Phillips and colleagues found a third of in-patients had HIV tests
following implementation of a routine HIV testing policy at Croydon
University Hospital1. We recently found similar rates of HIV testing in
young women in the community in our medical student research projects. In
line with the 2013 Framework for Sexual Health Improvement's "three
specific indicators for sexual health" 2, we investigated reported uptake...
Phillips and colleagues found a third of in-patients had HIV tests
following implementation of a routine HIV testing policy at Croydon
University Hospital1. We recently found similar rates of HIV testing in
young women in the community in our medical student research projects. In
line with the 2013 Framework for Sexual Health Improvement's "three
specific indicators for sexual health" 2, we investigated reported uptake
of HIV testing, chlamydia testing and long acting reversible contraception
(LARC) in young women attending a further education college and a
university in London.
In September 2013 consecutive women in common room areas were invited
to complete a confidential questionnaire on sexual health. The response
rate among women at Lambeth College was 78% (77/99). The mean age of
responders was 18 years (range 16-24), and 43% described themselves as
being of black ethnicity, 19% white, and 38% of other ethnicity. Of the 39
(51%) women who said they were sexually active, 51% (20/39) had been
tested for HIV in the past year and 78% (28/36) for chlamydia. A third
(13/39) were currently using LARC (implant n=10, injection n=3).
The response rate among women at London Southbank University was 92%
(79/86). The mean age of responders was 21 years (range 18-25) and 38%
were from ethnic minorities. In the past year, 32% (25/79) had been tested
for HIV and 34% (26/77) for chlamydia. Only 5% (4/79) reported the use of
LARC in the past year, all of these being the implant.
We agree with Phillips and colleagues that late diagnosis of HIV is a
major public health problem. The recent Natsal report found that 29% of
women but only 14% of men aged 16-24 years reported being tested for HIV
in the past 5 years 3. Although rates of HIV testing in sexually active,
multiethnic young women in our study were encouraging, it is also crucial
to promote HIV testing in young men.
Anne Tear and Jessica Herbert
3rd year Medical Students
Pippa Oakeshott
Reader in General Practice
Population Health Sciences and Education, St George's, University of
London
Correspondence: m1000382@sgul.ac.uk, m1101507@sgul.ac.uk
Acknowledgement
We thank students and staff at Lambeth College and London Southbank
University.
Reference List
(1) Philips. D, Barbour. A, et al, Implementation of a routine HIV testing
policy in an acute medical setting in a UK general hospital: a cross
sectional study, STI 2013, doi: 10.1136/sextrans-2013-051302
(2) Department of Health, Improving outcomes and supporting transparency,
November 2013, pg 53, 91,99
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263662/2901502_PHOF_Improving_Outcomes_PT2_v1_1.pdf
[Acessed 13th December 2013]
(3) Sonnenberg P, Clifton S, Beddows S, et al, Prevalence, risk factors,
and uptake of interventions for sexually transmitted infections in
Britain: findings from the National Surveys of Sexual Attitudes and
Lifestyles (Natsal), The Lancet, Volume 382, Issue 9907, Pages 1795 -
1806, 30 November 2013 doi:10.1016/S0140-6736(13)61947-9
Trichomonas Vaginalis (TV) is frequently described as being
associated with pre-term delivery and low birth weight - and was again by
Professor Hillier in her editorial in her (unreferenced) introductory
paragraph. As far as I can ascertain, this association appears to be based
on published evidence from the 80s and 90s.
Is it possible, given the more recent understanding of a link between
TV and poverty, that t...
Trichomonas Vaginalis (TV) is frequently described as being
associated with pre-term delivery and low birth weight - and was again by
Professor Hillier in her editorial in her (unreferenced) introductory
paragraph. As far as I can ascertain, this association appears to be based
on published evidence from the 80s and 90s.
Is it possible, given the more recent understanding of a link between
TV and poverty, that these 20 year old studies were confounded?
