Utility of rapid plasmin reagin titres in assessing treatment response and re-infection for infectious syphilis

Sexual Health ◽  
2020 ◽  
Vol 17 (4) ◽  
pp. 330
Author(s):  
Ricky Harjanto ◽  
Don E. Smith ◽  
Hamish Barratt ◽  
Melissa Kelly ◽  
Derek Chan ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Surrogate Marker ◽  
Syphilis Infection ◽  
Service Testing ◽  
Sexual Health Service ◽  
Subsequent Episode ◽  
Rate Of Decline ◽  
Sex With Men ◽  
Dilution Level

Abstract Background The rapid plasma reagin (RPR) assay is commonly used as a surrogate marker of infectious syphilis, but is non-specific, slow to change and variable in its rate of decline post treatment. Methods: Within an urban sexual health service testing predominantly men who have sex with men, a file review of RPR changes was undertaken in all subjects who had a dilution level of ≥1:4, between January 2015 to the end of December 2018. Results: Overall, 248 cases of infectious syphilis were identified in 215 subjects (165 HIV seropositive, 50 HIV seronegative). Among unique-subject cases with follow-up RPR recorded, seroreversion to a non-reactive titre was achieved in only 42.3% (71/168) cases at a median of 235 days (interquartile range: 138–348 days) and was significantly less likely if patients had HIV infection (P = 0.02), late latent syphilis (P = 0.003) or a subsequent syphilis infection (P < 0.0001). Having HIV infection (P = 0.03) or a subsequent episode of syphilis (P = 0.01) were associated with a lower likelihood of documented cure. Conclusions: The slow decay in RPR titres post therapy and the inability of a significant number of subjects to achieve a non-reactive result over time makes RPR a poor test for assessing the adequacy of treatment or in diagnosing re-infection, especially in populations having repeated and frequent risk exposures. As the number of syphilis cases continue to climb, better tests that accurately assess pathogen presence are urgently needed.

scholarly journals The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru

Sexual Health ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 261 ◽  
Author(s):  
Lao-Tzu Allan-Blitz ◽  
Kelika A. Konda ◽  
Silver K. Vargas ◽  
Xiaoyan Wang ◽  
Eddy R. Segura ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Hiv Infection ◽  
Predictive Model ◽  
Transgender Women ◽  
Risk Calculator ◽  
Syphilis Infection ◽  
Online Risk ◽  
History Of ◽  
Sex With Men

Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. Methods: Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. Results: Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3–24.3). HIV infection (RR 2.22; 95% CI 1.54–3.21) and history of syphilis infection (RR 2.23; 95% 1.62–3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. Conclusions: Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.

scholarly journals 863. Increasing PrEP Uptake: A Diffusion-Based Network Intervention for HIV Prevention Among Young Black Men Who Have Sex With Men

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S21-S22
Author(s):  
Matthew Ferreira ◽  
Lindsay Young ◽  
John Schneider
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Black Men ◽  
Controlled Trial ◽  
Biomedical Intervention ◽  
Network Intervention ◽  
Sex With Men ◽  
Hiv Negative ◽  
Peer Leader

Abstract Background Advances in biomedical prevention strategies provide new opportunities for reducing HIV incidence among young black men who have sex with men (YBMSM). Pre-exposure prophylaxis (PrEP) is for HIV-negative individuals and has been shown to be up to 99% effective in preventing HIV infection when taken as prescribed by CDC clinical practice guidelines. Several studies, however, have documented low rates of PrEP uptake among YBMSM. Methods PrEP Chicago is a randomized controlled trial peer leader intervention designed to promote uptake of PrEP for HIV prevention among YBMSM. Participants (n = 423) were recruited using respondent-driven sampling (RDS) and randomized to either an intervention (n = 209) or control (n = 214) condition. Eligibility criteria included: aged 18–35, identifies as a person of color, assigned male sex at birth, had sex with a man in the past 12 months, had an active Facebook profile, and resided in Chicago. The intervention includes a half-day, small group PrEP, and peer leader training workshop followed by monthly check-in booster calls. Approximately 12 months after their initial baseline visit, participants return to complete follow-up data collection and switch conditions, giving year 1 control participants the opportunity to learn about PrEP. Results The number of HIV-negative intervention participants on PrEP at baseline vs. 12-month follow-up (PrEP Chicago Study, Chicago, 2016–2018). A total of 341 participants (80.6%) returned at 12 months. Of 209 intervention participants at baseline, 176 (84.2%) completed a follow-up survey at 12 months. At baseline, 13 (13.3%) of 98 HIV-negative intervention participants indicated that they were currently taking PrEP. At 12 months, this number grew to 25 (32.5%) of 77 HIV-negative intervention participants, indicating that they were currently taking PrEP. A total of 21 participants reported initiating PrEP during their time in the intervention. Conclusion PrEP is a valuable biomedical intervention for preventing HIV infection in those at risk. PrEP Chicago, a network intervention designed to promote uptake of PrEP among YBMSM, shows promising results for PrEP adoption among this community. Disclosures All authors: No reported disclosures.

