Infected Male Partners Research Articles

Voluntary Medical Male Circumcision for HIV Prevention: a Global Overview.

With the promise of HIV prevention, there has been a scale-up of voluntary medical male circumcision (VMMC) in high HIV incidence/low circumcision prevalence nations worldwide. Nonetheless, debates over the implementation and the effectiveness and safety of the VMMC in real-world settings persist. We revisit the role of VMMC in HIV prevention to inform health professionals, policymakers, and advocates or opponents in this new era. There has been substantial progress on VMMC scale-up to date, but this has varied considerably by region. The evidence of solid and direct protection of VMMC is available for heterosexual men and older adolescent boys in sub-Saharan Africa. The protective effect in men who have sex with men is suggested by systematic reviews but is not confirmed by clinical trials. Sexual partners, including women, likely benefit indirectly from the increased VMMC coverage through a decreased risk of exposure to infected male partners. Fortunately, the preponderance of studies does not suggest higher sexual risk behaviors among circumcised men, so-called risk compensation. VMMC requires health systems strengthening and continued promulgation of other evidence-based HIV prevention strategies to be successful. Health authorities in high HIV incidence areas that have low circumcision coverage should implement VMMC within a context of complementary biomedical and behavioral prevention strategies.

Male-to-Female Presumed Transmission of Toxoplasmosis Between Sexual Partners.

Toxoplasmosis is one of the most widespread human parasitoses in developed countries. Sexual transmission has been confirmed in several animal species, and indirect evidence suggests it may occur in humans. We compared the seropositivity to Toxoplasma gondii in couples who visited the Center for Assisted Reproduction in Prague from June 2016 to June 2018 and analyzed various risk factors including the serological status of sexual partner. By comparing the risk factors in men and women, we tested the hypothesis of male-to-female sexual transmission of toxoplasmosis. The prevalence of toxoplasmosis in women with infected male partners (25.6%; n=156) was higher than in women with uninfected male partners (18.2%; n=477; P=0.045). Therefore, a partner's seropositivity seems to be a risk factor for infection in women (n=593; prevalence ratio=1.418; P=0.045) but not in men (n=573; prevalence ratio=1.058; P=0.816). Our results support the hypothesis of the sexual transmission of T. gondii from men to women. The risk may seem relatively low, but transmission can occur during unprotected sexual intercourse, which may be at the time of conception. Because of the risk of congenital toxoplasmosis, a lower risk of infection than that observed in our study can represent a serious health problem.

Male-to-Female Transmission of Toxoplasmosis Between Sexual Partners

Background: Toxoplasmosis is one of the most widespread human parasitoses in the developed countries. Toxoplasma gondii has been found in the ejaculate of various animals, including human. Sexual transmission of this zoonosis has been confirmed in several animal species but not in human. Nevertheless, a large part of infections in mothers of children with congenital toxoplasmosis cannot be explained by contact with any currently known risk factor, while high prevalence of toxoplasmosis has been observed in the fathers of children with this diagnosis. This indirect evidence supports the hypothesis of sexual transmission of toxoplasmosis in humans. Methods: We compared the prevalence of toxoplasmosis in couples and analysed various risk factors for toxoplasmosis including the infection status of sexual partner. By comparing the risk factors for Toxoplasma infection in men and women, we tested the hypothesis of man-to-woman sexual transmission of toxoplasmosis. Findings The prevalence of toxoplasmosis in women with infected male partners (25·6%; n=156) was higher than the prevalence in women with uninfected male partners (18·2%; n=477; p=0·023). Partner's infection therefore seems to be a risk factor for infection in women (n=593; odd ratio=1·602; p=0·022) but not in men (n=573; odds ratio=1·064; p=0·816). Interpretation: Our results support the hypothesis of sexual transmission of toxoplasmosis from men to women. The risk may seem relatively low, but transmission can occur during unprotected sexual intercourse, which may be the time of conception. Due to the risk of congenital toxoplasmosis, even a lower risk of infection than that observed in our study can represent a serious public health problem. Funding Statement: Charles University Grant Agency (number 104218), Czech Science Foundation Grant (number 18-13692S), Charles University Research Centre program (number 204056) and RVO-VFN64165 from the Ministry of Health of the Czech Republic. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Informed consent was obtained from all participants. Blood samples for serological testing for toxoplasmosis were taken during a routine examination. This research has been repeatedly approved by Ethics Committee of General University Hospital in Prague (No. 384/16; 92/17) and by Institutional review board of Faculty of Science, Charles University (No. 2015/29).