There is conflicting evidence as to whether the use of metronidazole
is itself associated with worse birth outcomes1,2 and so it is important
to have a full understanding of the role of TV.
In global terms I work and teach in a setting with a low prevalence
of HIV. Can anyone help me find reasonably strong evidence that TV is
other than a harmless commensal for those of my patients who are
asymptomatic?
1.What have we learned about vaginal infections and preterm birth?
Carey JC et al Semin Perinatol 2003 27(3):212-6
2. Investigation of metronidazole use during pregnancy and adverse
outcomes Catherine A Coss et al Antimicrobial Agents and Chemotherapy 2012
56(9) 4800-5
We very much appreciate the letter that Dr Haghdoost and colleagues
wrote in relation to some of the issues outlined in our paper HIV
surveillance in MENA: recent developments and results and, in addition,
described some more recent developments in HIV surveillance in Iran.
We would like to reflect on several issues that they raised.
Our paper states that Djibouti, Iran, Morocco and Pakistan can be...
We very much appreciate the letter that Dr Haghdoost and colleagues
wrote in relation to some of the issues outlined in our paper HIV
surveillance in MENA: recent developments and results and, in addition,
described some more recent developments in HIV surveillance in Iran.
We would like to reflect on several issues that they raised.
Our paper states that Djibouti, Iran, Morocco and Pakistan can be
classified as having fully functioning HIV surveillance systems as trends
in HIV prevalence in these countries can be assessed over time for certain
population sub-groups. Surveillance systems in these countries have a
sufficient quantity and quality of the data that can be used to guide the
programmatic responses. We also mentioned other nine countries that have
partially functioning HIV surveillance systems.
As described in the Methods section of our paper, the assessment of
the quality of HIV surveillance systems was based on the questionnaire
sent to National AIDS Programmes (NAPs) of the countries of the WHO
Eastern Mediterranean Region (EMR) in 2009, 2010 and 2011, and not on the
data presented in the paper by Garcia Calleja et al published in Sexually
Transmitted Infections in 2010. As described in our paper, to assess the
quality of HIV surveillance systems we adapted a method developed by WHO
and UNAIDS.123
As one of the limitations, we outlined that data were provided by the
NAPs, which might have missed data sources collected by other agencies
that Haghodoost et al. mention, such as surveys in partners of IDUs.
However, as planning of surveillance and programmatic responses is lead by
the NAPs, we think that collecting data from NAPs gives an appropriate
insight into the type and quality of data that the countries use for
planning and evaluating the national HIV response. We are aware that many
studies might be undertaken in the EMR, but their results are not
disseminated, and this is particularly the case with studies done in
groups at higher risk of HIV that are heavily stigmatized.
In relation to some other issues that the colleagues raised, surveys
using respondent-driven sampling were done in many other countries in the
Region (some of these are referenced in the paper) as well as Mode of
Transmission studies.4
We have not reflected on the reasons for the improvements in HIV
surveillance in North Africa and the Middle East, but we believe this has
been due to greater availability of funding provided by the Global Fund to
Fight AIDS, Tuberculosis and Malaria and capacity building efforts of
numerous international and national agencies.
We agree with Dr Haghdoost and the colleagues that there are
substantial improvements in HIV surveillance in Iran though significant
challenges remain in bridging the gaps that the system still has. One of
them is certainly in conducting studies on HIV and sexually transmitted
infections in MSM and transgendered individuals, which due to prevailing
stigmatization are still lacking throughout the Region.
References:
1. Garcia Calleja JM, Jacobson J, Garg R, et al. Has the quality of
serosurveillance in low- and middle-income countries improved since the
last HIV estimates round in 2007? Status and trends through 2009. Sex
Transm Infect 2010;86(Suppl 2):ii35-42
2. Walker N, Garcia-Calleja JM, Heaton L, et al. Epidemiological
analysis of the quality of HIV sero-surveillance in the world: how well do
we track the epidemic? AIDS 2001;15:1545-54
3. Lyerla R, Gouws E, Garcia-Calleja JM. The quality of sero-
surveillance in low- and middle-income countries: status and trends
through 2007. Sex Transm Inf 2008;84: i85-91.
