Sexual behaviour/PH Flashcards
What is the relationship between HIV in MSM and social/structural disadvantages?
A range of structural and social disadvantages (termed ‘syndemics’ including Depression
Substance use
Violence
Sexual stigma
Homelessness
show a clear dose– response relationship with risk of UPAI and HIV infection in MSM.
Which stressors may disproportionately affect young MSM in comparison to heterosexual peers?
Young MSM are more likely to suffer life stressors-
anxiety, depression, suicide attempts and post-traumatic stress disorder than their heterosexual peers.
Do asymptomatic men need examination
No. Anogenital examination in asymptomatic clients including MSM yields few new STI diagnoses in retrospective studies
What should consultations with MSM include?
Holistic risk assess-ment to identify the factors known to be associated with risk of STI including HIV
Appropriate questioning for hepatitis C risk should be included in the sexual history of all MSM
In symptomatic men, review should routinely include questions relating to perianal and rectal symptoms
Questions on drug and alcohol use should be routine in all MSM consultations
What are the recommendations for alcohol/drug assessment in MSM?
Binge drinking of alcohol, use of inhaled nitrites and methamphetamine should be employed as markers of increased STI risk in MSM
• The use of other recreational drugs including mephedrone, other Novel Psychoactive Substances (NPS) and non-prescribed sildenafil are also likely to be reliable markers of increased STI risk in MSM
• Routine enquiry should cover the use of all drugs, including NPSs
• All individuals who report the use of any injectable drug should be asked if they are injecting and if so is equipment ever shared (
Outcome measures for partner notification?
- % of index cases offered discussion for PN with a healthcare worker
- % of index cases with documented agreed action to contact or not contact partners
- Number of partners attending a SH service as reported by index
- Number of verified partners attending
D- discussion
A- agreed action
R- reported
V- verified
Factors that influence STI epidemiology
Changes in the number of sexual partners
Variation in antimicrobial resistance
Sexual contact in a high prevalence countries
Changes in the HIV epidemic
Increased level of socio-economic deprivation
Patterns of human migration
Epidemiology/trend in syphilis
There was a 12% increase in syphilis diagnoses (primary, secondary and early latent) between 2015 and 2016.
The number of syphilis diagnoses in 2016 was the largest reported since 1949 and is consistent with the increasing trend seen in recent years.
Since 2012, syphilis diagnoses have risen by 97%, mostly associated with transmission in gay, bisexual or other men who have sex with men
Epidemiology/trend in gonorrhoea
Despite the decrease in gonorrhoea diagnoses between 2015 and 2016, sustained transmission is of concern given the emergence and circulation of antimicrobial resistant strains of Neisseria gonorrhoeae, the bacterium which causes gonorrhoea.
The decline in gonorrhoea coincides with a 23% decrease HIV diagnoses in MSM attending SHSs between 2015 and 2016, likely due to improvements in HIV testing and time to anti-retroviral treatment, as well as private access to HIV pre-exposure
Epidemiology/trend in herpes
The rise in diagnoses is most probably related to increased public and professional awareness to infection, the increased use of highly sensitive molecular tests and an increased referral of diagnoses from primary care to genitourinary medicine clinics
What information is required for STI Surveillance?
Examples of required information are:
Recently emerged infection
Established infection with a low prevalence
Established infection that is the subject of a screening or vaccination programme
Re-emerging infections such as syphilis
The epidemiological characteristics of each STI are unique and result from the interaction of the parameters described in the following equation?
Ro= BcD
Ro = Reproductive rate ß = probability of transmission (organism and host characteristics): Cellular immune response Host susceptibility Asymptomaticity Prevalence
c = behaviours that facilitate transmission:
Rate of partner change
Sexual mixing
Number of sex acts/partner
Non-use of barrier protection (condoms)
D = duration of infectiousness:
Host response
Variations in infectivity during infectious period
Access to services
Time to treat infected contacts (partner notification)
Effectiveness of treatment
Diagnostic sensitivity
What is disassortative mixing?
As sexual networks develop, people from high and low risk groups may be included in the network. As this happens, infection is transmitted from relatively high risk to relatively low risk populations. This is known as disassortative mixing
