Sex Transm Inf 2000;76:407–414 407

A E MURRAY is not that high pro rata, possibly because Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from Department of Medical Microbiology cultural factors prohibit sex outside LETTERS TO Correspondence to: Dr Bhattacharjee marriage. Quinn et al3 have shown recently that viral load is the chief predictor of the risk of THE EDITOR 1 Sweet RL. Role of in pelvic inflammatory disease. Clin Infect Dis heterosexual transmission of HIV-1, and that 1995;20(suppl 2):s271–5. transmission is rare among people with levels 2 Hay PE, Lamont, Taylor-Robinson D, et al. of less than 1500 copies of HIV-1 RNA per Abnormal bacterial colonisation of genital tract and preterm delivery and late miscarriage. ml. A study on the possible association of BMJ 1994;308:295–5. It may be that HAART (highly active 3 Korn AP, Bolan G, Padian, et al. Plasma cell antiretroviral therapy) for HIV infected peo- dysfunctional uterine bleeding with in women with bacterial ple has caused transmission to be low in the bacterial vaginosis, , vaginosis. Obstet Gynaecol 1995;85:387– 90. United Kingdom but, as Cohen says, such a ureaplasma, and Gardnerella vaginalis 4 Keane FFA,Thomas B, Renton A, et al. Investi- theory has not been proved.4 gation into possible role of bacterial vaginosis The viral subtype dominant in parts of EDITOR,—A number of studies in the recent in non-gonococcal urethritis. Genitourin Med Africa (clade C), has unique properties that years have shown that bacterial vaginosis or 1997;73:373–7. favour sexual transmission.5 Other factors its associated micro-organisms mycoplasma/ 5 Bhattacharjee B, Sunderland D, Herrington S, et al. Scanning electron microscopy of endo- that make Africans more susceptible to HIV ureaplasma may be associated with various metrial biopsy of patients with bacterial than those who live in more developed obstetric and gynaecological complications vaginosis shows morphology resemblimg countries include lack of host factors that such as pelvic inflammatory disease and mycoplasma/ureaplasma. Sex Transm Inf 1999; 75:202–10. reduce infection risk; the plasma HIV-1 ,1 premature rupture of membranes and preterm labour,2 plasma cell RNA level in seropositive people being Accepted for publication 7 June 2000 endometritis,3 non-specific urethritis in male higher in sub-Saharan Africans; the lack of partners,4 and in our previous study5 we mutations in the gene for chemokine showed colonisation of the by receptor 5; circumcision status, with most Ethnicity and country of acquisition of men in Africa being uncircumcised; and the mycoplasma and ureaplasma in patients with HIV in the current Leicester bacterial vaginosis high prevalence of ulcerative sexually genitourinary medicine clinic cohort 4 The purpose of this study was to see if transmitted diseases. Some of these factors will operate for Asian patients born in there is any association between dysfunc- EDITOR,—We have surveyed the regular HIV tional uterine bleeding (DUB) and myco- Africa. infected attenders in the Leicester genito- Thus, ethnicity and country of acquisi- plasma, ureaplasma, and/or bacterial vagino- urinary medicine (GUM) HIV cohort; there sis. tion of HIV in Leicester as elsewhere, are currently 60 men and 16 women. Twenty is a reflection of interwoven, genetic, Ten patients, all with dysfunctional uterine five per cent are black African and 13% are of bleeding admitted for abdominal hysterec- environmental and behavioural, political, Indian/Pakistani/Bangladeshi stock, while and geographical factors.4 Therefore, tomy, were recruited for the study. Patients 62% are white. This amounts to 19 of were between 38 and 48 years (mean age 44) we cannot just examine nationality in 8258 black Africans in the Leicestershire isolation when considering HIV epidemiol- and all except one were parous. Appropriate total county population (which includes ethics committee approval and informed ogy. Travellers from Britain to Thailand, the Leicester central district) being HIV positive. Philippines, India, and Africa especially consents were taken. Forty seven of 771 181 white people and should be forewarned of the risks of sex and A detailed history was taken, particularly 10 of 77 537 Asians in the Leicestershire healthcare needle exposure and/or blood obstetrics and gynaecological, and any his- total county population were also HIV transfusions in all travel medicine consulta- tory of bacterial vaginosis or troublesome positive (Leicester City Council, from 1991 tions. . A preoperative high vaginal census figures, 2000, personal communica- swab for microscopic diagnosis of bacterial tion). DEREKTPEVANS vaginosis was taken. At operation, the en- VINCENT C RILEY