DNA fragmentation index and human papilloma virus in males with previous assisted reproductive technology failures.

This study was designed to evaluate the prevalence of Human Papilloma Virus (HPV) in semen and document the cycle outcomes in couples with previous intra-cytoplasmic sperm injection (ICSI) failures. One hundred and seventeen couples with at least two ICSI attempts were included in the study. HPV infection in semen and DNA fragmentation in samples were analyzed by commercially available kits. The percentage of spermatozoa with fragmented DNA (DNA fragmentation index: DFI) was determined during fluorescence microscopic examination as previously described. The cycle outcomes of couples with or without HPV infected male partners were recorded. According to our results, the prevalence of HPV was 7.7% in asymptomatic males with at least two previous ICSI failures. The increased DFI (>30%) was observed in 82.9% of the cases. In HPV-positive cases significantly lower number of good quality embryos were obtained. The implantation and pregnancy rates were similar in infected and non-infected males (p>0.05). The early miscarriage rate was slightly higher in HPV- positive group (33% vs. 10%, p>0.05). In cases with previous ICSI failures, the prevalence of HPV infection in semen is not higher than previously reported infertile populations. The reproductive outcome might be impaired in HPV-positive semen due to lower number of good quality embryos, which needs to be clarified by further large population-based studies.

Hidden in plain sight: Making a case for heterosexual Black college women being identified as a high-risk population for HIV infection.

Black emerging adult women (ages 18-25 years) are among the fastest growing demographics of HIV infection, second only to men who have sex with men. Black women account for nine of 10 new HIV cases, whereas 84% of these cases are reported to be from heterosexual contact with infected male partners. Heterosexual Black college women (BCW) have been nearly ignored in the HIV literature despite having shared (e.g., risky alcohol use, multiple and concurrent sex partnerships, and inconsistent condom use) and unique (e.g., segregating dating practices and high sexually transmitted infection rates) risk factors when compared with broader college student demographics. This conceptual paper uses a multiple risk factor framework to underscore shared and unique risk factors that may work to increase the potential HIV infection risk burden in this understudied population. Prevention and intervention implications and recommendations for future research that have potential to impact the ways in which colleges, universities, and researchers engage this population are presented. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The implications of male human papilloma virus infection in couples seeking assisted reproduction technologies.

Human papilloma virus (HPV) is one of the most common viral sexually-transmitted diseases worldwide. The prevalence of HPV is higher in infertile males when compared with fertile men and ranges between 10 and 35.7% in men affected by unexplained infertility. HPV can bind to spermatozoa and can potentially be transferred to fertilized oocytes. Viral detection in blastocysts and trophoblastic cells is associated with impaired embryo development and poor pregnancy outcomes. Nevertheless, attempts to eliminate HPV-DNA from sperm samples through routine washing techniques have failed. In assisted reproduction technologies (ART), intracytoplasmic sperm injection involves no natural selection of the sperm cell, which means that these procedures have a plausible risk of injecting sperm containing HPV. The possible detrimental effects of HPV on ART in couples with infected male partners are summarized in this review.

Hepatitis B virus infection on male partner has negative impact on in-vitro fertilization

It is common to see HBV-infected couple seeking for fertility treatment in reproductive medical centers. The effect of hepatitis B virus (HBV) infection on pregnancy outcome after In Vitro Fertilization (IVF) treatment has been a controversy. The study aims this was to evaluate the outcome of in vitro fertilization in couples with the male partner being HBsAg-seropositive. A retrospective analytic study was in HBV-infected and non-HBV infected male partner groups who have been treated with in vitro fertilization (IVF) from October 2016 until May 2017 in HFC IVF Center. From 101 couples, 17 (16.83%) male partners were HBV seropositive. They had similar semen parameters compared to thenon-HBV infected group. Couples with the male partner being HBsAg-seropositive had significantly lower fertilized oocytes and cleaved embryos compared to thenon-HBV infected group. We also found lower clinical pregnancy rate in infected male partner group compared to control group (23.52% vs 51% respectively). Statistically, there was a significant difference in clinical pregnancy rate between HBV-infected group and control group (p<0.05). An hbv-infected male partner may lower the clinical pregnancy rate in couple undergoing IVF treatment. Therefore, the mechanism of impact of HBV infection on IVF outcome needs further exploration.

Hepatitis B virus infection status and infertility causes in couples seeking fertility treatment-Indicator of impaired immune response?

The relationship between hepatitis B (HBV) infection in infertile couples seeking in vitro fertilization (IVF) treatment and infertility causes is unknown. A total of 831 infertile couples attending our unit seeking IVF during January to December 2015 were recruited. HBV infection was found in 6.3% and 7.3% of female and male partners, respectively, and infection in one or both partners was associated with less primary infertility (44.2% vs 55.1%, P=.038). Infected female partners had increased tubal (69.2% vs 43.2%, P<.001) and uterine (13.7% vs 3.1%, P<.001) causes and reduced idiopathic infertility, while infected male partners were associated with increased tubal (62.3% vs 43.4%, P=.004) causes and reduced endometriosis (62.3% vs 73.9%, P=.050). Our results suggest HBV infection in either partner was associated with tubal infertility. HBV infection in either partner probably increases the risk of pelvic infection in female partner through impaired immune response to sexually transmitted infections, with consequent tubal damage and infertility.

Vulval Tuberculosis Mimicking Malignancy – A Diagnostic Dilemma

Abstract Extrapulmonary tuberculosis can occur in conjunction with pulmonary focus or in isolation. Tuberculosis of vulva and vagina is rare and is seen in only 1% of genital TB that usually occurs in women of reproductive age. We report a case of postmenopausal woman with isolated vulval tuberculous lesion that clinically mimicked malignancy. Keywords Vulval tuberculosis; Vulval malignancy; Cauliflower growth. Case presentation A 72 years old postmenopausal woman was referred with the diagnosis of vulval malignancy, she presented with 4x3 cms irregular friable cauliflower growth that bleeds on touch, present on lower one third of labia majora and minora (Figure 1). Although clinically it mimicked vulval malignancy but punch biopsy histopathological examination showed granuloma consisting of clusters of epitheloid and langhans cells, suggestive of tuberculosis. She was started on antitubercular drugs and after 2 months the lesion regressed by 50% and after 4 months of completion of ATT normal anatomy of vulva was restored. Discussion Tuberculosis of vulva and vagina is rare, seen in only 1% of genital TB and usually occurs in women of reproductive age [1]. Vulval TB usually is the extrapulmonay manifestation of primary focus at lungs but venereal transmission also can occur from infected male partner, harbouring tuberculous epididymo-orchitis [2]. It begins as a nodule which breaks down and forms irregular ragged ulcer. It may have varied presentation and mimics sexually transmitted diseases or malignancy [3]. Antitubercular drugs causes full regression of ulcer and histopathological confirmation is a necessity before radical surgery

The Gonococcal Transcriptome during Infection of the Lower Genital Tract in Women.

