Among MSM in Peru, HIV and syphilis prevalence and HIV incidence were high, especially among cross-dressers. The high prevalence of bisexuality and low rates of consistent condom use, especially with female sexual partners indicates potential HIV transmission into the heterosexual population.

SummaryBackgroundWe assessed prevalences of seven sexually transmitted infections (STIs) in Peru, stratified by risk behaviours, to help to define care and prevention priorities.MethodsIn a 2002 household-based survey of the general population, we enrolled randomly selected 18–29-year-old residents of 24 cities with populations greater than 50 000 people. We then surveyed female sex workers (FSWs) in these cities. We gathered data for sexual behaviour; vaginal specimens or urine for nucleic acid amplification tests for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; and blood for serological tests for syphilis, HIV, and (in subsamples) herpes simplex virus 2 (HSV2) and human T-lymphotropic virus. This study is a registered component of the PREVEN trial, number ISRCTN43722548.Findings15 261 individuals from the general population and 4485 FSWs agreed to participate in our survey. Overall prevalence of infection with HSV2, weighted for city size, was 13·5% in men, 13·6% in women, and 60·6% in FSWs (all values in FSWs standardised to age composition of women in the general population). The prevalence of C trachomatis infection was 4·2% in men, 6·5% in women, and 16·4% in FSWs; of T vaginalis infection was 0·3% in men, 4·9% in women, and 7·9% in FSWs; and of syphilis was 0·5% in men, 0·4% in women, and 0·8% in FSWs. N gonorrhoeae infection had a prevalence of 0·1% in men and women, and of 1·6% in FSWs. Prevalence of HIV infection was 0·5% in men and FSWs, and 0·1% in women. Four (0·3%) of 1535 specimens were positive for human T-lymphotropic virus 1. In men, 65·0% of infections with HIV, 71·5% of N gonorrhoeae, and 41·4% of HSV2 and 60·9% of cases of syphilis were in the 13·3% who had sex with men or unprotected sex with FSWs in the past year. In women from the general population, 66·7% of infections with HIV and 16·7% of cases of syphilis were accounted for by the 4·4% who had been paid for sex by any of their past three partners.InterpretationDefining of high-risk groups could guide targeting of interventions for communicable diseases—including STIs—in the general Peruvian population.FundingWellcome Trust-Burroughs Wellcome Fund Infectious Disease Initiative and US National Institutes of Health.

Although first reported more than a century ago, sporotrichosis, caused by Sporothrix schenckii, still remains a poorly studied disease. Results from recently published studies on sporotrichosis in endemic areas are summarised and assembled with previous findings, providing a comprehensive review that highlights the needs for further research.

SummaryBackgroundPrevious community-randomised trials of interventions to control sexually transmitted infections (STIs) have involved rural settings, were rarely multicomponent, and had varying results. We aimed to assess the effect of a multicomponent intervention on curable STIs in urban young adults and female sex workers (FSWs).MethodsIn this community-randomised trial, baseline STI screening was done between August, and November, 2002, in random household samples of young adults (aged 18–29 years) and in FSWs in Peruvian cities with more than 50 000 inhabitants. Geographically separate cities were selected, matched into pairs, and randomly allocated to intervention or control groups with an S-PLUS program. Follow-up surveys of random samples were done after 2 years and 3 years. The intervention comprised four modalities: strengthened STI syndromic management by pharmacy workers and clinicians; mobile-team outreach to FSWs for STI screening and pathogen-specific treatment; periodic presumptive treatment of FSWs for trichomoniasis; and condom promotion for FSWs and the general population. Individuals in control cities received standard care. The composite primary endpoint was infection of young adults with Chlamydia trachomatis, Trichomonas vaginalis, or Neisseria gonorrhoeae, or syphilis seroreactivity. Laboratory workers and the data analyst were masked, but fieldworkers, the Peruvian study team, and participants in the outcome surveys were not. All analyses were done by intention to treat. This trial is registered, ISRCTN43722548.FindingsWe did baseline surveys of 15 261 young adults in 24 Peruvian cities. Of those, 20 geographically separate cities were matched into pairs, in each of which one city was assigned to intervention and the other to standard of care. In the 2006 follow-up survey, data for the composite primary outcome were available for 12 930 young adults. We report a non-significant reduction in prevalence of STIs in young adults, adjusted for baseline prevalence, in intervention cities compared with control cities (relative risk 0·84, 95% CI 0·69–1·02; p=0·096). In subgroup analyses, significant reductions were noted in intervention cities in young adult women and FSWs.InterpretationSyndromic management of STIs, mobile-team outreach to FSWs, presumptive treatment for trichomoniasis in FSWs, and condom promotion might reduce the composite prevalence of any of the four curable STIs investigated in this trial.FundingWellcome Trust and Burroughs Wellcome Fund, National Institutes of Health, Center for AIDS Research, CIPRA, and USAID-Peru.