For acquisition of HIV related to ethnicity, http://sti.bmj.com/ dometrial cavity was opened by splitting the the results are as displayed in table 1. PETER G FISK anterior wall of the and an endome- In 1997, of those with heterosexually Department of Genito-urinary Medicine, Leicester trial swab and biopsy were taken for microbial transmitted HIV1 in the United Kingdom, Royal Infirmary, Leicester LE1 5WW culture and scanning electron microscopy for 3.3% were black Caribbeans, 49% were black Correspondence to: Dr Evans mycoplasma, ureaplasma, and Gardnerella African, with 33% being white, and 2.3% vaginalis. were Asian. None of the patient had any history of 1 Communicable Disease Report. 1999;9(No 22): In 1999, the Communicable Disease 200. bacterial vaginosis, troublesome vaginal 2 Report stated that, of female HIV infected 2 Communicable Disease Report. 1999;9(No 26): discharge, or any obstetric or gynaeco- people in England and Wales, 32% were 236. on September 24, 2021 by guest. Protected copyright. logical complications. Microscopic exam- white people and 49.5% were black Africans, 3 Quinn TC, Wawer MJ, Sewankambo N, et al. ination of the high vaginal swabs were and 2.7% were black Caribbeans, and 1.3% Viral load and heterosexual transmission of all normal except one with possible bac- human immunodeficiency virus type I. N Engl were south Asians. JMed2000;342:921–9. terial vaginosis. Microbial culture and Compared with the latter England and 4 Cohen MS. Preventing sexual transmission of scanning electron microscopy showed no Wales figures, Leicester appears to have a HIV—new idea from sub-Saharan Africa. N mycoplasma, ureaplasma, or Gardnerella Engl J Med 2000;342:970–2. moderate underrepresentation of black 5 Ping LH, Nelson JA, HoVman IH. Charac- vaginalis. Africans with HIV, and a moderate terisation of V3 sequence heterogenicity in Although there is definite association of overrepresentation of Asians in its cohort. sub-type C human immunodeficiency virus colonisation of the endometrium by This latter figure is to be expected because type I isolates from Malawi under- mycoplasma and ureaplasma in patients with representation of X4 variants. J Virol 1999;73: Leicester’s Asian population is 23.7% of the 6271–81. bacterial vaginosis, as we showed in our total population of the city (Leicester City previous study, this study did not show Council, 1991 census figures, 2000, personal any association of DUB with bacterial communication). However, the Asian figure Accepted for publication 14 June 2000 vaginosis, Gardnerella vaginalis, mycoplasma, or ureaplasma. Any significant association of DUB and bacterial vaginosis appears un- likely, as the age group of the majority of Table 1 Table of ethnicity in relation to country of acquisition of HIV,as found in the Leicester genitourinary medicine clinic HIV cohort, and assessed in April 2000 patients with DUB, as in this study, is also diVerent from the age group for bacterial vaginosis. Ethnicity Country of acquisition Asian African White Total (%) B BHATTACHARJEE A K GHOSH Asia 2 (3%) 2 (3%) 2 (3%)* 9% Department of Genitourinary Medicine, Arrowe Park Africa 2 (3%) 15 (25%) 2 (3%) 31% UK 2 (3%) 2 (3%) 43 (54%) 60% Hospital, Upton, Wirral, Merseyside, L49 5PE Total 9% 31% 60% 100% A MURRAY Department of Obstetrics and *Thailand.

