LGV cases almost triple in one year; UK public health officials warn against serosorting

The number of gay men infected with the sexually transmitted infection lymphogranuloma venereum (LGV) has almost tripled in one year, and the UK now has the world’s worst epidemic of LGV, the Health Protection Agency reported today. At the same time, the agency is tracking an outbreak in gay men of shigellosis, a bacterial infection that is transmitted through contact with tiny amounts of human faeces.

The HPA suspects that transmission of both infections is being fuelled by serosorting behaviour, in other words men choosing to have unprotected sex with men who have the same HIV status as themselves. While HIV-positive men who serosort may avoid passing on their HIV infection, they still risk acquiring unpleasant and often serious sexually transmitted infections such as LGV, shigella and hepatitis C. Serosorting “is unsafe”, the HPA says.

LGV is a previously rare sexually transmitted infection, seen in UK gay men since 2003. It is caused by specific strains of Chlamydia. If left untreated, symptoms can be complex and severe, including proctitis (inflammation of the anus or rectum).

Diagnoses of LGV increased from 190 in 2009 to 530 in 2010. Of the total 1560 cases seen between 2003 and 2010, more than one third have been diagnosed since the beginning of 2010.

The vast majority (83%) of LGV cases were in HIV-positive gay men. The infection is thought to be transmissible during unprotected anal intercourse, an activity which 84% of infected men report. Two-thirds of diagnoses were in London, but there are cases from across the country, especially Brighton and Manchester.

The public health agency is also concerned about a smaller outbreak of shigellosis. This bacterial infection, caused by either Shigella sonnei or Shigella flexneri has only occasionally been seen in UK gay men. The symptoms of shigellosis can include severe and bloody diarrhoea, but it can be successfully treated with antibiotics.

Shigella is transmitted by contact with tiny amounts of faeces. This can occur as a consequence of poor hygiene, or may be linked to sex, especially rimming, fingering, fisting, anal sex, and handling used sex toys and douching equipment. The bacteria may pass from dirty fingers to the mouth; basic hygiene and handwashing habits reduce the risk of transmission.

There have been 29 cases of infection with Shigella flexneri recorded since May 2011, mostly in London or Manchester. The HPA have not yet identified the key characteristics of the men who have been infected or identified the shared use of specific venues. However some previous shigellosis outbreaks have been concentrated in men with HIV and in men who used sex-on-premises venues.

The HPA report also notes the ongoing epidemic of sexually acquired hepatitis C in gay and bisexual men with HIV - 228 cases of recent infection were recorded at 22 of the larger HIV clinics in 2008-2010.

In addition, new diagnoses of the more widespread infections chlamydia and gonorrhoea are higher than they have been for more than a decade, at around 4500 and 5000 diagnoses respectively.

The HPA believes these figures highlight the dangers for HIV-positive men of ‘serosorting’, in other words having unprotected sex with partners thought also to be HIV-positive. “Serosorting poses a risk of acquiring other STIs and hepatitis, with serious treatment implications,” the agency warns.

It does not encourage HIV-negative men to serosort either, because rates of undiagnosed HIV are high. One quarter of those infected do not know that they have HIV.

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High rate of new diagnoses when gay men phoned and asked to come back for sexual health check-up

It’s feasible for sexual health clinics to take steps to invite ‘high-risk’ patients to come back for re-screening, and doing so leads to a high number of new diagnoses being made, London clinicians report in the December issue of Sexually Transmitted Infections.

When they implemented the strategy with 301 gay or bisexual men who had just been diagnosed with a bacterial sexually transmitted infection (STI), two-thirds came back for a check-up three months later. At the second visit, five new HIV diagnoses and 15 new STI diagnoses were made.

People who have previously been diagnosed with a sexually transmitted infection are a group of patients who have a greater risk of having another STI or HIV in the future. If an effective way of encouraging repeat screening can be identified, this may allow for the early diagnosis of infections.

While a number of organisations recommend that sexually active gay men should test for HIV “at least” once a year, UK clinical guidelines are not clear on the frequency with which gay men who have had an STI should re-screen. Moreover it is likely that only a minority of men come in for a check-up every few months.

