J A Varela

Actualización en infecciones de transmisión sexual: epidemiología, diagnóstico y tratamiento

immune-response modifier in the treatment of genital warts, and that are questions in the goal of this review. Viral hepatitis and HIV were no reviewed by space reasons.

Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009.

During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35–39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.

Phthirus pubis in a sexually transmitted diseases unit: A study of 14 years

Background There have been few epidemiologic studies of pubic lice in recent times, and the exact incidence is unknown. Goal The goal was to determine the trends of pubic lice infestation in a risk group of males and female prostitutes in an STD unit in Spain. Study Design This was a prospective 14-year study, from 1988 to 2001, of all patients attending the STD unit in Gijón (Asturias, Spain), investigating crab lice and other STDs. Results One hundred ninety-seven patients (2.2%) had pubic lice, with a male/female proportion of 1.8/1. The yearly infestation rate ranged from 1.3% to 4.6%. The mean age was 30.3 years, and 18.8% of patients were older than 35 years. There were more cases involving men who had sex with men (MSM) (P < 0.001) than those involving heterosexual men. Reinfestation occurred in 7.6% of patients, more often in males (P < 0.05) and mainly in MSM (P < 0.01). Conclusion Infestation rates were stable during the period of study, with more older patients involved than reported previously, and infestation frequently was associated with STDs. MSM were infested and reinfested more often than heterosexual men, and in general reinfestations occurred more frequently in males than in females.

Molluscum contagiosum: A 20-Year Study in a Sexually Transmitted Infections Unit

A prospective 20-year (1988-2007) study in an STI unit in Spain investigating trends in Molluscum contagiosum infection included 12,424 patients. We found 339 Molluscum contagiosum infections (2.7% incidence) with a yearly distribution ranging from 0% to 6.8%. There was a three-fold increase from an incidence of 1.3% in the first decade (1988-1997) to 4.0% in the second (1998-2007) (P < 0.001).

Sentinel surveillance of HIV infection in HIV test clinics, Spain 1992-2002.

HIV infection in Spain was monitored in persons undergoing voluntary HIV testing in ten sentinel clinics between 1992 and 2002. Only patients on their first visit were considered for inclusion, and their numbers rose from 4426 in 1992 to 6649 in 2002. Most of them recognised their risk exposure as heterosexual. The proportion of injecting drug users decreased from 19% to 2% of the study population, and the proportion of female sex workers increased from 6% to 26%. The number of patients diagnosed with HIV infection declined from 604 in 1992 to 153 in 2002, and HIV prevalence fell from 13.6% to 2.3% in the same period. In all risk exposure categories, a decrease in HIV prevalence was observed, more pronounced during the first few years and stabilised in the later years. In 2002, the highest HIV prevalence was found in injecting drug users (IDUs) (14.2%), homo/bisexual men (7.5%) and individuals who had an HIV infected heterosexual partner (10.2%).

Gonorrhoea diagnoses in a network of STI clinics in Spain during the period 2006–2010: differences by sex and transmission route

BackgroundGonorrhoea infection is one of the most common bacterial sexually transmitted infections and an important cause of morbidity and serious complications. The objectives of this paper are: a) to describe gonorrhoea cases diagnosed in a network of 15 (out of 16) STI clinics in Spain during 2006–2010; b) to analyse differences among men who have sex with men (MSM), men who have sex exclusively with women (MSW) and women; and c) to evaluate factors associated to with HIV co-infection.MethodsAll gonorrhoea cases diagnosed in the network were included (25.7% of total cases notified in Spain). Data were collected by clinical staff. Descriptive/bivariate analyses were carried out stratifying by sex and transmission category; association and trends were evaluated using the chi-square test. Factors associated with HIV co-infection were estimated using a logistic regression model.Results2385 cases were included: 55.3% among MSM, 31.3% among MSW and 13.3% among females; cases among MSM increased from 55.8% in 2006 to 62.9% in 2010 while no trends were found among the other two groups.Most MSM cases were Spaniards (72%), aged 25–34xa0years (46%), 49% reported previous STI and 25% concurrent STI (excluding HIV); casual partners were the commonest source of infection, and 21% of cases had rectal gonorrhoea. MSW cases did not differ from MSM by age, origin or source of infection, but frequencies of prior or concurrent STI were lower. Female cases were younger than male, were mostly foreigners (58%), and 41% were sex workers; concurrent STI (other than HIV) were diagnosed in 30%; 20.4% had symptoms (72.5% and 89.2% in MSM and MSW), and pharyngeal location was present in 30%.HIV co-infection was highest in MSM (20.9%). Co-infection was associated with ageu2009>u200935xa0years, low educational level, being Western European or Latin-American, being MSM, having previous or concurrent STI and reporting contact with an HIV-infected partner; it was inversely associated with female sex.ConclusionDifferences by sex, transmission route and origin should be considered when implementing care and preventive programmes for gonorrhoea, and MSM are a priority group for intervention, in particular HIV-infected MSM.