4. Mumtaz G, Hilmi N, Zidouh A, El Rhilani H, Alami K, Bennani A,
Gouws E, Ghys P, Abu- Raddad L. HIV Mode of Transmission Analysis. Rabat:
Kingdom of Morocco. Ministry of Health, Department of Epidemiology and
Disease Control, 2010.
We very much enjoyed reading Dr. Bozicevic's paper about the recent
developments in HIV Surveillance in MENA in a recent issue of your journal
[1]. Some topics discussed in that paper concern us and we would like to
share a few opinions about the current HIV surveillance system in Iran and
its recent advances.
In the paper it is stated that only two countries in the region (Morocco
and Sudan) have a partially functioning H...
We very much enjoyed reading Dr. Bozicevic's paper about the recent
developments in HIV Surveillance in MENA in a recent issue of your journal
[1]. Some topics discussed in that paper concern us and we would like to
share a few opinions about the current HIV surveillance system in Iran and
its recent advances.
In the paper it is stated that only two countries in the region (Morocco
and Sudan) have a partially functioning HIV surveillance; however, we
assume this is based on the data presented in a study conducted in 2009
[2] and at present, Iran has also a somewhat functioning HIV surveillance
system. For example, Iran has done a pretty fine job in controlling the
HIV infection among IDUs and monitoring the epidemic trend in pregnant
women [3]. Iran has been also conducting biannual bio-behavioral surveys
among IDUs, FSWs, IDU partners, and prisoners [3]. More recently, size
estimation programs have been introduced to the system and we have
conducted size estimation studies in estimating the size of at risk
populations [4]. On top of the above, Iran is one the only countries in
the region that has conducted Respondent Driven Sampling as well as Mode
of Transmission studies [3, 5]. What is more, the number of HIV/AIDS
related publications in Iran (in PubMed database) has doubled in a five-
year period which is also an evidence of improvement of the system [6].
We think a number of reasons may have contributed to this progress. The
role of the Regional Knowledge Hubs in HIV/AIDS Surveillance in educating
healthcare providers and researchers as well as health policy makers
cannot be ignored [7]. These educations have been given through national
and international workshops and sending out educational packages to
different policy makers, from members of the parliament to those in the
presidential office. We assume highlighting the burden of HIV/AIDS in the
upcoming years has been successful in drawing policy makers' attention to
the seriousness of the HIV epidemic across the country in a way that
controlling HIV/AIDS throughout the country was a serious concern in the
recent presidential debates.
Despite all the achievements in addressing the HIV epidemic, there is
still a lot to be done and the current system still suffers to a
considerable extent. For example, likewise most countries in the region,
MSM and transgendered populations have long been overlooked in the HIV
surveillance system; ignorance mainly originated from the stigma
surrounding such populations. We think one of the main challenges to be
overcome is the pitfalls in the case finding and reporting system of Iran.
The sensitivity of case finding in Iran is low and following up the HIV
patients and assessing their adherence to therapy is a major challenge in
front of healthcare providers [5, 8]. Although the case reporting system
is not fully functioning, a national computer-based is being launched in
the country that opens a window of hope in fixing the defects in the
current reporting system. The Ministry of Health is really optimistic
about this system; however, its effectiveness is yet to be evaluated.
References:
1. Bozicevic I, Riedner G, and Garcia Calleja JM. HIV surveillance in
MENA: recent developments and results. Sex Transm Infect, 2013. online: p.
1-6.
2. Garc?a Calleja JM, Jacobson J, Garg R, et al. Has the quality of
serosurveillance in lowand middle-income countries improved since the last
HIV estimates round in 2007? Status and trends through 2009. Sex Transm
Infect, 2010. 86 (Suppl 2): p. 35-42.
