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Many marginalized populations face severe health inequities in developed countries. These include people who are poor, homeless, sell sex or use alcohol or illegal drugs. In Toronto, an estimated 19% [...]

Objectives: To determine whether 'high-risk' clients occupied important sociometric positions in sexual networks of commercial sex workers and to estimate whether they were more likely to be HIV and STI infected. Goal: To determine whether a classification of high-risk clients could be validated by network analysis. Study Design: We used proxy data on clients collected from a cross-sectional survey of 49 indoor female sex workers. Results: Two types of clients were categorized as high risk, including those who created sexual bridges between sex establishments and those who had sex with most or all the FSW at an establishment. High-risk clients were significantly more central and were more likely to be members of cohesive subgroups than were lower-risk clients. The few known HIV and STI infectious were in high-risk clients. Conclusions: It is possible to identify theoretically high-risk commercial sex clients from the network perspective using simple data collection and categorization approaches.

Certain demographic and socioeconomic variables may help predict which women are at risk for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Identifying the characteristics of women at risk for these infections may help in targeting prevention and treatment strategies. Researchers in the province of Manitoba, Canada found that women who had both chlamydia and N. gonorrhoeae infection were more likely to be young, with an average age of 21, North American Indian, residents of urban areas, and poor. Women with higher income levels may have better access to diagnosis and treatment for gonorrhea. Women perceived to have a low risk for chlamydia may also need to be screened to prevent its transmission.

Background: Methods for accessing large sexual networks are essential for investigating the mechanisms for the spread of sexually transmitted infections. Goal: Four samples of cases were compared with the total population to determine which identified the largest networks. Study Design: Individuals with positive test results for chlamydia during a 6-month period were selected from a laboratory database and linked with sex partner information from a notifiable disease registry. Sexual networks were constructed for a random sample, people with positive results from two or more tests for chlamydia, people with positive tests results for both gonorrhea and chlamydia, and the preceding two groups combined. Results: The coinfected people combined with the repeaters yielded the highest proportion (47.8%) of large networks ([is greater than] 10 people), followed by the coinfected people, the repeaters, and finally the random sample. Conclusions: People coinfected with chlamydia and gonorrhea and those with repeated chlamydial infection present ideal opportunities for both research and prevention.

Objectives: To determine the antimicrobial susceptibility of Neisseria gonorrhoeae from Shanghai and to type the quinolone resistance-determining regions (QRDRs) of ciprofloxacin-resistant isolates.Methods: N. gonorrhoeae isolates (n = 159) were consecutively collected from male patients in Shanghai and examined for their antimicrobial susceptibilities to penicillin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone. The mutation profiles of the QRDRs of gyrA and parC were determined for 103 isolates including one susceptible isolate and one isolate with intermediate levels of susceptibility to ciprofloxacin.Results: High percentages of the 159 isolates were resistant to ciprofloxacin (98.7%), penicillin (93.1%) and tetracycline (56.5%). Penicillinase-producing N. gonorrhoeae (PPNG, 37.8%) or penicillinase-producing/tetracycline-resistant N. gonorrhoeae (PP/TRNG, 13.8%) accounted for 51.6% of the isolates. Chromosomal resistance to penicillin was observed in 41.5% of the isolates. Tetracycline resistance was noted in 56.5% of the isolates with 20.1% carrying plasmid-mediated resistance and 36.4% being chromosomally resistant. All isolates were susceptible to ceftriaxone and spectinomycin, although a trend to decreased susceptibility was noted. QRDR mutations were observed in the 101 ciprofloxacin-resistant isolates and the one ciprofloxacin-intermediate isolate, in contrast to the ciprofloxacin-susceptible isolate tested. Mutations in the QRDRs comprised four predominant (65.0% of the 103 isolates) patterns of a total of 19 patterns. Mutations in parC were significantly associated with higher MICs of ciprofloxacin.Conclusions: Spectinomycin and ceftriaxone are currently recommended for the treatment of gonorrhoea in Shanghai. Although the present study indicates that these antimicrobials should remain effective, the identification of isolates with decreased susceptibility underscores the importance of ongoing antimicrobial susceptibility surveillance to monitor and respond to the emergence of resistant isolates.

ABSTRACTporBDNA sequence analysis and Neisseria gonorrhoeaemultiantigen sequence typing (NG-MAST) methods were compared for their abilities to discriminate strains and to identify epidemiologically congruent pairs of N. gonorrhoeae. Both methods provided high-level discrimination of strains. NG-MAST further differentiated large porB-based clusters. However, considerations of cost suggest that porBDNA sequence analysis is a useful tool for preliminary molecular analysis of the epidemiology of N. gonorrhoeae.