scholarly journals Risk Factors for HIV/Syphilis Infection and Male Circumcision Practices and Preferences among Men Who Have Sex with Men in China

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Yali Zeng ◽  
Linglin Zhang ◽  
Tian Li ◽  
Wenhong Lai ◽  
Yujiang Jia ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Male Circumcision ◽  
Anal Intercourse ◽  
Receptive Anal Intercourse ◽  
Cross Sectional Survey ◽  
Syphilis Infection ◽  
Unprotected Receptive Anal Intercourse ◽  
Male Sex ◽  
Sex With Men

Objective. To investigate factors associated with HIV infection and the frequency and willingness of male circumcision among men who have sex with men (MSM) in Chengdu city, China.Methods. A cross-sectional survey provided information on participants' demographics, risk behaviors, circumcision, and uptake of HIV prevention services.Results. Of 570 participants, 13.3% were infected with HIV and 15.9% with syphilis. An estimated 43.0% of respondents reported having unprotected receptive anal intercourse, and 58.9% reported having ≥2 male sexual partners in the past 6 months. Multivariable logistic regression revealed that syphilis, more male sex partners, predominantly receptive anal intercourse, and exclusively receptive male sex were associated with HIV infection. Higher level of education and peer education service were inversely associated with HIV infection. Nearly a fifth (18.0%) of participants were circumcised. More than half of uncircumcised participants expressed willingness to be circumcised.Conclusion. This study reveals a high prevalence of HIV and syphilis among MSM in Chengdu province of China. The frequency of unprotected receptive anal intercourse and multiple male sexual partnerships highlight the urgency for an effective comprehensive HIV prevention strategy. Although the willingness to accept male circumcision (MC) is high, further research is needed to assess the protective effective of MC among MSM.

Risk factors for HIV infection among men who have sex with men in the ANRS IPERGAY PrEP trial

2021 ◽  
pp. sextrans-2021-055199
Author(s):  
Julien Gras ◽  
Marine Pillet ◽  
Guillemette Antoni ◽  
Eric Cua ◽  
Isabelle Charreau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Sexual Practices ◽  
Recreational Drugs ◽  
Anal Sex ◽  
Increased Risk ◽  
Receptive Anal Sex ◽  
Sex With Men ◽  
Hiv Acquisition

ObjectivesWe aimed to assess among men who have sex with men (MSM) risk factors for HIV infection, to identify those who require urgent pre-exposure prophylaxis (PrEP) prescription.MethodsAll participants enrolled in the placebo arm of the ANRS IPERGAY trial, or infected between screening and day 0, were included. Baseline characteristics were described and HIV incidence rate ratios (RRs) were estimated with their 95% CIs.Results203 MSM were included with a median follow-up of 9 months. During the study period, 16 participants acquired HIV infection while not receiving tenofovir disoproxil and emtricitabin (TDF/FTC) over 212.4 person-years (PYs) of follow-up (incidence rate 7.5/100 PYs, 95% CI: 4.3 to 12.2). Being enrolled in Paris was associated with a significant increased risk of HIV infection (RR: 4.1; 95% CI: 1.1 to 28.3). A high number of sexual partners in prior 2 months (≥10 vs <5) and of condomless receptive anal sex episodes in prior 12 months (>5 vs <5) were strong predictors for HIV acquisition (RR: 10.6 (2 to 260.2) and 3.3 (1.2 to 10.2), respectively). Those who reported more often or only receptive sexual practices were also at increased risk (RR: 9.8 (2.0 to 246.6)). The use of recreational drugs in prior 12 months, especially gamma hydroxybutarate/gamma butyrolactone (RR: 5.9; 95% CI: 2 to 21.7), was associated with a significantly increased risk of HIV acquisition even after adjustment for sexual practices.ConclusionsMSM who have frequent condomless receptive anal sex and multiple partners, or use recreational drugs should be targeted in priority for PrEP prescription especially if they live in an area with a high prevalence of HIV infection.

