As a general rule when it comes to policy-making, scare tactics rarely rule. However, that is not to say that it is not important to know what key concern may motivate an individual to seek help for their problem. A recently published study has come out with findings that suggest that young women are more concerned about preventing genital warts than cancer when it comes to being motivated to get the HPV vaccine.

The study, which was published in the journal Health Communication, included a total of 188 college women and 115 of their mothers. The college women had an average age of 22, whereas the mothers had an average age of 50. All the participants were given packets of materials that had a pro-vaccine message and a questionnaire. Both age groups were then split into half. One half of the young women's group received a leaflet that had a heading stating “prevent cervical cancer”, whereas the other half of this age group received a leaflet with a header that stated “prevent genital warts”. In this age group the main outcomes were to see whether any message would be a higher motivator for the participant to speak to a doctor about the HPV vaccine. The mothers group was also split into half and received similar packets. The main difference was that rather than advocating that they speak to a doctor, the leaflet was wondering whether the mothers would encourage their daughters to speak to a doctor about HPV vaccinations. In addition to that, all the participants received a questionnaire where their feelings about the vaccine were investigated.

The researchers postulated that young women would be more motivated to seek medical advice if they worried about genital warts than about cervical cancer. This was based on past studies, which have found that adults tend to worry about cancer at a much later stage in life. This was supported by the current study's findings. The researchers also hypothesised that the mothers would prefer to encourage their daughters if their key concern was cancer, as sexually transmitted illnesses would have been a cause of embarrassment. However, this was not supported by the findings. Instead the mothers seemed keen to speak to their daughters regardless of the type of risks.

This study certainly is interesting and valuable, as it has illuminated the need to consider generational differences when it comes to campaigns for this vaccination. In addition to that, the findings appear quite reliable (albeit in need of replication in other populations). However, it is also worth noting that there seem to be many steps between the findings and the conclusion that do not automatically follow. Perhaps the most notable ones come from the fact that the study is asking whether the women would do something, rather than measuring whether they performed the task (i.e. went to the doctor or spoke to their daughters). As such, it is not possible to rule out intentions from actions and the presence of social desirability remains ignored throughout the publication. Nevertheless, it offers a refreshing perspective that takes two points of view into account. It is our hope that this study inspires further studies in other populations in order to establish how to best motivate various individuals to get HPV vaccinations. You can read more here.

Although we have been aware about the concerns relating to antibiotic resistant gonorrhoea for some time, there has been a new development. The antibiotic resistant gonorrhoea strain, which goes by the name “gonorrhoea HO41”, was initially discovered in a sex-worker in Japan. Although there were some reports recently that the virus had spread outside of Japan, they have now been retracted in mainstream media. To date, the virus has not gone beyond Japan and there are no known cases where an individual has died after contracting the virus.

It was reported recently that the Chief Medical Officer in the UK recommended that the threat from drug resistant gonorrhoea be added to the civil emergencies risk register. In addition to that, several articles in US media recently compared the threat of antibiotic resistant gonorrhoea to the threat AIDS once used to pose. Gonorrhoea is easier to transmit than HIV so there is potentially a greater public health risk.

The main reason for the widespread media reporting on this matter was that experts announced that gonorrhoea HO41 could be considered as a rather aggressive virus, which could potentially kill the infected individual in a matter of days as a result of septic shock. Perhaps it would be helpful if the current reports were put into context along with other research on “super bugs” that may be resistant to treatment (such as such as MRSA). Although there is a steady increase of cases with gonorrhoea HO41 in Japan, when weighing these numbers to the reports on MRSA, the rate of infection is still comparatively low.

Although there is always room for new research to be conducted and for policies to be implemented, it is also clear that simple individual precautions should not be ignored. These include keeping informed about sexually transmitted infections and new viruses, practising safe sex and getting tested when appropriate, such as after a risky event or when you change partners.

Some viruses, such as the herpes varicella-zoster virus, never leave the infected persons body. Instead, they remain dormant in the central nervous system and flare up occasionally. Yet, the long-term consequences of having certain viruses remain relatively unexplored. However, one study that has come to our attention recently has tried to do this. Here we consider the findings of a study that sought to see whether a cumulative presence of infections would have an impact on cognitive functioning.

