History Of Sexual Contact Research Articles

Scabies prevalence and its associated factors among prisoners in southern Ethiopia: An institution-based analytical cross-sectional study.

Scabies is an ectoparasitic infestation that can easily spread during close human contact and in overcrowded areas such as prisons and public places where sanitation is a problem. Globally, as many as 300 million people are infested with scabies each year. Within Ethiopia, its burden in institutions like prisons is not well-studied. As a consequence, we sought to estimate the prevalence of scabies and also identify factors associated with it among prison inmates in southern Ethiopia. An institution-based analytical cross-sectional study design was employed. We used, a simple random sampling technique to select 422 prisoners. A pretested-structured questionnaire was used to collect the necessary information. EpiData version 4.2.0.0 and Statistical Packages for Social Science version 25 software were used for data entry and analysis respectively. Both descriptive and inferential statistics were computed. The model fitness was checked using the Hosmer-Lemeshow and omnibus tests. The association between the independent and outcome variables was presented in the form of a table showing the crude odds ratio and adjusted odds ratio (AOR) along with their 95% confidence interval (CI). The level of statistical significance was declared at P.value ≤ 0.05. A total of 418 prisoners were interviewed, yielding a 99.1% response rate. The age of the participants ranged from 17 to 60 years. As many as 381 (91.1%) participants were male. The prevalence of scabies was found to be 8.9%. A history of sexual contact in the past two months, before imprisonment (AOR: 9.92 (95% CI 3.07, 32.02), P <0.001), a period of stay less than two months duration in the prison (AOR: 4.54 (95% CI 1.51, 13.54), P = 0.007), poor ventilation (AOR: 3.36 (95% CI 1.07, 10.58), P = 0.038), lack of hygiene soap (AOR: 5.53 (95% CI 1.45, 21.17), P = 0.012), and sharing clothes among each other (AOR: 3.81 (95% CI (1.09, 13.29), P = 0.036) were factors independently associated with a scabies infestation. In this study, we found the prevalence of scabies was high among prison inmates in Wolaita Zone prison. Furthermore, scabies infestations were associated with a previous history of sexual contact, poorly ventilated rooms, lack of hygiene soaps for washing, and sharing clothes amongst the inmates. Prison administrations should be encouraged to improve sanitary and screening and isolation of prisoners during imprisonment.

Cultural and religious barriers in the Middle East leading to delayed management of acute HIV case resulting in irreversible blindness: a case report.

A 26-year-old male who resides in a country in the Middle East visited the local general hospital emergency department on 17 July 2018. He presented with symptoms of persistent upper respiratory tract infection, dysphagia, and generalized fatigue. Denied any previous history of sexual contact, smoking, drinking, or using illicit drugs. This patient repeatedly attended the emergency department seeking medical attention and was treated for viral and bacterial upper respiratory tract symptoms by conservative and antibiotic therapy, yielded in short term relief but recurrence and worsening symptoms, especially dysphagia symptoms. On examination, the patient looked unwell, cachectic, and frail with normal vital signs and no positive findings on chest and abdominal examination; however, Ear Nose and Throat and oral examination revealed extensive oropharyngeal candidiasis. That is when he was suspected of having an immunodeficiency syndrome of some sort, and based on those serious findings, he was advised hospital admission for further investigations, diagnosis and management. The patient refused hospital admission against medical advice despite all the potential risks explained clearly, as he had a pre-planned family reunion holiday to Turkey, which was again strongly advised against as likely he will deteriorate while on holiday, but he went on with his plan, accordingly, oropharyngeal candidiasis was successfully treated with oral antifungal tablets, pending further investigations and definitive management. Then in 24 July 2018, he travelled to Turkey, where he developed symptoms of shortness of breath and dry a cough then he became systemically unwell and was admitted to a local hospital in Turkey where he was diagnosed with a lower respiratory tract infection and treated with intravenous antibiotics for 7 days; then on 6 August 2018, he flew back on an emergency flight to his home country, where he was admitted to the acute medical admission unit and arranged to have patient laboratory investigations. The results revealed positive HIV infection with a plasma HIV viral load was greater than 3000000 copies/ml, and advanced immunosuppression with CD3+/CD4+ T-lymphocyte was 40 cells/mm3. The social aspect of this case was apparent from denying sexual contact. The patient did not have any history of surgical operations, no family history of HIV infection, no previous blood transfusion, or use of contaminated syringes. By exclusion sexual mode of transmission is the only possible way of contracting HIV infection in this case, considering the fact that he was outside his country as single man for few years while studying. In the Middle East countries, due to religious and cultural reservations coupled with HIV diagnosis stigma, the diagnosis of the serious sexually transmitted infections such as HIV is usually delayed, as a result these patients will go on and develop late-stage disease and irreversible complications when diagnosed, entering the AIDS stage with rapid progression of irreversible complications like Cytomegalovirus, Ear Nose and Throat retinitis and blindness before they start definitive treatment. The oropharyngeal candidiasis and repeated upper and lower respiratory tract infections that are non-responding to therapy are usually red flag signs of immunosuppression, which warrants high clinical vigilance from the clinician side to take a detailed sexual history and rule out acute HIV infection by testing for it at early stages, in patients with high clinical suspicion , in addition to the other possible causes of immunosuppression. Therefore, assuring confidentiality, taking a careful sexual history and gathering data in an acceptable way for these patients and considering a holistic approach yield a better management outcome.

