Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020.

BACKGROUND: Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). METHODS: We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019-February 2020. Women aged over 45years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. RESULTS: A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. CONCLUSIONS: Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician-patient discourse regarding these important issues should be explored.

Clinical Presentation of Incident Syphilis Among Men Who Have Sex with Men Taking HIV Pre-Exposure Prophylaxis in Melbourne, Australia.

BACKGROUND: Current international guidelines on human immunodeficieny virus (HIV) Pre-Exposure Prophylaxis (PrEP) recommend serological screening for syphilis at routine 3-monthly PrEP appointments. The aim of our study was to describe the pattern of clinical presentation of syphilis among men who have sex with men (MSM) taking PrEP. We were interested in whether syphilis is detected through screening at scheduled3-monthly PrEP clinic appointments or whether primary or secondary syphilis presented at unscheduled interval visits. METHODS: This was a retrospective study of MSM attending the PrEP clinic at the Melbourne Sexual Health Centre between February 2016 and March 2019. Serological screening for syphilis was routinely undertaken at 3-monthly PrEP clinic appointments. Diagnoses of early syphilis were identified from PrEP clinic visits and from interim walk-in STI clinic attendances. RESULTS: There were 69 cases of early syphilis among 61 MSM taking PrEP during the study period. There were 24 (35%) primary, 16 (23%) secondary, and 29 (42%) early latent infections. The incidence of early syphilis was 8.6 per 100 person-years. A substantial proportion of primary (58%) and secondary (44%) syphilis diagnoses were made at interim STI clinic attendances, between PrEP appointments. CONCLUSIONS: Syphilis screening at routine 3-monthly PrEP visits alone fails to detect a proportion of primary and secondary syphilis infections and may be insufficient in preventing onward transmission. Education of MSM taking PrEP regarding the risk of syphilis and symptom recognition is necessary together with access to syphilis testing between PrEP visits.

Spatial and Temporal Epidemiology of Infectious Syphilis in Victoria, Australia, 2015-2018.

ABSTRACT: This analysis of notified syphilis cases in Victoria, Australia between 2015 and 2018 shows that the syphilis epidemic in Victoria has become more generalized, with increases among heterosexual men and women residing in outer Melbourne suburbs-areas that differ from those of gay men.

Chlamydia infection in individuals reporting contact with sexual partners with chlamydia: a cross-sectional study of sexual health clinic attendees.

OBJECTIVES: We aimed to ascertain the proportion of positive, and predictive factors of chlamydia infection among females, heterosexual males and men who have sex with men (MSM) presenting to a sexual health service reporting contact with a chlamydia infected sexual partner. METHODS: A cross-sectional analysis of patients attending the Melbourne Sexual Health Centre from October 2010 to September 2013. Behavioural data obtained using computer assisted self-interview were analysed to determine factors predictive of chlamydia. RESULTS: Of the 491 female, 808 heterosexual male, and 268 MSM chlamydia contacts, the proportion diagnosed with chlamydia were 39.9% (95% CI 35.7% to 44.3%), 36.1% (95% CI 32.9% to 39.9%) and 23.5% (95% CI 18.8% to 29.0%), respectively. Female chlamydia contacts were more likely to have chlamydia if age <25 (adjusted OR (AOR) 1.86, 95% CI 1.12 to 3.10) or if they reported inconsistent condom use during vaginal sex with a regular male partner (AOR 2.5, 95% CI 1.12 to 6.14). Heterosexual male contacts were more likely to have chlamydia if age <25 (AOR 1.69, 95% CI 1.25 to 2.28) or if they had a regular female sexual partner (AOR 1.38, 95% CI 1.03 to 1.85). In MSM urethral chlamydia was diagnosed in 8.8%, rectal chlamydia in 20.2%, and 3.9% at both sites. MSM were more likely to have chlamydia if they had a regular male sexual partner (OR 2.12, 95% CI 1.18 to 3.81). CONCLUSIONS: This study of female, heterosexual male, and MSM presentations with self-reported chlamydia contact provides insight into the likelihood and predictive factors of infection. The data may inform policy and individual clinical decision making regarding presumptive treatment of chlamydia contacts.

