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The aim of this study is to evaluate the range, quality and availability of diagnostic services for non-viral sexually transmitted infections (STIs), i.e. C. trachomatis, N. gonorrhoeae, T. vaginalis and T. pallidum, in Lithuania from September 2002 to December 2003. Surveillance data describing the organisation and performance characteristics of non-viral STI diagnostic services in Lithuania were collected using a questionnaire and subsequent site-visits. International evidence-based recommendations for non-viral STI diagnosis were used to evaluate the quality of the STI diagnostics. There were 171 facilities providing non-viral STI diagnostic services for the 3.5 million inhabitants of Lithuania. However, only 6% (n=9) of the respondents (n=153) could provide a confirmatory diagnosis, in accordance with international recommendations, for the full minimum range of relevant non-viral STIs in Lithuania, i.e. C. trachomatis, N. gonorrhoeae, T. pallidum, and T. vaginalis. In addition, accessibility to STI diagnostic services differed significantly among the different counties in Lithuania. Several of the respondents analysed low numbers of samples each year, and overall the sampling size was extremely low, especially for C. trachomatis diagnostics. In Lithuania, optimisation of non-viral STI diagnostics as well as of epidemiological surveillance and management of STIs is crucial. It may be worth considering a decrease in the number of laboratories, with those remaining having the possibility of performing STI diagnostic services that are optimised, in concordance with international recommendations, standardised, and quality assured using systematic internal and external quality controls and systems. In addition, establishment of national inter-laboratory networks and reference centres for non-viral STIs is recommended.

Gonorrhoea is a sexually transmitted infection with major public health implications and Neisseria gonorrhoeae has developed resistance to all antimicrobials introduced for treatment. Enhanced surveillance of antimicrobial resistance in N. gonorrhoeae is crucial globally. This is the first internationally reported antimicrobial resistance data for N. gonorrhoeae from Estonia (44 isolates cultured in 2009–2013). A high prevalence of resistance was observed for azithromycin, ciprofloxacin and tetracycline. One and two isolates with resistance and decreased susceptibility to the last remaining first-line treatment option ceftriaxone, respectively, were identified. It is crucial to implement surveillance of gonococcal antimicrobial resistance (ideally also treatment failures) in Estonia.

Background In Russia, the microscopy- and culture-based diagnostics of trichomoniasis is mainly suboptimal. Recent years, domestically produced diagnostic PCR assays have been implemented; however, ...

Background Adolescents and young adults are at increased risk of sexually transmitted infections (STIs). Knowledge of STI prevalence and risk factors are essential tools to elaborate preventive str ...

Background Diagnosis of Mycoplasma genitalium is entirely based on nucleic acid amplification tests (NAATs). In Russia, several M. genitalium polymerase chain reaction (PCR) assays have been developed; however, any evaluation of their performance has never been performed. Objective To assess the performance of five PCRs developed and currently used in Russia for diagnosis of M. genitalium. Materials and methods Vaginal swabs and first voided urine samples (FVUs) from 281 females and urethral swabs and FVUs from 125 males were analysed using three conventional PCRs and two real-time PCRs developed by three Russian companies. As reference tests, a real-time PCR targeting the MgPa adhesin gene was used; positive results were confirmed by two conventional PCRs targeting the 16S rRNA gene and MgPa gene, respectively. For evaluation of detection limits and analytical specificities, a blinded control panel consisting of dilutions of six strains of M. genitalium and 14 other Mycoplasma species was tested. Results The prevalence of M. genitalium was 2.5% among females and 9.6% among males. The highest sensitivity (71.4-100% in different specimens) was exhibited by one real-time PCRs. Conventional PCRs from two manufacturers failed to detect M. genitalium in any of the seven positive female FVUs. All tests had a 100% clinical specificity; however, one cross-reacted with Mycoplasma pneumoniae. Conclusions Only one of the five Russian PCRs displayed reasonable sensitivity for all specimen types, but the specificities of all assays were high. Accordingly, improvements regarding sensitivity of all the tests are needed. However, larger studies, including other populations, evaluating these assays are crucial.

The present guidelines aim to provide comprehensive and precise information regarding the laboratory diagnosis of the sexually transmitted infection (STI) syphilis in East European countries. These recommendations contain important information for laboratory staff working with STIs and/or STI-related issues. Individual East European countries may be required to make minor national adjustments to these guidelines as a result of lack of accessibility to some reagents or equipment, or laws in a specific country.

Systems architects commonly use multiple cores to improve system performance. Unfortunately, multicore hardware is evolving faster than software technologies. New multicore software standards are necessary in light of the new challenges and capabilities that embedded multicore systems provide. The newly released multicore communications API standard targets small-footprint, highly efficient intercore and interchip communications.