3. National AIDS Committee Secretariat and Ministry of Health and Medical
Education. Islamic Republic of Iran AIDS Progress Report On Monitoring of
the United Nations General Assembly Special Session on HIV and AIDS.2012,
available at:
www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/IRiran,1.PDF2012.
4. Shokuhi M, baneshi MR and haghdoost AA. Size Estimation of Groups at
High Risk of HIV/AIDS using Network Scale Up in Kerman, Iran. Int J Prev
Med, 2012 .3(7): p. 471-476.
5. Nasirian M, Doroudi F, Gooya MM, et al. Modeling of Human
Immunodeficiency Virus Modes of Transmission in Iran. Journal of Reaserch
in Health Sciences, 2012. 12(2): p. 81-87.
6. Saba HF, Kouyoumjian SP, Mumtaz GR, et al. Characterising the progress
in HIV/AIDS research in the Middle East and North Africa. Sex Transm
Infect, 2013. online: p. 1-5.
7. Mostafavi E, Haghdoost AA, mirzazadeh A, et al. Regional HIV knowledge
hubs: a new approach by the health sector to transform knowledge into
practice. Health Promotion International, 2012. online: p. 1-7.
8. Haghdoost AA, Mostafavi E, Mirzazadeh A, et al. Modelling of HIV/AIDS
in Iran up to 2014. Journal of AIDS and HIV Research Journal of AIDS and
HIV Research, 2011. 3(12).
UK and USA guidelines recommend at least annual HIV testing for men
who have sex with men (MSM), with more frequent testing for those at risk.
Although measures of risk and regularity of HIV testing are essential for
evaluating interventions, these are not yet standardised across the UK.1
Risk criteria could include recent unprotected anal intercourse (UAI), a
high number of partners, unknown partners, and recent STI.2...
UK and USA guidelines recommend at least annual HIV testing for men
who have sex with men (MSM), with more frequent testing for those at risk.
Although measures of risk and regularity of HIV testing are essential for
evaluating interventions, these are not yet standardised across the UK.1
Risk criteria could include recent unprotected anal intercourse (UAI), a
high number of partners, unknown partners, and recent STI.2 From self-
report data collected in Glasgow with a bar-based sample (excluding non-
Scottish and HIV positive men, n = 683), we compared two groups on these
risk criteria, in addition to demographic variables and psychosocial
testing barriers. The groups were those reporting an HIV test within the
previous 6 months (recent testers) and those reporting a test 6-12 months
previously.
Recent testers (39.7%, n = 271) and those tested 6-12 months
previously (17.6%, n = 120) differed significantly on the number of sexual
partners reported in the previous year; those tested 6-12 months
previously were more likely to report only 0-1 sexual partner, while
recent testers were more likely to report 2-10 partners: ??2 (2) = 6.33, p
= .042. However, the proportions of those reporting ?11 partners were
almost identical: 22.5% and 22.9% respectively. The groups did not
differ significantly on the numbers of UAI partners in the previous year.
Among those with at least one UAI partner, the groups did not differ on
status of partners (casual or regular), knowledge of the partners' HIV
status, or whether those partners were HIV positive. There was a non-
significant trend (p = .094) for recent testers to report STI in the
previous year. The groups did not differ on demographic characteristics
(age, employment, education, use of the gay scene) or barriers to HIV
testing (benefits, fear, clinic barriers, attitudes to sex with HIV
positive partners, testing norm).
Most measures of risk did not differentiate between the two groups of
testers, suggesting further research on the measurement of risk and
frequency or regularity of testing is warranted. We are exploring the
utility of including measures of regularity and frequency of HIV testing
in our surveys: one of the limitations of the analysis reported here (in
addition to reliance on self-reported and cross-sectional data from a bar-
based sample) was the use of a retrospective measure of the most recent
HIV test.