The electronic identification protects privacy and has consistent HIV incidence with the traditional real-name follow-up among Chinese MSM: A 24-month prospective cohort study (Preprint)

2021 ◽  
Author(s):  
Jie Wei ◽  
Xiangjun Zhang ◽  
Jing Zhang ◽  
Zhenxing Chu ◽  
Wenqing Geng ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cox Regression ◽  
Retention Rates ◽  
Kappa Statistics ◽  
Hiv Incidence ◽  
Predictive Values ◽  
The Real ◽  
Hiv Seroconversion ◽  
Sex With Men

BACKGROUND Men who have sex with men (MSM) usually face stigma and discrimination in relation to their sexual orientation and have the fear of identification disclosure, which may prevent them from taking HIV tests and participating in research studies. The traditionally used real-name identification methods might lead to biased estimates in HIV incidence. OBJECTIVE This study evaluated an electronic identification (eID) method in estimating HIV incidence among MSM using a social media application that allowed good protection of privacy than the real-name identification. METHODS From January 2018 to January 2020, a WeChat OpenID identifier was used to generate and assign eID for MSM who attended the First Affiliated Hospital of China Medical University for voluntary counselling and testing (VCT) services. The inclusion criteria were men aged 18 years and older who had consensual anal or oral sex with men in the previous 12 months and agreed to WeChat authorization. The eID group was compared with the real-name identification group (PID) that we acquired through HIV testing information regarding participants’ demographic and behavioral characteristics and HIV incidence. Sensitivity, specificity, positive and negative predictive values, and Kappa statistics were used to compare the consistency of the two groups. Cox regression was used to assess factors that were associated with HIV infection during the follow-up period. RESULTS Of 1499 WeChat OpenID users, 1133 participants were identified and linked to their traditional PID and some participants used multiple OpenIDs. The Kappa consistency between eID and traditional PID method were 0.753. At baseline, 4.2% participants in eID group received an HIV positive testing result, which was comparable to PID group (5.4%, Kappa=0.992). Thirty-five participants infected HIV during the follow-up period. The incidence of HIV infection was 7.3/100 person-years for eID group (95% CI, 5.4-10.1) and 5.8/100 person-years for PID group (95% CI, 4.2-8.0), and the consistency was high (Kappa=0.712, P>.05). The retention rates between eID and PID group were also accordant (Kappa=0.722). Number of sexual partners, recent unprotected anal sex, and recent party drug use were associated with HIV seroconversion. CONCLUSIONS The eID method that allowed anonymous tests and multiple visits had consistent results compared to the traditional real-name PID method. This method can be scaled up in future prevention and testing programs in HIV high risk populations with high privacy and confidentiality demands.

scholarly journals A Young Black MSM on PrEP Is Lost to Follow-Up and Acquires HIV Infection: A Case to Call for Improved Strategies to Support Youth Adherence and Engagement in HIV Prevention

2019 ◽  
Vol 18 ◽  
pp. 232595821985383 ◽  
Author(s):  
Ketzela Jacobowitz Marsh ◽  
Meghan Rothenberger
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Sexual Behaviors ◽  
The United States ◽  
Black Msm ◽  
Sex With Men ◽  
Young Black Msm ◽  
Exposure Prophylaxis ◽  
Lost To Follow Up

Young men who have sex with men (YMSM) are disproportionately affected by HIV in the United States. High-risk sexual behaviors are difficult to modify; thus, HIV pre-exposure prophylaxis (PrEP) with a daily pill is a promising prevention tool for this vulnerable population. We present a case of a young black MSM who was able to successfully access PrEP with the help of a community program but was not able to adhere to the regimen or engage in care. He ultimately acquired HIV infection. We review the existing literature and advocate for increased services and research to support youth’s adherence to PrEP and engagement in HIV prevention programs, with a focus on YMSM of color.

