Hjc de Vries

Botryomycosis in an HIV-positive subject.

A 28‐year‐old male AIDS patient with generalized painful skin ulcers, fever and malaise presented to us. The differential diagnosis included varicella zoster infection, herpes simplex infection, actinomycosis, sporotrichosis and botryomycosis. Histopathology revealed clusters of Gram‐positive coccoid bacteria in the deep dermis, surrounded by a mixed dense inflammatory infiltrate. A bacterial culture grew Staphylococcus aureus. Viral cultures remained negative. Based on these findings botryomycosis was diagnosed. Large lesions were excised surgically and with antimicrobial therapy all skin symptoms disappeared. We discuss this case with reference to a short review of the literature on botryomycosis in relation to HIV infection.

The cervico-vaginal microbiota in women notified for Chlamydia trachomatis infection: A case-control study at the STI outpatient clinic in Amsterdam, the Netherlands.

Background. Increasing evidence suggests that the cervicovaginal microbiota (CVM) plays an important role in acquiring sexually transmitted infections (STIs). Here we study the CVM in a population of women notified by a sex partner for Chlamydia trachomatis infection. Methods. We included 98 women who were contact-traced by C. trachomatis–positive sex partners at the STI outpatient clinic in Amsterdam, the Netherlands, and analyzed their cervicovaginal samples and clinical data. CVMs were characterized by sequencing the V3/V4 region of the 16S ribosomal RNA gene and by hierarchical clustering. Characteristics associating with C. trachomatis infection were examined using bivariable and multivariable logistic regression analysis. Results. The CVM was characterized for 93 women, of whom 52 tested C. trachomatis positive and 41 C. trachomatis negative. We identified 3 major CVM clusters. Clustered CVM predominantly comprised either diverse anaerobic bacteria (n = 39 [42%]), Lactobacillus iners (n = 32 [34%]), or Lactobacillus crispatus (n = 22 [24%]). In multivariable analysis, we found that CVM was significantly associated with C. trachomatis infection (odds ratio [OR], 4.2 [95% confidence interval {CI}, 1.2–15.4] for women with diverse anaerobic CVM and OR, 4.4 [95% CI, 1.3–15.6], for women with L. iners–dominated CVM, compared with women with L. crispatus–dominated CVM), as was younger age (OR, 3.1 [95% CI, 1.1–8.7] for those ⩽21 years old) and reporting a steady sex partner (OR, 3.6 [95% CI, 1.4–9.4]). Conclusions. Women who tested positive for Chlamydia trachomatis infection after having been contact-traced by a chlamydia-positive partner were more likely to have CVM dominated by L. iners or by diverse anaerobic bacteria, than by L. crispatus.

Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men

Introduction Men who have sex with men (MSM) are at high risk for anorectal chlamydia and gonorrhoea infections. Many MSM use rectal douches in preparation for sex, which might break down the mucosal barrier function and facilitate the acquisition of STI. We determined whether rectal douching or sharing douching equipment was associated with anorectal chlamydia and gonorrhoea. Methods In a cross-sectional study among 994 MSM attending the STI outpatient clinic of Amsterdam between February and April 2011, data were collected on rectal douching, sexual behaviour and STI. We used multivariable logistic regression analysis to determine the association between rectal douching, including sharing of douching equipment, and anorectal chlamydia and gonorrhoea for those reporting receptive anal sex. We adjusted for other risk behaviour, that is, condom use, number of partners and HIV status. Results Of 994 MSM, 46% (n=460) practised rectal douching, of whom 25% (n=117) shared douching equipment. Median age was 39 years (IQR 30–47), median number of sex partners in the 6 months prior to consult was five (IQR 3–10) and 289 (29.0%) participants were HIV positive. The prevalence of anorectal chlamydia and/or gonorrhoea for those reporting receptive anal sex was 9.6% (n=96). In multivariable analysis, HIV positivity (aOR=2.2, 95% CI 1.3 to 3.6), younger age (aOR=2.5, CI 1.4 to 4.5 for those aged <35 years compared with those aged ≥45 years), and more sexual partners (aOR=1.2, 95% CI 1.0 to 1.5 for 1 log increase) were significantly associated with anorectal STI. However, rectal douching or sharing douching equipment were not significantly associated with anorectal chlamydia and/or gonorrhoea (p=0.647). Conclusions Almost half of MSM used rectal douching and a quarter of these shared douching equipment. Though using douching equipment does not appear to contribute to anorectal chlamydia and gonorrhoea in this study, STI prevalence remains high and prevention strategies like early testing and treatment remain of utmost importance.