BACKGROUND: The numbers and performance characteristics of laboratories providing sexually transmitted infection (STI) diagnostic services, as well as the rates of morbidity due to STIs in St. Petersburg, Russia, remain largely unknown. OBJECTIVE: The aim of the present study was to evaluate the range, quality and availability of diagnostic services for several non-viral STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis) in St. Petersburg during the period September 2005 to June 2006. METHODS: Survey data focusing on organization and performance characteristics of STI diagnostic services were assessed using questionnaires, telephone interviews and site visits. RESULTS: A total of 118 laboratories providing STI diagnostic services were identified. Of the surveyed laboratories, 54% (64 of 118) diagnosed syphilis, 81% (96 of 118) gonorrhoea, 80% (94 of 118) trichomoniasis and 49% (58 of 118) chlamydial infections. Although most of the laboratories could provide a presumptive diagnosis for syphilis, most of the N. gonorrhoeae and T. vaginalis testing of women did not adhere to international recommendations. Of the laboratories with the capacity to diagnose C. trachomatis infection, 69% still used serological testing (enzyme-linked immunosorbent assay) to detect antibodies to C. trachomatis. CONCLUSIONS: Overall, the diagnostic methods used to establish a laboratory diagnosis, the system of case reporting, the training of laboratory personnel and the level of interlaboratory communication clearly require improvement. This study represents the first step in a process of evaluation of the laboratory support for STI services and the establishment of an interlaboratory network in St. Petersburg.

The article represents the data of screening carried out on 905 women attended the outpatient departments of gynecologic clinics of Saint Petersburg and Leningrad region. Infectious diseases of genital-urinary system were diagnosed in 65.5% of the women, 53.5% having asymptomatic course, which must be important in epidemiological respect. Risk factors and characteristic symptoms of the diseases were taken into account while analyzing the questionnaires. The valuable risk factors were young age, early debut of sexual intercourse and occasional sexual contacts, the history of STI as well as the pregnancy.

The results of Chlamydia trachomatis detection in different urogenital samples (vagina, cervix, urethra, urine) are presented in this report. The study was carried out for the period of 1999 to 2000. A total of 397 women and 253 men were examined. Cervical, urethral and vaginal swabs from women, and urethral, first voided urine (FVU) specimens from men were tested. For diagnosis of Chlamydia, trachomatis the following methods were used: polymerase chain reaction (PCR), direct immunofluorescence test (DIF) and cell culture (CC). In male samples, more often chlamydiae were detected in the urethra (11,6%), more rarely - in the FVU (6%). When female samples were tested, more often C. trachomatis was found in the vagina (18,4%), and less often - in the cervix (14. 4) and the urethra (8. 8%). The sensitivity and specificity of the methods used to test urogenital samples were determined. The PCR sensitivity and specificity was shown to be 75 and 100% for C. trachomatis detection in the cervix, 75 and 97. 5% - in the female urethra, and 63 and 99% - in the vagina, respectively. The PCR sensitivity and specificity was found to be 78 and 100% in the male urethral specimens and 100 and 99. 6% in the FVU, respectively. The sensitivity of cell culture method used for chlamydiae detection in cervical, female and male urethral samples was low - 33. 9, 47. 1 and 50% respectively. The CC specificity was 100%.

The technique of pooling endocervical samples for PCR detection of C. trachomatis was developed and compared with individual testing. The efficiency of pooling strategy was evaluated for its accuracy and cost saving ability. Population prevalence based on pooled data was estimated. 1. 500 endocervical samples were tested individually and pooled by 5 (300 pools) and 10 (150 pools) specimens. The sensitivity and specificity of PCR was not affected by pooling either by 5 or by 10 samples. The estimated prevalence was 6. 1% (95% CI: 4,5-7,7) and 6,0% (95% CI: 4,3-7,) for pooling by 5 and 10, respectively. The prevalence of 6. 6% determined by individual testing (99 of 1. 500) was within 95% CI of the estimated prevalence for pooling by 5 and 10. The used pooling strategy has resulted in 53. 3 and 44. 0% cost savings, when endocervical samples were pooled by 5 and 10, respectively. Thus, pooling endocervical samples for detection of C. trachomatis is an accurate and cost saving approach for realization of large-scale studies.

Genital Chlamydia trachomatis infections in women are traditionally detected by testing cervical and urethral samples. This sampling approach is not acceptable in some, e.g. screening situations. We evaluate an alternative approach, i.e. use of vaginal self-collected specimen for testing by polymerase chain reaction.The sensitivity of self-collected vaginal (introital) samples to diagnose genital infections by Chlamydia trachomatis using Roche AMPLICOR CT/NG PCR was compared with the cervical- and first-voided urine samples from women consulting with- (Group 1; n=123) and without (Group 0; n=160) genital symptoms. Women were interviewed regarding genital hygiene. Genital symptoms and signs were noted.C. trachomatis DNA was detected in 13.0% of women from Group 1 and in 5.0% of women from Group 0, i.e. in urine of 6.5% vs. 1.9%, in the cervical swab in 9.8% vs. 5.0% and in vaginal swab in 11.4% vs. 3.8% of women, respectively. The vaginal sample was the most sensitive specimen for detecting C. trachomatis in the Group 1 women. It had sensitivity of 87.5% vs. 75% for cervical- and 50% for urine specimens. In Group 0, the cervical sample was 100% sensitive, while the vaginal introital sample and urine had a sensitivity of 75% and 37.5%, respectively. C. trachomatis was less often detected in urine of women who routinely practised genital washing.Vaginal sampling performed by the woman herself is a sensitive approach and might serve as an important stimulus for screening for C. trachomatis infections in young women at risk.