www.sextransinf.com 408 Letters, Notices, Correction, Current publications

Detection of 14-3-3 brain protein in protein in CSF is not useful for diagnosis of Hepatitis B vaccination in a high risk Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from cerebrospinal fluid of HIV infected HADC. Detectable 14-3-3 protein has MSM population: the need for vaccine patients previously been reported in a non-HIV education infected patient with CNS lymphoma,3 so EDITOR,—The 14-3-3 proteins are a group of this observation in our patient is not unique, EDITOR,—Estimates of the prevalence of highly conserved proteins involved in although brain necrosis from coexisting cer- hepatitis B virus (HBV) markers among men intracellular signalling. Detection of 14-3-3 ebral toxoplasmosis provides an alternative who have sex with men (MSM) range from brain protein has been described in cere- explanation. Of the two patients with ex- 5% to 81%, and the prevalence of HBV sur- brospinal fluid (CSF) of patients with traneural lymphoma and detectable 14-3-3 face antigen varies from 1% to 11%.12 transmissible spongiform encephalopathies protein in CSF, one had EBV DNA in CSF Despite a safe and eVective vaccine against including both sporadic and variant and so was at high risk of developing cerebral HBV, sexually active MSM are not vacci- Creutzfeldt–Jakob disease.12 False positive lymphoma. This possibility could not be nated adequately.2–5 Few empirical data de- results have been reported in conditions confirmed as necropsy was not performed. scribe the factors associated with HBV vacci- producing (sub)acute neuronal destruction, In neither of the latter two patients was there nation among MSM. We conducted a study including encephalitis, ischae- a CSF pleocytosis, so contamination by to identify correlates of HBV vaccination mic stroke, multi-infarct dementia, and para- 14-3-3 protein derived from peripheral among MSM that could inform future inter- neoplastic syndromes.1–3 We postulated that blood leucocytes is unlikely. In the final case ventions designed to enhance HBV vaccina- 14-3-3 brain protein may be detected in CSF the absence of limbic encephalitis or cere- tion. from patients with HIV associated dementia bellar degeneration3 makes it diYcult to Data were collected at two male “gay” bars complex (HADC) as this condition is charac- ascribe the finding to a paraneoplastic in Birmingham, Alabama, USA, using a brief, terised neuropathologically by a giant cell process. self administered questionnaire. Of 130 bar encephalitis, leucoencephalopathy, astroglio- patrons, our sample consisted of 111 re- R F MILLER sis and neuronal loss. Department of Sexually Transmitted Diseases, Royal spondents who identified themselves as We prospectively studied 17 HIV antibody Free and University College Medical School, Mortimer MSM and knew their vaccination status. positive patients (14 men) aged 27–60 Market Centre, Mortimer Market, OV Capper Street, Their average age was 31 years with a range of (median 37) years, with CD4 counts of London WC1E 6AU, UK 18–48 years. The sample was disproportion- × 6 0–220 (median 20) cells 10 /l, who A J E GREEN ately white (91.9%); 42% reported being underwent lumbar puncture for investigation G GIOVANNONI vaccinated for HBV. of HADC (six patients), staging of E J THOMPSON Based on bivariate associations nine char- lymphoma (five patients), or investigation of Department of Neuroimmunology, Institute of acteristics were significantly associated with other conditions (six patients): epilepsy Neurology, National Hospital for Neurology and HBV vaccination—age; condom use; factual (two), cervical radiculopathy (one), chronic Neurosurgery, Queen Square, London WC1N 3BG knowledge of hepatitis; HBV knowledge; demyelinating polyradiculopathy (one), Correspondence to: Dr Miller HCV knowledge; HBV vaccination knowl- CMV encephalitis (one), self limiting edge; number of sources for information headache (one). Of those with HADC, the about hepatitis; information from a physician; severity of dementia assessed using Memo- 1 Hsich G, Kenney K, Gibbs C J, et al. The 14-3-3 and information from professional training. rial Sloan-Kettering criteria,4 was mild in brain protein in cerebrospinal fluid as a marker Two factors retained significance when ad- for transmissible spongiform encephalopathies. two and moderate in four. The degree of N Engl J Med 1996;335:924–30 justing for all other factors in a multivariate atrophy on cranial magnetic resonance 2 Zeidler M, Stewart GE, Barraclough CR, et al. logistic regression model: respondents’ HBV imaging, used as a marker of neuronal loss5 New variant Creutzfeldt-Jakob disease: neuro- vaccination knowledge (OR=10.18; 90% CI logical features and diagnostic tests. Lancet = 4.0–25.37, p = 0.0001) and their frequency was mild in four and moderate in two. Clini- 1997;350:903–7 cal details of those with lymphoma are given 3 Saiz A, Graus F, Dalmau J, et al. Detection of condom use (OR=6.1; 90% CI = 2.54– in table 1. At each lumbar puncture an ali- of 14-3-3 brain protein in the cerebrospinal 14.67, p = 0.0007). The predictive power of quot of CSF (250 µl) was frozen immediately fluid of patients with paraneoplastic the model (÷2 = 42.33; p = 0.0001) was high, ° neurological disorders. Ann Neurol 1999;46: at −20 C and stored for subsequent 14-3-3 774–7. correctly classifying 76.4% of the respond- protein analysis. 4 Price RW, Brew BJ. The AIDS dementia ents into their actual vaccination status http://sti.bmj.com/ CSF was routinely processed as described complex. J Infect Dis 1988;158:1079–83. categories (p = 0.0001). These findings sug- previously.6 Detection of 14-3-3 protein was 5 Miller RF, Lucas SB, Hall-Craggs MA, et al. gest that respondents with high HBV vacci- Comparison of magnetic resonance imaging done without knowledge of the patient’s with neuropathological findings in the diagno- nation knowledge and condom use are diagnosis, using a technique described by sis of HIV and CMV associated CNS disease in significantly more likely to have been vacci- Hsich et al,1 modified to use anti-14-3-3 ã AIDS. J Neurol Neurosurg Psychiatry 1997;62: nated against HBV. 346–51. polyclonal rabbit antibody. 6 Miller RF, Hall-Craggs MA, Costa DC, et al. There is need to enhance awareness and In 14 of 17 patients CSF was negative for Magnetic resonance imaging, thallium-201 facilitate vaccination among this high risk 14-3-3 protein. Of the three with detectable SPET scanning and laboratory analyses for population for HBV infection; 32% reported 14-3-3 protein in CSF, all had lymphoma discrimination of cerebral lymphoma and toxo- having no information about hepatitis. Many on September 24, 2021 by guest. Protected copyright. plasmosis in AIDS. Sex Transm Inf 1998;74: but only one had CNS disease, the other two 258–64. respondents reported engaging in behaviours had only extraneural disease (table 1). These that put them and their sexual partners at risk data, although from a small study for HBV infection; 95.5% and 30.6% re- population, suggest that detection of 14-3-3 Accepted for publication 14 July 2000 ported using a condom less than 50% of the

