eLetters

203 e-Letters

  • This study did not measure vertical transmission of Chlamydia trachomatis

    The authors estimated vertical transmission of Chlamydia trachomatis by a retrospective analysis using national registry data and clinical records and concluded that transmission was much lower (<2%) than the rate commonly quoted (50-70%). Their suggested explanation is that the modern use of highly sensitive NAATs detects nonviable chlamydiae so that mothers testing positive could actually be noninfectious whereas older studies based on use of culture only identified infectious pregnant women. That is not a likely explanation for such a big difference. When NAAT performance with cervical swabs was evaluated about 2/3 of NAAT positive specimens were culture positive.
    A more likely explanation comes from examining their case definition. It is not chlamydial infection, but rather laboratory confirmed cases of chlamydial conjunctivitis or pneumonia. And that is very different. When prospective studies were being done in San Francisco 175 infants born to chlamydia infected mothers were followed: 31 (18%) developed pneumonia; 29 (17%) conjunctivitis; 64 (37%) were culture positive and 105 (60%) had serologic evidence of infection. Thus there were many more infections than cases of conjunctivitis and pneumonia. But the difference between cases of disease and infection in the Finnish material is probably greater. In the prospective study there were cases of very mild disease that would likely not have been diagnosed in ordinary circumstances (seeing the whole clinical s...

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  • Data from the iPrEx Trial Does Not Support This Hypothesis

    The authors impute a biological mechanism to the high incidence of syphilis in men who have sex with men using anti-retroviral drugs (in particular, HAART). We suggest, empiric data do not support the biological hypothesis, and behavioral explanations (i.e. increased condomless sex and selection of higher risk partners) are supported by stronger evidence.

    Randomized double-blind trials of pre-exposure prophylaxis (PrEP) for HIV prevention [1] provide a rigorous test of the author’s hypothesis. The methodological strength includes an unconfounded and clearly unexposed control group and an exposed group which received an agent that would putatively increase susceptibility — tenofovir disoproxil fumarate (TDF) co-formulated with emtricitabine (FTC). A unique feature is that these trials were blinded and PrEP was unproven that the time trials were undertaken; hence, we would not expect that the TDF/FTC-exposed group would adopt higher risk practices.

    An analysis of the iPrEx trial [2], a randomized PrEP trial in men who have sex with men/trans women, found [1] a relative rate of syphilis acquisition for TDF/FTC of 1.14 with a 0.95 confidence interval (0.90 to 1.45) compared to placebo. Incident syphilis, can be difficult to differentiate from a previous infection. Among those with a negative rapid plasma reagin titer at screening the relative rate of an on-study infection was 1.03, 0.95 CI (0.76 to 1.38). Adherence, was low in the iPrEx study and when pharmaco...

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  • Syphilis Presents Differently to Chlamydia and Gonorrhea Which May Impact Subsequent Behavior
    Aaron M Steppe

    I'm writing to ask if the authors considered an alternate hypothesis: perhaps the symptoms of primary infection with syphilis are easier to ignore than chlamydia and gonorrhea--the latter two often cause painful urination and discharge, while with syphilis (in men) a chancre often appears in the genital area, usually (but not always) on the penis. These sores are often painless.

    To me it seems quite reasonable...

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  • Re: Trimming the estimate: Unmeasured confounding in the association between pubic hair grooming and sexually transmitted infections
    Benjamin N Breyer

    As few studies have examined the relation between pubic hair grooming and sexually transmitted infections (STIs), we took advantage of nationally representative survey data to begin to explore this possible association and to develop hypotheses for future prospective studies. In our analysis, we observed a positive association between self-reported pubic hair grooming and STI history, which we interpreted in several poss...

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  • Street and Labour Children; Special Group for Elimination of Viral Hepatitis in Iran
    Seyed Moayed Alavian

    Dear editor,

    We read with much interest the recently published article by Foroughi et al. [1] in your journal. They have demonstrated that prevalence of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among street and labour child are 4.5%, 1.7% and 2.6% in Iran, respectively and well discussed about HIV infection in this population, However, we would like to highlight some points about HBV a...

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  • Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae
    Thomas Meyer

    Dear Madam, dear Sir: With interest, we read the paper of Chow et al. (1) reporting that Listerine antiseptic mouthwash can kill Neisseria gonorrhoeae in vitro and reduce the amount of gonococci on pharyngeal surfaces. There is no doubt that measures beyond antibiotic treatment of gonococcal infections detected clinically or by laboratory testing are needed to reduce the prevalence of infection and that mouthwash can dimi...

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  • Re: Oral sex practice as an essential criteria to define the safe sex behavior
    Christopher T. Lewis

    We thank the contributor for his interest in our paper,[1] and for highlighting the role of oral sex in the transmission of STI.

    On a population level, public health intervention tends to focus on the encouragement of "safer" sexual practices. The British Association for Sexual Health and HIV defines safer sex as "having sex with less risk of transmission a sexually transmitted infection," and its guidance states...

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  • Excellent investigation of a much-needed subject
    Nita C. Ostroff

    The topic of prostitution is of utmost importance to the public health. The study by Parvez, Katyal, Alper, Leibowitz, and Venters (2013) thoroughly investigates the population of female sex workers in New York City who have been arrested for prostitution. This study is seminal because it is the first one that investigates rates of sexually transmitted disease infection in female sex workers incarcerated in New York. Th...

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  • Trimming the estimate: Unmeasured confounding in the association between pubic hair grooming and sexually transmitted infections
    Rohit P. Ojha

    Osterberg et al. [1] assessed the association between pubic hair grooming and sexually transmitted infections (STIs) using self-reported data from a cross-sectional survey of adults aged 18 to 65 years in the United States. The primary result was that individuals who reported ever- grooming had 1.8 times the odds (odds ratio [OR]=1.8, 95% confidence limits [CL]: 1.4, 2.2) of a history of STIs compared with individuals who...

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  • Oral sex practice as an essential criteria to define the safe sex behavior
    Lukman A. Chandra

    Dear Editor,

    Modifying sexual behavior remains the primary goal of preventing the transmission of HIV/STIs among populations. However, with the various borderlines of "safe sex" definition, people sometimes get confused to describe how to practice low-risk sex activities. In general, safe sex is defined as sexual activities in which avoiding any bodily fluid exchanges (sperm, vaginal fluid, blood, and saliva),...

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