BackgroundIn urban Guinea-Bissau, adults with a vaccinia scar had better survival but also a higher prevalence of HIV-2 infection. We therefore investigated the association between vaccinia scar and survival and HIV infection in a rural area of Guinea-Bissau.Methodology/Principal FindingsIn connection with a study of HIV in rural Guinea-Bissau, we assessed vaccinia and BCG scars in 193 HIV-1 or HIV-2 infected and 174 uninfected participants. Mortality was assessed after 2½–3 years of follow-up. The analyses were adjusted for age, sex, village, and HIV status. The prevalence of vaccinia scar was associated with age, village, and HIV-2 status but not with sex and schooling. