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BACKGROUND: Gonorrhoea infection is one of the most common bacterial sexually transmitted infections and an important cause of morbidity and serious complications. The objectives of this paper are: a) to describe gonorrhoea cases diagnosed in a network of 15 (out of 16) STI clinics in Spain during 2006-2010; b) to analyse differences among men who have sex with men (MSM), men who have sex exclusively with women (MSW) and women; and c) to evaluate factors associated to with HIV co-infection. METHODS: All gonorrhoea cases diagnosed in the network were included (25.7% of total cases notified in Spain). Data were collected by clinical staff. Descriptive/bivariate analyses were carried out stratifying by sex and transmission category; association and trends were evaluated using the chi-square test. Factors associated with HIV co-infection were estimated using a logistic regression model. RESULTS: 2385 cases were included: 55.3% among MSM, 31.3% among MSW and 13.3% among females; cases among MSM increased from 55.8% in 2006 to 62.9% in 2010 while no trends were found among the other two groups.Most MSM cases were Spaniards (72%), aged 25-34 years (46%), 49% reported previous STI and 25% concurrent STI (excluding HIV); casual partners were the commonest source of infection, and 21% of cases had rectal gonorrhoea. MSW cases did not differ from MSM by age, origin or source of infection, but frequencies of prior or concurrent STI were lower. Female cases were younger than male, were mostly foreigners (58%), and 41% were sex workers; concurrent STI (other than HIV) were diagnosed in 30%; 20.4% had symptoms (72.5% and 89.2% in MSM and MSW), and pharyngeal location was present in 30%.HIV co-infection was highest in MSM (20.9%). Co-infection was associated with age > 35 years, low educational level, being Western European or Latin-American, being MSM, having previous or concurrent STI and reporting contact with an HIV-infected partner; it was inversely associated with female sex. CONCLUSION: Differences by sex, transmission route and origin should be considered when implementing care and preventive programmes for gonorrhoea, and MSM are a priority group for intervention, in particular HIV-infected MSM.

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OBJECTIVE: Human Papillomavirus (HPV) infection in men may produce cancer and other major disorders. Men play an important role in the transmission of the virus and act as a reservoir. The aim of this study was to determine the HPV-genotypes and their prevalence in a group of men attending a Sexually Transmitted Infection service. PATIENTS AND SAMPLES: Between July 2002 and June 2011, 1392 balanopreputial, 435 urethral, 123 anal, and 67 condyloma lesions from 1551 men with a mean age of 35.8±11.3 years old (range: 17-87) were collected for HPV-DNA testing. METHODS: A fragment of the L1-gene and a fragment of the E6/E7-genes were amplified by PCR. Positive samples were typed by hybridization. RESULTS: The HPV genome was detected in 36.9% (486/1318) balanopreputial and in 24.9% (101/405) urethral (p<0.0001) swabs from 38.1% (538) of 1469 men. Co-infections were present in 5.4% (80/1469) of cases. HPV was found in 43.9% (373/850) of men younger than 35 vs. 31.7% (187/589) of men aged >35. HPV was found in 59.4% (104) of 165 men with lesions (macroscopic or positive peniscopy), and in 22.8% (61/267) without clinical alterations. HPV was also detected in 71.4% (40/56) men with condylomata and in 58.7% (64/109) of men with positive peniscopy. CONCLUSIONS: HPV prevalence in men was high and decreased with age. HPV was found more frequently in balanopreputial than in urethral swabs. There was a low rate of co-infections. Low-risk HPV vaccine genotypes were the most recurrent especially in younger. Although HPV has been associated with clinical alterations, it was also found in men without any clinical presentation. Inclusion of men in the national HPV vaccination program may reduce their burden of HPV-related disease and reduce transmission of the virus to non-vaccinated women.

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Introducción: El estudio de la implantación de una prueba rápida de VIH en Asturias. Métodos Previa campaña de divulgación, se realizó en dos Unidades de ITS mediante el reactivo Determine® VIH1/2.ResultadosSe realizó en 1.011 usuarios. El 65,3% no tenían pruebas previas y el 71,4% eran heterosexuales. 21 pruebas fueron confirmadas por EIA/WB. Se produjo un aumento en el diagnóstico de VIH. Conclusión Campañas de sensibilización y pruebas rápidas de VIH parecen ser instrumentos eficaces para su diagnóstico precoz (AU)

Introduction: The aim of the study was to analyze the implementation of a rapid HIV test in Asturias(Spain).Methods: The study was conducted in two STI Units using the Determine®HIV-1/2 test. Results: A total of 1011 people were tested, of whom 65.3% had never been tested for HIV previously, and 71.4% were heterosexual men. Twenty-one tests were confirmed positive by Enzyme Immunoassay/Western Blot (EIA/WB) assay An increase was observed in the diagnosis of HIV. Conclusion: Awareness campaigns and rapid tests could be effective methods for the early diagnosis of HIV (AU)

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INTRODUCTION: The aim of the study was to analyze the implementation of a rapid HIV test in Asturias (Spain). METHODS: The study was conducted in two STI Units using the Determine® HIV-1/2 test. RESULTS: A total of 1011 people were tested, of whom 65.3% had never been tested for HIV previously, and 71.4% were heterosexual men. Twenty-one tests were confirmed positive by Enzyme Immunoassay/Western Blot (EIA/WB) assay An increase was observed in the diagnosis of HIV. CONCLUSION: Awareness campaigns and rapid tests could be effective methods for the early diagnosis of HIV.