The study, which was published in Neurology included a total of 1625 participants. At the start of the study, the participants were 69 years old on average. The studies lasted eight years, and during this time the researchers performed a range of tests and assessments. They analysed blood samples for herpes simplex 1 and 2 and cytomegalovirus. In addition to that, they screened all the participants for Chlamydia pneumoniae and helicobacter pylori. Lastly, they performed annual tests to assess changes in cognitive abilities such as memory. The key findings indicated that a high level of infection was related to an increased risk of memory deficiencies. This association remained even after mental sharpness, education, smoking, heart disease and diabetes were taken into account. However, the researchers were keen to stress that their study reflected an association and not causation. As such, they recommended that further studies be carried out within this field.

Although it looks like an acceptable study on the face of it, we cannot help but feel a bit sceptical about it. One of the reasons for that is that many aspects relating to the rationale were not sufficiently clarified in the publication. In particular, it was not mentioned how long the individuals had had each virus before the researchers detected an increased risk for poorer memory. As such, there was no baseline to compare the findings to. Similarly, we cannot help but feel that a case-control study that sought to give participants a battery of rigorous and reliable cognitive tests would have been more suitable for the type of research that was being carried out. That’s not to say that the current study lacked qualities worth replicating. The sample and the adjustment for confounding variables as well as the long follow up period are commendable. Therefore, it is our hope that further studies aiming to confirm and extend on these findings will be undertaken.

Since we first became aware of HIV, various attempts were made to within research to develop treatments and vaccinations. Sadly, with the exception of one trial, there was little success in developing an efficacious vaccine. So we were not surprised when we recently heard about the reports of another trial being interrupted.

The trial, which was conducted in the US, was rather large scale and had enrolled 2504 volunteers to date. In total, 19 cities took part, and all the participants were either gay males or transgender males having sexual relationships with gay men. All the participants were offered condoms and took part in extensive counselling about the risks of HIV. The entire sample was randomly split into two groups. One group received a placebo, whereas the other one was given two different types of injections. Firstly they were given a vaccine that had genetically engineered HIV material. This was done in order to prime the immune system to attack the virus. The second injection was a booster, which was meant to enhance and strengthen the immune response. Neither of these vaccines was capable of causing HIV.

However, an independent review board concluded that the vaccine was not reducing the amount of HIV in the blood or preventing HIV infection. In addition to that, a marginal difference was noted between the groups in that a few more participants in the vaccination group had been infected with HIV. However, this was not statistically significant and was likely to be due to chance. Due to the risk to the participants’ health, the study was stopped by the National Institute of Health. Nevertheless, the researchers stated that they would continue to monitor the participants’ health.

Despite that, it is worth noting that here are several other ongoing trials within this field. The most notable of those is a follow up of a Thai trial, which was the most successful HIV trial to date. The initial trial, which occurred in 2009 indicated that their vaccine reduced HIV infections by 31.2%. Therefore, it is unlikely that the idea of developing an HIV vaccine will be abandoned any time soon.

Although it is unfortunate that the current trial was unsuccessful, the data from the research could still hold valuable and useful information. In the world of research, where it is often a case of publish or perish, it is interesting to note that a study which failed to produce the desired results is given its due attention. Nevertheless, until vaccinations are developed, the best interventions appear to be condoms and early detection.

Early detection and diagnosis of HIV are key aspects related to a better prognosis in HIV. However, there are many reasons why individuals may get diagnosed long after their infection. For instance, some individuals may consider themselves to be low risk and not bother to get tested. Similarly, the choice of getting tested is not a privilege offered to everyone across the globe and testing can be expensive. However, this may soon change, as researchers from the Royal Institute of Technology in Sweden suggest that it may be possible to use modified DVD players for HIV testing.

Their findings were recently published in Nature, where the team explained the key alterations that needed to be done in further detail. Essentially, rather than having a light sensor that reads DVDs, the equipment would require a light sensor that could read information from blood samples. In addition to that, there would be a need for a semi translucent disc, which would hold the sample. Lastly, there would be a need for a different type of software. (In other words, not a DVD player at all but they clearly wanted a headline…).

The early prototype that has been developed appears to be functional and if this apparatus were to go further to be developed for clinical use, there could be many benefits. In addition to being made at a low cost ($200 in contrast to $30 000 or more), it would also be portable and easy to use. Perhaps most importantly, it would make fast and reliable results a reality in more clinics across the globe.