P3.18 Monitoringchlamydia trachomatisinfections after treatment for test of cure purposes

Introduction Performing a test of cure (TOC) could demonstrate success or failure of antimicrobial treatment of C. trachomatis (CT) infection, but the value of using a nuclear acid amplification test (NAAT) based TOC after treatment is subject to discussion, as the presence of CT nucleic acids after treatment may be prolonged and intermittent without the presence of infectious bacteria. We used cell culture to assess if a NAAT positive TOC indicates the presence of viable CT. Methods We analysed follow up (FU) data from women with a CT infection who visited the STI clinic of Amsterdam, the Netherlands, from September 2015 through June 2016. After giving informed consent, participants underwent baseline and three FU speculum examinations to obtain cervical swabs for both CT culture and NAAT testing. Speculum examinations were scheduled at 7, 21 and 49 days after treatment (single dose 1000 mg azithromycin). Collected samples were analysed using a RNA and DNA-based NAAT. CT cell culture was performed on all samples at baseline, and in FU samples that were NAAT-positive. Clearance was defined as conversion to negative NAAT results at any FU visit. Results We included 78 women with NAAT proven CT infection prior to receiving treatment of whom 58 (74%) were also culture positive. At the first visit after treatment (median 7 days; IQR 7–8) 44 (47%) women were NAAT positive, of whom three tested also positive by culture. CT infection was cleared in 73 women (94%), of whom 61 (78%) at their second FU visit (median 21 days; IQR 21–25). Of the five women who did not clear their infection, three were also culture positive indicating a viable infection. All five reported unprotected sexual contact after inclusion prior to their last FU visit, indicating potentially new infections. Conclusion We observed prolonged and intermittent positive results over time for both NAAT tests. For three participants (4%) viable CT infections were detected 49 days after treatment. All three cases reported new sexual contacts. In conclusion, persisting infections or treatment failure were rare. Support: Hologic provided Aptima test materials and kits in-kind. Roche provided Cobas test materials and kits in- kind. Copan provided Universal Transport Medium in-kind

P5.20 Hpv vaccination intention among female sex workers in amsterdam, the netherlands

Introduction Female sex workers (FSW) are at risk for HPV-induced diseases but are currently not targeted by the HPV vaccination program in the Netherlands. We explored the determinants of their intention to get vaccinated against HPV in case vaccination would be offered to them in the near future. Methods In 2016, FSW aged >18 years having an STI consultation with the Prostitution and Health Centre (P and G292) in Amsterdam, either at the clinic or at their working location, were invited to complete a questionnaire assessing the socio-psychological determinants of their HPV vaccination intention (scale ranging from −3 to +3). Determinants of HPV vaccination intention were assessed with uni- and multivariable linear regression. Additionally, we explored the effect of out-of-pocket payment on intention. Results Between May and September 2016, 293 FSW participated; 98 (34%) worked in clubs/private houses/massage salons, 111 (38%) worked at ‘prostitution windows’, and 81 (28%) worked as escorts or from home. The median age was 29 years (IQR 25–37). HPV vaccination intention was relatively high (mean 2.0; 95% CI:1.8–2.2). In multivariable analysis attitude (β=0.6; 95% CI:0.5–0.7), descriptive norm (β=0.3; 95% CI:0.2–0.4), self-efficacy (β=0.2; 95% CI:0.1–0.3), beliefs (β=0.1; 95% CI:0.0–0.2) and anticipated regret (β=0.1; 95% CI:0.0–0.2) were the strongest predictors of HPV vaccination intention. Demographic variables did not improve the multivariable regression model. The explained variance in the model (R2) was 0.54. HPV vaccination intention decreased significantly when vaccination would require out-of-pocket payment (€50 mean: 1.2 (95%CI: 0.8–1.7); €100 mean: 1.6 (95%CI: 1.1–2.0); € 200 mean: 1.0 (95%CI: 0.5–1.5); € 350 mean: 0.2 (95%CI: −0.2–0.7). Conclusion HPV vaccination intention among FSW in Amsterdam appears to be very high. The included socio-psychological factors explained most of the variance in HPV vaccination intention among FSW. Out-of-pocket payment had a significant negative effect on HPV vaccination intention.