Features of Mpox infection: The analysis of the data submitted to the ID-IRI network

BackgroundMpox is a rare zoonotic disease caused by the Mpox virus. On May 21, 2022, WHO announced the emergence of confirmed Mpox cases in countries outside the endemic areas in Central and West Africa. MethodsThis multicentre study was performed through the Infectious Diseases International Research Initiative network. Nineteen collaborating centres in 16 countries participated in the study. Consecutive cases with positive Mpoxv-DNA results by the polymerase chain reaction test were included in the study. ResultsThe mean age of 647 patients included in the study was 34.5.98.6% of cases were males, 95.3% were homosexual-bisexual, and 92.2% had a history of sexual contact. History of smallpox vaccination was present in 3.4% of cases. The median incubation period was 7.0 days. The most common symptoms and signs were rashes in 99.5%, lymphadenopathy in 65.1%, and fever in 54.9%. HIV infection was present in 93.8% of cases, and 17.8% were followed up in the hospital for further treatment. In the two weeks before the rash, prodromal symptoms occurred in 52.8% of cases. The incubation period was 3.5 days shorter in HIV-infected Mpox cases with CD4 count <200/μL, we disclosed the presence of lymphadenopathy, a characteristic finding for Mpox, accompanied the disease to a lesser extent in cases with smallpox vaccination. ConclusionsMpox disseminates globally, not just in the endemic areas. Knowledge of clinical features, disease transmission kinetics, and rapid and effective implementation of public health measures are paramount, as reflected by our findings in this study.

Mekanisme Penyebaran Cacar Monyet dan Faktor-Faktor Yang Mempengaruhinya

Introduction: On May 29, 2022, the World Health Organization (WHO) described the global public health risk from multi-country monkeypox outbreaks in non-endemic countries as "moderate." WHO pointed out that "this is the first time that cases and groups of monkeypox have been reported simultaneously in very different geographic areas and with no known epidemiological link to endemic countries". On 7 May 2022, England confirmed a case of monkeypox. Their report marks the start of the detection of the rapid and unprecedented global spread of the virus, featuring human-to-human and community transmission. Approximately one month later, confirmed cases of monkeypox rose to 3,453 in at least 55 non-endemic countries, covering every continent other than Antarctica. Objective: To know the mechanism of the spread of monkeypox and the factors that influence it. Results: Based on several kinds of literature, shows the spread of the monkeypox virus starts from travelers to endemic areas so currently there are many cases of monkeypox found in non-endemic areas. Factors that influence the spread of the disease with the highest presentation are associated with a history of sexual contact where the highest proportion occurs in MSM (men who have sex with men), followed by droplet exposure and direct contact with lesions on the patient's skin.