Impact of minimum catch size on the population viability of Strombus gigas (Mesogastropoda: Strombidae) in Quintana Roo, Mexico.

The queen conch Strombus gigas represents one of the most important fishery resources of the Caribbean but heavy fishing pressure has led to the depletion of stocks throughout the region, causing the inclusion of this species into CITES Appendix II and IUCN's Red-List. In Mexico, the queen conch is managed through a minimum fishing size of 200 mm shell length and a fishing quota which usually represents 50% of the adult biomass. The objectives of this study were to determine the intrinsic population growth rate of the queen conch population of Xel-Ha, Quintana Roo, Mexico, and to assess the effects of a regulated fishing impact, simulating the extraction of 50% adult biomass on the population density. We used three different minimum size criteria to demonstrate the effects of minimum catch size on the population density and discuss biological implications. Demographic data was obtained through capture-mark-recapture sampling, collecting all animals encountered during three hours, by three divers, at four different sampling sites of the Xel-Ha inlet. The conch population was sampled each month between 2005 and 2006, and bimonthly between 2006 and 2011, tagging a total of 8,292 animals. Shell length and lip thickness were determined for each individual. The average shell length for conch with formed lip in Xel-Ha was 209.39 ± 14.18 mm and the median 210 mm. Half of the sampled conch with lip ranged between 200 mm and 219 mm shell length. Assuming that the presence of the lip is an indicator for sexual maturity, it can be concluded that many animals may form their lip at greater shell lengths than 200 mm and ought to be considered immature. Estimation of relative adult abundance and densities varied greatly depending on the criteria employed for adult classification. When using a minimum fishing size of 200 mm shell length, between 26.2% and up to 54.8% of the population qualified as adults, which represented a simulated fishing impact of almost one third of the population. When conch extraction was simulated using a classification criteria based on lip thickness, it had a much smaller impact on the population density. We concluded that the best management strategy for S. gigas is a minimum fishing size based on a lip thickness, since it has lower impact on the population density, and given that selective fishing pressure based on size may lead to the appearance of small adult individuals with reduced fecundity. Furthermore, based on the reproductive biology and the results of the simulated fishing, we suggest a minimum lip thickness of ≥ 15 mm, which ensures the protection of reproductive stages, reduces the risk of overfishing, leading to non-viable density reduction.

Recent advances in understanding and combatting Mycoplasma genitalium.

Mycoplasma genitalium has emerged over the last 30 years as a sexually transmitted infection (STI). As data have accumulated, our understanding of this pathogen and its role in disease continues to evolve. This in turn creates new challenges and complexities. Questions remain regarding the natural history of M. genitalium, its contribution to disease and long-term sequelae. A decline in cure rates for first-line anti-microbials has been observed. This is likely in part due to high usage of single-dose azithromycin in the sexual health field but also due to the intrinsic ability of M. genitalium to rapidly acquire anti-microbial resistance. Consequently, the term 'the new STI superbug' is not infrequently used by the media to describe this pathogen. Currently available antibiotics have side effects that, though rare, are potentially serious. This leads to inherent questions regarding the benefit of testing for and treating M. genitalium, particularly in asymptomatic individuals or in genital syndromes where the benefit of treatment is not well established. In this review, we summarize the most recent evidence and literature regarding M. genitalium and explore areas of research where disparities exist. We discuss the contribution of M. genitalium to genital syndromes, particularly those where data are conflicting, in order to inform indications for testing and treatment. Avoidance of increasing anti-microbial resistance with astute anti-microbial stewardship is paramount if we are to successfully manage M. genitalium infection. We examine the state of play regarding anti-microbial resistance and how to combat this, including currently available anti-microbials, resistance-guided therapy and novel therapeutic approaches. We aim to provide an overview of the current understanding of M. genitalium and the implications for current clinical practise and suggestions for future research.

