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Broadening sexual health horizons in Georgia
– Reported, January 20, 2012
The scientific program spanned 3 days and included satellite symposiums organized by the WHO and another by the Eastern European Network for Sexual and Reproductive Health. Both of these sessions drew large audiences and included prominent reference to a major message of the meeting, namely, the emergence of drug-resistant gonorrhea and, in particular, the increasing rates of reported resistance to cephalosporins and the existence of significantly increased rates of macrolide resistance, including to spectinomycin and azithromycin. This means that although gonorrhea rates across Europe have been falling overall, our ability to treat this condition requires increased surveillance and major efforts to find antibacterial medications that will be effective. A major cause for concern is the lack of consistent and robust sexually transmitted infection (STI) microbiology surveillance systems, both because of the problems with cost and the logistics of organization of laboratory support, as well as the increasing use of PCR technology (often coupled with chlamydia testing), which does not render organisms amenable to culture and antibiotic sensitivity testing. Van Westreenen from Erasmus University in Holland proposed clear strategies for this and it was emphasized that as well as the search for new therapies and strict adherence to guidelines for treatment of gonorrhea, early diagnosis and partner notification can reduce the transmission of resistant organisms.
Both the excellent opening ceremony lecture by Harald Moi from Norway and the closing address from King Holmes of the USA emphasized the pivotal role of human behavior on STI epidemiology and how we must design effective healthcare in the context of social upheaval (e.g., war, migration and poverty). The need to maintain and improve continued STI surveillance, vigilance and expert analysis of all interventions designed to reduce STI requires funders of research to recognize the continuing global impact of STIs, including HIV.
In terms of behavioral impact on transmission, Gaspar de Matos presented a study assessing knowledge, sexual activity and sexual health/HIV awareness among adolescents in Portugal. Nearly 5000 adolescents completed a behavioral and knowledge-based questionnaire. Results showed relatively low levels of sexual activity among the study population, but interestingly showed that adolescents substantially overestimate sexual experience of their peers. Understanding of HIV transmission was generally quite good, suggesting some success in destigmatizing HIV. The study results can be used to inform curriculum planning with regard to sex education. The model could be a valuable tool for other countries aiming to evaluate or develop effective primary prevention in schools. It is a study repeated at regular intervals and can therefore be of ongoing use to identify knowledge deficits and also to ensure continuity of appropriate sex education.
With the conference being held in Georgia, both visiting and local healthcare workers were eager to learn more about local health challenges. Wayne Shandera presented an analysis of US Censor Bureau data of HIV studies from the three caucasus nations. Meta-analyses of the HIV epidemics of Georgia, Armenia and Azerbaijan were presented based on all available study data from 1997 onwards. A total of 49 studies from Georgia were included. HIV prevalence of over 1% was found in studies of intravenous drug users, men who have sex with men, TB patients, prisoners and commercial sex workers.
Other presentations included work from Barbara Van Der Pol who reported that 40% of men who have sex with men in their study thought that they had been appropriately screened for chlamydia by having a urine test, even though they had oral or anal intercourse. The presented data demonstrated the use of rectal amplified DNA testing to improve chlamydia case findings. This has implications for STI screening services everywhere and increases the importance of taking a clear sexual history from all individuals.
There were a fine series of plenary talks and presentations, and posters regarding human papillomavirus (HPV), particularly that from Stella Helley from Australia regarding the major impact of introducing quadrivalent HPV vaccination on the incidence rates of genital warts in women over the age of 28 years, with less effect being seen on men and no significant effect being seen on gay men. There was a general discussion of the need to ensure that vaccination programs target STIs as well as cancers in terms of prevention. The importance of research in this area was highlighted by Skerlev from Croatia in his plenary talk. Skerlev also gave an important tribute to the life and work of the late Geo Von Krogh who contributed much to improving treatment for genital HPV infection.
Other highlights included a highly charged interactive session based on partner notification and confidentiality of an index case of an individual with HIV, presented by Ceri Evans. There were many examples revealed of differences in legislation across the world, for example, public health legislation to compel partner notification, and the benefits and problems that physicians face in managing STIs. There appeared to be a consensus that the International Union against Sexually Transmitted Infection (IUSTI) should recommend open debate about the conflict between public health and individual health rights, and that any legislation must be consistent with clinical benefit as well as human rights.
A plenary by Raj Patel (UK) summarized the disappointing results of studies designed to reduce HIV infection by suppressing herpes simplex virus using antivirals. Despite negative results, several questions remain regarding the interaction of these viruses, and with future research, particularly relating to herpes simplex virus vaccine development, these may be better understood.
There was a Gilead Sciences Invited Lecture on HIV by Ed Wilkins from Manchester (UK) that demonstrated the need for wider HIV testing to reduce late diagnoses. This will enable avoidance of morbidity and mortality from HIV-induced immunosuppression as well as reduce transmission. Wilkins gave a clear summary of treatment strategies and the need for specialist care to detect and manage drug toxicities and complex interactions, especially as patients with HIV develop age-related comorbidities, such as hypertension and diabetes.
The conference brought together delegates from many countries to Georgia, and the warmth of Georgian hospitality, and the enthusiasm of Georgian doctors and nurses to be involved in STI surveillance and improve the healthcare system for STIs in both Georgia and across Eastern Europe was very evident. The support of several pharmaceutical companies was recognized at the meeting but the limited number of trials of new therapies for STIs other than HIV is a cause for serious concern, given the increasing epidemiology and development of resistance.
Credits: Simon E Barton
More information at: http://www.expert-reviews.com/doi/full/10.1586/eri.10.137
– WF Team