A Case Report of Turner Syndrome Diagnosed at Age 61 Years.

Here, we describe a case of Turner syndrome first diagnosed at 61 years of age. The patient's chief complaint was general edema. A cardiologist was consulted, who performed echocardiogram and coronary heart computed tomography. Chromosomal analysis yielded inconclusive results for Turner syndrome. The patient's karyotype was 45,X[17]/46,X,psu idic(Y)(q11.23), and she was referred to a gynecologist a time span. The patient was nulliparous with no history of sexual contact. We performed a prophylactic gonadectomy, but no malignancy was detected pathologically.

Secondary syphilis mimicking psoriasis vulgaris on the buttock

Sir, Secondary syphilis is caused by Treponema pallidum, classically characterized by a diffuse, symmetric macular or papular eruption involving the entire trunk and extremities [1]. We, herein, describe a case of secondary syphilis mimicking psoriasis vulgaris in an unusual location and with specific histologic hallmarks. A 28-year-old homosexual male presented with asymptomatic, erythematous patches of the buttock, which were misdiagnosed as psoriasis vulgaris for one month. He reported a history of sexual contact with an anonymous male four months prior to presentation. A clinical examination revealed multiple, well-defined, erythematous, scaling patches on the buttock (Fig. 1a). He had no regional lymphadenopathy. Other mucocutaneous manifestations were undetectable.

Combined treatment modality including topical 20% fluorescein dye in the management of phthiriasis palpebrarum - A case series.

Purpose:To study the clinical presentations and outcomes of phthiriasis palpebrarum (PP) managed with combined treatment modality comprising of 20% fluorescein dye, mechanical removal of the ectoparasites, and topical application of antibiotic eye ointment with paraffin base.Methods:This is a prospective interventional noncomparative hospital-based series of 13 patients of PP. All the patients underwent local application of 20% fluorescein dye over the eyelashes and eyebrows of both the eyes followed by the mechanical removal of all the ectoparasites and trimming of the eyelashes from the base followed by application of ophthalmic ointment.Results:Mean age of the patients was 28 ± 22 years (range 3–60 Years). Out of the total of 13 patients, 11 patients (85%) were having bilateral involvement. The mean duration of symptoms in 11 patients (rest 2 were accidental findings) was 4 ± 3 weeks (range 1–10 weeks). Three patients (23%) had a history of sexual contact with possible parasite-infested partners. Four patients (31%) had additional parasites in the pubic area or torso. All the patients were completely parasite free at the end of 1 month. There was no infestation of the treating medical personnel from the patient. The average follow-up was 8 ± 5 months (range 3–21 months)Conclusion:Itching and irritation of the eyes were the most common presentations of PP. Combined treatment modality comprising of 20% fluorescein dye, mechanical removal of ectoparasites, and topical application of antibiotic eye ointment with paraffin base is effective in the management of PP.

HIV prevalence among men who have sex with men in Iran: A systematic review and meta-analysis.

Background: The need for informed policymaking highlights the importance of data on human immunodeficiency virus (HIV) prevalence on key populations. In this systematic review and meta-analysis, we aimed to provide an overview of HIV prevalence in men who have sex with men (MSM) in Iran. Methods: We searched literature published between January 2008 and December 2019 to identify studies reporting the prevalence of HIV infection or acquired immunodeficiency syndrome (AIDS) in a population of adult Iranian men with history of sexual contact with other men. We employed Metaprop command in Stata to pool proportions from different studies. Results: Among the 16 studies retrieved, 2 were performed on MSM population directly, 7 among people who inject drugs, 4 among prisoners, 2 among the homeless, and 1 among methamphetamine users. HIV prevalence was 7% (95% CI, 5%-10%) based on the meta-analysis, although noticeable heterogeneity existed because of target population, study year, and study location, which imposed limitations to provide a robust summary measure for the prevalence of HIV. Conclusion: There is a potential risk of observing a high prevalence of HIV in MSM that could hamper the results of various preventive strategies and their achievements in other subpopulations.