ACKNOWLEDGEMENTS
The survey was funded by NHS Greater Glasgow & Clyde, Ayrshire &
Arran and Lanarkshire. The MRC funds Dr Lisa McDaid.
ETHICS APPROVAL
Granted by the Psychology Ethics Subcommittee at Glasgow Caledonian
University.
REFERENCES
1. Desai M, Desai S, Sullivan AK, et al. Audit of HIV testing
frequency and behavioural interventions for men who have sex with men:
policy and practice in sexual health clinics in England. Sex Transm
Infect. Published Online First: January 7, 2013. doi:10.1136/sextrans-
2012- 050679.
2. Katz DA, Dombrowski JC, Swanson F, et al. HIV intertest interval
among MSM in King County, Washington. Sex Transm Infect 2013;89:32-37.
doi:10.1136/sextrans-2011-050470.
We enjoyed reading Dr. Saba's paper[1] and would like to share some
opinions about HIV/AIDS related publications in the Middle East and North
Arica (MENA). This paper showed a positive trend in the number of annual
HIV/AIDS related publications in the MENA, on the other hand, this paper
suggests that this number is still very low considering the sharp upward
trend of HIV new infections in this region.
This gap might be d...
We enjoyed reading Dr. Saba's paper[1] and would like to share some
opinions about HIV/AIDS related publications in the Middle East and North
Arica (MENA). This paper showed a positive trend in the number of annual
HIV/AIDS related publications in the MENA, on the other hand, this paper
suggests that this number is still very low considering the sharp upward
trend of HIV new infections in this region.
This gap might be due to several factors. The unsupportive dominant
political climate as well as the stigma and sensitivity surrounding at-
risk populations such as Men having Sex with Men is very high[2]. Some of
these countries have long been struggling with internal wars, uprisings,
and terrorism; that may overshadow the importance of this infection in the
minds of those in charge.
On the other hand, the dynamic of research have profound pitfalls in
the region. The potential research capacity and the availability of
funding do differ greatly across the region[2]. Lack of a clear and
comprehensive plan in several countries in this region might also be an
influencing factor.
Last but not least, scarce publications on HIV/AIDS related topics may
stem from the policy of credited scientific journals in publishing the
findings of researchers from this region. Most scientific journals stick
to high international research standards (regarding methodology mainly),
while reviewing manuscripts from the MENA region. Some barriers such as
low sample size, presence of selection and information biases to some
extent might convince journals to reject the papers from this region[3].
However, implementation of high quality studies might be impossible in
some of these countries. We think even simple descriptive data using even
convenience sampling methods could be an important step forward in
enriching the available data in the region[2].
Out of the formerly mentioned factors, we assume changing the viewpoints
of journal editors is one of the most feasible options we have ahead.
Lastly, although publishing the findings of researches and studies across
the region is of importance, the way and to the extent those findings are
applied in the countries to make a change and better the situation is much
more vital.
References:
1. Hanan F Saba, et al., Characterising the progress in HIV/AIDS research
in the Middle East and North Africa. Sex Transm Infect, 2013(0): p. 1-5.
2. Ivana Bozicevic, Gabriele Riedner, and Jesus maria Garcia Calleja, HIV
surveillance in MENA: recent developments and results. Sex Transm Infect,
2013(0): p. 1-6.
3. Ghina R Mumtaz, et al., Are HIV epidemics among men who have sex with
men emerging in the Middle East and North Africa?: a systematic review and
data synthesis. PLoS Med, 2011. 8(8): p. e1000444.