Factors associated with repeat diagnosis of syphilis in genitourinary medicine (GUM) clinic attendees in the North East of England, 2002–2014

2018 ◽  
Vol 29 (8) ◽  
pp. 790-799 ◽  
Author(s):  
G Dolan ◽  
M Chauhan ◽  
K Foster ◽  
M Basta ◽  
S Bushby ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Hiv Seropositivity ◽  
Syphilis Infection ◽  
Factors Associated ◽  
North East ◽  
The North ◽  
Genitourinary Medicine ◽  
Sex With Men ◽  
And Control

This study aimed to identify factors associated with repeat syphilis infection in North East England, in order to inform local prevention and control opportunities. We undertook a case–case study comparing individuals diagnosed with single or multiple episodes of syphilis infection within genitourinary medicine (GUM) clinics in NE England (12 clinics serving a population of 2.5 million). Study cases were verified as having had true re-infection by a GUM clinician (using serological and/or clinical parameters) and control cases (3 per case) frequency matched to cases by age and year of presentation. The odds of exposure to sexual behavioural and clinical factors were compared for cases and control cases using stepwise multivariable logistic regression. We included 66 cases and 235 control cases. The majority of cases (62/66) and control cases (165/235) were men who had sex with men (MSM). Data were missing for 0–64% of cases across different variables. Following multivariable analysis HIV seropositivity (OR 23.3, 95% CI 4.32–125.9), failure to attend follow-up (OR 4.63, 95% CI 1.11–19.31), stage of infection and deprivation were associated with re-infection ( p < 0.001). In this study, HIV seropositivity and failure to attend follow-up were associated with re-infection with syphilis. Actions targeted at these groups may help to reduce ongoing transmission.

scholarly journals Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa

2019 ◽  
Author(s):  
Cheick Haïballa Kounta ◽  
Luis Sagaon-Teyssier ◽  
Pierre-Julien Coulaud ◽  
Marion Mora ◽  
Gwenaelle Maradan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Risk Reduction ◽  
Prospective Cohort ◽  
Sexual Partners ◽  
Anal Sex ◽  
Male Sexual Partners ◽  
Sex With Men ◽  
Hiv Negative

AbstractMen who have sex with men (MSM) are at much greater risk of HIV infection in Africa. Little is known about their involvement in transactional sex (TS). We aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM conducted in Burkina Faso, Côte d’Ivoire, Mali and Togo. Our study focused on HIV-negative MSM, recruited between 06/2015 and 01/2018 by a team of trained peer educators. Scheduled study visits at 6, 12 and 18 months included medical examinations, HIV screening, risk-reduction counselling and face-to-face interviews to collect information on their sociodemographic characteristics, sexual behaviours, and HIV risk-reduction strategies. Three stigmatization sub-scores were constructed. The generalized estimating equation method was used for data analysis. Of the 630 HIV-negative participants recruited at baseline, 463, 410 and 244 had a follow-up visit at 6- and 12- and 18-months, respectively. Over a total of 1747 visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 participants reported systematic TS (31.5%), 55 (19.0 %) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline. Ninety participants (31.1 %) reported occasional TS. After adjusting for country of study and follow-up visits, the following factors, reported for the previous 6 months, were associated with a greater likelihood of TS: younger age, an educational level <high-school diploma, satisfaction with current sex life, group sex with men, multiple male sexual partners, condomless anal sex, receptive or versatile anal sex with male sexual partners, giving benefits in exchange for sex with a man, alcohol consumption and drug use during sex, and experiencing stigmatization. The majority of MSM in this study who received benefits in exchange for sex had high-risk HIV infection exposure practices and were characterized by socioeconomic difficulties.