Stomatal density, leaf area and plant size variation of Rhizophora mangle (Malpighiales: Rhizophoraceae) along a salinity gradient in the Mexican Caribbean / Variación en la densidad estomática, área foliar y tamaño de Rhizophora mangle (Malpighiales: Rhizophoraceae) a lo largo de un gradiente de salinidad en el Caribe Mexicano

AbstractIn community ecology, the knowledge of abiotic factors, that determine intraspecific variability in ecophysiological and functional traits, is important for addressing major questions, such as plant community assembly and ecosystem functioning. Mangroves have several mechanisms of resistance to salinity and most species exhibit some xeromorphic features in order to conserve water. Leaf area and stomatal density play an important role in maintaining water balance, and gas exchange is regulated by their aperture and density, two traits that vary intraspecifically in response to environmental conditions, such as water stress and salinity. In this study, we evaluated the effects of salinity on stomatal density, leaf area and plant size in R. mangle and we tested for associations among the three variables, across three sites along a natural salinity gradient in the XelHá Park, Quintana Roo, Mexico. We hypothesized that high salinity sites would produce smaller plants, with smaller leaves, and fewer stomata. Three sampling sites with different environmental conditions were chosen and salinities were monitored monthly. A total of 542 plants were tagged and tree heights and diameters were measured for each individual within each of the three sampling sites. Three leaves from 20 trees from each site were measured to determine leaf area. Stomatal densities were determined in each leaf using nail polish casts, examining ten 1 mm squares per leaf under an optical microscope. A principal component analysis was used to assess association between tree height, leaf area, and stomatal density for each plot. The salinity gradient was reflected in plant size, producing smaller plants at the higher salinity site. The largest leaves were found at the low salinity site (51.2 ± 24.99 cm2). Leaf length was not correlated to plant size (LL vs. tree height: r= 0.02, P= 0.8205; LL vs. trunk diameter: r= 0.03, P= 0.7336), so we concluded that leaf length is an environmentally plastic trait of red mangroves that may vary as a function of environmental conditions, such as hydric stress caused by elevated salinity. The larger leaves from the low salinity site had lower densities of stomata (65.0 stomata.mm2 SD= 12.3), and increasing salinities did not decrease stomatal density (intermediate salinity site: 73.4 stomata.mm2 SD= 13.5; high salinity site: 74.8 stomata.mm2 SD= 17.3). Our results confirm that stomatal density is inversely related to leaf area (r= -0.29, P < 0.001), especially leaf width (r= -0.31, P < 0.001), and that salinity may increase stomatal density by causing reduction of leaf size.

ResumenLos manglares tienen varios mecanismos de resistencia salina y la mayoría de las especies presentan algunas características xeromórficas con el fin de conservar el agua. El tamaño de la hoja y la densidad de los estomas desempeñan un papel importante en el mantenimiento del equilibrio hídrico. El intercambio de gases puede mediarse mediante la regulación de la apertura de los estomas, así como el número de estomas sobre la epidermis, dos características que pueden variar intraespecíficamente en función las condiciones ambientales, tales como el estrés hídrico. Rhizophora mangle es una de las especies de mayor importancia en América del Norte y Sur, y de África occidental. El objetivo de este trabajo fue evaluar los efectos de la salinidad sobre la densidad de los estomas, el tamaño de la hoja y el tamaño de las plantas de Rhizophora mangle y determinar si existe una relación entre las tres variables, comparándose tres ambientes diferentes a lo largo de un gradiente natural de salinidad en Xel-Há, Quintana Roo, México. La hipótesis fue que los ambientes de alta salinidad producirían plantas más pequeñas, con hojas más pequeñas y menos estomas. Se seleccionaron tres sitios de estudio con condiciones ambientales diferentes y se midió la salinidad cada mes. Un total de 542 plantas fueron etiquetadas en los tres sitios, y se midió su altura y diámetro del tronco. Se recolectaron tres hojas de 20 árboles en cada uno de los sitios, y se obtuvo el área de cada hoja. La densidad estomática se midió mediante la técnica de microrelieve con barniz de uñas, observando diez 1 mm cuadrados bajo un microscopio óptico. Se utilizó un análisis de componentes principales para determinar la asociación entre altura de árbol, área de hoja y densidad estomática. El gradiente de salinidad se vio reflejado en el tamaño de las plantas, produciendo plantas más pequeñas en el sitio de alta salinidad. El largo de las hojas no se correlacionó con el tamaño de las plantas, por lo cual se concluyó que esta variable tiene plasticidad ambiental particular. Las hojas más grandes fueron encontradas en el sitio de baja salinidad y tuvieron densidades estomáticas menores. No se pudo observar que la densidad de estomas disminuyera con las altas salinidades. Estos resultados confirman que la densidad estomática es inversamente relacionada con el tamaño de la hoja, especialmente el ancho, y que la densidad estomática incrementa con la salinidad debido a la reducción del tamaño de hoja.