P3.229 Sti prevalence and follow-up among female victims of a sexual assault tested at the sti clinic in amsterdam, the netherlands

Introduction During a sexual assault (SA), female victims may become infected with sexual transmitted infections (STI). Because of possibly high infection rates and low percentage returning for treatment, several STI clinics provide empiric antimicrobial therapy at the first consultation. The objective of this study was to assess the STI prevalence and follow-up of female sexual assault victims (SAV) at the STI clinic of Amsterdam, the Netherlands. Methods In the electronic patient database, SA is recorded as one of the reasons for visiting the clinic. We collected routine clinical data from the period 2005–2016. Characteristics and STI screening results of SAV and non-victims (NV) were compared. Backward multivariable logistic regression analysis was conducted to assess whether SAV was associated with STI positivity (chlamydia, gonorrhoea, infectious syphilis, infectious hepatitis B, and/or HIV). Results Between 2005 and 2016 166,808 STI consultations were performed with female clients and in 1066 consultations SA was reported. In 96% of the assaults no condom was used. All the assailants were male. Forensic examination was performed in 22% of the cases. Prior to the STI clinic consultation, in 10% an HIV test had been performed, 27% were vaccinated for hepatitis B and in 11% a pregnancy test was performed. SAV were less often Dutch (60% vs. 68% in NV, p<0.001), the median age was 24 years (vs. 24 in NV, p=0.003) and 34% reported STI related complaints (vs. 24% in NV, p<0.001). STI positivity was 11.7% in SAV and 11.8% in NV (p=0.53). In the multivariable analysis being an SAV was not associated with STI (OR 0.99; 95% CI 0.82–1.19). 91.3% of the SAV requiring antibiotics returned to the clinic. Conclusion The STI positivity in female SAV was comparable to NV attending the STI clinic. The return rate for treatment was high and does not support empiric prophylactic antimicrobial therapy. As most victims were not tested for HIV, and did not receive a hepatitis B vaccination after the assault, STI clinics can play a key role in providing care to SAV including STI testing.

001.4 Recent rise in reduced susceptibility to ceftriaxone in neisseria gonorrhoeae is not caused by strains with a pena mosaic gene

Background Resistance of Neisseria gonorrhoeae against third generation cephalosporins is a threat to public health. A known determinant is the presence of a mosaic penA gene in N.gonorrhoeae , partially derived from commensal Neisseria spp. We report resistance figures of N.gonorrhoeae against ceftriaxone from 2010 to 2013 and looked at penA characteristics of specific strains. Methods MICs for ceftriaxone were assesed from 2010–13 (4191 strains). A specific PCR identifying strains with a mosaic penA gene and partial sequence analysis (aa 180 – 550) of the penA gene were used for further characterisation of specific strains. Results Strains resistant to ceftriaxone were not found during the study period. The frequency of strains with an increased MIC (>0.032) to ceftriaxone was 5.2% in 2010, this rate dropped to 2.0 and 3.1% in 2011 and 2012 respectively, but increased to 7.8% in 2013. In 2010, 46/48 (96%) strains with an increased MIC against ceftriaxone contained a mosaic penA gene; in 2013, only 15/68 (22%) of such strains contained this gene. Sequence analysis of 16 of the strains isolated in 2013 with reduced susceptibility to ceftriaxone and lacking a mosaic penA gene showed that they all had an identical penA gene which was similar to type XVIII, including a 502 A-T mutation, but lacking the 543 G-S mutation. 1 Conclusion The recent increase of the frequency of strains with reduced susceptibility to ceftriaxone in 2013 is due to strains with a penA sequence not yet found in the Netherlands in 2010 among strains with reduced susceptibility to ceftriaxone. Disclosure of interest statement Nothing to declare Reference Whiley DM, Limnios EA, Ray S, et al . Diversity of penA alterations and subtypes in Neisseria gonorrhoeae strains from Sydney, Austrlia, that are less susceptible to ceftriaxone. Antimicrob Agents Chemother . 2007; 51 :3111–6