Modelling the impact of correlations between condom use and sexual contact pattern on the dynamics of sexually transmitted infections

Background

It is believed that sexually active people, i.e. people having multiple or concurrent sexual partners, are at a high risk of sexually transmitted infections (STI), but they are likely to be more aware of the risk and may exhibit greater fraction of the use of condom. The purpose of the present study is to examine the correlation between condom use and sexual contact pattern and clarify its impact on the transmission dynamics of STIs using a mathematical model.

Methods

The definition of sexual contact pattern can be broad, but we focus on two specific aspects: (i) type of partnership (i.e. steady or casual partnership) and (ii) existence of concurrency (i.e. with single or multiple partners). Systematic review and meta-analysis of published studies are performed, analysing literature that epidemiologically examined the relationship between condom use and sexual contact pattern. Subsequently, we employ an epidemiological model and compute the reproduction number that accounts for with and without concurrency so that the corresponding coverage of condom use and its correlation with existence of concurrency can be explicitly investigated using the mathematical model. Combining the model with parameters estimated from the meta-analysis along with other assumed parameters, the impact of varying the proportion of population with multiple partners on the reproduction number is examined.

Results

Based on systematic review, we show that a greater number of people used condoms during sexual contact with casual partners than with steady partners. Furthermore, people with multiple partners use condoms more frequently than people with a single partner alone. Our mathematical model revealed a positive relationship between the effective reproduction number and the proportion of people with multiple partners. Nevertheless, the association was reversed to be negative by employing a slightly greater value of the relative risk of condom use for people with multiple partners than that empirically estimated.

Conclusions

Depending on the correlation between condom use and the existence of concurrency, association between the proportion of people with multiple partners and the reproduction number can be reversed, suggesting the sexually active population is not necessary a primary target population to encourage condom use (i.e., sexually less active individuals could equivalently be a target in some cases).

     

Immunodiagnosis of sexually transmitted disease

Methods for detecting microbial antigens in clinical specimens offer an alternative to culture in the diagnosis of some sexually transmitted diseases. Developers of the immunologic methods are faced with a number of problems in evaluating the new tests. Traditionally, these tests are compared to culture as the "gold standard." Unfortunately, culture for Neisseria gonorrhoeae or Chlamydia trachomatis--the two agents most commonly sought--is considerably less sensitive than 100 percent. Immunologic methods may appear to produce false positives when the paired specimens are actually false-negative cultures. Another source of discordant results is sampling variation. These considerations, however, will not account for all false-positive results. Even the best non-culture methods have a low rate of false-positive results. If a new test has a specificity of 97 percent, it, by definition, yields approximately 3 percent false-positive reactions. In low-prevalence settings this false-positive rate will create problems in interpreting the results. For example, in a population with 3 percent prevalence of infection, a positive result in a 97 percent specificity test could only have a predictive value of 50 percent. Most testing for STD agents is performed in low-prevalence settings. None of the currently available immunodiagnostic procedures has a performance profile that suggests it will be satisfactory for diagnostic use in the low-prevalence setting.     

Evolution of sexually transmitted and sexually transmissible human herpesviruses

Herpesviruses occur in an impressively wide range of animals and are associated with various diseases. The numerous routes taken during hundreds of millions of years of evolution have contributed to their striking adaptability and success as pathogens. Herpesviruses share a distinct virion structure and are classified taxonomically into a single order, the Herpesvirales, which is divided into three families. The phylogenetic relationships among members of the most populous family, the Herpesviridae, which includes all nine human herpesviruses, are generally similar to those among their hosts, supporting the view that there has been a large degree of coevolution between virus and host. Three human herpesviruses (human cytomegalovirus, Kaposi's sarcoma-associated herpesvirus, and herpes simplex virus type 1) are classed as agents capable of sexually transmissible infection (StxI), and one (herpes simplex virus type 2) as an agent capable of sexually transmitted infection (STI). The evolutionary characteristics of these viruses are described.     

Modeling AIDS as a function of other sexually transmitted disease.