In Russia, the microscopy- and culture-based diagnostics of trichomoniasis is mainly suboptimal. Recent years, domestically produced diagnostic PCR assays have been implemented; however, any evaluation of these PCRs has never been internationally reported.To assess the performance characteristics of PCR assays developed and currently used in Russia to detect Trichomonas vaginalis.Five PCR assays were assessed on 448 samples (317 vaginal and 131 male urethral) collected from symptomatic attendees of youth centres (n = 415) and patients of a dermatovenereological dispensary that were previously diagnosed with trichomoniasis (n = 33). As reference assay, a sensitive and specific real-time multiplex PCR was used.T. vaginalis DNA was detected in five (all females) of the 415 patients of youth centres (1.2%). All 33 patients previously diagnosed at the venereological dispensary proved to be true positive. For 445 (99.3%) of these 448 samples identical results were obtained by all PCRs, 35 positive and 410 negative. The three discordant samples were positive in all PCRs except one conventional PCR assay. The sensitivities of the PCRs were 94.3-100% and 66.7-100% for vaginal and urethral swabs, respectively. All evaluated assays were 100% specific. The detection limits of the different PCRs ranged from 0.1 to 5 genome equivalents per reaction.The PCR assays currently used in Russia for the detection of T. vaginalis have in general high sensitivities and excellent specificities for both vaginal samples and urethral samples from males.

Adolescents and young adults are at increased risk of sexually transmitted infections (STIs). Knowledge of STI prevalence and risk factors are essential tools to elaborate preventive strategies. However, internationally reported studies on epidemiology of STIs among the youth in Russia are mainly lacking.To ascertain sexual behaviours, knowledge and attitudes about safe sex and prevalence and correlates with STIs in attendees of youth clinics in St. Petersburg, Russia.A total of 301 women and 131 men, who self-referred for STI testing, completed a questionnaire and were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis using nucleic acid amplification tests.The overall STI prevalence was 16.9%, and similar in the female patients and male patients (15.6% and 19.8% respectively). C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis were detected in 13%, 2.5%, 4.6% and 1.2% of the attendees respectively. The men displayed riskier sexual behaviours and worse knowledge and attitudes regarding safe sex compared to the women, with the most distinguishing features being younger age at first intercourse (P0.0005), higher numbers of sex partners during lifetime (P = 0.001) and latest 6 months (P0.0005), more frequently consuming alcohol (P0.0005), poorer knowledge of STI/HIV prevention measures (P0.0005), and less positive attitudes towards safe sex (P = 0.001). However, no significant predictors of STI positivity were found in the men. In the women, the strongest predictors of STI positivity were young age (15-19 years) and multiple sex partners (≥ 2) during latest 6 months.The overall prevalence of STIs among users of STI services at youth clinics in St. Petersburg was high. Comprehensive epidemiological data on STI prevalence and sexual behaviour correlates are necessary to initiate new and strengthen existing STI prevention programmes for the youth, in Russia as well as in many other settings.

The present guidelines aim to provide comprehensive information regarding laboratory diagnosis of Mycoplasma genitalium infections in East European countries. These guidelines are intended primarily for laboratory professionals testing specimens from patients at sexual health care clinics, but may also be useful for community-based screening programmes. Diagnosis of M. genitalium infection is performed exclusively using nucleic acid amplification tests (NAATs), owing to the poor and slow growth of the bacterium in culture. Because no internationally validated and approved commercial NAAT for M. genitalium detection is presently available, it is necessary that laboratories performing M. genitalium diagnostics not only carefully evaluate and validate their in-house PCRs before using them routinely, but also use comprehensive internal controls and take part in external quality assessment programmes. The guidelines were elaborated as a consensus document of the Eastern European Sexual and Reproductive Health (EE SRH) Network, and comprise one element of a series of guidelines aimed at optimizing, standardizing, and providing guidance on quality laboratory testing for reproductive tract infections.

International audience; Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (gonococcus) is a major problem worldwide. Quality-assured and quality-controlled AMR surveillance data on gonococci globally is crucial for public health purposes. In East-European countries, the knowledge regarding gonococcal AMR and its prevalence is limited. Objectives: To ascertain the recommendations for antimicrobial treatment of uncomplicated gonorrhoea in 11 East-European countries; valuable information for introducing an international gonococcal AMR surveillance programme. Methods: A questionnaire was used to collect information regarding the types, doses and manufacturers of the antimicrobials recommended for gonorrhoea treatment in all countries. Results: Ceftriaxone (250-1000 mg, intramuscularly (IM)×1) was reported as first-line antimicrobial in all countries (n=11). Many of the second-line and alternative treatments seemed suboptimal for empirical treatment. Regionally manufactured antimicrobials were predominantly used, were easily available and some may be of suboptimal quality. This generates effective prerequisites for emergence, and rapid spread of gonococcal AMR and gonorrhoea. Conclusion: Ceftriaxone was first-line antimicrobial in all the 11 East-European countries, which is an appropriate choice also in a global perspective. However, the adherence, especially among private physicians, to these public sector recommendations is questionable. Implementation of national and international gonococcal AMR surveillance in this region is crucial; to provide evidence-based data for regular and timely updating of treatment guidelines, to identify emerging resistance, and to assist in the prevention, control and containment of gonococcal AMR and gonorrhoea.

