagus can be left to pass spontaneously. Passage can be ensured by examination of the stools.

Stable incidence of HIV diagnoses among Danish MSM despite increased engagement in unsafe sex.

BACKGROUND: Since introduction of highly active antiretroviral therapy (HAART), the prevalence of Danish HIV-positive men who have sex with men (MSM) has increased substantially. In contrast, the incidence of MSM diagnosed with HIV has not increased, and this paradox has been the focus of intensive debate. METHODS: Study period was 1995-2010. Data were obtained from 2 Danish nation-wide registries of HIV and syphilis, and 5 consecutive surveys on sexual behavior in Danish MSM. We calculated incidences of HIV and syphilis in MSM, prevalence of HIV-positive MSM with detectable viral load (>400 HIV RNA copies/mL), and changes in frequency of unprotected anal intercourse. We introduce The Cohort Community Reproductive Rate (CCRR) to describe the number of newly diagnosed MSM per HIV-positive MSM per year and used Poisson regression to model CCRR. RESULTS: From 1995 to 2010, the prevalence of Danish MSM diagnosed with HIV increased from 1035 to 1813 (75%), whereas the number of HIV-positive MSM with detectable viral load (>400 HIV RNA copies/mL) decreased by 75% from 1035 to 262. The incidence of syphilis and unprotected anal intercourse rose dramatically in the same period, whereas CCRR decreased from 0.099 (95% confidence interval: 0.092 to 0.108) to 0.071 (95% confidence interval: 0.065 to 0.079). CONCLUSIONS: Our results strongly indicate that HAART has decreased the risk of transmission of HIV despite increased practice of unsafe sex and thereby substantiate that HAART should be offered to MSM to reduce risk of transmission of the disease.