Reversibility of hyperglycaemia and islet abnormalities in the high fat-fed female ZDF rat model of type 2 diabetes.

INTRODUCTION: We characterised the development of Type 2 diabetes and associated changes in islet appearance in female ZDF rats and explored its suitability for studies with novel therapeutic agents. METHODS: Female ZDF rats were either chow or high fat (60%) fed for up to 36 days and blood glucose and plasma insulin concentration measured. Additionally, we restored two groups of rats back to chow diet after ten and nineteen days of high fat feeding to determine the reversibility. Finally, two other groups of high fat-fed animals were dosed either orally with drug vehicle or had a minipump implanted subcutaneously to determine the effect of dosing method upon the progression of this disease model. The beta cell mass and morphology were assessed by immunohistochemistry for insulin. RESULTS: High fat feeding elevated blood glucose compared to chow-fed controls which peaked by 15 days, and maintained throughout the study. Plasma insulin reached a maximum after 8 days, but declined over the remaining 4 weeks. Assessment of islets revealed marked disruption, dispersion and weaker insulin staining. The area and percentage ß-cells were higher in high fat-fed animals. High fat diet treatment reversal when animals were moderately hyperglycaemic, when plasma insulin was still elevated, reversed the hyperglycaemia and maintained islet morphology similar to that of chow-fed animals. In contrast, dietary reversal when plasma insulin was declining, did not prevent continual decline in plasma insulin, ß-cell mass or islet disruption. Oral dosing tended to increase blood glucose and decrease plasma insulin whereas administration by minipump lowered blood glucose. DISCUSSION: The obese female ZDF rat offers the opportunity for preclinical evaluation of novel therapies directed towards improving pancreatic function, provided treatment is initiated prior to the precipitous decline in insulin production. Caution should be exercised in comparison of compounds administered by different dosing routes however.

Impact of minimum catch size on the population viability of Strombus gigas (Mesogastropoda: Strombidae) inQuintana Roo, Mexico / Impacto de la talla mínima de captura en la viabilidad de la población de Strombus gigas (Mesogastropoda: Strombidae) en Quintana Roo, Mexico

The queen conch Strombus gigas represents one of the most important fishery resources of the Caribbean but heavy fishing pressure has led to the depletion of stocks throughout the region, causing the inclusion of this species into CITES Appendix II and IUCN’s Red-List. In Mexico, the queen conch is managed through a minimum fishing size of 200mm shell length and a fishing quota which usually represents 50% of the adult biomass. The objectives of this study were to determine the intrinsic population growth rate of the queen conch population of Xel-Ha, Quintana Roo, Mexico, and to assess the effects of a regulated fishing impact, simulating the extraction of 50% adult biomass on the population density. We used three different minimum size criteria to demonstrate the effects of minimum catch size on the population density and discuss biological implications. Demographic data was obtained through capture-mark-recapture sampling, collecting all animals encountered during three hours, by three divers, at four different sampling sites of the Xel-Ha inlet. The conch population was sampled each month between 2005 and 2006, and bimonthly between 2006 and 2011, tagging a total of 8 292 animals. Shell length and lip thickness were determined for each individual. The average shell length for conch with formed lip in Xel-Ha was 209.39±14.18mm and the median 210mm. Half of the sampled conch with lip ranged between 200mm and 219mm shell length. Assuming that the presence of the lip is an indicator for sexual maturity, it can be concluded that many animals may form their lip at greater shell lengths than 200mm and ought to be considered immature. Estimation of relative adult abundance and densities varied greatly depending on the criteria employed for adult classification. When using a minimum fishing size of 200mm shell length, between 26.2% and up to 54.8% of the population qualified as adults, which represented a simulated fishing impact of almost one third of the population. When conch extraction was simulated using a classification criteria based on lip thickness, it had a much smaller impact on the population density. We concluded that the best management strategy for S. gigas is a minimum fishing size based on a lip thickness, since it has lower impact on the population density, and given that selective fishing pressure based on size may lead to the appearance of small adult individuals with reduced fecundity. Furthermore, based on the reproductive biology and the results of the simulated fishing, we suggest a minimum lip thickness of ≥15mm, which ensures the protection of reproductive stages, reduces the risk of overfishing, leading to non-viable density reduction. Rev. Biol. Trop. 62 (4): 1343-1352. Epub 2014 December 01.