The laboratory diagnosis of sexually transmitted infections in many Eastern European countries remains suboptimal. The main objective of the present evidence-based guidelines is to provide comprehensive information regarding the laboratory diagnosis of infections caused by Trichomonas vaginalis in East European countries. In particular, the present guidelines recommend: (i) to encourage examination of the wet mounts of vaginal exudates, instead of stained smears, at all clinical settings; (ii) nucleic acid amplification tests (NAATs) or culture could be employed if no trichomonads are detected on microscopic examination of the wet preparation and there is a strong indication of infection and (iii) the use of NAATs is encouraged in screening, using non-invasive specimens, or high volume testing situations. In the absence of internationally recognized commercial NAAT systems, tests developed in-house should be validated using obtainable international standards and quality assured strictly. Individual East European countries may be required to make minor national adjustments to these guidelines as a result of lack of accessibility to some reagents or equipment, or laws in a specific country.

This report outlines the proceedings of the 4th Annual Meeting of the Eastern European Network for Sexual and Reproductive Health (EE SRH Network) [1,2], which took place at Uppsala University in Uppsala, Sweden between 30 May and 3 June, 2009.

The present guidelines aim to provide comprehensive information regarding the laboratory diagnosis of infections caused by Chlamydia trachomatis in East European countries. These recommendations contain important information for laboratory staff working with sexually transmitted infections (STIs) and/or STI-related issues. Individual East European countries may be required to make minor national adjustments to these guidelines as a result of lack of accessibility to some reagents or equipment, or laws in a specific country.

In Russia, laboratory diagnosis of gonorrhoea has been mainly based on microscopy only and, in some settings, relatively rare suboptimal culturing. In recent years, Russian developed and manufactured nucleic acid amplification tests (NAAT) have been implemented for routine diagnosis of Neisseria gonorrhoeae. However, these NAATs have never been validated to any international well-recognized diagnostic NAAT.This study aims to evaluate the performance characteristics of six Russian NAATs for N. gonorrhoeae diagnostics.In total, 496 symptomatic patients were included. Five polymerase chain reaction (PCR) assays and one real-time nucleic acid sequence based amplification (NASBA) assay, developed by three Russian companies, were evaluated on urogenital samples, i.e. cervical and first voided urine (FVU) samples from females (n = 319), urethral and FVU samples from males (n = 127), and extragenital samples, i.e. rectal and pharyngeal samples, from 50 additional female patients with suspicion of gonorrhoea. As reference method, an international strictly validated real-time porA pseudogene PCR was applied.The prevalence of N. gonorrhoeae was 2.7% and 16% among the patients providing urogenital and extragenital samples, respectively. The Russian NAATs and the reference method displayed high level of concordance (99.4-100%). The sensitivities, specificities, positive predictive values and negative predictive values of the Russian tests in different specimens were 66.7-100%, 100%, 100%, and 99.4-100%, respectively.Russian N. gonorrhoeae diagnostic NAATs comprise relatively good performance characteristics. However, larger studies are crucial and, beneficially, the Russian assays should also be evaluated to other international highly sensitive and specific, and ideally Food and Drug Administration approved, NAATs such as Aptima Combo 2 (Gen-Probe).

Electronic reporting systems improve the quality and timeliness of the surveillance of communicable diseases. The aim of this paper is to present the process of the implementation and introduction of an electronic reporting system for the surveillance of communicable diseases in Lithuania. The project which started in 2002 was performed in collaboration between Lithuania and Sweden and was facilitated by the parallel process of adapting the surveillance system to European Union (EU) standards. The Lotus-based software, SmittAdm, was acquired from the Department of Communicable Diseases Control and Prevention of Stockholm County in Sweden and adopted for Lithuania, resulting in the Lithuanian software, ULISAS. A major advantage of this program for Lithuania was the possibility to work offline. The project was initiated in the two largest counties in Lithuania where ULISAS had been installed and put in use by January 2005. The introduction was gradual, the national level was connected to the system during late 2005, and all remaining counties were included during 2006 and 2007. The reporting system remains to be evaluated concerning timeliness and completeness of the surveillance. Further development is needed, for example the inclusion of all physicians and laboratories and an alert system for outbreaks. The introduction of this case-based, timely electronic reporting system in Lithuania allows better reporting of data to the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) compared to the former reporting system with paper-based, aggregated data.