In order to increase rates of re-screening, clinicians at the Mortimer Market Centre (a central London clinic popular with gay men) set up a system in which patients were phoned by a health adviser and invited to make an appointment for a check-up, three months after their last visit.

The clinic only invited gay or bisexual men who had been diagnosed with chlamydia, gonorrhoea, syphilis or LGV. Staff made up to three attempts to contact the patient; if an appointment was made but the patient did not attend, the clinic attempted to arrange one more appointment.

The check-up was managed in the same way as for other gay or bisexual men without symptoms. At the time, standard tests were for HIV, syphilis, gonorrhoea (urethra, rectum and throat) and chlamydia (urethra).

During the nine-month evaluation period, 301 men were asked if they would be happy for the clinic to contact them by phone in order to be invited to make a new appointment for a check-up in the future. All men had just been diagnosed with a bacterial STI, 9% were also HIV-positive, half reported unprotected anal sex in the past three months, three-quarters were white, and their average age was 32.

Of the 301 patients:

Half (153 men) came back to the clinic because of the recall programme; 12% of this group had STI symptoms.One in six (53 men) came back to the clinic for another reason; 49% had symptoms.Just under one third (95 men) did not come back to the clinic during the recall period. They either did not want to take part in the programme (30 men), made an appointment but did not turn up (27), could not be reached by telephone (21) or were no longer in the area (17).

Men with HIV were over-represented amongst those who did not come back to the clinic.

On the other hand, men who did come back for re-screening appeared to report more unprotected sex and more sexual partners than non-attenders. However these differences were not statistically significant in this small study.

Several diagnoses of gonorrhoea, chlamydia and syphilis were made at re-screening: nine in those men attending because of the programme, and six in men attending for other reasons.

HIV was diagnosed in four men attending because of the programme and in one man who attended for another reason. Two of these patients had declined testing at their previous appointment; the other three had tested negative at their previous appointment but had not noticed any seroconversion symptoms.

The authors describe the incidence (rate of new infections) as “high” for both bacterial STIs and HIV. They suggest that the identification of recent HIV infections is particularly important as men may otherwise inadvertently pass on their infection.

The results of this study should be considered alongside an Australian study earlier this year which found that sending a text message reminder to ‘high-risk’ gay men every four months increased the numbers who returned for HIV testing during a nine-month period – from 31% to 64%.

Text messages are very simple and cheap to send through automated procedures, while making telephone contact with patients is a more labour-intensive approach. However the London clinicians suggest that phone calls may result in more patients re-screening, and so be more cost-effective.

“This evaluation has demonstrated that recall for re-screening of MSM diagnosed as having a bacterial STI is a feasible strategy both in terms of the high rates of re-screening achieved and the number of new diagnoses made,” they say. Further studies with control groups, which examine cost-effectiveness, are called for, they conclude.

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UK considering lifting restrictions on health workers with HIV – as long as viral load is undetectable

The Department of Health has opened a consultation on possible changes to its policy on the employment of people with HIV. The current ban on people with HIV performing specific procedures in surgery, dentistry and gynaecology may be lifted, so that staff who are taking antiretroviral therapy and have a viral load below 200 copies/ml could work in the NHS.

Implementation of the proposal will, in part, depend on the responses received during the public consultation that is open until 9 March 2012. Patient safety in the NHS is a sensitive political issue and if public discussion is not informed by scientific evidence, the proposals could be controversial.

Current UK policy is for a total ban on HIV-positive healthcare workers performing ‘exposure-prone procedures’. As a result, a number of medical jobs are not open to people with HIV and the consequences for someone diagnosed in the middle of their career can be devastating.

An exposure-prone procedure is one in which injury to the healthcare worker could result in the worker’s blood contaminating the patient’s open tissues. These procedures involve a combination of sharp objects and the worker’s hands being in a body cavity. Surgery is the most obvious example, but many dental procedures are also considered ‘exposure-prone’.

Only a few other developed countries (including Australia, Ireland and Italy) have a policy as restrictive as that of the UK. It is more common for the management of an HIV-positive healthcare worker to be determined on a case-by-case basis. This is the situation in Austria, Belgium, Canada, France, New Zealand and Sweden, for example.

A current court case, in which a dentist with HIV is claiming the current ban is discriminatory and unlawful, helps explains why the government is considering the change.