The spread of AIDS, as with any sexually transmitted disease, will depend on the pattern of sexual activity. Both the proportion of the population who have high partner exchange rates and the extent to which that proportion interacts with the remainder of the population are likely to be important determinants of the AIDS epidemic. However, it does not seem likely that surveys could obtain sufficiently reliable information of this nature for use in an accurate model of the AIDS epidemic. On the other hand, such information is implicitly contained in the epidemiology of other sexually transmitted diseases (STDs). Therefore a method is suggested of calculating the parameters of a model of the AIDS epidemic by comparing it with the epidemiology of another STD. The result is a model that predicts the likelihood of infection by the AIDS virus as a function of time and an individual's history of STD. It is suggested that further work along these lines may lead to a quantitative approach to assessing the importance of various STDs as cofactors in the spread of AIDS.     

The evolution of risky behaviour in the presence of a sexually transmitted disease

Sexually transmitted diseases (STDs) are widespread in nature, often sterilizing their hosts or causing other pathogenic effects. Despite this, there is a widespread occurrence of behaviours that are likely to increase the risk to an individual of contracting an STD. Here, we examine the evolution of behaviours such as promiscuity or mate choice that increase the risk of contracting an STD, but also provide a fitness benefit. As might be expected, the balance between risk and fitness benefit defines the optimal strategy, but this relationship is not straightforward. In particular, we often predict the coexistence of highly risky and highly risk-averse individuals. Surprisingly, very safe strategists that only suffer a small cost will tend to coexist with highly risky strategists rather than outcompete them as might have been expected. Rather than selecting for monogamy or for reduced mate choice, therefore, the presence of an STD may often lead to variability in either promiscuity or mate choice.     

DNA biosensor for detection of Neisseria gonorrhoeae causing sexually transmitted disease

A sequence-specific electrochemical sexually transmitted disease (STD) sensor based on self-assembled monolayer of thiolated DNA probe specific to target opa gene for detection of Gonorrhoea, a sexually transmitted disease has been fabricated. 6-Mercapto-1-hexanol (MCH) has been used as a blocking agent to facilitate oligos "stand" up at the surface, a configuration favoring subsequent DNA hybridization and to repel non-specific adsorption of undesired DNA. The results of differential pulse voltammetric studies of this STD sensor reveal low detection limit (1.0 × 10(-18)M) and a wide dynamic range (from 1.0 × 10(-6)M to 0.5 × 10(-18)M) arising due to the stable hybridization using methylene blue as an electro-active DNA hybridization indicator. The experimental results with genomic DNA, clinical patient sample of Neisseria gonorrhoeae, culture of non-N. gonorrhoeae Neisseria species (NgNS) and gram negative bacteria indicate that the fabricated sensor is specific to this STD.     

The influence of sexually active non-reproductive groups on persistent sexually transmitted diseases

We describe several population models exposed to a mild life-long sexually transmitted disease, i.e. without significant increased mortality among infected individuals and providing no immunity/recovery. We then modify these models to include non-reproductive groups consisting of those isolated from sexual contact and those who are sexually active but infertile due to choice, medical or other reasons. We analyse the potential effect on the dynamics of the population. We are interested in how the isolated class may curb the growth of the infected group while keeping the healthy population at acceptable levels. We also analyse the difference between being sexually active and abstained within the non-reproductive class and its impact on the epidemic reproductive number and the nature of the bifurcation around the disease-free equilibrium. We provide a comparison with our models introduced in a previous article, which include only the isolated from sexual contact class.     

The influence of sexually active non-reproductive groups on persistent sexually transmitted diseases

We describe several population models exposed to a mild life-long sexually transmitted disease, i.e. without significant increased mortality among infected individuals and providing no immunity/recovery. We then modify these models to include non-reproductive groups consisting of those isolated from sexual contact and those who are sexually active but infertile due to choice, medical or other reasons. We analyse the potential effect on the dynamics of the population. We are interested in how the isolated class may curb the growth of the infected group while keeping the healthy population at acceptable levels. We also analyse the difference between being sexually active and abstained within the non-reproductive class and its impact on the epidemic reproductive number and the nature of the bifurcation around the disease-free equilibrium. We provide a comparison with our models introduced in a previous article, which include only the isolated from sexual contact class.     