We were intrigued to hear about this report, as we have long been aware of the problems related to a delayed diagnosis. We were particularly glad to hear that the report was coming from the Royal Institute of Technology, which has a strong standing in research. As such, we are inclined to think that the research community will give serious consideration to these findings and that there will be more research dedicated to making the development of this equipment a reality.

Chlamydia is the most prevalent sexually transmitted infection in the UK. Testing is free on the NHS for 16 – 24 year olds and some local health authorities provide a postal testing service. Going to your local GU or sexual health clinic is not the most ideal solution for most people so fortunately there are low cost private solutions available online.

While there are a large number of websites that now provide this sort of sexual health service, you need to make sure that you are dealing with a genuine healthcare company. Even if you do not wish to use The STI Clinic, make sure that you are selecting a service that has an accredited laboratory. Do not buy chlamydia testing kits that give you the result in your home after peeing on a stick as these are notoriously unreliable. A lab-based service is your best option as most labs will be using the latest detection technology. Using a service such as our gives you the additional comfort you are dealing with qualified healthcare professionals so you have access to treatment in the event of a positive result. We also provide a very fast results service with most results back in under 24 hours.

If you wish to use your local GUM clinic then you will be able to find the service that you need here.

Circumcision has often been the cause of numerous debates, with some reports of the effects of unconventional practices even becoming substantial legal controversies. However, it has also been a perspective to consider when researching the spread of HIV among men. What most studies appear to have found is that circumcision is related to a lower risk of getting HIV by up to 60%. Now a recent study has confirmed this and explained the underlying mechanisms for why this may be.

The study, which was published in mBio, was a prospective observational intervention study. In total, 156 uncircumcised men took part. After the researchers obtained baseline levels of bacteria in the genital area from all of the men, they were randomly split into two groups. In one of the groups all the men received circumcision, whereas the other group did not receive any intervention. Both groups were then followed up a year later, with the same measurements being taken to see the levels of bacteria in the genital area. These results were then compared to the initial baseline levels as well as between groups. The key findings indicated that the circumcised men had a non-significant increase in aerobic bacteria levels and an average of 81% decrease of anaerobic bacteria levels. Based on this the researchers concluded that circumcision positively affected the men’s penile ecosystem as a result of increased oxygen reaching previously covered skin. As a result, the prevalence of anaerobic bacteria levels decrease, which reduces the risk of inflammation that has been associated with making HIV infections more likely.

Several aspects of this study are commendable, with its prospective design perhaps also being its strongest point. Theoretically speaking the findings are useful to rule out other competing theories within this field. Although the findings certainly appear robust, it is also important to bear in mind that understanding underlying mechanisms within biological research requires in depth research to rule out variables and competing theories. As such, the most ideal scenario would be if these findings were replicated in another study. However, it is questionable whether this is feasible given that the execution of this type of research may be rather difficult. Nevertheless, if further studies were to gain an understanding of the underlying mechanisms for this phenomenon, then it would have a substantial impact on developing interventions.

We were not surprised to read about these findings as we are already well aware of other studies where male circumcision was associated with a lower incidence of HSV-2 lower risk of transmission of STIs (such as HPV and Trichomonas Vaginalis infections) to their female partners. Therefore, it should not come as a surprise if we write other significant studies within this field in the future.

It is rare for most people to think about infants when it comes to sexually transmitted infections. Yet reports concerning HIV and herpes in infants have been cropping up rather regularly in the media lately.

It was recently reported that two infants in New York City were infected with herpes as a result of being circumcised in a rather controversial way. Specifically, in the procedure called metzitzah b'peh, the practitioner was required to orally suck the baby’s penis in order to cleanse the wound. Although this is in stark contrast to the way prevailing circumcision procedures are carried out (where sterile tools are used to clean the wound), there is still a minority of families that prefer this practice.

When an infant is infected with a virus, the effects of it are different from what they would be for an adult, as an infant does not have a fully developed immune system. According to the Centre for Disease Control and Prevention, there have been past cases where infants’ herpes infection has led to brain damage and even death. In milder effects, the infants have had a fever (which is not unusual in adults). Given this, it is not surprising that the health department has informed medical staff to be vigilant to cases of male infant sepsis and to ask whether this could be due to circumcision. In addition to that, regulations have been passed that require that parents of a child sign a consent form that allows the oral sucking to occur during the procedure.