In their topical editorial, Jain and Ison state that "testing (for
chlamydia) is a crucial part of any effective control strategy"1. In
January 2013 we conducted a pilot study of Chlamydia trachomatis and
Neisseria gonorrhoea testing in female students at Lambeth Further
Education College, London to assess recruitment to a possible POPI
(prevention of pelvic infection) 2 screening trial.2
In their topical editorial, Jain and Ison state that "testing (for
chlamydia) is a crucial part of any effective control strategy"1. In
January 2013 we conducted a pilot study of Chlamydia trachomatis and
Neisseria gonorrhoea testing in female students at Lambeth Further
Education College, London to assess recruitment to a possible POPI
(prevention of pelvic infection) 2 screening trial.2
Two female general practitioners approached consecutive female
students in the common room and asked them to help with a women's health
study. We explained that only women aged 16-27 who were sexually
experienced were eligible. Those who consented completed a questionnaire
and provided a self-taken vaginal swab. We explained that as samples might
not be tested for six months, it was participants' responsibility to get
tested independently if they were at risk of STIs. Subjects were given a
small honorarium (?5 and a lollipop) when they returned the samples.
Of 40 women approached, eight were aged >27 and seven refused:
response rate 78% (25/32). Responders were broadly similar to non-
responders in the proportion of black ethnicity (56%, 14/25 versus 86%,
6/7) but were younger (mean (sd) 19.3 (2.7) years versus 22.9 (3.5) years,
p<0.01)). Unlike our difficulties in the POPI trial2, we recruited our
target of 25 women in 90 minutes and had to turn away potential
participants as we had run out of packs. Three women were later excluded
as their questionnaire responses showed they had never had sex. Of the 22
sexually active women, 41% reported two or more sexual partners in the
previous year and 45% were smokers. Mean age of sexual debut was 15.5
years (range 13 to 19). Four women reported a history of STI.
Within a week, samples were randomly allocated to immediate or
deferred testing. Two of 16 participants in the immediate testing group
were positive - one for chlamydia and one for gonorrhoea. They were easily
contactable by mobile phone and email and referred for treatment. We will
return to the college in six months to request a further vaginal swab and
questionnaire from the 22 eligible participants. Although we need to
ensure only those who are sexually experienced are recruited, our study
suggests small financial incentives may be useful.
Ethics review: Bromley REC: 12/LO/0855
Acknowledgements: We thank students and staff at Lambeth College.
References
1. Jain A, Ison CA. Chlamydia point-of-care testing: where are we
now? Sex Transm Infect 2013;89(2)88-89.
2. Oakeshott P, Kerry S, Aghaizu A et al. Randomized control trial of
screening for Chlamydia trachomatis to prevent pelvic inflammatory
disease: the POPI (prevention of pelvic infection) trial. BMJ.
2010;340:c1642
Butler and colleagues[1] report convincing results confirming that
the availability of HIV prevention tools such as condoms in prisons does
not increase sexual activity among inmates but rather increases safe sex.
These results represent a major step towards negating the widespread
belief that the general availability of prevention measures in prisons
increases at-risk practices associated with HIV, Hepatitis and other...
Butler and colleagues[1] report convincing results confirming that
the availability of HIV prevention tools such as condoms in prisons does
not increase sexual activity among inmates but rather increases safe sex.
These results represent a major step towards negating the widespread
belief that the general availability of prevention measures in prisons
increases at-risk practices associated with HIV, Hepatitis and other
sexually transmitted infections (STI). Indeed similar ad hoc studies
regarding the availability of needles and syringes programs in prisons
(NSP) showed no increase in injection but an increase in safe injecting
practices.[2] Despite such evidence, NSP continues to be banned in prisons
in several countries.
Recommendations by the authors about breaking down the last barriers
to condom availability in prisons are particularly significant and timely
for several reasons.
First, condoms are not always available in prisons and, paradoxically,
this is particularly true in countries with a high prevalence of HIV among
inmates. When "potentially" available, inmate access to condoms is not
always easy both due to a lack of condom machines, and because inmates are
reluctant to ask for them out of fear of stigmatization. Moreover, a
French study has already shown that HIV post-exposure prophylaxis is
neither known nor prescribed to prisoners[3] and this is perhaps the case
for many other correctional institutions.