Table 1 Clinical features, results of CSF brain protein detection, and outcome in patients with lymphoma

CSF

No of Interval between lumbar lumbar puncture 14-3-3 Patient Type of lymphoma puncture (weeks) detection Outcome

1 Primary CNS 1 No Died 2 weeks after second lumbar puncture 11 Necropsy showed also cerebral toxoplasmosis 2Yes 2 Primary CNS 1 No Died 2 weeks after second lumbar puncture 3 Necropsy confirmed diagnosis 2No 3 Primary CNS 1 NA No Died 3 weeks later. No necropsy 4 Systemic, disseminated extraneural 1 NA Yes Died 6 weeks later. Cranial MR scan normal but EBV DNA detected in cell free CSF No necropsy 5 Systemic, extra neural 1 NA Yes Alive. Cranial MR scan normal. Treated with local RT and HAART. No lymphoma recurrence after 39 months follow up

CNS = central nervous system. NA = not applicable. EBV = Epstein–Barr virus. CSF = cerebrospinal fluid. MR = magnetic resonance. RT = radiotherapy. HAART = highly active antiretroviral therapy.

www.sextransinf.com Letters, Notices, Correction, Current publications 409

time during oral and anal intercourse, A catalogue of publications is available online sity, Hat Yai, Songkla 90110, Thailand (fax: Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from respectively. Given that HBV transmission (www.paho.org). The monthly journal of (66-74) 446 361; email: cverapol@ usually results from mucous membrane PAHO, the Pan American Journal of Public ratree.psu.ac.th or Bangkok Secretariat, exposure to infectious body fluids, including Health, is also available (subscriptions: Dr Thanit Palanuvej, Bangkok Hospital, 189 semen,6 the failure to vaccinate this high risk [email protected]). Sathorn Road, Bangkok 10120, Thailand population is a missed opportunity to prevent (fax: (66-2) 286 3013; email: pthanit@ disease. Imperial College School of Medicine, email.ksc.net). Our findings suggest that MSM lack infor- Division of Paediatrics, Obstetrics and mation about HBV risk and vaccination, and Gynaecology, symposium on Maternal Imperial College School of Medicine, are engaging in behaviours that put them at Mental Health and the Child, 12 October Division of Paediatrics, Obstetrics and risk for HBV infection. It is critical to develop 2000 Gynaecology, revision course for DCH innovative interventions that encourage con- Further details: Symposium OYce, Imperial (at Wolfson Conference Centre), 13–17 dom use and increase knowledge of HBV College School of Medicine, Queen Char- November 2000 vaccination among MSM. lotte’s and Chelsea Hospital, Goldhawk Further details: Symposium OYce, Imperial Road, London W6 0XG, UK (tel: +44 (0) 20 College School of Medicine, Queen Char- This study was supported financially by the 8383 3904; fax: +44 (0) 20 8383 8555; email: researchers themselves. We wish to thank the [email protected]). lotte’s and Chelsea Hospital, Goldhawk participants, the bar owners, managers, and staV. Road, London W6 0XG, UK (tel: +44 (0) 20 SCOTT D RHODES 11th Regional Meeting of International 8383 3904; fax: +44 (0) 20 8383 8555; email: Department of Health Behavior, School of Public Union against Sexually Transmitted In- [email protected]). Health, University of Alabama, Birmingham, fections, South East Asian and Western Alabama, USA Pacific Branch and 24th National Con- Consortium of Thai Training Institutes RALPH J DICLEMENTE ference of Indian Association for the for STDs and AIDS—International Re- Department of Behavioral Sciences and Health Study of Sexually Transmitted Diseases union and Refresher Course on Sexual Education, Rollins School of Public Health, Emory and AIDS, 13–15 October 2000, Chandi- Health, Lee Garden Plaza Hotel, Hat Yai, University, Atlanta, Georgia, USA garh, India Thailand 24–26 November 2000 LELAND J YEE Further details: Dr Bhushan Kumar, Organ- Further details: Hat Yai Secretariat, Dr Department of Epidemiology and International ising Secretary, 11th Regional Meeting of Verapol Chandeying, Dept of OB-GYN, Fac- Health, School of Public Health, University of IUSTI–Asia Pacific (SE Asia and W Pacific ulty of Medicine, Prince of Songkla Univer- Alabama, Birmingham, Alabama, USA Branch), Department of Dermatology, Ve- sity, Hat Yai, Songkla 90110, Thailand (fax: KENNETH C HERGENRATHER nereology and Leprosy, PGIMER, Chandi- (66-74) 446 361; email: cverapol@ Department of Rehabilitation, Auburn University, garh - 160 012, India (tel: +91 (0172) ratree.psu.ac.th Bangkok Secretariat, Auburn, Alabama, USA or 745330; fax: +91 (0172) 744401/745078; Dr Thanit Palanuvej, Bangkok Hospital, 189 Correspondence to: Ralph J DiClemente, PhD, email: [email protected]). Rollins School of Public Health, Emory University, Sathorn Road, Bangkok 10120, Thailand 1518 Clifton Road, NE; BSHE/5th Floor, Atlanta, (fax: (66-2) 286 3013; email: pthanit@ GA 30322, USA New Zealand Venereological Society email.ksc.net). Conference, Centennial Convention [email protected] Centre, Palmerston North, New Zea- Royal Society of Medicine and National land, 18–20 October 2000 Institutes of Health International Con- 1 Brook MG. Sexual transmission and prevention Ka Hikoitia Ka Korerotia Mo Te Tau Rua of the hepatitis viruses A-E and G. Sex Transm Mano (Maori) “Walk the Talk 2000.” Fur- ference, RSM London, 7–8 December Inf 1998;74:395–8. ther details: Sue Peck, Conference Organiser, 2000 2 Seage GR 3rd, Mayer KH, Lenderking WR, et The RSM in London, UK, and the NIH in al. HIV and hepatitis B infection and risk SP Conference Management, PO Box 4400, behavior in young gay and bisexual men. Public Palmerston North, New Zealand (tel: 64 6 Bethesda, Maryland, US, are organising an Health Rep 1997;112:158–67. international conference to be held at the 3 Loke RH, Murray-Lyon IM, Balachandran T, et 357 1466; fax 64 6 357 1426; email al. Screening for hepatitis B and vaccination of [email protected]). RSM on “New trends in HIV management http://sti.bmj.com/ homosexual men. BMJ 1989;298:234. and research.” Further details: Victoria 4 Katz M. Undervaccination for hepatitis B Boswell, Academic Conference Assistant, among young men who have sex with men: San Imperial College School of Medicine, Francisco and Berkeley, California. MMWR Division of Paediatrics, Obstetrics and Royal Society of Medicine (tel: +44 (0)20 1996;45:215–7. Gynaecology, symposium on Women and 7290 2965; fax:+44 (0)20 7290 2977; email: 5 Kane M. Epidemiology of hepatitis B infection Children with HIV and AIDS, 20 October [email protected]). in North America. Vaccine 1995;13(Suppl 1):S16–17. 2000 6 Abram SB, ed. Control of communicable diseases Further details: Symposium OYce, Imperial International Symposium on Disorders 16 ed. Washington, DC: American manual. College School of Medicine, Queen Char- of the Prostate, 21–23 March 2001, Cast- on September 24, 2021 by guest. Protected copyright. Public Health Association, 1995. lotte’s and Chelsea Hospital, Goldhawk res, France Accepted for publication 17 July 2000 Road, London W6 0XG, UK (tel: +44 (0) 20 Further details:Dr Mike Briley, Scientific 8383 3904; fax: +44 (0) 20 8383 8555; email: Director, Pierre Fabre Medicament, Parc [email protected]). Industriel de la Chartreuse, F-81106 Castres Cedex, France (tel:+33 563 714 501; fax: Imperial College School of Medicine, +33 563 725; email: briley@pierre- Division of Paediatrics, Obstetrics and fabre.imagenet.fr). NOTICES Gynaecology, symposium on key issues in the Care of Women and Gynaecologi- Call for papers—6th European Forum on cal Gancers (for nurses), 30 October 2000 Quality Improvement in Health Care, Further details: Symposium OYce, Imperial 29–31 March 2001, Bologna, Italy International Herpes Alliance and Inter- College School of Medicine, Queen Char- Further details: BMA/BMJ Conference Unit, lotte’s and Chelsea Hospital, Goldhawk national Herpes Management Forum BMA House, Tavistock Square, London The International Herpes Alliance has intro- Road, London W6 0XG, UK (tel: +44 (0) 20 WC1H 9JP, UK (tel: +44 (0) 20 7383 6409; duced a website (www.herpesalliance.org) 8383 3904; fax: +44 (0) 20 8383 8555; email: fax: +44 (0) 20 7383 6869; email: from which can be downloaded patient infor- [email protected]). mation leaflets. Its sister organisation the [email protected]; website: www.quality. International Herpes Management Forum Consortium of Thai Training Institutes bmjpg.com). (website: www.IHMF.org) has launched new for STDs and AIDS—10th STDs/AIDS guidelines on the management of herpesvirus diploma course, Bangkok Hospital, 6th European Conference on Experi- infections in pregnancy at the 9th Inter- Bangkok (30 Oct−12 Nov) and Prince of mental AIDS Research (ECEAR ‘2001), national Congress on Infectious Disease Songkla University, Hat Yai, Thailand 23–26 June 2001, Heriott-Watt Univer- (ICID) in Buenos Aires. (13–23 Nov) 30 October–23 November sity, Edinburgh, UK 2000 Further details: ECEAR ‘2001 Conference Pan-American Health Organization, re- Further details: Hat Yai Secretariat, Dr Secretary, Division of Retrovirology, NIBSC, gional oYce of the World Health Organi- Verapol Chandeying, Dept of OB-GYN, Fac- Blanche Lane, South Mimms, Potters Bar, zation ulty of Medicine, Prince of Songkla Univer- Herts, EN6 3QG, UK.