Condylomata Acuminata in Adolescent Girl 19th Years Old Successful with Multimodality Therapy and Combination with HPV Vaccination: A Case Report

Background: Condylomata acuminata (KA) or better known as genital warts disease is a genital area infectious disease caused by Human papilloma virus (HPV). The highest prevalence infection of the condylomata acuminata occurs during active sexual periods, namely age 17-33 years, with the peak occurring at the age of 20-24 years. Currently HPV 16 and 18 are known to cause malignancy in the genital and anogenital region including cervical cancer and anal cancer, while HPV 6 and 11 are the cause of 90% of condylomata acuminata. HPV is linked to the findings of 500,000 new cases of cervical cancer and 250,000 deaths from cervical cancer each year worldwide.1&#x0D; Case report: One case of condylomata acuminata in a 19-year-old adolescent girl with a major complaint of warts around her genitals that felt itchy and gradually getting bigger since 2 weeks ago. Patient was a student and unmarried. History of sexual contact with men with genito-genital without using condoms since 5 months ago. Venereological state : on the vulva and perineal there were multiple vegetations with verucose surfaces with the largest size 0.8 cm x 0.5 cm x 0.1 cm and the smallest size 0.2 cm x 0.2 cm x 0.1 cm. Acetowhite examination result was positive and PCR examination results found positive HPV types 6,11,16 and 18.&#x0D; Discussion: Patients are diagnosed to condylomata acuminata with a history of free sex at an early age. The condylomata acuminata experienced by patients was type 6,11,16 and 18. These types of 16 and 18 HPV are know to cause malignancy in the genital and anogenital region including cervical cancer and anal cancer.

Condylomata Acuminata in Adolescent Girl 19th Years Old Successful with Multimodality Therapy and Combination with HPV Vaccination: A Case Report

Background: Condylomata acuminata (KA) or better known as genital warts disease is a genital area infectious disease caused by Human papilloma virus (HPV). The highest prevalence infection of the condylomata acuminata occurs during active sexual periods, namely age 17-33 years, with the peak occurring at the age of 20-24 years. Currently HPV 16 and 18 are known to cause malignancy in the genital and anogenital region including cervical cancer and anal cancer, while HPV 6 and 11 are the cause of 90% of condylomata acuminata. HPV is linked to the findings of 500,000 new cases of cervical cancer and 250,000 deaths from cervical cancer each year worldwide.1&#x0D; Case report: One case of condylomata acuminata in a 19-year-old adolescent girl with a major complaint of warts around her genitals that felt itchy and gradually getting bigger since 2 weeks ago. Patient was a student and unmarried. History of sexual contact with men with genito-genital without using condoms since 5 months ago. Venereological state : on the vulva and perineal there were multiple vegetations with verucose surfaces with the largest size 0.8 cm x 0.5 cm x 0.1 cm and the smallest size 0.2 cm x 0.2 cm x 0.1 cm. Acetowhite examination result was positive and PCR examination results found positive HPV types 6,11,16 and 18.&#x0D; Discussion: Patients are diagnosed to condylomata acuminata with a history of free sex at an early age. The condylomata acuminata experienced by patients was type 6,11,16 and 18. These types of 16 and 18 HPV are know to cause malignancy in the genital and anogenital region including cervical cancer and anal cancer.

