IUSTI Regions: North America

ASTDA (American Sexually Transmitted Diseases Association)

 

Dr Charlotte Gaydos, Regional Director IUSTI-North America Dr Jeanne Marrazzo, IUSTI-North American regional chair person & ASTDA President.

 

Regional Newsletter

March 2008 IUSTI North America Newsletter (pdf 191 Kb). The newsletter contains some interesting updates:

The CDC has prioritised measures to decrease infertility due to STIs. Their three pronged approach involves expedited partner therapy (see below), the creation of harmonized guidance for partner services for HIV and STD and increasing efforts to explore the delivery of partner services through the internet, email and chat rooms. As an example of an internet-based approach to STI testing (Johns Hopkins), have a look at I want the kit.

The American Social Health Association is also active in the STI arena, see for example the web-based  animation on how to use a condom!

The ASTDA is offering annual developmental awards to encourage new investigators to pursue careers in research related to STI and it will continue to manage the annual CDC National STD Prevention Conference.

Last but not least, have you heard the Chlamydia song ?

Point of care tests

A grant for developing and evaluating point of care tests for the diagnosis of STIs have been awarded by the NIH Institute of Biomedical Imaging and Bioengineering to John Hopkins University (Charlotte Gaydos). 

NIH Workshop on self-obtained vaginal specimens for detection of STI

The proceedings of this workshop held in June 2006 have been published in Sexually Transmitted Diseases (2008) 35, 8 - 13. Further details are available in the newsletter but essentially, for the diagnosis of C. trachomatis and N. gonorrhoeae infections, self obtained vaginal specimens are considered to be well accepted by patients and to perform at least as well as other specimen types.

CDC Treatment guidelines

The new 2006 Centers for Disease Control (CDC) and Prevention treatment guidelines are available here.

Guidelines for Screening Males for Chlamydia

The CDC had published a meeting/workshop report on the web and sent a Dear Colleague letter about testing men for chlamydial sexually transmitted infection.  For the purposes of state and local program activities, the following guidance is provided to assist with decisions about which populations of males to screen for Chlamydia trachomatis (Ct) and how best to screen. The report is available here.

  • Among males, those <30 years of age entering jails should be the highest priority for Ct screening.

  • Males attending sexually transmitted disease (STD) clinics should be screened for Ct.

  • Males with Ct infection should be re-screened at 3 months for repeat Ct.

  • Urine is the specimen of choice for screening asymptomatic men for Ct.

  • Nucleic acid amplification tests (NAATs) are the test of choice. The leucocyte esterase test is not recommended for screening males for Ct.

  • Pooling of urine specimens should be considered for Ct testing in low prevalence settings to conserve resources.

  • Partner services should be offered to partners of males with Ct infection.

Expedited Partner Therapy for Chlamydia and Gonorrhea

An alternative approach to assuring treatment of partners is expedited partner therapy (EPT). EPT is the delivery of medications or prescriptions by persons infected with an STD to their sex partners without clinical assessment of the partners. Clinicians (e.g., physicians, nurse practitioners, physician assistants, pharmacists, public health workers) provide patients with sufficient medications directly or via prescription for the patients and their partners. After evaluating multiple studies involving EPT, CDC concluded that EPT is a “useful option” to further partner treatment, particularly for male partners of women with chlamydia or gonorrhea. In August 2006, CDC recommended the practice of EPT for certain populations and specific conditions. For more information see report here.

Vaccine for Human Papilloma Virus

In 2006, a vaccine to prevent infection with four types of HPV (6, 11, 16 and 18) was approved by the Food and Drug Administration (FDA) for use in females aged 9 – 26.  HPV 6 and 11 cause most genital warts in the US and HPV 16 and 18 are “high risk” types that cause up to 70% of all cancers of the cervix.  Another vaccine to prevent “high risk” HPV (16 and 18) is expected to be approved in 2007.  In the United States, there continues to be controversy over the implementation of HPV vaccine.  Although approved by the CDC Advisory Committee on Immunization Practices and major specialty and primary care organizations, and approved for payment by the major insurers, implementation of universal vaccination mandates at the State level have met with resistance.  The most prominent example was in Texas, where the governor proposed mandatory HPV vaccination and was rebuked by the state legislature. Surveillance data released by CDC has demonstrated that approximately 1 out of 6 women tested are infected with HPV.

Gonorrhea Resistance: Fluoroquinolones no longer recommended for treatment of gonococcal infections

In early 2007, the CDC made major recommendations for gonorrhoea treatment which removed quinolones as first-line therapy.  Ceftriaxone and other third-generation cephalosporins are now the primary therapy.  This was in response to the increased levels of QRNG observed in the National Gonorrhoea surveillance system.  The information was widely disseminated and appears to have been implemented by most clinics and private practitioners.  There are major concerns over management of allergic patients as well as anxiety over the lack of any real alternatives to the cephalosporins, if resistance develops. See report here.

Abstinence-only for prevention of STDs

Several reports have been published by federal health agencies which indicate that the Government's abstinence-only policy, which currently receives almost $200 million US dollars annually, is a failure.  Nearly all reports demonstrate that coital debut is modestly delayed, but when it occurs, contraception and condoms are not used, resulting in higher disease and pregnancy rates.

Coinfection with syphilis and HIV

The CDC will be reporting that persons with HIV who are coinfected with syphilis may have neurosyphilis rates as high as 4% subsequently.  This has resulted in a call for increased and more aggressive screening, post therapy, of persons with syphilis.

ISSTDR/IUSTI

The next ISSTDR meeting will be London, 28 June-1 July 2009. The meeting will be held in conjunction with the British Association for Sexual Health and HIV (BASHH). For details of the conference as they become available click here.

ASTDA-BASHH-IUSTI N. America Conference May 7-10 2008

This conference bringing together investigators and practioners from both sides of the Atlantic is being held in Brooklyn NY around the theme "Converging approaches in STD/HIV Control and Reproductive Health". Should be a very interesting meeting. For details click here.

 

Updated by webmaster March 12th 2008.