El caracol rosa Strombus gigas representa una de las especies de mayor importancia pesquera en el Caribe, pero la creciente presión pesquera ha llevado al deterioro de las poblaciones en toda la región, llevando a la inclusión de esta especie en el apéndice II de CITES y la lista roja de UICN. En México, el caracol rosa se maneja con una talla mínima de pesca de 200mm longitud de heliconcha y una cuota pesquera que generalmente representa el 50% de la biomasa adulta. Este estudio tuvo como objetivos determinar la tasa intrínseca de crecimiento poblacional del caracol rosa en Xel-Ha, Quintana Roo, México, y evaluar el efecto de un esfuerzo pesquero regulado, simulando la extracción del 50% de la biomasa adulta. Utilizamos tres diferentes criterios de talla mínima para la pesca, para evaluar el efecto de ésta sobre la densidad de la población y discutimos las implicaciones bilógicas asociadas. Los datos demográficos se obtuvieron mediante un muestreo de marcaje-recaptura, recolectando todos los animales presentes, durante tres horas, con tres buzos, en cuatro sitios diferentes de la caleta. En 2005 los muestreos fueron mensuales, y de 2006 a 2011 bimensuales, marcándose un total de 8 292 caracoles. Se obtuvo la longitud de heliconcha y grosor de labio de cada individuo. La talla media de caracoles con labio formado fue de 209.39±14.18mm y la mediana de 210mm. La mitad de los caracoles con un labio formado presentaban tallas de 200mm a 219mm longitud de heliconcha. Suponiendo que la presencia del labio es un indicador de madurez sexual, se puede concluir que muchos animales alcanzan la madurez sexual a tallas mayores de 200mm longitud de heliconcha y deberían ser considerados inmaduros. La estimación de la abundancia relativa y densidad de adultos varía ampliamente según el criterio de clasificación utilizado. Cuando se aplicó una talla mínima de 200mm longitud, el 26.2% a 54.8% de la población calificó como adulta, correspondiendo a un impacto pesquero simulado de casi un tercio de la población. El impacto fue menor simulando la extracción de adultos, utilizando un criterio de clasificación basado en grosor de labio. Se concluyó que la mejor estrategia de manejo para S. gigas es una talla mínima basada en el grosor de labio, ya que esta medida reduce el impacto sobre la densidad poblacional, y por el otro lado disminuye la presión selectiva sobre la talla, lo cual conduce a la aparición de individuos pequeños con fecundidad inferior. Más allá, basado en la biología reproductiva y los resultados de las simulaciones, recomendamos un grosor de labio mínimo de ≥15mm para la pesca, ya que esta medida asegura la protección de las etapas reproductivas y reduce el riesgo de sobrepesca, el cual llevaría a reducciones no viables de la densidad poblacional.