Opioid-Related Disparities in Sexual Minority Youth, 2017

In light of the opioid epidemic, it is essential to understand which subgroups of youth are at elevated risk for opioid use. Sexual minority groups have increased rates of substance use compared to heterosexual youth. Our study aims to examine the prevalence of both prescription opioid misuse and heroin use in adolescents. We then examine odds of prescription opioid misuse and heroin use adjusting for common covariates. Using 2017 Youth Risk Behavior Surveillance System data, we examined lifetime odds of prescription opioid misuse and heroin use among sexual minority youth as defined by sexual identity and sexual behavior. We used logistic regression adjusting for age, sex, and race. 28.5% of gay/lesbian and 25.1% of bisexual youth reported misuse compared to 12.5% of heterosexual youth. Nearly 1 in 10 gay/lesbian youth reported a history of heroin use compared to 4.1% of bisexual and 1.1% of heterosexual young people. Among those who reported having a history of sexual contact, those with same sex contact and sexual contact with both sexes had elevated odds of lifetime heroin use compared to those with a history of opposite sex contact only (aOR: 3.77; 95% CI: 1.68, 8.44 and aOR: 7.44; 95% CI: 4.59, 12.06, respectively). We demonstrated preliminary evidence sexual minority youth have significant opioid-related health disparities with greater odds of lifetime prescription opioid misuse and heroin use. As early exposure to opioids is associated with greater risk for developing an opioid use disorder and increased opioid-morbidity and mortality, it is critical that providers recognize and incorporate the unique needs for sexual minority youth into traditional treatment and prevention models.

1997 The Usefulness of Uterine Manipulation Simulation Among Ob-Gyn Residents as Bottom Person Prior to Assisting a Total Laparoscopic Hysterectomy: A Quirino Memorial Medical Center Experience

Study Objective To determine the usefulness of uterine manipulation in a simulator prior to assisting as bottom person during total laparoscopic hysterectomies (TLH) among OB-GYN residents of Quirino Memorial Medical Center. Design Single-blinded Randomized Controlled Trial. Setting Quirino Memorial Medical Center with Residency Training in OB-GYN Patients or Participants Thirty-three obstetrician-gynecologic residents with no background on laparoscopy but assisting and performing gynecological laparotomy cases. Patients were female with age ranged of 20 to 55 years old, history of sexual contact, scheduled for elective total laparoscopic hysterectomy and adnexectomy for benign uterine or ovarian pathologies. Interventions The residents were randomly grouped into two. Group A consisted of sixteen residents who underwent uterine manipulation training using the pelvic trainer box and Group B consisted of seventeen residents who did not undergo training. Group A was given PST which were performed in 5 repetitions in one session. One set of tasks commanded to perform in this order were antevert uterus, uterus to the patient's left, uterus to the patient's right, push uterus cephalad, pull uterus caudally and retrovert uterus. One session consisted of 5 sets. After a week, both groups were asked to scrub-in on actual procedure with the same instructor commanding the tasks and recording the time to perform the tasks. Measurements and Main Results Group A performed the procedure-specific tasks correctly with a significantly shorter time than Group B (p-value of 0.000). The senior residents did not perform the PST better than the junior residents (correlation coefficient was significant with p-value of 0.023 and a negative correlation coefficient of -0.200, this means that as the negative time difference to perform from the first to the fifth specific tasks increases, the actual time decreases). Conclusion We have shown that uterine manipulation exercises in the pelvic trainer box is effective in the proper performance of residents as bottom person for uterine manipulation during TLH.

Pharyngeal Chlamydia and gonorrhea: a hidden problem.

In this study we assessed the prevalence and predictors of pharyngeal infections due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in a cohort of patients attending an STI Clinic. From January 2016 to September 2018, 893 patients attending the STI Clinic of St Orsola-Malpighi Hospital (Bologna, Italy) and reporting unprotected oral sex were enrolled. A pharyngeal swab for the molecular detection of CT and NG was collected from each patient. Positive CT samples were further genotyped by an omp1 gene PCR. A total of 134 cases of gonorrhea (15%) and 34 chlamydial infections (3.8%) were detected in the pharyngeal site, with no significant differences between males (all men who have sex with men [MSM]) and females. More than 90% of the infections were completely asymptomatic, suggesting that symptoms were not predictors of a pharyngeal infection ( P = 0.7). On the contrary, a history of sexual contacts with a partner positive for CT and/or NG ( P &lt; 0.0001), HIV positivity ( P = 0.01), and the presence of concurrent genital and/or rectal infections ( P &lt; 0.0001) were significantly associated with CT/NG pharyngeal infections. Pharyngeal lymphogranuloma venereum cases were rare (prevalence: 0.4%), asymptomatic, and only found in MSM. Better knowledge about pharyngeal CT/NG infections could help to set up effective strategies for their prevention.