Although the two infants that were infected have survived, it is not clear whether there will be any long-term effects to their health. In general, the prognosis of neonatal herpes infection is unclear as contracting this illness is rather unusual and the known cases have not reached adulthood yet. As such, it also raises questions of how to treat these cases.

Naturally these cases should not be taken lightly. However, it is also important to remember that parents should be allowed the choice of how to circumcise their children. Perhaps, rather than having parents sign consent for the procedure, it would be more prudent to ensure that the practitioners carrying out the procedure are not posing a risk to the child.

The topic concerning whether pubic hair should be removed or trimmed has been discussed quite extensively in the past. While those discussions have relied rather heavily on feminist arguments and health concerns that may arise as a result of extensive grooming in such a sensitive area, there have been few studies worth mentioning. Today, a recently published editorial suggesting that water warts can develop as a result of shaving or clipping pubic hair grabbed out attention.

The editorial, which was published in the journal Sexually Transmitted Infections, was based on an observational study comparing patient records among 30 patients that had been treated for so-called “water warts” at a private skin clinic in France. The researchers mostly relied on comparing patient notes and observed that 28 of their cases had in fact had pubic hair removal, with the majority shaving the hairs off. Based on this, the researchers argued that shaving could potentially cause micro-trauma to the skin, which in turn would increase the risk for the so-called Molluscum contagiosum pox virus that causes water waters. This virus can be spread via sexual activity, but also can also be spread by skin on skin contact. They further argued that although the reasons for the increase in removal of pubic hairs were debatable at best (i.e. cultural, religious or trendy), the increased cases of water-warts appeared to be strongly related to the increase of Brazilian waxes and other hair removal methods in that area over the past ten years.

While the editorial was well-written, and the arguments appeared straightforward, it is still worth noting that this was an editorial based on a small scale study that relied on secondary data and did not use statistical analysis to reach their conclusions. Although this indicates that a more thorough study would be warranted, we feel like it is unlikely that this will happen. Nevertheless, the value of the findings is clear from a clinical perspective and from a research perspective.

Further details are available on this website.

A little while ago we wrote about a baby that had been functionally cured of HIV, but that these findings were not applicable to adult cases. Now a new study claims that their adult patients were functionally cured.

The study, which was published in Plos Pathogens, was an observational study that followed up 14 patients who had been infected with HIV in the 1990s or early 2000s. All of the participants had been treated with combination antiretroviral therapy (c-ART) within ten weeks of infection. They had ceased to use this treatment after 36 months on average, but not had the virus return. This is unusual, as the virus tends to return as soon as the treatment is ended.

In order to explore how and why they remained functionally cured, the researchers aimed to assess whether these patients had common similarities beyond their early intervention. In order to do so, they compared the types of infection the participants had presented with, variations in cell count and differences in how their T-cells responded to treatment. This was done by analysing blood samples, with the results being statistically analysed. The researchers also compared their findings to other published findings, as well as with hospital records of other patients that had started c-ART therapy early but were still having the treatment. The key findings indicated that their participants had a low T-cell activation and that they had a very low HIV reservoir levels. The latter was suggested to decline for several years after treatment cessation. In comparison to other patients that had received c-ART therapies, the researchers argued that their study group most likely represented 15% of those cases.

This study was well executed, and it was clear that it aimed to put their sample in context with other studies and other patient groups. The basis of the study reflected that the researchers were well aware of their limited sample, and that their findings were in their infancy. Nevertheless, by focusing on a functional cure for HIV, the authors made a realistic and valuable contribution to the field. Clearly, there is a need to follow up these patients and conduct extensive assessments that were beyond the scope of this study.

From our point of view, we are intrigued to see what discussions will form concerning the clinical implications of the findings. While the study forms an argument for early intervention, there are some concerns regarding the long-term toxicity it could lead to, the potential for viruses to develop resistance and for the cost of a lengthy treatment. On the other hand, there are recent studies that have illuminated that the c-ART treatments on the market are well tolerated and reduce the risk of resistance. Moreover, it is worth noting that early treatment reduces the risk of HIV-1 transmission and that it would be highly unethical to deny patients early treatments. Overall, diagnosing and treating early is absolutely key to successful outcomes and we advocate regular testing for high prevalence groups.