Natural selection on floral traits of female Silene dioica by a sexually transmitted disease

Floral traits endowing high reproductive fitness can also affect the probability of plants contracting sexually transmitted diseases. We explore how variations in floral traits influence the fitness of Silene dioica females in their interactions with pollinators carrying pollen or spores of the sterilizing anther-smut fungus Microbotryum violaceum. We collected healthy and infected plants in a highly diseased population and grew them under conditions that 'cure' infected individuals, and used standard regression methods to detect natural selection on floral traits. Narrow-sense heritabilities, coefficients of additive genetic variation (CV(A)) and genetic correlations among traits were estimated from paternal half-sib groups. Pollinator preferences imposed strong direct and directional selection on traits affecting female attractiveness and pollen-/spore-capturing abilities. Levels of additive genetic variance were high in these traits, suggesting that rapid responses to selection are possible. By considering our results in the light of spatial and temporal heterogeneity resulting from the colonization dynamics typical for this species, we suggest that the conflicting selective effects of pollen/spore loads lead to the maintenance of genetic variation in these traits.     

Use of a dual priming oligonucleotide system to detect multiple sexually transmitted pathogens in clinical specimens

Aims:  To evaluate a new dual priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) assay for detection of six sexually transmitted pathogens, including Chlamydia trachomatis , Neisseria gonorrhoeae , Mycoplasma genitalium , Mycoplasma hominis , Ureaplasma urealyticum and Trichomonas vaginalis .
Methods and Results:  Using 130 clinical specimens, the results obtained by the multiplex PCR, previously established in-house PCR and COBAS Amplicor PCR assays were compared. The specimens frequently contained multiple pathogens (34/130 specimens). The multiplex PCR assay had an overall sensitivity of 96% and specificity of 100% compared to the in-house PCR assay at >20 μg ml⁻¹ of DNA concentrations in samples and there was no cross-reaction with nonpathogenic Neisseria species that cause the majority of false-positive results with the COBAS Amplicor PCR assay.
Conclusions:  The DPO-based multiplex PCR assay detected the six sexually transmitted pathogens in clinical specimens with a high sensitivity and specificity, although its sensitivity was dependent on the DNA content of the samples.
Significance and Impact of the Study:  It is the first report about the new DPO-based technique to detect multiple sexually transmitted pathogens in a single assay, which has considerable potential to diagnose the infections accurately and rapidly.     

Monogamous networks and the spread of sexually transmitted diseases

Patterns of sexual mixing and heterogeneity in the number of sexual partners can have a huge effect on the spread of a sexually transmitted disease (STD). The sexual mixing network identifies all partnerships within a population over a given period and is a powerful tool in the study of such infections. Previous models assumed all links within the network to be concurrent active partnerships. We present a novel modelling approach in which we adapt the notion of a sexual contact network to a monogamous population by allowing the nature of the links to change. We use the underlying network to represent potential sexual partnerships, only some of which are active at any one time. Thus serial monogamy can be modelled while maintaining the patterns of mixing displayed by the population.     

Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women.     

女性泌尿生殖系统性病病原体感染情况分析

目的 研究性传播疾病病原体在女性泌尿生殖系统的感染情况。方法 选择2018年广州市皮肤病防治所性病门诊收治的484例女性初诊患者为患者组,选择同期30例健康女性体检者作为对照组,检测两组对象8种性病的患病情况,包括6种法定报告性病（HIV感染、梅毒、生殖器疱疹、沙眼衣原体感染、淋病、尖锐湿疣）和2种非法定报告性病（解脲脲原体及人形支原体感染、假丝酵母菌感染）。结果 484例初诊女性患者中共有292人患性病,占女性初诊患者的60.3%,与对照组相比差异有统计学意义（P<0.05）。292例性病患者合并感染率较高,出现性病合并感染的患者共94人,占32.2%（94/292）。入选患者共有感染类型23型,患者最多可同时患有4种性病。沙眼衣原体感染患者合并感染率最高,达到83.7%（36/43）。结论 应加强女性性病患者性病病原体的全面筛查和相关感染的预防。