Darlene Taylor

An assessment of the use of intravesical potassium in the diagnosis of interstitial cystitis

PURPOSE We evaluated the use of intravesical potassium in the diagnosis of interstitial cystitis. MATERIALS AND METHODS A blinded test assessment on 39 consecutive subjects attending our urology clinic for the evaluation of symptoms consistent with interstitial cystitis was performed. The pain response to intravesical potassium and water as a control was measured. The response rate was compared to the results of cystoscopy using standard outcome measures associated with diagnostic test assessment. RESULTS The probability of having interstitial cystitis given a positive intravesical potassium test was 66%. This finding added no new useful information and would not be helpful with clinical decisions as the probability of having interstitial cystitis in this population was already 56% before the test. Similarly, if the test was negative then 46% or nearly half of the subjects were still likely to have interstitial cystitis. Therefore, a negative test would have no ability to rule out disease nor would it be useful in making clinical decisions about how to proceed with evaluation or therapy. Test characteristics were considered poor with a sensitivity of 69.5% and a specificity of 50%. Likelihood ratios (positive 1.39, negative 0.61) also indicated poor inclusion and exclusion capabilities. CONCLUSIONS The general use of intravesical potassium as a diagnostic test for interstitial cystitis is not validated. The diagnosis of interstitial cystitis must depend on the clinical presentation and endoscopic findings based on National Institutes of Health criteria.

A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

ObjectiveTo compare the outcome, advantages and disadvantages of retropubic and perineal approach to radical prostatectomy, as performed by one surgeon.

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis.

Background The increases in STI rates since the late 1990s in Canada have occurred despite widespread primary care and targeted public health programs and in the setting of universal health care. More innovative interventions are required that would eliminate barriers to STI testing such as internet-based or mail-in home and community service testing for patients that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. Jurisdictions such as New Zealand and some American states currently use self-collected sampling, but without the required evidence to determine whether self-collected specimens are as accurate as clinician-collected specimens in terms of chlamydia and gonorrhea diagnostic accuracy. The objective of the review is to compare self-collected vaginal, urine, pharyngeal and rectal samples to our reference standard - clinician-collected cervical, urethral, pharyngeal and rectal sampling techniques to identify a positive specimen using nucleic acid amplification test assays. Methods The hierarchical summary receiver operating characteristic and the fixed effect models were used to assess the accuracy of comparable specimens that were collected by patients compared to clinicians. Sensitivity and specificity estimates with 95% confidence intervals (CI) were reported as our main outcome measures. Findings We included 21 studies based on over 6100 paired samples. Fourteen included studies examined chlamydia only, 6 compared both gonorrhea and chlamydia separately in the same study, and one examined gonorrhea. The six chlamydia studies comparing self-collection by vaginal swab to a clinician-collected cervical swab had the highest sensitivity (92%, 95% CI 87-95) and specificity (98%, 95% CI 97-99), compared to other specimen-types (urine/urethra or urine/cervix). Six studies compared urine self-samples to urethra clinician-collected samples in males and produced a sensitivity of 88% (95% CI 83-93) and a specificity of 99% (95% CI 0.94-0.99). Taking into account that urine samples may be less sensitive than cervical samples, eight chlamydia studies that compared urine self-collected verses clinician-collected cervical samples had a sensitivity of 87% (95% CI 81-91) and high specificity of 99% (95% CI 0.98-1.00). For gonorrhea testing, self-collected urine samples compared to clinician-collected urethra samples in males produced a sensitivity of 92% (95% CI 83-97) and specificity of 99% (95% CI 0.98-1.00). Conclusion The sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab as the recommended specimen of choice in home-based screening for chlamydia and gonorrhea. Urine samples for gonorrhea collected by men had comparably high sensitivity and specificity, so could be recommended as they can be left at room temperature for several days, allowing for the possibility of mail-in home-based testing. In populations that may not go for testing at all, do not have the option of clinical testing, or who refuse a clinical examination, self-collected screening would be a good alternative. We recommend that guidelines on how to self-collect gonorrhea and chlamydia urine, vaginal, rectal and pharyngeal specimens be published.