To perform a comprehensive inventory of the number of samples, performance characteristics, and quality assurance of the laboratory diagnosis of Neisseria gonorrhoeae at five laboratories in St Petersburg and Leningradskaya Oblast, Russia, in 2004, and to recommend optimisations for an increased adherence to international evidence based recommendations of diagnostics.Surveillance data were obtained with questionnaire and site visits. For evaluation of the culture media utilised at the laboratories, N gonorrhoeae reference strains (n = 29) were used.During 2004 the total numbers of N gonorrhoeae samples analysed at the five laboratories using microscopy of stained smears and culturing were 330 879 (407 positive) and 38 020 (420 positive), respectively. Four laboratories used a Russian non-selective culture medium-that is, Complegon, and one laboratory utilised Biocult-GC. Both media seemed suboptimal. Only two of the laboratories used any species confirmative assay. Antibiotic susceptibility testing of N gonorrhoeae was performed at only two of the laboratories and each year only occasional isolates were analysed. None of the laboratories comprised a complete laboratory quality assurance system.According to international recommendations, the diagnosis of N gonorrhoeae in St Petersburg and Leningradskaya Oblast, Russia, is suboptimal. More samples need to be analysed by culturing on a highly nutritious and selective medium and, furthermore, species confirmation and antibiotic susceptibility testing should be more frequently performed. In addition, the utilised methods for culturing and antibiotic susceptibility testing, including medium and interpretative criteria used, ought to be optimised, standardised, and quality assured using systematic internal and external quality controls.

Objectives Data regarding the performance characteristics of STI diagnostic tests used in Eastern Europe are very scarce. The objective of this study was to validate the AmpliSens test systems (Central Research Institute for Epidemiology, Moscow, Russia), compared to internationally acknowledged and validated tests, for genetic detection of N gonorrhoeae (NG) , C trachomatis (CT) , M genitalium (MG) and T vaginalis (TV) . Methods In total, 319 females and 127 males were recruited. For evaluation of the TV tests, additional 33 patients with diagnosed trichomoniasis at dermatovenereological dispensaries (VD) were involved. Conventional AmpliSens PCR assay (cPCR), real-time PCR assay (rtPCR), and a real-time nucleic acid sequence-based amplification assay for detection of NG or CT were evaluated. Furthermore, AmpliSens cPCR and rtPCR for detection of MG or TV were tested. As international reference tests an internationally validated real-time N gonorrhoeae porA pseudogene PCR, Cobas Amplicor CT PCR and LightMix 480HT CT PCR, MG rtPCR targeting the MgPa adhesin gene with positive results confirmed by two MG cPCRs targeting the 16S rRNA gene and MgPa gene, and a TV rtPCR targeting a TV specific repeat DNA fragment, respectively, were used. Results The overall prevalence of CT infection was 12.6%. The AmpliSens CT NAATs and the reference methods displayed a high level of concordance (97.9%–99.2%). The prevalence of NG was 2.7% and 16% among the urogenital and extragenital samples, respectively. The AmpliSens NG NAATs and the reference method displayed high level of concordance (99.4–100%). The prevalence of MG was 2.5% among females and 9.6% among males. The highest sensitivity (71.4%–100% in different specimens) was exhibited by the AmpliSens rtPCR. All tests had a 100% clinical specificity. The prevalence of TV was 1.2% among the females, and all additional VD patients tested positive. The sensitivity and the specificity of both Russian TV tests validated was 100%. Conclusion It seems clear that the biomedical industry in Eastern Europe has the potential for producing reliable reagents and tests kits at affordable prices for genetic diagnosis of STIs. This would open new perspectives for the whole region and could also be cost-effective for some other regions experiencing financial constraints. However, more comprehensive evaluations of regionally manufactured tests should be conducted according to internationally accepted guidelines.

Background The prevalence of sexually transmitted infections in Russia is high. Young sexually active individuals it is at highest risk to be infected, therefore increased access for consultations and testing is of great importance. Methods .The data was collected during the site visit from the records of the Center in February, 2013. Results The Regional Center for Prevention of the Reproductive Health of Teenagers and Youth “Your world.ru” (Твой мир.ru) was established in Tver, Russia in 2006. One of the multiple activities of the centre is prophylaxis and early detection of reproductive tract disorders, including STI and HIV infections. Medical and psychological help for the young population, aged from 15 to 24 years, of Tver city and region of Tver is provided free of charge by a team including young medical professionals, namely dermatovenereologists, gynaecologists, endocrinologists, urologists-andrologists and psychologists. In 2012, 2,000 young persons (more than 6,000 visits) attended the STI centre for testing and a genital tract infection was diagnosed in 15.3% of these. Chlamydia trachomatis was detected in 8.8% (71/805) and Neisseria gonorrhoeae in 4.0% (8/202) of the young persons tested. During the same year three new cases of syphilis and nine cases of HIV were also diagnosed. It is of grave concern that spread of HIV among the young population of Tver is exclusively sexual and is increasing! Conclusion The STI morbidity of the young population, aged 15–24 years, is high in Tver and Tver region, Russia. Among the risk factors for acquiring STIs in Tver and Tver region are early sexual debut, active sexual life with frequent change of sexual partners, casual sex and unprotected sex. More active sexual education within this young age group is essential.