Magnitude and risk factors for cytomegalovirus infection among voluntary blood donors at National Blood Bank, Addis Ababa Ethiopia

BackgroundHuman cytomegalovirus (CMV) is a ubiquitous agent that commonly infects individuals from diverse geographical and socio‐economic backgrounds. The infection is a major concern among some populations of blood transfusion recipients, especially neonates and immune‐compromised patients. Information on the burden of the infection is very scarce, and to the best of our knowledge, there is no documented evidence regarding its distribution and risk factors among blood donors in Ethiopia. Therefore, this study assesses the magnitude and risk factors for cytomegalovirus infection among voluntary blood donors at National Blood Bank, Addis Ababa Ethiopia.MethodsIn this cross‐sectional study, a consecutive sampling of donors was used to select 605 participants. Data were collected by using a self‐administered structured questionnaire, and blood samples were collected for laboratory tests following standard blood centre SOPs. Serum samples were assayed for CMV IgG and CMV IgM using enzyme‐linked immunosorbent assay (ELISA). Descriptive statistical techniques were used to assess the distribution, and chi‐square test was performed to identify associated factors at P values &lt;0·05.ResultOf 605 voluntary blood donors included in the study, 458 (75·7%) were males. Mean ± SD age of the study participants was 30·3 ± 8·37 years with range between 18 and 63 years. There were 571 (94·4%) CMV IgG and 24 (4·0%) CMV IgM positivity donors. Transfusion‐transmissible infections (TTIs) positivity rate was 2 (0·3%) for HIV, 6 (1·0%) for HBsAg and 3 (0·5%) for syphilis. There were no statically significant associations between the dependent and independent variables.Conclusion and RecommendationThe magnitude of CMV is high among voluntary blood donors, and it has no association with transfusion and sexual contact history of donors. Therefore, we recommend CMV screening should be considered while transfusing immunosuppressed individuals, investigation of risk‐mitigation strategies, such as universal leucoreduction versus selective bed‐side leucoreduction should be considered.

P180 Unusual causes of genital ulceration presenting to genitourinary medicine clinic – a case series

IntroductionGenital ulceration presents frequently at GUM clinics, with herpes simplex (HSV) infection a common aetiology. A diagnosis of HSV is distressing with possible implications for relationships and future pregnancies. It is therefore important to consider other causes if atypical presentation or negative HSV PCR from area of active ulceration.MethodCase review of uncommon aetiologies of ulceration.ResultsCase 1: 25 year old. Prodromal sore throat and flu-like symptoms. Examination revealed deep ulcers on vulva and oral mucosa without eye or skin involvement. CRP 120, ESR 80, ASOT titre 400, negative autoimmune screen, monospot negative. Developed anterior uveitis and erythema nodosum 24 hours later. Diagnosed with Behcet’s disease requiring prednisolone and mycophenolate mofitil.Case 2: 28 year old. Prodromal sore throat and headache. Sexual history atypical for HSV. Known Graves’ disease, on propylthiouracil. On examination, patient looked unwell. Shallow vulval ulceration noted. Neutrophils 0.1, ESR 31. Diagnosed with apthous ulceration secondary to neutropenia and admitted for neutropenic-sepsis treatment. Required thyroidectomy with pathology revealing papillary carcinoma.Case 3: 13 year old referred by SARC. No history of sexual contact or features of child sexual exploitation. Prodromal flu-like illness. Of note, mother Influenza A positive.No response to empirical acyclovir. HSV PCR negative. Nasopharyngeal swab confirmed Influenza A. Case subsequently closed with SARC and Social Services.DiscussionThis case series highlights less common but important causes of genital ulceration. Full systemic history and clinical assessment remains essential in those where alternate diagnoses to HSV are being considered.