Approximately 9 million ha of wheat (Triticum aestivum and T. durum) is sown in the Southern Cone of America (Argentina, Brazil, Chile, Paraguay, and Uruguay). Two rust epidemiological zones separated by the Andean mountain range have been described in the region. Presently, leaf rust (caused by Puccinia triticina) is the most important rust disease of wheat. The utilisation of susceptible or moderately susceptible cultivars in a high proportion of the wheat area allows the pathogen to oversummer across large areas, resulting in early onset of the epidemics. Severe epidemics cause important economic losses if chemical control is not used. The pathogen population is extremely dynamic, leading to transitory resistance in commercial cultivars. Lr34 is commonly present in the regional germplasm, but there is limited knowledge about the presence of other genes conferring resistance in cultivars. Genes Lr28, Lr36, Lr38, Lr41, and Lr43 provide effective resistance in the region. The best strategy for the stabilisation of the pathogen population and resistance is considered to be the use of adult plant resistance conferred by minor additive genes including Lr34 and Lr46. Sources of this type of resistance from CIMMYT and the region have been made available to breeding programs in the Southern Cone. Stripe rust (P. striiformis f. sp. tritici) is endemic in Chile where chemical control is required to prevent severe losses in stripe rust susceptible cultivars. Although new virulent races emerge frequently, resistance genes Yr5, Yr8, Yr10, Yr15, and YrSp are currently effective in Chile. Some important stripe rust epidemics have occurred in Argentina, Brazil, and Uruguay. Avoiding the use of highly susceptible cultivars appears to be an effective strategy to prevent stripe rust epidemic development in this area. There have been no serious stem rust (P. graminis f. sp. tritici) epidemics for over 2 decades; the disease was controlled by resistant cultivars. The most important genes conferring resistance in Southern Cone germplasm at the present time are probably Sr24 and Sr31. Other effective genes are Sr22, Sr25, Sr26, Sr32, Sr33, Sr35, Sr39, and Sr40. Several stem rust susceptible wheat cultivars have recently been released. The increased cultivation of susceptible cultivars may lead to higher stem rust incidence, increasing the probability of appearance of new virulent races. Since the 1BL.1RS translocation possessing Sr31 is present in a high proportion of the regional germplasm, the possible introduction of stem rust with Sr31 virulence from Africa is of great concern.

A randomized, open, controlled clinical trial was designed to evaluate the efficacy, tolerance, and safety of sodium stibogluconate plus allopurinol and sodium stibogluconate alone as treatment of patients with mucocutaneous leishmaniasis. In phase 1 of the study, all 22 patients with severe disease had improvement of their lesions, but only two had clinical cure (both of these patients received sodium stibogluconate alone). In phase 2, which included 59 patients with moderate disease, the cure rate among sodium stibogluconate recipients was 75% (21 of 28) compared with 63.6% (14 of 22) among the sodium stibogluconate plus allopurinol recipients. The rates of clinical adverse events were similar among both groups. Thrombocytopenia was more frequent in the sodium stibogluconate plus allopurinol recipients, but the difference was not statistically significant. Eight patients (two sodium stibogluconate recipients and six sodium stibogluconate plus allopurinol recipients) withdrew from the study because of severe thrombocytopenia. In this study, the addition of allopurinol to sodium stibogluconate provided no clinical benefit as treatment of mucocutaneous leishmaniasis.

During 1999 to 2000, we identified HIV-infected persons with new episodes of tuberculosis (TB) at 10 hospitals in Lima-Peru and a random sample of other Lima residents with TB. Multidrug-resistant (MDR)-TB was documented in 35 (43%) of 81 HIV-positive patients and 38 (3.9%)of 965 patients who were HIV-negative or of unknown HIV status (p < 0.001). HIV-positive patients with MDR-TB were concentrated at three hospitals that treat the greatest numbers of HIV-infected persons with TB. Of patients with TB, those with HIV infection differed from those without known HIV infection in having more frequent prior exposure to clinical services and more frequent previous TB therapy or prophylaxis. However, MDR-TB in HIV-infected patients was not associated with previous TB therapy or prophylaxis. MDR-TB is an ongoing problem in HIV-infected persons receiving care in public hospitals in Lima and Callao; they represent sentinel cases for a potentially larger epidemic of nosocomial MDR-TB.

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