www.sextransinf.com 410 Letters, Notices, Correction, Current publications

genitourinary medicine clinics in England” Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from published in the August issue of STI CORRECTION (2000;76:262–7) contained errors in tables 1 CURRENT and 2. The correct versions of these tables are published here. The multivariable statistical PUBLICATIONS analyses presented in tables 3 and 4, on which The paper by Hughes et al “Comparison of the paper focuses and on which the discussion risk factors for four sexually transmitted infec- and conclusions are based, are unaVected by tions: results from a study of attenders at three the errors and remain unchanged. Selected titles form recent reports published worldwide are arranged in the Table 1 Characteristics of patients attending three GUM clinics in England, April 1994 to September 1997 following sections: Gonorrhoea Royal Hallamshire, St Thomas’s, London2 Mortimer Market Centre SheYeld1 (%) (%) (MMC), London3 (%) Bacterial vaginosis Total attenders 20 334 15 155 15 882 Sex: Males 9 992 (49) 7 969 (53) 8 143 (51) and other treponematoses Females 10 314 (51) 7 186 (47) 7 659 (48) Hepatitis Not recorded 28 (<1) – 80 (1) Herpes Age group: Human papillomavirus infection 13–15 189 (1) 64 (<1) 20 (<1) Cervical cytology and colposcopy 16–19 2 319 (11) 977 (6) 671 (4) Other sexually transmitted infections 20–24 5 672 (28) 3 199 (21) 3 390 (21) Public health and social aspects 25–34 7 809 (38) 7 425 (49) 7 658 (48) Microbiology and immunology 35+ 4 254 (21) 3 485 (23) 4 135 (26) Dermatology Not recorded 91 (<1) 5 (<1) 8 (<1) Male sexual orientation: Miscellaneous Heterosexual 9 181 (92) 6 744 (85) 2 176 (27) Homo/bisexual 800 (8) 1 174 (15) 1 751 (22) Not recorded 11 (<1) 51 (1) 4 216 (52) Female sexual orientation: Heterosexual 10 145 (98) 7 057 (98) 4 001 (52) Gonorrhoea Homo/bisexual 165 (2) 89 (1) 96 (1) Not recorded 4 (<1) 40 (1) 3562 (47) Ethnic group: White 18 014 (89) 8 383 (55) 8 629 (54) Sexually transmitted disease clinic cli- Black Caribbean 1 038 (5) 4 308 (28) 433 (3) ents at risk for subsequent Black African 140 (1) 1 611 (11) 435 (3) Asian 483 (2) 496 (3) 506 (3) and chlamydia infections—possible Other/mixed4 297 (1) 357 (2) 498 (3) ‘core’ transmitters. Not recorded 362 (2) – 5 381 (34) RA GUNN, S FITZGERALD, SO ARAL. Sex Transm Presenting diagnosis Dis 2000;27:343–9 Genital warts5 1 976 (10) 963 (6) 619 (4) Genital HSV5 548 (3) 433 (3) 265 (2) Gonorrhoea6 389 (2) 559 (4) 285 (2) Gonorrhea among men who have sex Chlamydia6 2 175 (11) 752 (5) 633 (4) with men: outbreak caused by a single 7 Number of partners (heterosexuals): genotype of erythromycin-resistant 0–1 10 353 (53) 7 299 (53) 2 897 (47) 2 5 027 (26) 3 541 (26) 1 611 (26) Neisseria gonorrhoeae with a single- 3+ 3 961 (20) 2 802 (20) 1 669 (27) base pair deletion in mtrR promoter http://sti.bmj.com/ Not recorded 13 (<1) 159 (1) – region. Previous STI: MS XIA, WLH WHITTINGTON, WM SHAFER, KK Yes 5 791 (28) 5 807 (38) 3 483 (22) Not recorded – 3 (<1) 7 533 (47) HOLMES. J Infect Dis 2000;181:2080–2 Ever injected drugs Yes 361 (2) 228 (2) 145 (1) Amultiplex polymerase chain reaction to Not recorded – 2 (<1) 7 486 (47) diVerentiate â-lactamase plasmids of Commercial sex work (ever): Yes 543 (3) – 181 (1) Neisseria gonorrhoeae. Not recorded – 15 155 (100) 7 641 (48) HM PALNER, JP LEENING, A TURNER. J Antimicrob on September 24, 2021 by guest. Protected copyright. Chemother 2000;45:777–82 1 Data for 1 April 1994 to 30 September 1997. 2 Data for 1 April 1994 to 31 December 1996. 3 Data for 1996 only. A typing system for Neisseria gonor- 4 Includes “black other.” rhoeae based on biotinylated oligonucle- 5 First episode. otide probes to PIB gene variable re- 6 Uncomplicated infection. 7 Number of partners in past 12 months for SheYeld and St Thomas’s clinics and in past 3 months for MMC gions. (see methods for details). DK THOMPSON, CD DEAL, CA ISON et al. J Infect Dis 2000;181:1652–60 Table 2 Numbers of attenders diagnosed with first episode genital warts, first episode genital HSV, uncomplicated gonorrhoea and uncomplicated chlamydia, showing concurrent infections, in attenders at three GUM clinics in England, April 1994 to September 1997 (+ = present, − = absent) The lipopolysaccharide structures of Salmonella enterica serovar typhimu- No of attenders (%) Warts HSV Gonorrhoea Chlamydia rium and Neisseria gonorrhoeae determine the attachment of human 3320 (6.46) + − − − mannose-binding lectin to intact 3101 (6.04) − − − + M DEUYATROVAJOHNSON, IH 1184 (2.30) − + − − organisms. 957 (1.86) − − + − REES, BD ROBERTSON et al. Infect Immun 233 (0.45) − − + + 2000;68:3894–9 187 (0.36) + − − + 28 (0.05) − + − + 21 (0.04) + + − − Expression of AniA , the major anaero- 21 (0.04) + − + − bically induced outer membrane protein 11 (0.02) − + + − of Neisseria gonorrhoeae, provides pro- 9 (0.02) + − + + tection against killing by normal human 2 (0.00) − + + + sera. 42 297 (82.34) − − − − Total 51 371 (100) JA CARDINALE, VL CLARK. Infect Immun 2000;68:4368–9