Gonorrhea is a highly prevalent disease resulting in significant morbidity worldwide, with an estimated 106 cases reported annually. Neisseria gonorrhoeae, the causative agent of gonorrhea, colonizes and infects the human genital tract and often evades host immune mechanisms until successful antibiotic treatment is used. The alarming increase in antibiotic-resistant strains of N. gonorrhoeae, the often asymptomatic nature of this disease in women and the lack of a vaccine directed at crucial virulence determinants have prompted us to perform transcriptome analysis to understand gonococcal gene expression patterns during natural infection. We sequenced RNA extracted from cervico-vaginal lavage samples collected from women recently exposed to infected male partners and determined the complete N. gonorrhoeae transcriptome during infection of the lower genital tract in women. On average, 3.19% of total RNA isolated from female samples aligned to the N. gonorrhoeae NCCP11945 genome and 1750 gonococcal ORFs (65% of all protein-coding genes) were transcribed. High expression in vivo was observed in genes encoding antimicrobial efflux pumps, iron response, phage production, pilin structure, outer membrane structures and hypothetical proteins. A parallel analysis was performed using the same strains grown in vitro in a chemically defined media (CDM). A total of 140 genes were increased in expression during natural infection compared to growth in CDM, and 165 genes were decreased in expression. Large differences were found in gene expression profiles under each condition, particularly with genes involved in DNA and RNA processing, iron, transposase, pilin and lipoproteins. We specifically interrogated genes encoding DNA binding regulators and iron-scavenging proteins, and identified increased expression of several iron-regulated genes, including tbpAB and fbpAB, during infection in women as compared to growth in vitro, suggesting that during infection of the genital tract in women, the gonococcus is exposed to an iron deplete environment. Collectively, we demonstrate that a large portion of the gonococcal genome is expressed and regulated during mucosal infection including genes involved in regulatory functions and iron scavenging.

Hepatitis B: An Overlooked STI, a Silent Threat, a Global Disease

In the Western world, exposure to hepatitis B virus (HBV) occurs in adulthood via sexual or percutaneous transmission. One-third develop acute hepatitis, while half undergo a subclinical course. Both groups acquire antibodies. The remaining 5-10% of adults develop chronic HBV, the majority of whom are immunocompromised (HIV, chronic renal dialysis or immunosuppression). In endemic regions, primary infection occurs perinatally. Nearly 90% of neonates become chronic HBV carriers. While neonates are at high risk in endemic regions, sexual exposure remains the most common risk factor in the United States. Populations at risk are those with infected partners, multiple partners, or same-sex male partners. Untreated, 25-40% of chronically infected individuals develop cirrhosis and hepatocellular carcinoma (HCC). Following the discovery of HBV, Blumberg also developed an HBV vaccine using HBV-infected human plasma. Produced during the AIDS epidemic, while highly efficacious, recombinant vaccine replaced plasma because of concern the plasma could be coinfected. The 1980s yielded another triumph in the fight against HBV. Again, as HIV came to the forefront of public and political attention, research began in the field of anti-HIV drugs. The anti-HBV drugs used today, starting in 1998, were actually discovered to be efficacious in trials developed for HIV patients. HIV-patients coinfected with HBV showed regression of HBV while on HIV therapy. Currently, these therapies delay disease progression and reduce the incidence of HCC. Now armed with both preventative and therapeutic measures for HBV, coupled with increased awareness and education, the eradication of HBV as we move into the 21 st century seems within grasp.

Association of Human Mannose Receptor in Sexual Transmission of Human Immunodeficiency Virus in Serodiscordant Couples

HIV binds specifically to the human mannose receptor (hMR) on vaginal epithelial cells that are devoid of a conventional CD4 receptor. HIV binding to hMR on vaginal epithelial cells induces the production of matrix metalloproteinase 9 (MMP9) leading to degradation of the extracellular matrix, which may increase the risk of HIV entry into vaginal epithelial cells and further transmission into distal cells. Immunofluorescent localization of hMR on vaginal epithelial cells of seronegative females from the general population included the control group (n=52) and seronegative females from serodiscordant couples. There was PCR amplification of DNA from peripheral blood mononuclear cells (PBMCs) of the serodiscordant females for the CCR5 gene flanking the CCR5-Δ32 region; PCR amplification and sequencing of the C2-V3 region of HIV variants in PBMCs and sperm of the infected male partners of the serodiscordant couples; and the presence of hMR on 0-11% of the vaginal epithelial cells of seronegative females (n=39) from serodiscordant couples and 90-95% that of a control group of females (n=52). Nine of these serodiscordant females did not show a CCR5-Δ32 deletion. The translated amino acid sequence of the C2-V3 region of the env gene of HIV-1C in PBMCs (n=9) and sperm (n=5) of the male partners showed the presence of distinct variants and the variation in PBMCs and sperm of serodiscordant males was almost similar to that of infected males from concordant couples. The presence of hMR in a smaller number of vaginal epithelial cells of serodiscordant females prevented binding and HIV entry into these cells and therefore prevented sexual transmission of HIV.

