M F Schim van der Loeff

Vaginal high-risk human papillomavirus infection in a cross-sectional study among women of six different ethnicities in Amsterdam, the Netherlands: the HELIUS study

Objective In the Netherlands the incidence of cervical cancer is higher among ethnic minority populations compared with the general Dutch population. We investigated the prevalence of, and risk factors associated with, vaginal high-risk human papillomavirus (hrHPV) infection in women of six different ethnicities living in Amsterdam. Methods For this cross-sectional study we selected women aged 18–34 years old of six ethnicities from the large-scale multiethnic HEalthy LIfe in an Urban Setting study. Self-collected vaginal swabs were tested for HPV DNA and genotyped using a highly sensitive PCR and reverse line blot assay (short PCR fragment (SPF)10-PCR DNA enzyme immunoassay/LiPA25-system version-1, delft diagnostic laboratory (DDL)). Participants completed a questionnaire regarding demographics and sexual behaviour. Logistic regression using generalised estimating equations was used to assess risk factors of hrHPV, and to investigate whether prevalence of hrHPV differed among ethnicities. Results The study population consisted of 592 women with a median age of 27 (IQR: 23–31) years. Dutch and African Surinamese women reported the highest sexual risk behaviour. HrHPV prevalence was highest in the Dutch (40%) followed by the African Surinamese (32%), Turkish (29%), Ghanaian (26%), Moroccan (26%) and South-Asian Surinamese (18%). When correcting for sexual risk behaviour, the odds to be hrHPV-positive were similar for all non-Dutch groups when compared with that of the Dutch group. Conclusions We found an overall higher hrHPV prevalence and higher sexual risk behaviour in the native Dutch population. Further research is needed to unravel the complex problem concerning cervical cancer disparities, such as differences in participation in the cervical cancer screening programme, or differences in clearance and persistence of hrHPV.

High-risk human papillomavirus seroprevalence in men and women of six different ethnicities in Amsterdam, the Netherlands: The HELIUS study

Background Ethnic variations in the (sero)prevalence of Human Papillomavirus (HPV) and HPV related diseases have been observed previously. We explored if high-risk HPV (hrHPV) seropositivity indeed differs among 6 ethnic groups in Amsterdam the Netherlands and assessed if hrHPV seroprevalence is higher among women than men within each ethnic group, both after adjustment for confounders. Methods From the multi-ethnic HEalthy Life In an Urban Setting (HELIUS) study in Amsterdam (the Netherlands) we randomly selected 4637 men and women aged 18–44 years with a Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan, or Turkish ethnicity. Blood samples were tested for HPV-16,−18,−31,−33,−45,−52, and −58 antibodies using a validated Luminex-based multiplex serology assay. We assessed the association of both ethnicity and gender with hrHPV seropositivity using logistic regression models with generalised estimating equations. Results The hrHPV seroprevalence in Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan, and Turkish participants was 18%, 12%, 23%, 19%, 17%, and 15% in men, and 30%, 22%, 34%, 31%, 14%, and 15% in women, respectively. HrHPV seroprevalence of non-Dutch men did not differ significantly from Dutch men. HrHPV seroprevalence was significantly higher among African Surinamese women, and significantly lower among Moroccan and Turkish women when compared to Dutch women. These differences were not significant anymore after adjustment for demographic, health, and sexual behavioural differences between ethnicities. HrHPV seroprevalence varied by age, age of sexual debut, and lifetime sexual partners among women but not among men. Seroprevalence of hrHPV was higher among women than among men, except in the Turkish group. Conclusion Among women hrHPV seroprevalence differed by ethnicity, yet among men no pronounced differences were observed across ethnicities.

HPV vaccination intention among male clients of a large STI outpatient clinic in Amsterdam, the Netherlands

We explored HPV vaccination intention and its determinants among male clients of the sexually transmitted infections (STI) clinic in Amsterdam. In 2015, male clients aged ≥18 years were invited to complete a web-based questionnaire regarding HPV vaccination intention and socio-psychological determinants. Determinants (scale −3 to +3) were assessed with linear regression, stratified for men who have sex with men (MSM) (including men who have sex with men and women) and men who only have sex with women (MSW). Additionally, we explored the effect of out-of-pocket payment on intention. Of 1490 participants (median age 33 years [IQR:25–44]), 1,053(71%) were MSM. HPV vaccination intention was high (mean 1.68, 95%CI:1.55–1.81 among MSW; mean 2.35, 95%CI:2.29–2.42 among MSM). In multivariable analyses, socio-psychological determinants had similar effects on intention in both groups (R2=0.70 among MSW; R2=0.68 among MSM), except for subjective norms, self-efficacy, and HPV knowledge (significantly stronger associations among MSW). HPV vaccination intention decreased significantly when vaccination would require out-of-pocket payment; intention was negative at the current list price (€350). HPV vaccination intention among male clients of the Amsterdam STI-clinic is high and variance in intention was mostly be explained by socio-psychological factors. Out-of-pocket payment had a strong negative effect on HPV vaccination intention.

