Between February 1993 and December 2006, HIV-1-seronegative women attending a municipal sexually transmitted infection (STI) clinic were invited to enroll in a prospective cohort study. Screening for HIV-1 and STIs were done at monthly follow-up visits. Archived blood samples were tested for HSV-2.

Of 1527 HIV-1-seronegative women enrolled, 302 (20%) were HSV-2 seronegative at baseline of whom 297 had at least one follow-up visit. HSV-2 incidence was high (23 cases/100 person-years; 115 cases). In multivariate analysis, HSV-2 was significantly associated with more recent entry into sex work, workplace and higher number of sex partners per week. Condom use was protective, although this was statistically significant only for the intermediate strata (25–75% condom use; HR 0.43; p = 0.05). There were statistical trends for bacterial vaginosis to increase HSV-2 risk (HR 1.56; p = 0.07) and for oral contraceptive use to decrease risk (HR 0.50; p = 0.08). The 23% annual HSV-2 incidence in this study is among the highest reported anywhere in the world.

Women were at increased risk if they had recently entered sex work, had a higher number of sex partners or worked in bars. HSV-2 risk reduction interventions are urgently needed among high-risk African women.

Participants (n = 655) were from the baseline and 12-month follow-up waves of a 2001–2 population-based longitudinal study of sexual networks among urban African–American adolescents. Sexual network position was characterised as the interaction between degree (number of partners) and two-reach centrality (number of partners’ partners), resulting in the following five positions: confirmed dyad, unconfirmed dyad, periphery of non-dyadic component, centre of star-like component and interior of non-star component. STI risk was measured as laboratory-confirmed infection with gonorrhoea and/or chlamydia.

Results of logistic regression models with generalised estimating equations showed that being in the centre of a sexual network component increased the odds of infection at least sixfold compared with being in a confirmed dyad. Individuals on the periphery of non-dyadic components were nearly five times more likely to be infected than individuals in confirmed dyads, despite having only one partner. Measuring network position using only individual-based information led to twofold underestimates of the associations between STI risk and network position.

These results demonstrate the importance of measuring sexual network structure using network data to fully capture the probability of exposure to an infected partner.

Retrospective study comparing the proportion of new clients with genital warts attending Melbourne Sexual Health Centre (MSHC) from January 2004 to December 2008. Australia provided free quadrivalent HPV vaccine to 12–18-year-old girls in a school-based programme from April 2007, and to women 26 years and younger through general practices from July 2007.

36 055 new clients attended MSHC between 2004 and 2008 and genital warts were diagnosed in 3826 (10.6%; 95% CI 10.3 to 10.9). The proportion of women under 28 years with warts diagnosed decreased by 25.1% (95% CI 30.5% to 19.3%) per quarter in 2008. Comparing this to a negligible increase of 1.8% (95% CI 0.2% to 3.4%) per quarter from the start of 2004 to the end of 2007 also in women under 28 years generates strong evidence of a difference in these two trends (p<0.001). There was no evidence of a difference in trend for the quarterly proportions before and after the end of 2007 for any other subgroup, and on only one occasion was there strong evidence of a trend different to zero, for heterosexual men in 2008 in whom the average quarterly change was a decrease of 5% (95% CI 0.5% to 9.4%; p = 0.031).

The data suggest that a rapid and marked reduction in the incidence of genital warts among vaccinated women may be achievable through an HPV vaccination programme targeting women, and supports some benefit being conferred to heterosexual men.

Men who underwent anal Pap smear reported clinical, sociodemographic and behavioural information collected through questionnaire and interview between January 2007 and April 2008. ² and logistic regression were used to evaluate ASIL prevalence and risk factors among HIV positive and HIV negative MSM.