A Population-Based Study of Infectious Syphilis Rediagnosis in British Columbia, 1995–2005

BACKGROUND The Canadian province of British Columbia has experienced an ongoing heterosexual infectious syphilis epidemic since July 1997. In this study, we sought to characterize individuals who received a diagnosis of syphilis more than once in a cohort of reported cases from 1995 through 2005 in British Columbia. METHODS Data for all cases of primary, secondary, and early latent syphilis from 1 January 1995 through 31 December 2005 were extracted from the British Columbia Provincial Sexually Transmitted Disease Surveillance Database. A descriptive analysis was conducted on all variables from the cases, and the incidence density of syphilis rediagnosis was calculated. Bivariate and multivariate analyses were conducted using Cox proportional hazards regression techniques to compare those who received a syphilis diagnosis once with those who received a syphilis diagnosis more than once within the 10-year period. RESULTS By 2006, up to 10% of new cases of syphilis in the province were attributed to individuals who had received a previous diagnosis of syphilis within the preceding 10 years. In Cox proportional hazards regression analysis, individuals with the following characteristics were associated with an increased risk of becoming reinfected with syphilis: human immunodeficiency virus seropositivity, history of ever having gonorrhea or chlamydia, aboriginal ethnicity, and being a man who had sex with men. CONCLUSIONS In this study, an increasing proportion of syphilis cases in British Columbia were attributed to a rediagnosis during the previous decade. Individuals with syphilis rediagnosis may represent a core group of transmitters who continue to engage in risky behavior and sustain the epidemic. Policies for prevention need to better consider the role of interventions to decrease rates of repeat diagnoses of sexually transmitted infections.

Self-collection of genital human papillomavirus specimens in heterosexual men

Background: We assessed the accuracy of self-collected human papillomavirus (HPV) specimens in men compared with clinician-collected specimens from men in British Columbia and determined the prevalence of HPV subtypes at different male genital sites. Methods: Heterosexual men were recruited at the Provincial Sexually Transmitted Infection (STI) Clinic in Vancouver, Canada. Participants were randomly assigned to conduct self-collection or clinician-collected specimens first. Clinicians obtained specimens using emery paper followed by saline-moistened Dacron swab from three genitourinary sites: glans penis/foreskin, penile shaft (ventral and dorsal surfaces) and scrotum. Participants received written instructions and took specimens from one of the three sites using the same technique as clinicians. HPV testing was performed with the Roche Amplicor HPV test and samples found to be reactive were tested with the Roche Linear Array HPV typing assay to establish the HPV genotype(s) in the sample. Results: Overall prevalence of any HPV genotype from any site was 69.8% in clinician-collected specimens and 55.3% in self-collected specimens. Order of collection (clinician vs self-collected) did not impact on the prevalence of HPV in the specimens. The κ scores for agreement between clinician-collected and self-collected specimens ranged from fair to excellent. Overall, there was better agreement between self-collected and clinician-collected specimens for HPV-18 (range: κ = 0.88 to 0.92) than for HPV-16 (range: κ = 036 to 0.62). Conclusion: HPV is a prevalent genital tract infection in men. Site-specific agreement for specific HPV genotypes between clinician-collected and self-collected specimens varied broadly and neither clinicians nor patients routinely obtained samples with consistently higher or lower prevalence at specific genital sites, indicating there are continued opportunities to improve techniques for clinician-collected and self-collected male specimens for HPV.

Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women

To study the feasibility of self-collected specimens for testing human papillomavirus (HPV) status among hard-to-reach women, outreach nurses recruited women in womens centres, shelters and alleys in Vancouvers Downtown Eastside. Of the 151 participants for whom samples were available, 43 (28.5%) tested positive for high-risk HPV. Outreach nurses were able to recontact 81.4% of the participants who tested positive and referred them for further testing. About 14% (21/151) of participants had never received a Papanicolaou smear in British Columbia, as compared with 8.3% (608/7336) of women in the BC general population (p < 0.05). This difference suggests that self-collection of specimens for HPV testing is a feasible method to reach women who have not previously participated in cervical cancer screening programs.