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.

O16.5 Concordance of Anal, Penile, and Oral Human Papillomavirus Hr-HPV Infections and HPV Seropositivity in HIV-Infected and HIV-Negative Men Who Have Sex with Men: The HIV & HPV in MSM (H2M) Study

Background Infection with human papillomavirus (HPV) is not generally followed by seroconversion for reasons not yet fully understood. This cross-sectional study investigated concordance between high-risk (hr) HPV infections at three anatomical sites and concordant seropositivity, in both HIV-infected and HIV-negative men who have sex with men (MSM). Methods MSM aged ≥ 18 years were recruited from the Amsterdam Cohort Studies, an STI clinic and an HIV treatment centre in Amsterdam, the Netherlands. The associations between anal, penile, and oral HPV infections and concordant seropositivity of 7 hr-HPV types (16, 18, 31, 33, 45, 52 and 58) were estimated using generalised estimating equations (GEE) regression analyses. Results Among the 306 HIV-infected MSM 93% were hr-HPV seropositive (i.e. seropositive for at least one of the 7 hr-HPV types) and 69% were infected with at least one anal, penile, or oral hr-HPV infection. Of 441 HIV-negative MSM 74% were hr-HPV seropositive and 41% were infected with one or more hr-HPV infections. Type-specific hr-HPV seropositivity was not more likely for men with concordant infections at multiple anatomical sites (OR 1.58, 95% CI 1.06–1.86) compared to those with concordant infections at only one anatomical site (OR 1.45, 95% CI 1.22–1.73). In multivariable analysis, adjusting for key demographic and sexual behavioural factors, type-specific hr-HPV seropositivity was associated with concordant anal hr-HPV infections (OR 1.60, 95% CI 1.32–1.92), but not with concordant penile (OR 0.79, 95% CI 0.58–1.06) or oral (OR 1.36, 95% CI 0.85–2.17) hr-HPV infections; in stratified analyses, these associations were similar for HIV-infected and HIV-negative men. Conclusions In both HIV-infected and HIV-negative MSM, anal hr-HPV infections were associated with hr-HPV seropositivity, while penile and oral hr-HPV infections were not. Our findings support the hypothesis that seropositivity differs by the type of epithelium infected, implying that mucosal infection may provide a stronger signal to the immune system.

O1-S03.05 Community-acquired methicillin-resistant and susceptible Staphylococcus aureus among men who have sex with men

Background Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) has been found more often among men who have sex with men (MSM) in some studies (USA). This study assesses the prevalence and sexual risk factors for CA-MRSA and methicillin susceptible Staphylococcus aureus (MSSA) colonisation and infection among MSM in Amsterdam, the Netherlands. Methods MSM attending the sexually transmitted infections outpatient clinic in Amsterdam were invited to participate in this study and divided in two groups: (1) MSM with clinical signs of a skin/soft tissue infection (symptomatic group) and (2) MSM without clinical signs of such infections (asymptomatic group). Demographic characteristics, medical history, sexual behaviour, history of sexual contacts and known risk factors for colonisation with S aureus were collected through a self-completed questionnaire. Swabs were collected from the anterior nasal cavity, throat, perineum, penile glans and, if present, from infected skin lesions. Culture for S aureus was done on blood agar plates and for MRSA broth on selective chromagar plates after enrichment in broth. If MRSA was found, the sex partners of the index patient were invited for screening for MRSA. Results Between October 2008 and April 2010 a total of 214 MSM were included in the study: 76 into the symptomatic group and 138 MSM into the asymptomatic group. The prevalence of MSSA in the nose was 36% (78/214) and in skin lesions 36% (27/76). The prevalence of MRSA was 0.9% (2/214). Both MRSA cases, one asymptomatic and one symptomatic, were HIV positive. The asymptomatic MRSA carrier had been hospitalised the previous year. None of the four sexual contacts that could be traced were colonised by MRSA. The symptomatic MRSA case had a soft tissue infection in the genital area; in this case also the nasal cavity, perineum and glans penis were positive for MRSA. No sexual contacts could be traced. There were no significant differences in age, sexual risk behaviour, drug use, history or diagnoses of sexual transmitted diseases, circumcision status or hygiene behaviour between those with and without a genital S aureus infection, but those infected with S aureus were significantly more often HIV infected (55% vs 34%; p<0.01). Conclusion CA-MRSA among MSM STI outpatient clinic visitors in Amsterdam is rare. There were no indications for sexual transmission of MRSA or MSSA in this population.