Prevalencia de vih entre las personas de ocho ciudades españolas que se realizan la serología tras exposiciones heterosexuales, 1992-2003

Fundamento: La epidemia de infecciones por el virus de la inmunodeficiencia humana (VIH) en Espana se caracterizo durante los primeros anos por el predominio de casos en personas usuarias de drogas inyectadas, pero en la actualidad todo parece apuntar a un progresivo predominio de la transmision sexual. El objetivo de este trabajo es describir la evolucion en la prevalencia de VIH en varios grupos de poblacion heterosexual y caracterizar las situaciones en las que se produjeron las infecciones. Metodos: Estudio descriptivo de las personas que se realizaron la prueba por primera vez en nueve centros de diagnostico de VIH entre 1992 y 2003 por exposiciones heterosexuales de riesgo, excluyendose a los usuarios de drogas inyectadas. Resultados: El numero de personas en las que se determino la serologia fue de 47.870. La prevalencia de VIH en la poblacion estudiada descendio del 3,2% al 1,0% (p<0,001). En las personas con pareja con diagnostico de infeccion por VIH la prevalencia se mantuvo en torno al 10%, en hombres usuarios de prostitucion descendio del 1,9% al 1,0% (p=0,049), en las mujeres que ejercen la prostitucion del 1,4% al 0,7% (p=0,008), y en el resto de heterosexuales disminuyo del 1,6% al 1,0% en hombres (p=0,014) y del 1,1% al 0,7% en mujeres (p=0,012). Conclusiones: Los resultados indican avances en el control de la transmision heterosexual del VIH, principalmente en mujeres, aunque todavia se requiere insistir en la prevencion.

Effects of region of birth, educational level and age on late presentation among men who have sex with men newly diagnosed with HIV in a network of STI/HIV counselling and testing clinics in Spain.

This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined asu2009<350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those testedu2009>u200912 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0);u2009>u200924 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. Region of birth interacted with educational level and steady partner as infection source: only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.

Investigación de infecciones de transmisión sexual en varones heterosexuales asintomáticos pareja de mujeres con neoplasia cervical intraepitelial

Resumen Introduccion Los virus del papiloma humano (VPH) son los agentes etiologicos de las verrugas genitales y de la neoplasia cervical intraepitelial (CIN), siendo su mecanismo de transmision la via sexual. El objeto de este estudio es determinar la prevalencia de infecciones de transmission sexual (ITS) en varones heterosexuales asintomaticos que acuden a la consulta en busca de consejo despues de haber diagnosticado a su pareja una CIN. Metodos Se estudiaron 181 varones asintomaticos, pareja de mujeres con diagnostico de CIN, en la unidad de ITS en Gijon durante un periodo de 5 anos (1999-2003). Se empleo el mismo protocolo diagnostico en todos los casos: examen clinico, genitoscopia y obtencion de muestras para cultivo de bacterias, hongos y Trichomonas, asi como muestras para la deteccion genomica de Chlamydia y serologia de sifilis, virus de la inmunodeficiencia humana (VIH) y virus de las hepatitis. Resultados Se diagnosticaron 101 infecciones en 85 pacientes (47%), que por orden de mayor prevalencia fueron: uretritis por Ureaplasma urealyticum (35 de 181; 19,3%), verrugasgenitales (31 de 181; 17,1%), Haemophilus spp. (12 de 181; 6,6%) y balanopostitis micotica (10 de 181; 5,5%). Conclusiones La prevalencia de ITS en las parejas de mujeres con CIN es elevada, y en estos casos es necesario establecer programas de deteccion y control de ITS en ambos miembros de la pareja.

Prevalencia de VIH en pacientes de consultas especializadas en el diagnóstico de esta infección

Objetivo. Describir la prevalencia del VIH en personas que se realizaron la prueba entre 1992 y 2001. Diseño. Estudio epidemiológico descriptivo transversal. Emplazamiento. Diez centros ambulatorios especializados en diagnóstico del VIH en 9 ciudades españolas. Participantes. Un total de 53.183 personas mayores de 12 años analizadas por primera vez para el VIH. Mediciones principales. Número anual de personas analizadas, de diagnósticos de VIH y seroprevalencia en función del sexo, la edad y las categorías de exposición. Resultados. El número de personas analizadas aumentó desde 4.401 en 1992 hasta 6.407 en 2001. Aproximadamente la mitad refería exposiciones heterosexuales de riesgo, excluida la prostitución. Los usuarios de drogas por vía parenteral (UDVP) pasaron del 15,3% en 1992-1993 al 1,4% en 2000-2001, y las mujeres que ejercían la prostitución aumentaron del 6,7 al 25,1%. Se diagnosticó a 2.898 personas infectadas por el VIH, de las que el 78% era varones. El número de diagnósticos disminuyó de 1.058 en 1992-1993 a 304 en 2000-2001, tendencia observada en todas las categorías de exposición excepto en las mujeres que ejercían la prostitución y en los varones con riesgo heterosexual. La prevalencia descendió del 14% en 1992 al 2% en 2001. Se produjeron descensos en todas las categorías de exposición, más pronunciados en los primeros años y con una posterior tendencia a la estabilización, con valores que en 2001 fueron: 23,8% en UDVP, 7,9% en homosexuales, 0,8% en prostitución y 1% en otros heterosexuales. Conclusiones. Estos centros realizan una importante labor de diagnóstico del VIH que complementa a la de atención primaria. Es preciso dar mayor impulso a la prevención.