Highlights from this issue
==========================

* Jackie A Cassell

By the time you read this, Olympic fever will be upon those of us in the UK—leave is cancelled in the public health agencies, road closure imminent, and a frenzy of emergency planning and resilience exercises is reaching its final stages. Where does sexual health fit in to Olympic preparation? Traditionally, large construction projects and major public events have been seen a magnet for sex work, bringing together large communities of men living apart from partners and families. A before and after analysis exploring Canada's 2010 Winter Olympics suggests that an influx of sex workers is no longer to be expected in a developed setting, but displacement and perceived police harassment need to be addressed.1 Significantly, the researchers noted no increase in new reports of youth or trafficked sex workers. Some of our editors are involved in work to assess impact in the UK—watch this space!

In this month's Editor's Choice, Lyons *et al*2 explore the relationship between age at first anal intercourse, and HIV/STI vulnerability in Australian MSM (men who have sex with men). Men with a history of STI or HIV experienced first anal sex earlier, a fact with important implications for prevention interventions for this vulnerable adolescents. In a thought-provoking accompanying editorial, Gebrekristos3 explores the landscape and assesses the implications of this and other work for policy and practice in schools. Another Australian study explores attitudes to HIV post-exposure prophylaxis, condom use and risk perception in this group,4 concluding that the match between vulnerability to HIV and willingness to use is good enough to justify post-exposure prophylaxis introduction.

The need for adaptation of epidemic responses to local structural features is a constant theme of our Programme Science series, edited by Aral and Blanchard, which continues with with Sgaier and colleagues' exploration of India's HIV epidemic response.5 Their theme resonates throughout the journal, with an important article by Benzaken *et al*6 demonstrating the value of a Situational Analysis of Sexual Health in assessing transmission potential the Brazilian Amazon. They identify conditions for rapid transmission, but relatively low rates of HIV and STI, which suggest there is a window of opportunity for prevention interventions to derail rapid growth of the epidemic. On a smaller scale, a study of male sex workers in Côte d'Ivoire assesses the vulnerability and behaviours of male sex workers, with a view to improved intervention,7 showing high rates of STI and HIV, despite good rates of condom use. And Pépin's8 fascinating history of how STI treatment may have contributed to the early HIV epidemic brings a rich account of the life of a migrant worker community into epidemic analysis. David Mabey has reviewed Pépin's recent book9—we highly recommend it.

Recent infection algorithm tests for HIV have an important place worldwide in assessing HIV epidemics and potential for testing interventions to reduce transmission in different population groups. However, UK clinicians have led the way in using these tests in clinical practice—this is a controversial use of the tests, which are not designed for use in the management of patients. Carlin and Taha10 are to be congratulated for their ‘How to do it’ article, which sets out the practical issues in using these tests with patients to inform customised partner notification strategies. Tell us what you think on the website. Will other countries follow?

Clinicians will be interested in Orellana *et al*'s demonstration of the low sensitivity of Gram stain for urethritis,11 and a case report of inguinal syndrome secondary to *Prevotella bivia* following a bite during oral sex.12 Bacterial microbiology is increasingly becoming an Achilles heel for STI control. The threat of untreatable gonorrhoea looms, and we still do not understand the role of *Mycoplasma genitalis*, while bacterial vaginosis continues to present mysteries. As our testing regimes rely increasingly on nucleic acid amplification, we will increasingly be testing only for what we already think could be there. Sobel's editorial13 on genital malodour provides clinicians and researchers alike a timely reminder that there are still major unsolved problems that will not be eliminated by multiplex point of care NAAT tests. Patients come to us because they itch, they smell, they are sore, they have discharge, they are afraid of infection, they cannot get pregnant. As the age of ‘pee in a pot and wait for the text’ comes upon us, we need to make sure that sexual health services, our research interests and our advocacy are driven by felt patient needs and not only by available technologies.

## Footnotes

*   Provenance and peer review Commissioned; not peer reviewed.

## References

1.  Deering KN, Chettiar J, Chan K, et al. Sex work and the public health impacts of the 2010 Olympic Games. Sex Transm Infect 2012;88:301–3.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8zMDEiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  Lyons A, Pitts M, Grierson J, et al. Age at first anal sex and HIV/STI vulnerability among gay men in Australia. Sex Transm Infect 2012;88:252–7.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yNTIiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  Gebrekristos HT. Health inequalities among sexual minority youth: a need for sexual orientation and gender expression sensitive school environment. Sex Transm Infect 2012;88:236–7.
    
    [FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yMzYiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

4.  Holt M, Murphy DA, Callander D, et al. Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men. Sex Transm Infect 2012;88:258–63.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yNTgiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

5.  Sgaier SK, Claeson M, Gilks C, et al. Knowing your HIV/AIDS epidemic and tailoring an effective response: how did India do it? Sex Transm Infect 2012;88:240–9.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yNDAiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

6.  Benzaken A, Sabidó M, Galban E, et al. HIV and sexually transmitted infections at the borderlands: situational analysis of sexual health in the Brazilian Amazon. Sex Transm Infect 2012;88:294–300.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yOTQiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

7.  Vuylsteke B, Semde G, Sika L, et al. High prevalence of HIV and sexually transmitted infections among male sex workers in Abidjan, Côte d'Ivoire: need for services tailored to their needs. Sex Transm Infect 2012;88:288–93.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yODgiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

8.  Pépin J. The expansion of HIV-1 in colonial Léopoldville, 1950s: driven by STDs or STD control? Sex Transm Infect 2012;88:307–12.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8zMDciO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

9.  Mabey D. The origin of AIDS. Sex Transm Infect 2012;88:271.
    
    [FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yNzEiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

10. Carlin E, Taha Y. Using recent infection testing algorithm tests in clinical practice. Sex Transm Infect 2012;88:304–6.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8zMDQiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

11. Angeles MO, Gómez-Lus ML, Lora D. Sensitivity of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect 2012;88:284–7.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yODQiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

12. Sagristà M, Martin-Ezquerra G, Gallardo F. Inguinal syndrome secondary to *Prevotella bivia* after accidental bite in orogenital sex. Sex Transm Infect 2012;88:250–1.
    
    [Abstract/FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yNTAiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

13. Sobel JD. Genital malodour in women: an unmet therapeutic challenge. Sex Transm Infect 2012;88:238.
    
    [FREE Full Text](http://sti.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoic2V4dHJhbnMiO3M6NToicmVzaWQiO3M6ODoiODgvNC8yMzgiO3M6NDoiYXRvbSI7czoyMzoiL3NleHRyYW5zLzg4LzQvMjM1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)