Carrageenan-Based Gel Retains Limited Anti-HIV-1 Activity 8–24 Hours After Vaginal Application by HIV-Infected Thai Women Enrolled in a Phase I Safety Trial

Carrageenan-Based Gel Retains Limited Anti-HIV-1 Activity 8–24 Hours After Vaginal Application by HIV-Infected Thai Women Enrolled in a Phase I Safety Trial

P1-S5.25 Acyclovir and transmission of HSV-2 from HSV-2/HIV-1 dually infected persons

BackgroundDaily suppressive therapy with valacyclovir reduces the risk of sexual transmission of HSV-2 in healthy HSV-2 serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons who...

P1-S5.02 Towards more robust estimates of the per sex act transmission probability of Chlamydia trachomatis

BackgroundEstimating the per sex act transmission probability of Chlamydia trachomatis is necessary to assess an individual's risk of infection and re-infection after sexual contacts with chlamydia-positive partners. Katz (1992, Stat...

Handheld Computers to Run ACASI to Assess HIV Risk and Deliver Tailored Soap Opera Video Feedback

The majority of all adolescent and young adult women (90%) with HIV were infected by unprotected sex with an infected male partner (Centers for Disease Control and Prevention [CDC], 2010b). As of 2008, the epidemic had disproportionately affected Black women who were 14% of the population of women in the United States but comprised 67% of women with HIV infection. It is estimated that in a lifetime, 1 in 30 Black women will be infected with HIV (CDC, 2010a). Innovative approaches to reduce sexual transmission of HIV to this population are needed.

The Role of Estradiol and Progesterone in Mucosal HIV-1 Infection, Transmission and Pathogenesis

Heterosexual transmission of the human immunodeficiency virus type-1 (HIV-1) to women occurs after exposure of the mucosal surfaces of the female reproductive tract (FRT) to cell-free virus or to HIV-1 infected cells present in the seminal fluid of an infected male partner. However, exposure to virus at this site does not always result in transmission of HIV-1, indicating that the local microenvironment in the FRT at the time of viral exposure may influence a womans susceptibility to infection. Cleary, the sex steroid hormones, estradiol and progesterone, play an important role in the FRT. Although the primary function of these hormones is to regulate the reproductive status of a woman, they also exert profound effects on the subsets of immune cells in the FRT as well as on their phenotype and functional activity. In addition, estradiol and progesterone regulate the local cytokine and chemokine milieu by influencing the activation state of immune cells. Fluctuations in estradiol and progesterone levels in the FRT regulate expression of HIV-1 receptors CD4 and galactosyl ceramide (Gal-Cer), as well as HIV-1 co-receptors CCR5 and CXCR4. Moreover, these hormones control the development of leukocyte aggregates in the FRT that contain T cells and macrophages, resulting in foci of potential target cells for HIV-1 infection. Estradiol has also been shown to enhance HIV-1 transcription from infected cells, thereby increasing levels of viral shedding from the genital tract. In sum, these steroid hormones serve to alter a womans susceptibility to HIV-1 infection after exposure to virus in the genital tract. Keywords: HIV-1, ectocervix, estradiol, progesterone, steroid hormone, mucosal immunology, Mucosal HIV-1 Infection, Heterosexual transmission, human immunodeficiency virus type-1, female reproductive tract, HIV-1 infected cells, sex steroid hormones, cytokine, chemokine milieu, progesterone levels, HIV-1 receptors CD4, galactosyl ceramide, HIV-1 co-receptors, CXCR4, T cells, HIV-1 transcription, steroid hormones, heterosexual intercourse, highly active antiretroviral therapy, cervicovaginal fluid, genital mucosa, chronic inflammation, lamina propria, GalC, endometrial glands, R5 tropic strains, urethra, epididymal epithelium, columnar epithelium, cytokine Interleukin-6, pro-inflammatory cytokine, IL-1, IL-6, blood mononuclear cells, cervical biopsies, Toll-like receptors, pathogen associated molecular patterns, secretory leukocyte peptidase, macrophage inflammatory, uterine-derived natural killer, chemokine ligand-12