Transmission of Human Papillomavirus Without Sexual Contact

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. There are four common HPV strains: 6, 11, 16, and 18. Strains 6 and 11 cause genital warts, while strains 16 and 18 are asymptomatic in males and may progress to cervical cancer in females. Although uncommon, a small percentage of males and females have been diagnosed with HPV without previous sexual contact. In this case report, we discuss a case conducted on a 15-year-old South Asian male who contracted an unknown low-risk strain of HPV with no history of sexual contact. HPV is highly infectious, however in the majority of cases the immune system is able to clear the infection, preventing the appearance of genital warts. In cases such as these, it is important to help control the spread of viral infections. Several determinants of health are involved in and affect the transmission of HPV, including income and social status, social support networks, education and literacy, culture, social and physical environments, and health services. To aid in the prevention of HPV, sexual education should be taught at early ages within schools and the Gardasil® vaccine should be administered to both females and males at an early age to reduce the burden of disease and the incidence of HPV.

P015 BASHH MSM SIG Clinic Survey; Testing and vaccination

Background/introduction/Aim(s)/objectives Our aim was to investigate practice across the UK in aspects of the clinical care of MSM who are HIV negative or of unknown status where evidence is absent, or guidance varies. Methods An online questionnaire was drafted by the MSM SIG, tested by BASHH CGC members, revised and distributed to BASHH, FSRH members and CSP audit sites for one month to 31 st October 2015. Results There were 149 complete responses. Only 40% of respondents had a written protocol or policy on recall for HIV/STI testing of which 23% had an automated system to recall patients for testing. 50% routinely test for HIV at syphilis follow up. 90% of respondents report using both NAAT and culture for GC in contacts of gonorrhoea and 20% use both in asymptomatic men. 33% test anatomical sites according to sexual contact history. Self-taken throat (rectal) swabs for GC/Ct NAAT were used never by 26% (3%) and routinely in 18% (22.5%). 100%’routinely test MSM for Hepatitis B exposure and over 50% for’Hepatitis C. 78% routinely check HepB sAb levels following vaccination. 79% routinely recall men for Hepatitis B vaccination. Discussion/conclusion There is evidence of variation in clinical practice between clinics in the UK, not all of which can be explained by variations in local epidemiology and some of which has significant cost implications. Results have generated debate in the MSM SIG on the rationale for local policies.

Patterns of Presentation in Gonococcal Urethritis and Assessment of Antibiotic Sensitivity in Gonorrhea

Objective: To see various features of Gononcoccal Urethritis and assess the results of Gram stain and culture tests in cases of Gonorrhea and to see the antibiotic resistance pattern in them, in our local population (PNS Shifa hospital Karachi, Pakistan). Design: Prospective case series. Place and duration of study: Skin department of PNS Shifa Hospital Karachi, Pakistan. June 2004 to December 2007. Materials and methods: The study was carried out in the outpatient dermatology department of PNS Shifa hospital Karachi during the period from June 2004 to Dec 2007. It was a prospective study. One hundred clinically suspected patients of Gonococcal urethritis were included in the study. Detailed history including history of sexual contact was taken. General and systemic physical examination was carried out in all the patients. Dermatological examination including examination of external genitalia was also done. In all these patients following investigations were carried out. Urine complete examination ,complete blood counts, pus sample was collected from external urethral meatus by two sterile inoculating loops on to a clean glass slide for Gram staining which was seen under the microscope for the presence of gram-negative diplococci. The other loop was inoculated onto chocolate agar plate and was incubated in an atmosphere of 5% CO2 at 37oC for 24-48 h. The growths obtained were identified with colony morphology, Gram staining, oxidase reaction and rapid sugar fermentation. The Gonococci isolated were tested for antibiotic sensitivity using modified Kerby buer technique. The antibiotics included Penicillin G, Tetracycline, Cefotaxime, Cefuroxime, Ceftriaxone and Ciprofloxacin. HIV test was done in all patients. The results of two types of tests and their merits and demerits were assessed and compared. Results: A total of 100 patients having urethral discharge and dysuria were studied. All the patients were males. The ages varied from 20 to 40 years, the average being 29.2 years+5.8 years. History of illicit sexual exposure was elicited in 43 (43%) patients. The duration of period of symptoms ranged between 4 and 30 days with a mean of 12.8 days and a median of 12 days. The patients with gonorrhea presented with purulent discharge in 66 (66%) cases, and dysuria in 49 (49%) cases. No case had anal or oral symptoms. Examination showed a reddened external urethral meatus in 53(53%) cases. Eighty seven (87%) cases showed intracellular diplococci on direct microscopy of Gram stained smear. Sixty-two (62%) cases showed growth of gonococci on culture of urethral pus. No case was seen to be HIV positive. Tetracycline resistance was seen in 34(55%) strains. Penicillin resistance was seen in 25 (41%) strains of Neisseria Gonorrhea. Five strains (11.5%) showed resistance to Ciprofloxacin. No resistance was seen with Cephalosporins. Conclusion: Gram staining and culture for Neisseria Gonorrhea are both useful diagnostic tests for Gonococcal urethritis. Drug resistance of Neisseria Gonorrhea is high with various antibiotics except for Cephalosporins stressing the need for culture based therapy and enthusiastic prevention of Gonorrhea in our society.