Second, the need for condoms in prisons is justified by the recent
increase in industrialized countries of HCV permucosal transmission in HIV
-positive men who have sex with men (MSM)[4]. This increase is concomitant
with increased drug use and high risk sexual practices in this population.
Additionally, HIV and other STI, which are frequent in prisoners, appear
to be important cofactors in onward transmission of permucosally acquired
HCV.
Third, the criminalization of drug users and MSM in several countries
contributes to promiscuity in prisons, facilitating transmission of HIV
and Hepatitis B and C from one group to another. Though sexual violence
was infrequent and underreported in the study by Butler et al., this may
not be the case for other prisons where overpopulation may amplify such
risks.
Assuring the same prevention interventions for prisoners as those
enjoyed by the general population is not only a human right but a public
health need.
References:
1. Butler T, Richters J, Yap L, et al. Condoms for prisoners: no
evidence that they increase sex in prison, but they increase safe sex. Sex
Transm Infect. 2013 Jan 7.
2. WHO. Effectiveness of Interventions to Manage HIV in Prisons -
Needle and syringe programmes and bleach and decontamination strategies
(Evidence for Action Technical Papers). Geneva: WHO, UNAIDS, UNODC; 2007.
3. Michel L, Jauffret-Roustide M, Blanche J, et al. Limited access to
HIV prevention in French prisons (ANRS PRI2DE): implications for public
health and drug policy. BMC Public Health. 2011;11:400.
4. Bradshaw D, Matthews G and Danta M. Sexually transmitted hepatitis
C infection: the new epidemic in MSM? Curr Opin Infect Dis. 2013;26(1):66-
72.
Acute nongonococcal urethritis (NGU) is one of the commonest sexually
transmitted infections affecting man and woman. The diagnosis of NGU has
traditionally required microscopic evidence of urethritis. However, a
significant proportion of patients with urethral symptoms do not have
microscopic evidence of urethritis.
A recently published article by Orellana MA et al [1] highlighted the low
sensitivity of Gram stain in th...
Acute nongonococcal urethritis (NGU) is one of the commonest sexually
transmitted infections affecting man and woman. The diagnosis of NGU has
traditionally required microscopic evidence of urethritis. However, a
significant proportion of patients with urethral symptoms do not have
microscopic evidence of urethritis.
A recently published article by Orellana MA et al [1] highlighted the low
sensitivity of Gram stain in the diagnosis of urethritis in men, and the
low negative predictive value of microscopic results in symptomatic
patients.
Whereas, we recently evaluated the analytical performance of the UF-1000i
(Sysmex Co, Japan, Supplied by Dasit SpA, Cornaredo, Italy), a recently
introduced fluorescence flow cytometer intended for urinalysis purposes [2],
which provides new analytical features that seem particularly suitable for
microbiological diagnostics, for ruling out NGU or predicting the presence
of infection [3].
The Sysmex UF-1000i is a flow cytometry analyzer capable of quantifying a
lot of particles, including bacteria and white blood cells (WBCs). To
evaluate the analytical performance of the UF-1000i as a method for ruling
out NGU, we examined 200 urethral smear samples, collected in a liquid
transport medium (Eswab, Copan, Brescia, Italy).
We compared the UF-1000i results with microscopic Gram stain, and with
results obtained from standard cultures and molecular methods available in
our laboratory to detect NGU main pathogens (Chlamydia trachomatis,
Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum,
Mycoplasma hominis, Trichomonas vaginalis, Adenovirus, Herpes simplex) .
With instrument cut-off values of 200 BACT x10^6/L and 500 WBCs x10^6/L,
we obtained a sensitivity of 84%, a specificity of 82%, and a high
negative predictive value (96%).
Our data demonstrated that Sysmex UF-1000i represents a real tool for
ruling out NGU, capable of improving the efficiency of NGU presumptive
diagnosis, providing results in a few minutes, with a good value of
sensitivity and, above all, a very high negative predictive value.