Of the 174 MSM (mean age 32.1 years), 118 (67.8%) were HIV positive. Overall, 27% had abnormal anal cytology: 13.2% had atypical squamous cells of undetermined significance (ASC-US), 11.5% had low-grade squamous intraepithelial lesion (LSIL) and 2.3% had high-grade squamous intraepithelial lesion (HSIL). Prevalence of ASIL was higher among HIV positive than HIV negative MSM (33.9% vs 12.5%; p = 0.003). Among HIV positive MSM, 16.1% had ASC-US, 14.4% had LSIL and 3.4% had HSIL and 7.1%, 5.4% and 0% in HIV negative MSM, respectively. Anal condyloma was detected in 22% of HIV positive and 16.1% (9/56) of HIV negative MSM (p = 0.5). In HIV positive MSM, anal condyloma (OR 3.42, 95% CI 1.29 to 9.04; p = 0.01) was a significant risk factor for ASIL. Highly active antiretroviral therapy use and CD4+ T cell count were not associated with ASIL.

One-third of HIV positive and 12.5% of HIV negative MSM had ASIL. Thus, as greater numbers of HIV positive MSM live longer due to increasing access to HAART worldwide, effective strategies to screen and manage anal precancerous lesions are needed.

A cross-sectional design. Researchers recruited women from outpatient clinics at a major tertiary women’s hospital and a sexual health centre who completed surveys within 3 months of receiving results: 331 women, 18–45 years, who had experienced a normal cervical Papanicolaou (Pap) result, an abnormal Pap result, biopsy confirmed cervical intraepithelial neoplasia (CIN) or external genital warts (EGW). Main outcome measures: the HPV impact profile (HIP) designed to assess the psychosocial impact of HPV; two general health-related QoL surveys—the EuroQoL VAS and the Sheehan disability scale; and a HPV knowledge survey.

Response rate was 78%. Significant psychosocial impacts were found for women screened for, or having a diagnosis of, HPV-related genital disease. The largest impact was in women with CIN 2/3 and EGW. This HPV-related psychosocial impact was most sensitively detected with the HIP. Relative to generic measures of QoL, the HIP provided insight into the full range of psychosocial impacts of HPV testing and diagnoses.

Clinicians need to be aware of the potential psychosocial impact of testing for or diagnosing HPV-related genital disease, in particular CIN 2/3 and EGW. The HIP survey is a more sensitive measure of the psychosocial impact of HPV-related genital disease than generic QoL surveys.

A randomised, double-blind, multicentre controlled trial. Patients received podophyllotoxin cream or placebo twice daily for 3 days/week for up to 4 weeks, with weekly cryotherapy continued to week 12 if required. Further treatment from week 12 to 24 was discretionary. Patients were stratified by sex and history of warts. HIV positivity, warts treated in the past 4 months, or warts with a combined area of less than 10 mm² were exclusion criteria. Primary endpoints were clearance at weeks 4 and 12.

70 patients per group were randomly assigned and started treatment; 101 first-episode warts, 91 male. No treatment-related serious adverse events were reported. Follow-up at week 12 was 85%. By intention-to-treat analysis, clearances at 4 and 12 weeks were higher in the combination group (60.0% and 60.0%, respectively) than with cryotherapy alone (45.7%, 45.7%) although not statistically significant (RR 1.31, 95% CI 0.95to 1.81). By week 24 there was no difference between the groups (68.6% and 64.3%, respectively; RR 1.07, CI 0.84 to 1.35). At week 4, wart clearance was higher in men (p = 0.001) and those with a past history of warts (p = 0.009), but these differences were not detected at week 12. There was some evidence for a higher relapse rate in the group receiving cryotherapy alone.

Initial combination therapy with podophyllotoxin/cryotherapy was well tolerated and may have resulted in earlier clearance in some patients, compared with cryotherapy alone; however, overall differences in clearance rates were not statistically significant.

We undertook a retrospective cohort study between 1995 and 2005 of all general practices contributing data to the UK General Practice Research Database (GPRD), and data on persons accessing HIV care (Survey of Prevalent HIV Infections Diagnosed). We identified all practice-registered patients where an HIV test or HIV positive status is recorded in their general practice records. HIV testing in primary care and prevalence of recorded HIV positive status in primary care were estimated.

Despite 11-fold increases in male testing and 19-fold increases in non-pregnant female testing between 1995 and 2005, HIV testing rates remained low in 2005 at 71.3 and 61.2 tests per 100 000 person years for males and females, respectively, peaking at 162.5 and 173.8 per 100 000 person years at 25–34 years of age. Inclusion of antenatal tests yielded a 129-fold increase in women over the 10-year period. In 2005, 50.7% of HIV positive individuals had their diagnosis recorded with a lower proportion in London (41.8%) than outside the capital (60.1%).