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Role of hyphal formation in interactions Use of synthetic cardiolipin and lecithin Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from of Candida albicans with endothelial in the antigen used by the Venereal Chlamydia cells. Disease Research Laboratory Test for QT OHAN, PH BELANGER, SG FILLER. Infect Immun serodiagnosis of syphilis. 2000;68:3485–90 AR CASTRO, WE MORRILL, WA SHAW et al. Clin Diag Lab Immunol 2000;74:658–61 Duration of untreated genital infections Measurement of T-cell-derived antigen with Chlamydia trachomatis—a review binding molecules and immunoglobulin Comparison of the Serodia Treponema of the literature. 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Heterosexual transmission of hepatitis bott Laboratories LCx assay for Chlamy- GP JAROSIK, CB LAND. Infect Immun C, hepatitis B and HIV-1 in a sample of dia trachomatis and Neisseria gonor- 2000; :3443–54 68 inner-city women. rhoeae. JG FELDMAN, H MINKOFF, L LANDESMAN, J DEHO- AM GRONOWSKI, S COPPER, D BAORTO, PR VITZ. Sex Transm Dis 2000;27:338–42 MURRAY. J Clin Microbiol 2000;38:2416–8 Trichomoniasis The natural history of hepatitis C virus An important proportion of genital sam- infection—host, viral and environmental ples submitted for Chlamydia tracho- factors. matis detection by PCR contain small DL THOMAS, J ASTEMBORSKI, RM RAI et al. JAMA amounts of cellular DNA as measured by A randomized trial of intravaginal non- 2000;284:450–6 â -globin gene amplification. oxynol 9 versus oral metronidazole in the F COUTLEE, M DELADURANTAYE, C TRAMBLAY et treatment of vaginal trichomoniasis. al. J Clin Microbiol 2000;38:2512–9 http://sti.bmj.com/ NM ANTONELLI, SJ DIEHL, JW WRIGHT. 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AM THACKRAY, HJ FIELD. Th1 cellular immune responses. J Antimicrob Chem- other 2000;45:825–34 DJ ZHANG, X YANG, CX SHEN et al. Infect Immun 2000;68:3074–8 Syphilis and other Comparison of virus isolation and vari- Genetic diVerences in the Chlamydia treponematoses ous polymerase chain reaction methods trachomatis tryptophan synthase in the diagnosis of mucocutaneous her- pesvirus infection. á-subunit can explain variations in sero- ML NOGUEIRA, JB AMORIM, JG OLICEIRA et al. Acta var pathogenesis. Virol 2000;44:61–6 AC SHAW, G CHRISTIANSEN, P ROEPSTORFF, S BIR- Tracing a syphilis outbreak through KELUND. 2000; :581–92 Microbes 2 cyberspace. 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Immune protection against HSV-2 in Cervical neoplasia and repeated positiv- Inverse relationship between the expres- Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from B-cell-deficient mice. ity of human papillomavirus infection in sion of the human papillomavirus type 16 KL DUDLEY, N BOURNE, BN MILLIGAN. Virology human immunodeficiency virus- transcription factor E2 and virus DNA 2000;270:454–63 seropositive and -seronegative women. copy number during the progression of L AHDIEH, A MUNOZ, D VLAHOV et al. Am J Epi- cervical intraepithelial neoplasia. Decreased vaginal disease in J-chain- demiol 2000;151:1148–57 M STEVENSON, LC HUDSON, JE BURNS et al. J Gen deficient mice following herpes simplex Virol 2000;81:1825–32 type 2 genital infection. Genital human papillomavirus infection BA HENDRICKSON, J GUO,IBROWN et al. 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Syndromic treatment of sexually trans- Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from mitted diseases reduces the proportion Cervical cytology and Public health and social of incident HIV infections attributable to colposcopy aspects these diseases in rural Tanzania. KK ORROTH, A GAVYOLE, J TODD et al. AIDS 2000;14:1429–38