A Randomized Controlled Trial of Partner Notification Methods for Prevention of Trichomoniasis in Women

Trichomoniasis is associated with adverse pregnancy outcomes and increased risk for human immunodeficiency virus. Males are usually asymptomatic, and thus there is heavy reliance on partner notification for identifying infected male partners. The usual approach is partner referral but it is estimated that only a minority of men seek care. We conducted a randomized trial to compare the effectiveness of 3 methods of partner notification. Women were randomized to self-referral of partners (PR), partner-delivered therapy (PDPT), or public health disease intervention (DIS) locating partners and delivering medication in the field, if needed. Test-of-cure visits were conducted at 5 to 9 days after enrollment. Repeat infections at 1 and 3 months of follow-up were the measure of effectiveness. A total of 484 women were randomized. Initial cure rates were 95.3%. At the 1- and 3-month follow-up visits, there was no significant difference in repeat infection rates when PDPT or DIS were compared to the reference of PR. However, when PDPT was compared to DIS or PR/DIS combined, at 1 month the PDPT group had a lower repeat infection rate (5.8 vs. 15% and 5.8 vs. 12.5%, respectively). Of these, 80% of women randomized to PDPT reported delivering medication and 89% thought it likely that partners took the medication. No serious adverse events were reported. PDPT for trichomoniasis was well accepted and safe in this study. Rates of repeat infection in women in this intervention were lower than those in the DIS arm and DIS/PR arm combined although when compared directly to PR there was no significant difference.

Pregnancy and HIV Infection in Young Women in North Carolina

We described young women in North Carolina (NC) who were pregnant at the time of diagnosis with human immunodeficiency virus (HIV) infection to identify an at-risk population that could be targeted for increased HIV screening. We investigated the combined effect of partner counseling and referral services (PCRS) and comprehensive prenatal HIV screening. We conducted a retrospective review of PCRS charts on young women newly diagnosed with HIV in NC between 2002 and 2005. We determined the prevalence of pregnancy in the study sample and conducted bivariate analyses to assess predictors of pregnancy at the time of HIV diagnosis, calculating prevalence ratios (PRs) with 95% confidence intervals (CIs). We analyzed results of partner notification efforts, including timing and stage of diagnosis of HIV-positive partners. During the four-year period, 551 women aged 18-30 years were newly diagnosed with HIV; 30% were pregnant at the time of HIV diagnosis. Pregnant women were more likely to be Hispanic (PR=1.58, 95% CI 1.15, 2.17) and not report typical risk factors. Fourteen percent of pregnant women's partners had an undiagnosed infection compared with slightly more than 8% of nonpregnant women's partners (p<0.01). Ethnic differences in co-diagnosis of pregnancy and HIV suggest that young Hispanic women may have differential access to and acceptance of routine HIV screening. Comprehensive prenatal screening combined with partner notification can be effective in reaching infected male partners who are undiagnosed.

The Preliminary Findings of a Study Exploring the Perceptions of a Sample of Young Heterosexual Males Regarding HIV Prevention Education Programming in Nova Scotia, Canada

Abstract Despite the increasing numbers of young Canadian females becoming infected with HIV through heterosexual transmission with an infected male sexual partner, the majority of current HIV prevention programs and services in Canada continue to ignore the needs of young heterosexual males. This research is derived from 30 indepfh interviews, 9 focus groups and 13 indepfh interviews with sexual and reproductive health educators. The preliminary results of a province-wide, qualitative study on the sexual and reproductive needs of young sexually active males (n = 50) indicate that heterosexual males remain glaringly absent from HIV prevention programming in Nova Scotia. A number of key themes illustrate the current disconnect between sexual and reproductive health messages and the HIV prevention education needs of young heterosexual males. These themes include perceptions of male sexuality, peer norms, structural and attitudinal barriers to information, and confidentiality. This paper highlights these key...