Background The knowledge about approaches used for diagnosis of STIs in Ukraine is scarce. Aiming to optimise the laboratory diagnosis of STIs and introduce antimicrobial resistance surveillance for Neisseria gonorrhoeae , we aimed to survey the algorithms, methodologies and reagents used, and the laboratory capacities and possibilities in three regions of Ukraine. Methods Laboratories of three regions of Ukraine, namely Dnepropetrovsk, Ternopil and Zaporoz, were visited and detailed interviews were conducted. Results The three main dispensaries visited serve both the corresponding region as well as the city needs, and also have their own outpatient clinics. Large number of samples is tested, for example in Dnepropetrovsk and Zaporoz yearly 41,000 and 26,000 samples are tested by culture for gonococci, respectively. The majority of samples are coming from gynaecologists and only 0–0.4% contains gonococci. In contrast, testing 4,000 to 10,000 venereology patients per dispensary and year reveals 4–9% of positive samples in all three regions. PCR equipment is available in Dnepropetrovsk and Zaporoz, however, this is rarely used because of lack of funding from the state. Nevertheless, in the private laboratories PCR is run using variety of reagents. Gonococcal culture is primarily performed using Russian or Ukrainian selective growth media. Chlamydia trachomatis and Trichomonas vaginalis iagnosed using cytochrome staining, direct immunofluorescence nd/or serology. For the diagnosis of syphilis Wasserman reaction is still frequently sed; screening is conducted using non-treponemal microprecipitation test, an analogue o the VDRL test. Laboratory quality management systems are unavailable. Conclusion Optimization and quality assurance of he laboratory diagnosis of STIs in the three interviewed and visited laboratories is crucial. Both methods for testing, reagents as well as the opulations tested have to be revised and adjusted to international evidence-based standards.

Background The structure of laboratory services differs among different regions of Russia. In order to apply to international standards initially analysis of the organisational structure, methods and methodologies used is necessary. This study reviewed the features of the laboratory diagnosis of STIs in the Tver region, central Russia. Methods A questionnaire-based survey concerning STI laboratory services in the Tver region was conducted. Results The Tver region consists of 36 districts, populated by 1.3 million citizens (406,000 in the Tver city). The wast majority of the laboratories are owned by the State, however, a few privately owned laboratories are also present. The State-owned laboratories are divided into peripheral-district branches, most of them run mainly serology of syphilis and microscopy of genital smears. The remaining laboratory diagnostics is performed at the centralised laboratory at Center of Specialized Medical Aid in Tver. This laboratory examines samples sent from the regional branches and different city medical institutions, as well as samples collected from patients consulting physicians at its own Center. The test result is delivered either to the treating physicians or directly to the patient. Microscopy of Gram and methylene blue stained smears were the main methods for diagnosis of Neisseria gonorrhoeae and Trichomonas vaginalis infections. However, PCR was available for testing for Chlamydia trachomatis , N. gonorrhoeae , Mycoplasma genitalium , Gardnerella vaginalis , M. hominis and Ureaplasma urealyticum using Russia-produced diagnostic tests. Serology remained in use for diagnosis of chlamydial infection and trichomoniasis. No appropriate and complete quality assurance and control system was available. Conclusions In Tver, Russia, the detection of several STI agents has to be optimised, and international evidence-based standards and appropriate quality management systems introduced. Beneficially, the laboratory diagnosis is further centralised, which makes it easier to implement appropriate international evidence-based STI guidelines.

Background Tver region belongs to the Central part of Russia, its territory is 84,200 km 2 with a population of 1,342,200 inhabitants, including the city of Tver populated by 406,918 inhabitants. The aim of this paper is for the first time to internationally present the epidemiological trends of STIs in the region. Methods Site visits and yearly epidemiological reports of the Center. Results The peripheral laboratories are poorly equipped and therefore the diagnosis of STIs is mainly concentrated to the Center of the Specialized Medical Aid in Tver. However, the long distances for specimen transportation and lack of appropriate transport system are large obstacles for providing effective diagnosis of STIs. In 2009, vaccination against human papilloma virus (HPV) was introduced into the prevention programme against cervical cancer in Tver. The epidemiological trends of the main STIs in the Tver region are changing. A decrease in the incidence (cases per 100,000 inhabitants) of almost all STIs has been observed, namely during the years 2008 and 2012 the incidence of syphilis was 62.1 and 21.0, gonorrhoea - 42.5 and 19.2, genital chlamydial infection - 58.7 and 34.4 cases, T vaginalis - 120.5 and 73.6, genital herpes - 8.1 and 6.5, and anogenital warts 21.1 and 16.6, respectively. Since introduction in 2009, 373 girls, aged 12–13 years, have been vaccinated for HPV. Conclusion . In Tver, Russia, the difficulties to reach the population in most need for testing is of major concern. The reported epidemiologic data is also suboptimal due to many reasons such as lack of appropriate diagnostic methods, frequent use of self-treatment (antibiotics available over the counter), and private laboratories and outpatient clinics do commonly not report STI cases to the authorities. Accordingly, it is imperative to optimise the laboratory diagnosis and epidemiological surveillance of STIs, and introduce evidence-based STI guidelines.