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Fluctuation in lower urinary tract symp- Polyherbal formulations with wide spec- Peyronie’s disease: etiology, medical and Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from toms in women—reassurance and watch- trum antimicrobial activity against re- surgical therapy. ful waiting can prevent overtreatment. productive tract infections and sexually WJG HELLSTROM, TJ BIVALACQUA. J Andrology S HUNSKAAR. BMJ 2000;320:1418 transmitted pathogens. 2000;21:347–55 GP TALWAR, P RAGHUVANSHI, R MISHRA et al. Am Incidence and remission rates of lower J Reprod Immunol 2000;43:144–51 Evidence based assessment of long-term urinary tract symptoms at one year in results of plaque incision and vein graft- women aged 40–60: longitudinal study. Bacteriology and treatment of malodor- ing for Peyronie’s disease. LA MOLLER, H LOSE, T JORGENSEN. BMJ ous lower reproductive tract in gynaeco- F MONTORSI, A SALONIA, T MAGA et al. J Urol 2000;320:1429–31 logic cancer patients. 2000;163:1704–8 EVect of a three month course of VE VONGRUENIGEN, RL COLEMAN, AJ LI et al. Obstet Gynecol 2000;96:23–7 Safety and acceptability of a baggy latex ciprofloxacin on the outcome of reactive condom. arthritis. M MACALUSO, R BLACKWELL, B CARR et al. T YLIKERTTULA, R LUUKKAINEN, U YLIKERTTULA Association of Contraception 2000;61:217–24 et al. Ann Rheum Dis 2000;59:565–9 with abnormal reactive oxygen species levels and absence of leukocytospermia. Tuberculosis of the penis after intravesi- Reactive arthritis: the result of an anti- JM POTTS, R SHARMA, F PASQUALOTTO et al. J cal bacillus Calmette-Guerin treatment. idiotypic immune response to a bacterial Urol 2000;163:1775–8 lipopolysaccharide antigen where the JM LATINI, DS WANG, P FORGACS, WBIHRIE.J Urol 2000;163:1870 idiotype has the immunological appear- Acute vulvar vestibulitis occurring dur- ance of a synovial antigen. ing chemotherapy with cryptophycin JR KENNEDY. Med Hypotheses 2000;54:723–5 Clinical management of foreign bodies analogue LY355703. of the genitourinary tract. TM DEPAS, M MANDALA, G CURIGLIANO, F PECCA- Detection of Kaposi’s sarcoma- A VANOPHOVEN, JB DEKERNION. J Urol TORI.O 2000; :1030 associated herpesvirus in oral and geni- bstet Gynecol 95 2000;164:274–87 tal secretions of Zimbabwean women. Drug therapy: erectile dysfunction. TM LAMPINEN, S KULASINGAM, JN MIN et al. J Genital diseases in the Peruvian dusky Infect Dis 2000;181:1785–90 TF LUE. N Engl J Med 2000;342:1802–13 dolphin (Lagenorhynchus obscurus). MF VANBRESSEM, K VANWAEREBEEK, U SIEBERT et EVect of intravaginal practices on the EVect of erectile dysfunction on fre- al. J Comparative Pathol 2000;122:266–77 vaginal and cervical mucosa of Zimba- quency of intercourse: a population bwean women. based prevalence study in Finland. Scrotal dog bites. JHHM VANDEWIJGERT, ZM CHIRENJE, V ILIFF et al. J KOSKIMAKI, M HAKAMA, H HUHTALA, TLJ JM CUMMINGS, JA BOULLIER. J Urol J Acq Immun Defic Synd 2000;24:62–7 TAMMELA. J Urol 2000;164:367–70 2000;164:57–8 http://sti.bmj.com/ on September 24, 2021 by guest. Protected copyright.

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