Knowledge and practices related to reproductive health amongst adolescent girls

Objective: To assess knowledge and practices related to menstruation and reproductive health amongst college going adolescent girls. Materials and Methods: Cross-sectional study done on 323 adolescent girls admitted in the year 2012 to professional colleges belonging to the health sciences faculty of a private university in Pune, India, using self-administered proforma. Results: Mean age of onset of menarche was 13.35 years. Many girls (86.65%) had knowledge of menstruation prior to menarche. For 68% of girls, mother was a source of menstrual information. Half of the girls reported some form of restriction in activities during menstruation due to religious reasons. 11% girls suffered from some form of reproductive tract infections (RTIs). Practices related to menstruation revealed that cloth piece is used for menstrual protection by 3% of girls. Soaked sanitary pads were disposed sanitarily by 96% of girls. Adolescent of medical faculty had significantly more knowledge than nursing faculty adolescents regarding emergency contraceptives (P < 0.05). Only four girls reported a history of sexual contact, of these, three were aware of emergency contraceptives, while one used them to prevent pregnancy. Conclusions: Adolescent girls received knowledge of menstruation prior to menarche from their mothers. Restriction in activity during menstruation due to religious reasons is practiced by many girls. Sanitary pad was used by almost all girls, and all disposed the same in a sanitary manner. More than half of the girls were aware about emergency contraceptives. Prevalence of RTI was found to be low and very few girls reported history of sexual exposure.

Molecular analysis of the interspousal transmission of hepatitis B virus in two Japanese patients who acquired fulminant hepatitis B after 50 and 49 years of marriage

A 71-year-old (C1I) and 69-year-old (C2I) Japanese female contracted fulminant hepatitis B after 50 and 49 years of marriage, respectively. Both index cases exhibited high levels of anti-HBc IgM antibodies (24.2 and 31.5 S/CO, respectively), suggestive of acute hepatitis B virus (HBV) infection, although they had no discernible risk factors for HBV infection, except for chronically HBV-infected spouses with detectable HBV DNA (3.3 log copies/ml [C1S: 72-year-old] and 7.2 log copies/ml [C2S: 71-year-old]). The HBV genotype/subgenotype was identical in each couple (B/B1 or C/C2). The HBV isolates from the index cases and spouses shared a nucleotide sequence identity of 99.5% and 99.7%, respectively, over the entire genome, and these four isolates had the highest nucleotide sequence identity of only 97% to HBV isolates deposited in DNA databases. Phylogenetic trees confirmed a close relationship of the HBV isolates between C1I and C1S and between C2I and C2S, supported by a high bootstrap value of 100% within each couple, indicating the transfer of HBV infection between spouses. These four isolates shared a precore mutation of G1896A known to be associated with fulminant hepatitis B. Although the history of sexual contact within a reasonable incubation period was obscure for one stable, monogamous couple (C1I and C1S), the other couple had a monogamous sexual relationship within six months prior to disease onset. This study indicates that two elderly Japanese patients with fulminant hepatitis B acquired HBV infection via interspousal (most likely sexual) transmission during long-lasting marriages.