Factors Associated With Intention to Use Internet-Based Testing for Sexually Transmitted Infections Among Men Who Have Sex With Men

Background Internet-based testing programs are being increasingly used to reduce testing barriers for individuals at higher risk of infection, yet the population impact and potential for exacerbation of existing health inequities of these programs are not well understood. Objective We used a large online sample of men who have sex with men (MSM) in Canada to measure acceptability of Internet-based testing and perceived advantages and disadvantages of this testing approach. Methods We asked participants of the 2011/2012 Sex Now Survey (a serial online survey of gay and bisexual men in Canada) whether they intended to use Internet-based testing and their perceived benefits and disadvantages of use. We examined whether intention to use was associated with explanatory variables spanning (A) sociodemographics, (B) Internet and technology usage, (C) sexually transmitted infections (STI)/ human immunodeficiency virus (HIV) and risk, and (D) health care access and testing, using multivariable logistic regression (variable selection using Bayesian information criterion). Results Overall, intention to use was high (5678/7938, 71.53%) among participants with little variation by participant characteristics. In our final model, we retained the variables related to (B) Internet and technology usage: use of Internet to cruise for sex partners (adjusted odds ratio [AOR] 1.46, 95% CI 1.25-1.70), use of Internet to search for sexual health information (AOR 1.36, 95% CI 1.23-1.51), and mobile phone usage (AOR 1.19, 95% 1.13-1.24). We also retained the variables for (D) health care access and testing: not “out” to primary care provider (AOR 1.24, 95% CI 1.10-1.41), delayed/avoided testing due to privacy concerns (AOR 1.77, 95% CI 1.49-2.11), and delayed/avoided testing due to access issues (AOR 1.65, 95% CI 1.40-1.95). Finally, we retained the variable being HIV positive (AOR 0.56, 95% CI 0.46-0.68) or HIV status unknown (AOR 0.89, 95% CI 0.77-1.01), age <30 years (AOR 1.41, 95% CI 1.22-1.62), and identifying as bisexual (AOR 1.18, 95% CI 1.04-1.34) or straight/other (AOR 0.67, 95% CI 0.50-0.90). The greatest perceived benefits of Internet-based testing were privacy (2249/8388, 26.81%), general convenience (1701/8388, 20.28%), and being able to test at any time (1048/8388, 12.49%). The greatest perceived drawbacks were the inability to see a doctor or nurse (1507/8388, 17.97%), wanting to talk to someone about results (1430/8388, 17.97%), not wanting online results (1084/8388, 12.92%), and low trust (973/8388, 11.60%). Conclusions The high and wide-ranging intention to use that we observed suggests Internet-based testing has the potential to reach into all subgroups of MSM and may be particularly appealing to those facing current barriers to accessing STI/HIV testing and who are more comfortable with technology. These findings will be used to inform the promotion and further evaluation of an Internet-based testing program currently under development in British Columbia, Canada.

Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling.

Failure to understand the risk of false-negative HIV test results during the window period results in anxiety. Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. A 10-day eclipse period was used to estimate days from infection to first detection of HIV RNA. Median (interquartile range) days to seroconversion were calculated and probabilities of a false-negative result at various time periods post-exposure are reported. The median (interquartile range) window period for third-generation tests was 22 days (19–25) and 18 days (16–24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days’ post-exposure for third-generation tests and at 42 days for fourth-generation tests. The table of probabilities of falsely-negative HIV test results may be useful during pre- and post-test HIV counselling to inform co-decision making regarding the ideal time to test for HIV.

Patients with genital warts have a decreased quality of life.

Human papilloma virus (hpv) is one of the most common sexually transmitted infections. It is estimated that 75% of sexually active individuals will have HPV-related infection in their lifetime.1 Of the numerous HPV subtypes, 15 are considered high-risk and lead to the development of cervical cancer.

Finding a voice: participatory research with street-involved youth in the youth injection prevention project.

This article uses a Positive Youth Development framework to explore the experiences of six experiential youth coresearchers (YCs) in the Youth Injection Prevention (YIP) participatory research project, and the parallel track process of empowerment and capacity building that developed. The YIP project was conducted in Metro Vancouver at the BC Centre for Disease Control and community organizations serving street-involved youth. A process evaluation was conducted to explore themes in the YCs experience in the project, as well as process strengths and challenges. Semistructured interviews with the YCs, researcher field notes, and team meeting and debrief session minutes were analyzed. The YIP project appears to have exerted a positive influence on the YCs. Positive self-identities, sense of purpose, reconceptualization of intellectual ability, new knowledge and skills, supportive relationships, finding a voice, and social and self-awareness were among the positive impacts. Process strengths included team-building activities, team check-in and checkout sessions, and professional networking opportunities. Process challenges included the time required to help YCs overcome personal barriers to participation. The YIP project demonstrates that participatory research with street-involved youth is a viable research option that contributes to positive youth development and empowerment.