Background In 2007–2008, a questionnaire-based study evaluated the quality of the 316 State laboratory services that were engaged in diagnosis of STIs in Belarus. This comprehensive survey clearly demonstrated that many of the tests and testing algorithms used in the laboratory diagnosis were inappropriate and not in accordance with international evidence-based recommendations. Methods STI specialists from Belarus actively participated in the development of Eastern European consensus guidelines for the diagnosis of several STIs; an international collaborative work by the Eastern European Network for Sexual and Reproductive Health (EE SRH). Results The international evidence-based guidelines developed by the EE SRH have subsequently been adapted to national conditions and legalised by the Ministry of Health of Belarus as the national standard for laboratory diagnosis of STIs. Briefly, antibody testing for diagnosis of genital Chlamydia trachomatis and Trichomonas vaginalis infections has been abandoned. Internationally validated nucleic acid amplification tests (NAATs) have been strongly promoted and also introduced for diagnosis of several STIs. Diagnosis of Mycoplasma genitalium using NAATs was initiated and routine screening and/or testing for Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis and Mobiluncus spp. was excluded from the recommendations supported by the State. Laboratory specialists from the 11 laboratories of the dermatovenereological dispensaries were trained in diagnostics using NAATs and laboratories supplied by the necessary equipment and reagents for NAAT diagnostics. The cultivation of Neisseria gonorrhoeae has been optimised and gonococcal antimicrobial resistance surveillance has been established. Finally, evidence-based national STI clinical protocols, including treatment recommendations, have been elaborated and legalised by the Ministry of Health of Belarus. Conclusion The international EE SRH collaborative project has significantly improved the quality of the STI diagnostics and treatment in Belarus. A new EE SRH project is planned for Belarus, aiming to monitor and evaluate the implementation of the current developments.

Background The contemporary national epidemiological surveillance system of sexually transmitted infections in Lithuania was legalised in 2009. A national computerised reporting system has been introduced, aiming to standardise the data collection and analysis for all communicable diseases and their etiological agents through the country. Methods Analysis of the national database available at www.ulac.lt Results There are four reportable STIs in Lithuania, namely syphilis, Chlamydia trachomatis, Neisseria gonorrhoeae and HIV. Since 2010 both the physicians and the laboratories report identified STI cases. The physician reports individual new STI cases weekly, while the laboratory reports are provided monthly and only as aggregated data. During the period of 2009–2011, the incidences of bacterial STIs in Lithuania have been decreasing. The incidence (cases per 100,000 population) of syphilism decreased from 9.6 to 8.5 cases, of gonorrhoea from 11.5 to 7.9 cases, and of genital C. trachomatis infection from 11.9 to 10.6. In contrast, the incidence of HIV infection during the same time period increased from 0.49 to 5.15 cases! These changes in STI incidences were not due to the level of testing, which has been relatively stable from 2009 to 2011. Conclusion The substantial increase in HIV incidence during recent years in Lithuania is of major concern. The difference in reporting methodologies, namely reporting of individual cases by the physicians and aggregated data from the laboratory reports does not allow comparison of them sufficiency of such reporting as well as evaluation of the true epidemiological situation.

Background The emergence and international spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae has compromised the treatment and public health management of gonococcal infections. Appropriate diagnostics and surveillance of AMR are critical for controlling infections and in guiding international and national treatment guidelines to ensure appropriate patient management. Methods A questionnaire-based survey regarding the diagnostics and AMR surveillance of N. gonorrhoeae in Latvia was conducted by the Centre for Disease Prevention and Control and Infectology of Latvia. Telephone interviews were carried out among the 73 biggest medical laboratories in Latvia. Results In 2011, a total of 550 cases of gonorrhoea were reported giving a rate of 26.7 per 100 000 population. In 2012 – 602 cases and an incidence of 29.5. In total, the incidence of gonorrhoea increased by 73.5% from 2010 to 2012. For detection of N. gonorrhoeae, currently three laboratories are using nucleic acid amplification tests (NAATs), 10 - RNA probe hybridization tests, four laboratories culture, and 17 - Gram staining of specimen smears only. Monitoring of AMR in N. gonorrhoeae was initiated in 2010, however, during 2010 and 2012 in total only 35 isolates were tested. All 35 isolates were fully susceptible to cefixime, ceftriaxone, azithromycin, and spectinomycin, and the minimum inhibitory concentrations (MICs) of gentamicin were low. Resistance to ciprofloxacin was displayed by 43% of isolates, to penicillin by 31%, and to tetracycline by 23%. Conclusion The gonorrhoea incidence has significantly increased in Latvia during the recent years, which cannot only be explained by introduction of more sensitive diagnostics such as NAATs in a few laboratories. It is imperative to substantially strengthen the diagnostics and AMR surveillance in Latvia.

Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern, and gonorrhoea may become untreatable. However, AMR data from Eastern Europe are scarce beyond Russia, and in Belarus no AMR data or other characteristics of gonococci have been published in over 20 years. The aim was to describe the AMR and molecular epidemiological characteristics of gonococci circulating in 2009 and 2010 in Belarus. Methods N gonorrhoeae isolates cultured in 2009 (n=80) and 2010 (n=78) in the two different cities Minsk (n=45) and Mogilev (n=113) were examined using Etest for nine antimicrobials and nitrocefin solution for β-lactamase production. Where available, breakpoints for susceptibility and resistance according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST; http://www.eucast.org) were used. Moreover, screening for penA mosaic alleles, full-length porB gene sequencing, and N gonorrhoeae multiantigen sequence typing (NG-MAST) were performed. Results The levels of resistance in 2009–2010 to antimicrobials evidently used in the gonorrhoea treatment in Belarus were—ceftriaxone 0%, spectinomycin 0%, azithromycin 14.4%, tetracycline 30.9%, ciprofloxacin 34.6%, and erythromycin 59.2% (only tested in 2009). The levels of resistance to other antimicrobials of international interest but not used in Belarus were—cefixime 0%, gentamicin 1.3%, and penicillin G 9.9% (only tested in 2009). Extraordinarily, no β-lactamase producing isolates were detected. The circulating N gonorrhoeae population identified was very heterogeneous and contained many divergent NG-MAST STs, of which more than half have not been previously described worldwide. Conclusions Due to the high levels of resistance to all antimicrobials previously recommended as first-line treatment, only ceftriaxone and spectinomycin can be recommended for empirical gonorrhoea treatment in Belarus. Continuous and quality assured gonococcal AMR surveillance in Eastern Europe is crucial, in Belarus this surveillance is now initiated using WHO protocols.

Background The new variant of Chlamydia trachomatis (nvCT), first reported in Sweden in late 2006, has so far rarely been reported outside the Nordic countries. However, knowledge of the presence of nvCT beyond these countries is limited due to the few recent studies, many laboratories still cannot detect nvCT, and the ones that can detect nvCT do mainly not distinguish it from wild type CT. The aims were to i) investigate the presence of nvCT in St. Petersburg, the largest city of the Northwest of Russia and in close proximity to Sweden, and ii) assess nucleic acid amplification tests (NAATs) used in Russia to diagnose C trachomatis infections for their ability to identify nvCT. Methods June–December 2010, consecutive samples (cervical swabs from females and urethral swabs from males) found positive for C trachomatis during routine testing with commercial PCR assays able to detect nvCT were collected. For nvCT detection, DNA was isolated using NucliSens easyMAG (bioMerieux) or QIAamp DNA mini kit (Qiagen), and analysed with an international real-time nvCT-specific PCR. C trachomatis NAATs currently used in Russia was also examined regarding their ability to detect nvCT DNA. Results During the study period, 9517 samples were submitted from patients of gynaecological, urological and STI clinics for C trachomatis testing. Of these samples, 275 (2.9%) from 198 females and 75 males were positive for C trachomatis . The mean age of the patients was 26.4 years (range 19–51 years). nvCT was detected in one sample (0.4%), which was obtained from a 23-year-old Russian woman. Genotyping using variable number of tandem repeats (VNTR) typing showed that the nvCT was indistinguishable to the previously typed nvCT samples from the Nordic countries (type 8.7.1). Six NAATs, which are used in the majority of laboratories in Russia performing C trachomatis diagnostics, were assessed for the ability to detect nvCT (Abstract P1-S1.34 table 1). All evaluated assays, with exception of the Lytech PCR, tested positive with nvCT DNA. Conclusions This study is the first report of an nvCT case in Russia, and in general in Eastern Europe, and that evaluates most C trachomatis NAATs currently used in Russia for the ability to detect nvCT. Although the prevalence of nvCT is still considered low outside Northern Europe, wider geographic spread of nvCT cannot be excluded, and therefore regular monitoring and participation in external quality assessments of diagnostic methods in use are necessary.

These guidelines aim to provide comprehensive information about sexually transmitted herpes simplex virus (HSV) infection and its laboratory diagnosis in eastern European countries. They are primarily intended for professionals testing specimens from patients at a sexual healthcare clinic but may also be helpful for community-based screening programmes. In particular, the guidelines recommend: (i) either viral culture or validated and approved nucleic acid amplification tests (NAATs) as the tests of choice for symptomatic patients, which should be promoted for laboratory confirmation of HSV infection; (ii) if culture or NAATs are not available, antigen detection--a direct immunofluorescence test or enzyme immunoassay from samples from symptomatic patients--could be employed, but HSV type determination is of importance; (iii) only type-specific serology should be used for detecting asymptomatic individuals, testing pregnant women at risk of acquiring HSV infection close to delivery, men who have sex with men and people who are HIV positive; (iv) widespread screening for HSV antibodies should be discouraged; and (v) any non-validated diagnostic tests should be validated against a recommended, approved gold standard.