Growth and population assessment of the queen conch Strombus gigas (Mesogastropoda: Strombidae) by capture mark-recapture sampling in a natural protected area of the Mexican Caribbean / Evaluación del crecimiento y población del caracol rosado Strombus gigas (Mesogastropoda: Strombidae) mediante muestreo de marcaje-recaptura en un área natural protegida del Caribe mexicano

The Inlet of Xel-Ha is used as a park for ecotourism, representing a sanctuary for the conservation of Pink Queen Conch. Increasing fishing pressure has led to the inclusion of the species in CITES. Most knowledge about the growth of the queen conch was generated through aquaculture, ocean enclosures or obtained using estimates derived from population dynamics. In this study we estimated the growth rate of juvenile S. gigas in a natural protected area by direct methods, during the period of April 2009 to January 2011. Data was obtained by capture-mark-recapture sampling. 1418 individuals were tagged and growth of 714 conchs was analyzed. Population size and density was estimated using Schnabel’s method. The average density was estimated at 0.1694 ± 0.0996ind. m-2, while the highest density was estimated for September 2010 (0.3074ind. m-2). The highest growth rate (0.27 ± 0.10mm day-1) was detected in juveniles with an initial size between 100-149mm, followed by conch <100mm, with an increase of 0.24 ± 0.05mm day-1. The growth rate decreased for individuals with an initial size between 150-199mm (0.18 ± 0.09mm day-1) and for organisms > 200mm (0.08 ± 0.07mm day-1). Variability in growth rate was high in conch 100-149mm and showed seasonal differences, with the highest growth rate in May 2010. Recruitment of juveniles was highest in October 2009 and February 2010. The population of Xel-Ha has grown in size and more large and juvenile conch could be found than in previous studies, indicating that Xel-ha park is working as a sanctuary for the conservation of the queen conch in Mexico’s Riviera Maya. The growth rate of juvenile conch in Xel-Ha is high and exhibits large variations in individuals, reflecting the natural conditions of foraging and aggregation. Seasonal differences in growth rate may be associated with water quality and availability of nutrients for primary production. We conclude that the direct method is useful for the assessment of growth in juvenile S. gigas and that growth in natural conditions may be higher than in aquaculture systems. This information may be applied to fishery management as well as rehabilitation programs and aquaculture.

La Ensenada de Xel-Ha es usada como parque para ecoturismo y representa un santuario para la conservación del caracol rosado. El incremento en la presión de la pesca ha llevado a la inclusión de esta especie en CITES. Mucho del conocimiento acerca del crecimiento del caracol rosado ha sido generado a través de la acuicultura, encierros oceánicos o usando estimaciones derivadas de las dinámicas poblacionales. En este estudio estimamos la tasa de crecimiento de Strombus gigas juvenil en un área natural protegida, por métodos directos durante el período de abril 2009 a enero 2011. Los datos fueron obtenidos por muestras de captura-marca-recaptura. Un total de 1 418 individuos fueron marcados y el crecimiento de 714 caracoles fue analizado. La talla de la población y la densidad relativa fue estimada usando el método de Schnabel. La densidad promedio relativa fue estimada en 0.1694±0.0996ind. m-2, mientras que la densidad más alta fue estimada para septiembre 2010 con 0.3074ind. m-2. La tasa de crecimiento más alta (0.27±0.10mm día-1) fue detectada en juveniles con una talla inicial entre 100-149mm, seguida por juveniles <100mm, con un incremento de 0.24±0.05mm día-1. La tasa de crecimiento disminuyó para individuos con una talla inicial entre 150-199mm (0.18±0.09mm día-1) y para organismos >200mm (0.08 ± 0.07mm día-1). La variabilidad en la tasas de crecimiento fue alta en individuos entre 100-149mm y mostró diferencias estacionales; con la tasa de crecimiento más alta en mayo 2010. El reclutamiento de juveniles más alto se dio en octubre 2009 y en febrero 2010. La población de Xel-Ha ha crecido en tamaño y se pudo encontrar más adultos y juveniles que en estudios anteriores, lo que demuestra que el Parque de Xel-Há está funcionando como un santuario para la conservación del caracol rosado del Caribe en la Riviera Maya de México. La tasa de crecimiento de juveniles en Xel-Ha es alta y presenta grandes variaciones en los individuos, lo ...