International journal of STD & AIDS
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There are no evidence-based guidelines for the specific management of rectal Chlamydia trachomatis (CT) infection. All men who have sex with men (MSM) diagnosed with asymptomatic rectal CT by nucleic acid amplification test (NAAT) at a large London genitourinary (GU) medicine clinic between September 2006 and September 2009 were offered oral doxycycline 100 mg twice daily for seven days and invited for a test of cure (TOC) by CT NAAT four weeks after treatment. A total of 487 asymptomatic rectal CT infections were diagnosed and analysis was restricted to 165 TOCs from men whose only treatment had been doxycycline for seven days. ⋯ One had taken doxycycline only for three days; the other attended for TOC 240 days after the completion of doxycycline treatment and at this time presented with new symptoms in the context of ongoing high sexual risk. Our findings show that doxycycline 100 mg twice daily for seven days is highly effective treatment for asymptomatic rectal CT infection, achieving clearance of CT in 98.8% (163/165; 95% CI 95.4-99.9%) of cases. We advocate doxycycline for seven days as first-line therapy for asymptomatic rectal CT.
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Little information is available on the prevalence of Neisseria gonorrhoeae (GC) infections outside genitourinary (GU) medicine clinics. A number of National Chlamydia Screening Programme areas now carry out simultaneous testing for Chlamydia trachomatis (CT) and GC in a single sample using nucleic acid amplification tests (NAATs). The aim of this study was to gather together data on dual testing from community settings. ⋯ A total of 219,412 results were recorded with 18,370 CT positives, 1226 GC positives and among these 554 were with dual CT/GC infection. These figures highlight the fact that substantial numbers of positive GC NAAT results are found outside GU settings. An assessment of both the prevalence of GC and the proportion of extra cases that can be detected in all settings is needed, together with the implementation of robust plans to confirm, treat and manage these patients.
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Patient-initiated partner notification of sexually transmitted infection (STI), i.e. patients informing their sexual partners of a diagnosis, is a cornerstone of STI prevention. Growing evidence suggests that women exposed to intimate partner violence (IPV) may fear such notification, or face negative consequences in response to STI disclosure. The current study assessed associations of IPV with fear of partner notification, and experiences of partner notification, among adolescent and young adult female family planning clinic patients. ⋯ Such partners were less likely to seek indicated STI treatment or testing. Current findings suggest that partner notification for STI may be compromised by IPV. Clinical practices and policies to support effective partner notification should include IPV assessment, and provide mechanisms to address related fears concerning partner notification.
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Adequate antiretroviral therapy is essential for HIV-positive pregnant women to prevent mother-to-child transmission. We report a small case series of five women receiving raltegravir as part of their antiretroviral regimen during pregnancy.
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Case Reports
Osteomyelitis as the only manifestation of late latent syphilis: case report and literature review.
Bone infection, particularly of the skull and the long bones of the legs and arms, despite being a common characteristic of tertiary stage syphilis and congenital syphilis in the past, is seldom encountered clinically due to effective antibiotic therapy. We report a case of a 62-year-old man who presented with one-month acute pain in the left leg. Treponema pallidum particle agglutination test was positive, and radiography showed a pathological fracture of the left tibiofibula. ⋯ The patient's symptoms resolved completely after a six-week course of penicillin. We identified 17 previously published cases of bone lesions of syphilis, eight of which had syphilitic osteomyelitis, seven were syphilitic osteitis and two had syphilitic periostitis. We suggest that bone lesions such as osteomyelitis caused by syphilis can be the only manifestation of late latent syphilis.