Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa

Objectives:To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history of receptive anal intercourse (RAI) in adults identified as “high risk”.Methods:Rou...

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Veröffentlicht in:Sexually transmitted infections 2008-10, Vol.84 (5), p.364-370
Hauptverfasser: Grijsen, M L, Graham, S M, Mwangome, M, Githua, P, Mutimba, S, Wamuyu, L, Okuku, H, Price, M A, McClelland, R S, Smith, A D, Sanders, E J
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container_end_page 370
container_issue 5
container_start_page 364
container_title Sexually transmitted infections
container_volume 84
creator Grijsen, M L
Graham, S M
Mwangome, M
Githua, P
Mutimba, S
Wamuyu, L
Okuku, H
Price, M A
McClelland, R S
Smith, A D
Sanders, E J
description Objectives:To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history of receptive anal intercourse (RAI) in adults identified as “high risk”.Methods:Routine STI screening was offered to adults at high risk of HIV-1 upon enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk behaviours and STI prevalence were summarised and the value of microscopy assessed. Associations between prevalent HIV-1 infection and RAI or prevalent STI were evaluated with multiple logistic regression.Results:Participants had a high burden of untreated STI. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. RAI was reported by 36% of male and 18% of female participants. RAI was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95% CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9; 95% CI 3.4 to 48.7).Conclusions:High-risk adults recruited for HIV-1 prevention trials carry a high STI burden. Symptom-directed treatment may miss many cases and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. STI screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk of HIV-1 acquisition.
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Risk behaviours and STI prevalence were summarised and the value of microscopy assessed. Associations between prevalent HIV-1 infection and RAI or prevalent STI were evaluated with multiple logistic regression.Results:Participants had a high burden of untreated STI. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. RAI was reported by 36% of male and 18% of female participants. RAI was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95% CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9; 95% CI 3.4 to 48.7).Conclusions:High-risk adults recruited for HIV-1 prevention trials carry a high STI burden. Symptom-directed treatment may miss many cases and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. STI screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk of HIV-1 acquisition.</description><identifier>ISSN: 1368-4973</identifier><identifier>EISSN: 1472-3263</identifier><identifier>DOI: 10.1136/sti.2007.028852</identifier><identifier>PMID: 18375645</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd</publisher><subject><![CDATA[Acquired immune deficiency syndrome ; Adult ; AIDS ; AIDS Vaccines ; Anus Diseases - prevention & control ; Biological and medical sciences ; Cohort analysis ; Disease prevention ; Epidemiology. Vaccinations ; Female ; General aspects ; HIV ; HIV Infections - prevention & control ; HIV-1 ; Human immunodeficiency virus ; Human infectious diseases. Experimental studies and models ; Humans ; Infections ; Infectious diseases ; Kenya ; Laboratories ; Male ; Mass Screening ; Medical History Taking ; Medical sciences ; Pain - etiology ; Patients ; Pelvic Inflammatory Disease - diagnosis ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Rectal Diseases - prevention & control ; Risk Assessment ; Risk Factors ; Sexual Behavior ; Sexually transmitted diseases ; Sexually Transmitted Diseases - prevention & control ; STD ; Syphilis ; Ulcers ; Uterine Cervicitis - prevention & control ; Vaccines ; Vagina ; Vaginal Diseases - prevention & control ; Women]]></subject><ispartof>Sexually transmitted infections, 2008-10, Vol.84 (5), p.364-370</ispartof><rights>2008 BMJ Publishing Group</rights><rights>2009 INIST-CNRS</rights><rights>Copyright: 2008 2008 BMJ Publishing Group</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b522t-85f266d230b90e98027ceaa2de384bb3bdacbaf2bae32eb9aabe3ce915c170913</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://sti.bmj.com/content/84/5/364.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://sti.bmj.com/content/84/5/364.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,230,314,776,780,881,3183,23550,27901,27902,77342,77373</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=21099992$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18375645$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grijsen, M L</creatorcontrib><creatorcontrib>Graham, S M</creatorcontrib><creatorcontrib>Mwangome, M</creatorcontrib><creatorcontrib>Githua, P</creatorcontrib><creatorcontrib>Mutimba, S</creatorcontrib><creatorcontrib>Wamuyu, L</creatorcontrib><creatorcontrib>Okuku, H</creatorcontrib><creatorcontrib>Price, M A</creatorcontrib><creatorcontrib>McClelland, R S</creatorcontrib><creatorcontrib>Smith, A D</creatorcontrib><creatorcontrib>Sanders, E J</creatorcontrib><title>Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa</title><title>Sexually transmitted infections</title><addtitle>Sex Transm Infect</addtitle><description>Objectives:To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history of receptive anal intercourse (RAI) in adults identified as “high risk”.Methods:Routine STI screening was offered to adults at high risk of HIV-1 upon enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk behaviours and STI prevalence were summarised and the value of microscopy assessed. Associations between prevalent HIV-1 infection and RAI or prevalent STI were evaluated with multiple logistic regression.Results:Participants had a high burden of untreated STI. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. RAI was reported by 36% of male and 18% of female participants. RAI was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95% CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9; 95% CI 3.4 to 48.7).Conclusions:High-risk adults recruited for HIV-1 prevention trials carry a high STI burden. Symptom-directed treatment may miss many cases and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. STI screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk of HIV-1 acquisition.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>AIDS</subject><subject>AIDS Vaccines</subject><subject>Anus Diseases - prevention &amp; control</subject><subject>Biological and medical sciences</subject><subject>Cohort analysis</subject><subject>Disease prevention</subject><subject>Epidemiology. Vaccinations</subject><subject>Female</subject><subject>General aspects</subject><subject>HIV</subject><subject>HIV Infections - prevention &amp; control</subject><subject>HIV-1</subject><subject>Human immunodeficiency virus</subject><subject>Human infectious diseases. Experimental studies and models</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Kenya</subject><subject>Laboratories</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Medical History Taking</subject><subject>Medical sciences</subject><subject>Pain - etiology</subject><subject>Patients</subject><subject>Pelvic Inflammatory Disease - diagnosis</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Vaccinations</topic><topic>Female</topic><topic>General aspects</topic><topic>HIV</topic><topic>HIV Infections - prevention &amp; control</topic><topic>HIV-1</topic><topic>Human immunodeficiency virus</topic><topic>Human infectious diseases. Experimental studies and models</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Kenya</topic><topic>Laboratories</topic><topic>Male</topic><topic>Mass Screening</topic><topic>Medical History Taking</topic><topic>Medical sciences</topic><topic>Pain - etiology</topic><topic>Patients</topic><topic>Pelvic Inflammatory Disease - diagnosis</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Rectal Diseases - prevention &amp; control</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sexual Behavior</topic><topic>Sexually transmitted diseases</topic><topic>Sexually Transmitted Diseases - prevention &amp; control</topic><topic>STD</topic><topic>Syphilis</topic><topic>Ulcers</topic><topic>Uterine Cervicitis - prevention &amp; control</topic><topic>Vaccines</topic><topic>Vagina</topic><topic>Vaginal Diseases - prevention &amp; control</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grijsen, M L</creatorcontrib><creatorcontrib>Graham, S M</creatorcontrib><creatorcontrib>Mwangome, M</creatorcontrib><creatorcontrib>Githua, P</creatorcontrib><creatorcontrib>Mutimba, S</creatorcontrib><creatorcontrib>Wamuyu, L</creatorcontrib><creatorcontrib>Okuku, H</creatorcontrib><creatorcontrib>Price, M A</creatorcontrib><creatorcontrib>McClelland, R S</creatorcontrib><creatorcontrib>Smith, A D</creatorcontrib><creatorcontrib>Sanders, E J</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Sexually transmitted infections</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grijsen, M L</au><au>Graham, S M</au><au>Mwangome, M</au><au>Githua, P</au><au>Mutimba, S</au><au>Wamuyu, L</au><au>Okuku, H</au><au>Price, M A</au><au>McClelland, R S</au><au>Smith, A D</au><au>Sanders, E J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa</atitle><jtitle>Sexually transmitted infections</jtitle><addtitle>Sex Transm Infect</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>84</volume><issue>5</issue><spage>364</spage><epage>370</epage><pages>364-370</pages><issn>1368-4973</issn><eissn>1472-3263</eissn><abstract>Objectives:To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history of receptive anal intercourse (RAI) in adults identified as “high risk”.Methods:Routine STI screening was offered to adults at high risk of HIV-1 upon enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk behaviours and STI prevalence were summarised and the value of microscopy assessed. Associations between prevalent HIV-1 infection and RAI or prevalent STI were evaluated with multiple logistic regression.Results:Participants had a high burden of untreated STI. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. RAI was reported by 36% of male and 18% of female participants. RAI was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95% CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9; 95% CI 3.4 to 48.7).Conclusions:High-risk adults recruited for HIV-1 prevention trials carry a high STI burden. Symptom-directed treatment may miss many cases and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. STI screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk of HIV-1 acquisition.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd</pub><pmid>18375645</pmid><doi>10.1136/sti.2007.028852</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Acquired immune deficiency syndrome
Adult
AIDS
AIDS Vaccines
Anus Diseases - prevention & control
Biological and medical sciences
Cohort analysis
Disease prevention
Epidemiology. Vaccinations
Female
General aspects
HIV
HIV Infections - prevention & control
HIV-1
Human immunodeficiency virus
Human infectious diseases. Experimental studies and models
Humans
Infections
Infectious diseases
Kenya
Laboratories
Male
Mass Screening
Medical History Taking
Medical sciences
Pain - etiology
Patients
Pelvic Inflammatory Disease - diagnosis
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Rectal Diseases - prevention & control
Risk Assessment
Risk Factors
Sexual Behavior
Sexually transmitted diseases
Sexually Transmitted Diseases - prevention & control
STD
Syphilis
Ulcers
Uterine Cervicitis - prevention & control
Vaccines
Vagina
Vaginal Diseases - prevention & control
Women
title Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa
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