A working group of experts examined the evidence on the risk of transmission occurring in healthcare settings, especially when patients have been treated by an HIV-positive health worker. Internationally, there have only been four cases of transmission, none of them in the UK. In the United States, testing of 22,171 patients who had been treated by 51 different HIV-positive workers, including surgeons, obstetricians and dentists, did not identify any new HIV infections. 

During some of the less invasive ‘exposure-prone procedures’ (such as a local anaesthetic injection or a routine tooth extraction), the experts consider the transmission risk to be “negligible”. During the most invasive procedures (such as a caesarean section or open cardiac surgery), they consider the risk to be “extremely low”.

But the experts consider that the risk of HIV transmission will vary, depending on the infectiousness of the health worker, as measured by viral load.

They therefore recommend that HIV-positive workers should be allowed to perform exposure-prone procedures as long as:

They are taking combination antiretroviral therapyTheir viral load is consistently below 200 copies/ml (tests taken every three months)They are under the joint supervision of a consultant in occupational medicine and their usual doctor.

The recommendations therefore open the possibility of individuals taking HIV treatment for occupational health reasons, when it would not otherwise be recommended.

Workers whose viral load rebounded or who ceased to comply with the testing requirements would be asked not to perform exposure-prone procedures until the situation was resolved.

Based on the prevalence of HIV in the England and the number of NHS employees who perform exposure-prone procedures, the experts estimate that the measures could affect around 110 HIV-positive workers (including those with undiagnosed infection).

England’s Chief Medical Officer, Dame Sally Davies, commented: "We need to ensure that the guidelines and restrictions imposed are evidence-based and achieve a fair balance between patient safety and the rights and responsibilities of healthcare workers with HIV. This consultation will seek wide views on the expert advice and whether it should be accepted."

The chairman of the Expert Advisory Group on AIDS, Professor Brian Gazzard, said: "Our careful review of the evidence suggests that the current restrictions on healthcare workers with HIV are now out of step with evidence about the minimal risk of transmission of infection to patients and policies in most other countries. This risk can be reduced even further if the healthcare worker is taking effective drug therapy for HIV and being monitored by HIV and occupational health specialists."

As healthcare is a responsibility of the devolved administrations in the United Kingdom, there are likely to be parallel consultations in the four countries. England and Scotland have already issued consultation documents, both of which are open until 9 March 2012.

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Posi+ive Please post this everywhere.

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DAY 4 - Carl Crosco - The Hot Boys Sexpert

Q&A:

Q:What can you take if you believe you have been exposed to the HIV virus last night?

A: How REYATAZ Can Help


REYATAZ is an HIV medication available by prescription. It is in a class of HIV medications called protease inhibitors. Protease inhibitors are a kind of HIV medication that fight HIV in the body by preventing the virus from multiplying.

REYATAZ is a protease inhibitor, a type of HIV medication that helps the virus from destroying CD4+ cells.

Once-daily REYATAZ has been demonstrated effective in managing HIV. As part of an HIV therapy regimen, once-daily REYATAZ:

•Is taken once daily with food.

•Can help raise your CD4+ cell (or T-cell) count. CD4+ cells are an important part of your immune system. The more CD4+ cells you have, the stronger your immune system.

•Can help lower your viral load to undetectable levels.* That means REYATAZ can lower the amount of HIV in your blood until it cannot be measured by current tests.

•Has a low chance of diarrhea (a 1-3% rate of moderate-to-severe diarrhea clinical trials).

For most people, the recommended dose of REYATAZ is one 300 mg pill taken once daily with ritonavir as part of HIV combination therapy. For people who have never taken HIV medicines before and cannot tolerate ritonavir, the recommended dose of REYATAZ is two 200 mg pills once daily as part of HIV combination therapy.


REYATAZ does not cure HIV or help prevent passing HIV to others.

* "Undetectable" is defined as a viral load that is too low to be picked up by a particular test. Typically, it is a viral load of less than 400 or 50 copies/mL (depending on test used).
http://www.reyataz.com/

For More Information on Whitman-Walker Clinic,
E-mail us at wwcinfo@wwc.org

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DAY 1 with Carl Crosco- The Hot Boys Sexpert

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Chi Chi LaRue - Safe Sex Is HOT Sex!