References
1. Orellana MA, Gomez-Lus ML, Lora D. Sensitivit? of Gram stain in the
diagnosis of urethritis in men. Sex Transm Infect 2012; 88: 284-287.
2. Grosso S, Bruschetta G, Camporese A. Experimental evaluation of the
Sysmex UF-1000i for ruling out non-gonococcal urethritis. Infez Med 2012;
20 (3):188-194.
3. De Rosa R, Grosso S, Bruschetta G, et al. Evaluation of the Sysmex
UF1000i flow cytometer for ruling out bacterial urinary tract infection.
Clin Chim Acta 2010; 411 1137-1142.
HIV (Point of Care Tests) POCTs are increasingly popular and overcome
many barriers to testing. Yet POCTs have false reactive results requiring
confirmation. Teague et al,(2009) looked at using a second POCT as
confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid
Antibody Test; the confirmatory test the Alere Determine. The serum of 91
individuals with a positive INSTI was retrospectiv...
HIV (Point of Care Tests) POCTs are increasingly popular and overcome
many barriers to testing. Yet POCTs have false reactive results requiring
confirmation. Teague et al,(2009) looked at using a second POCT as
confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid
Antibody Test; the confirmatory test the Alere Determine. The serum of 91
individuals with a positive INSTI was retrospectively tested; Determine
successfully identified all false reactive INSTIs.1 These data led us to
introduce a testing algorithm using Determine (4th generation) as rapid
confirmation for all reactive INSTIs alongside the standard laboratory
test. This letter presents a review of its use from January to December
2010.
RESULTS
In this period, 220 INSTI reactive patients received both
confirmatory tests: 213 of these were reactive on Determine and laboratory
tests confirmed HIV infection.
7 had a negative Determine, with 5 proven to be false reactive by
laboratory testing. However, 2 were found to be lab positive and were
experiencing HIV seroconversion.
DISCUSSION
The results suggest reactive samples on both POCTs are extremely
unlikely to be falsely positive.
Although all false reactive INSTIs were identified by Determine, Determine
missed 2 patients with HIV seroconversion. Determine now includes a
p24antigen component. However, laboratory tests have a greater sensitivity
so it is expected that Determine will miss some seroconverters; Rosenberg
et al (2011) and Fox (2012) report the sensitivity of Determine in
detecting acute HIV infection at 25% and 50% respectively.2 3 Our data
goes further; indicating that while Determine is currently the only 4th
generation POCT, there are instances where 3rd generation POCTs may detect
infection earlier.
However, our data cannot say whether Determine could detect some acute
infections that INSTI may miss.
Significantly, these data highlight the importance of running laboratory
4th generation tests in parallel with POCTs when clinical history suggests
acute HIV infection, and when there has been significant risk of HIV
acquisition within the window period.
REFERENCES
1. Teague A, Rossi M, Gilmour C, et al. Use of two HIV-POCT tests to
identify false reactives. International Journal of STD & AIDS
2009;20:808-9.
2. Fox J, Dunn H, O'Shea S. Low rates of p24 antigen detection using
a fourth-generation point of care HIV test. Sexually Transmitted
Infections 2011;87:178-9.
3. Rosenberg NE, Kamanga G, Phiri S, et al. Detection of Acute HIV
Infection: A Field Evaluation of the Determine? HIV-1/2 Ag/Ab Combo Test.
Journal of Infectious Diseases 2012;205(4):521-4.
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INTRODUCTION
HIV (Point of Care Tests) POCTs are increasingly popular and overcome many barriers to testing. Yet POCTs have false reactive results requiring confirmation. Teague et al,(2009) looked at using a second POCT as confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid Antibody Test; the confirmatory test the Alere Determine. The serum of 91 individuals with a positive INSTI was retrospectiv...
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