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A prospective 20-year (1988-2007) study in an STI unit in Spain investigating trends in Molluscum contagiosum infection included 12,424 patients. We found 339 Molluscum contagiosum infections (2.7% incidence) with a yearly distribution ranging from 0% to 6.8%. There was a three-fold increase from an incidence of 1.3% in the first decade (1988-1997) to 4.0% in the second (1998-2007) (P < 0.001).

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INTRODUCTION: Human papillomaviruses (HPV) are the etiological agents of genital warts and of cervical intraepithelial neoplasia (CIN), and they are sexually transmitted. The aim of this study is to determine the prevalence of sexually transmitted infections (STI) in asymptomatic heterosexual males who consult their physicians seeking advice after their partners have been diagnosed with CIN. METHODS: 181 asymptomatic males whose partners were women diagnosed with CIN were studied at the STI unit in Gijón over a five-year period (1999-2003). The same diagnostic protocol was used in all cases: clinical exam, genitoscopy and the taking of samples for bacterial, fungus and Trichomonas cultures, as well as samples for the genomic detection of Chlamydia, and syphilis, HIV and viral hepatitis serology. RESULTS: 101 infections were diagnosed in 85 patients (47 %). By order of greatest prevalence, these were: urethritis from Ureaplasma urealyticum (35/181; 19.3 %), genital warts (31/181; 17.1 %), Haemophilus spp. (12 de 181; 6.6 %) and mycotic balanoposthitis (10/181; 5.5 %). CONCLUSIONS: The prevalence of STI in the partners of women with CIN is high, and in these cases it is necessary to establish STI detection and control programs in both members of the couple.

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BACKGROUND: Restriction fragment length polymorphism (RFLP) methods for genotyping genital human papillomavirus (HPV) are considered labor consuming and constrained by the reduced set of restriction enzymes capable of detecting specific mutations. However, we think that these methods have not taken full advantage of the high diversity of the known restriction enzymes. OBJECTIVE: We have set out to find the best restriction enzyme for HPV typing. STUDY DESIGN: An extensive search for enzymes was carried out by combining statistical methods and database information. The search maximized the discrimination between high- and low-risk types by examining the sequence of the L1 gene flanked by primers MY09/11. Different electrophoretic resolutions and two variations of the RFLP method were considered. RESULTS: HpyCH4V is the best enzyme for discriminating between risk types. Moreover, HpyCH4V generates different patterns for virtually all the HPV types. The typical pattern consists of two or three fragments, which facilitates typing in mixed infections. The typing of a set of clinical samples confirmed the expectations. CONCLUSIONS: This result illustrates the possibilities of statistical methods to exploit the high diversity of restriction enzymes in order to classify samples in a pre-established hierarchy of types for which DNA sequences are known.

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BACKGROUND: Few epidemiologic studies of scabies in sexually transmitted infection (STI) unit attenders exist. GOAL: The goal of this study was to determine epidemiology and trends of infestation among attenders at a Spanish STI unit. STUDY: A prospective 15-year (1988-2002) study was conducted of 9751 STI unit attenders, investigating scabies and other STIs. RESULTS: One hundred forty-seven patients (1.5%) had scabies, which was more frequent in males (2.1%, 73 of 3623) than in females (1.2%, 72 of 6128) (P <0.001). Infestation peaked in autumn/winter (70.1%) versus spring/summer (29.9%) (P <0.001). Significantly more cases occurred in single men (P <0.05), males under 35 (P <0.05), men with sporadic sexual contacts (P <0.001), and men who have sex with men (MSM) (P <0.001). In women, more cases occurred in Spanish patients (P <0.01), high alcohol users (P <0.05), and oral contraceptive users (P <0.01). In both sexes, scabies was commoner in smokers (P <0.05) and parenteral drug abusers (P <0.001). Scabies showed no significant association with other STIs. CONCLUSIONS: Scabies incidence has been stable, with autumn and winter peaks. Infestation is associated with lifestyle, MSM, and males with sporadic sexual contact.

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In the last years, there have been important advances in sexually transmitted infections such as genome sequencing of Treponema pallidum, Chlamydia trachomatis or Mycoplasma genitalium; the new taxonomic position of Calymmatobacterium granulomatis; commercial diagnostic systems based on nucleic acid amplification; the emergence of quinolone resistance in Neisseria gonorrhoeae; new therapeutic approaches in vulvovaginal candidiasis that include boric acid; the demonstration that valacyclovir reduces the risk of transmission of genital herpes or the availability of immune-response modifier in the treatment of genital warts, and that are questions in the goal of this review. Viral hepatitis and HIV were no reviewed by space reasons.

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BACKGROUND: There have been few epidemiologic studies of pubic lice in recent times, and the exact incidence is unknown. GOAL: The goal was to determine the trends of pubic lice infestation in a risk group of males and female prostitutes in an STD unit in Spain. STUDY DESIGN: This was a prospective 14-year study, from 1988 to 2001, of all patients attending the STD unit in Gijón (Asturias, Spain), investigating crab lice and other STDs. RESULTS: One hundred ninety-seven patients (2.2%) had pubic lice, with a male/female proportion of 1.8/1. The yearly infestation rate ranged from 1.3% to 4.6%. The mean age was 30.3 years, and 18.8% of patients were older than 35 years. There were more cases involving men who had sex with men (MSM) (P < 0.001) than those involving heterosexual men. Reinfestation occurred in 7.6% of patients, more often in males (P < 0.05) and mainly in MSM (P < 0.01). CONCLUSION: Infestation rates were stable during the period of study, with more older patients involved than reported previously, and infestation frequently was associated with STDs. MSM were infested and reinfested more often than heterosexual men, and in general reinfestations occurred more frequently in males than in females.

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