Social networks as drivers of syphilis and HIV infection among young men who have sex with men

2018 ◽  
Vol 94 (5) ◽  
pp. 365-371 ◽  
Author(s):  
Kayo Fujimoto ◽  
Charlene A Flash ◽  
Lisa M Kuhns ◽  
Ju-Yeong Kim ◽  
John A Schneider
Keyword(s):  
Hiv Infection ◽  
Multinomial Logistic Regression ◽  
Hiv Infections ◽  
Syphilis Infection ◽  
Study Objective ◽  
Logistic Regression Models ◽  
Hiv Coinfection ◽  
High Prevalence ◽  
Behavioural Factors ◽  
Sex With Men

ObjectivesSyphilis and HIV epidemics overlap, yet little is known about combined network and behavioural factors that drive syphilis-HIV coinfection. Our study objective was to assess network contexts and sexual behaviours associated with syphilis-HIV co-infection and monoinfection among a particularly vulnerable subgroup: young Black men who have sex with men (YBMSM). To achieve this objective, we examined factors associated with coinfection by each subgroup as classified by syphilis-HIV infection status: (A) HIV monoinfected, (B) syphilis monoinfected and (C) neither syphilis infected nor HIV infected. In addition, we further identified the factors that are associated with HIV infection or syphilis monoinfection.MethodsData were collected from a sample of 365 YBMSM, aged 16–29 years, recruited through respondent-driven sampling between 2014 and 2016, in two cities with large HIV epidemics: Houston, TX, and Chicago, IL. We conducted a series of multinomial logistic regression models to predict coinfection, HIV monoinfection and syphilis monoinfection as a function of network and sexual behavioural factors.ResultsCoinfection was associated with having network members who are coinfected or HIV infected within one’s social network. Syphilis monoinfection was associated with a higher number of social venues attended, and HIV monoinfection was associated with having more condomless top partners.ConclusionPublic health interventions that address the diagnosis and treatment of syphilis infection and ensure that those with syphilis are being tested for HIV may be promising in limiting the synergy of syphilis-HIV infections in onward transmission. Advancing HIV and syphilis prevention efforts in high-prevalence networks may allow prioritisation of limited resources.

scholarly journals Pre-exposure prophylaxis makes it possible to better live one’s sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Marie Bistoquet ◽  
Alain Makinson ◽  
Vincent Tribout ◽  
Cyril Perrollaz ◽  
Gérard Bourrel ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Phenomenological Study ◽  
Family Doctor ◽  
Motivational Factors ◽  
Social Representation ◽  
University Hospital ◽  
Sexual Life ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) for HIV is instrumental in the prevention of HIV for HIV-uninfected persons, by drastically reducing the risk of acquisition in the case of high-risk exposures. Despite its demonstrated efficacy, it remained under-prescribed in France until 2018. The principal aim of this study was to understand the motivations of Men who have Sex with Men (MSM) who started using PrEP in Montpellier, France. Methods A phenomenological study was undertaken, using semi-structured interviews with twelve participants attending the University Hospital of Montpellier for PrEP. Interviews were analysed by means of triangulation up to the point of theoretical saturation, using a semio-pragmatic method. Results Fear of HIV infection, personalised regular follow-up, and the wish to take care of one’s health were the primary motivational factors. PrEP allows for a better sexual life restoring a sense of freedom despite the risks of STI, deemed manageable by PrEPers. PrEP does not modify long-term risk-taking behaviours but helps them better live their own sexuality and guides them towards a responsible approach to sexuality. Unclear information on PrEP, delivered by their family doctor, public campaigns or the media, leads to misrepresentations or negative social representation, including within the MSM community, which may delay its implementation. Conclusions Fear of HIV infection and the benefits of regular medical follow-up to take care of one’s health were motivational factors of importance for the use of PrEP by MSM in this study. PrEP transforms all existential dimensions of their lived experience, improving sexual identity and happiness. There is a need to improve professional awareness of the effectiveness of PrEP and to develop a patient centered approach, to disseminate information more widely to the general public and among MSM to reduce stigmatisation.

Sign in / Sign up

Export Citation Format

Share Document