HIV testing rates in primary care remain low. Normalisation of HIV testing and recording in primary care in antenatal testing has not been accompanied by a step change in wider HIV testing practice. Recording of HIV positive status by GPs remains low and GPs may be unaware of HIV-related morbidity or potential drug interactions.

Patients with penile cancer seen during the period December 2002 to December 2007 were identified from the unit’s database. Information regarding presentation, diagnosis and pattern of referral was retrieved from records. Delay was defined as the time between the patient first noticing a penile lesion and date of first seeking medical advice, or additional time before being seen by a Urologist resulting from referral to another speciality.

Of 100 patients, with a median age of 54 years (range 2–81 years), 19% were initially referred to other specialities (Genitourinary Medicine—13%, Dermatology—4%, Plastics 2%). Initial referrals to Genito-urinary Medicine and Dermatology resulted in mean delays of 6 and 3.5 months respectively, whereas the mean duration for patients to present to any medical practitioner from onset of symptoms was 5.8 months. Overall, 47% presented with locally advanced disease.

Approximately one-fifth of patients with penile cancer are first referred to specialities other than Urology. This sometimes delays diagnosis, potentially affecting overall prognosis. The major source of delay, however, results from patient reluctance to seek medical advice. Thus, the greatest impact in this condition is likely to be achieved by increased public awareness and education.

To evaluate if culture confirmation of gonococcal infection can be improved for subjects found to be positive by BD ProbeTec in community clinics.

Two cervical swabs were collected for culture to confirm NAAT positive results in women aged over 16 years—a majority of whom were <25 years and asymptomatic. One swab was urgently transported (UTP) and processed in the laboratory within 2 hours whereas the other swab (RTP) was stored at 4°C, transported at room temperature and processed 4–72 hours after collection depending on the time and day of collection.

Altogether, 56 subjects with NAAT positive results were recruited into the study. Nine (16.1%) subjects who were culture negative were excluded from final analysis due to prior antibiotic treatment (4/9) or the culture having been taken more than 1 month after the NAAT was positive (4/9) or an incorrect specimen being received (1/9). Overall, 41/47 (87.2%) NAAT positive subjects were confirmed by culture. In total, 40/47 (85.1%) UTP swabs and 27/47 (57.4%) RTP swabs were positive (p<0.05).

This study shows that culture confirmation in NAAT positive subjects in a community gonococcus screening programme can be significantly improved by urgent transportation to and processing of specimens in the laboratory.

A formative study was conducted between January and April 2009 to assess care-seeking practices and perceptions on the prevention of mother-to-child transmission (PMTCT) and family planning services in Wakiso district, central Uganda. A household survey supplemented by 12 focus group discussions and 66 key informant interviews was carried out between January and April 2009.

10 706 women, mean age 25.8 years (14–49 years) were interviewed. The majority of women, 4786 (57%) were in the lowest wealth quintile; 62.0% were not using family planning (p<0.000); 56.2% did not access HIV counselling and testing because they feared knowing their HIV status (p<0.013), while 66.5% feared spouses knowing their HIV status (p<0.013). Access to these services among the young women and those with no education was also poor. Private midwives provide HIV testing to 7.8% of their clients; 5.9% received antiretroviral drugs and 8.6% received contraceptives. Client satisfaction with services at private midwifery practices was high. Private midwives are trusted and many clients confide in them. An intervention through private midwives was perceived to improve access because of short distances and no transport costs. Adolescents prioritised confidentiality, while subsidising costs, community sensitisation and focusing on male spouses were overwhelmingly recommended.

Private midwives clinics are potential delivery outlets for PMTCT in Uganda. A well-designed intervention linking them to the public sector and the community could increase access to services.

Computerised medical records of patients attending the Melbourne Sexual Health Centre (MSHC) between October 2005 and October 2008 were reviewed.

Consultations with FSW accounted for 15.1% of total consultation time (5722 of 37 670 h) and of these, 2896 h (7.7%) were used for monthly consultations involving testing for gonorrhoea, chlamydia and trichomonas, but no serology (termed swab-only testing). Only 133 (3.2%) of the 4208 cases of STI (defined as gonorrhoea, chlamydia, trichomonas, early syphilis, mycoplasma genitalium or HIV) that were detected at MSHC during the study period were among FSW who underwent swab-only testing. 1726 (41%) STI were detected among men who have sex with men (MSM). The STI detected per 100 h of consultation time was (fourfold) higher for MSM (19) than for FSW (4). If FSW were tested only every 3 months for gonorrhoea, chlamydia, trichomonas, syphilis and HIV the 2896 h spent on monthly swab-only testing would have been available for higher-risk clients

The current legislation requiring monthly STI testing is compromising the access for higher-risk individuals to sexual health. Other countries contemplating mandatory testing need to consider the influence that the frequency of testing has on access to sexual health services for high-risk groups.

Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record.

348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications.

HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways.

Seven cross-sectional surveys in commercial gay venues in Glasgow and Edinburgh (1996–2005). 9613 men completed anonymous, self-completed questionnaires (70% average response rate).

Among 8305 respondents included in these analyses, HIV testing increased between 1996 and 2005, from 49.7% to 57.8% (p<0.001). The proportion of men who had tested recently (in the calendar year of, or immediately before, the survey) increased from 28.4% in 1996 to 33.2% in 2005, when compared with those who have tested but not recently, and those who have never tested (adjusted odds ratio 1.31, 95% CI 1.13 to 1.52). However, among ever testers, there was no increase in rates of recent testing. Recent testing decreased with age: 31.3% of the under 25, 30.3% of the 25–34, 23.2% of the 35–44 and 21.2% of the over 44 years age groups had tested recently. Among men reporting two or more unprotected anal intercourse partners in the previous year, only 41.4% had tested recently.

HIV testing among gay men in Scotland increased between 1996 and 2005, and corresponds with the Scottish Government policy change to routine, opt-out testing in genitourinary medicine clinics. Testing rates remain low and compare unfavourably with near-universal testing levels elsewhere. The limited change and decline across age groups in recent HIV testing rates suggest few men test repeatedly or regularly. Additional, innovative efforts are required to increase the uptake of regular HIV testing among gay men.

Data from a cross-sectional survey of men ages 18–35 recruited from three community-based health clinics in an urban metropolitan area of the northeastern US (n = 1585) were analysed to estimate the prevalence of IPV perpetration and associations of such violent behaviour with both standard (eg, anal sex, injection drug use) and gendered (eg, coercive condom practices, sexual infidelity, transactional sex with a female partner) forms of sexual-risk behaviour, and self-reported STI/HIV diagnosis.

Approximately one-third of participants (32.7%) reported perpetrating physical or sexual violence against a female intimate partner in their lifetime; one in eight (12.4%) participants self-reported a history of STI/HIV diagnosis. Men’s IPV perpetration was associated with both standard and gendered STI/HIV risk behaviours, and to STI/HIV diagnosis (OR 4.85, 95% CI 3.54 to 6.66). The association of men’s IPV perpetration with STI/HIV diagnosis was partially attenuated (adjusted odds ratio (AOR) 2.55, 95% CI 1.77 to 3.67) in the multivariate model, and a subset of gendered sexual-risk behaviours were found to be independently associated with STI/HIV diagnosis—for example, coercive condom practices (AOR 1.67, 95% CI 1.04 to 2.69), sexual infidelity (AOR 2.46, 95% CI 1.65 to 3.68), and transactional sex with a female partner (AOR 2.03, 95% CI 1.36 to 3.04).

Men’s perpetration of physical and sexual violence against intimate partners is common among this population. Abusive men are at increased risk for STI/HIV, with gendered forms of sexual-risk behaviour partially responsible for this association. Thus, such men likely pose an elevated infection risk to their female partners. Findings indicate the need for interwoven sexual health promotion and violence prevention efforts targeted to men; critical to such efforts may be reduction in gendered sexual-risk behaviours and modification of norms of masculinity that likely promote both sexual risk and violence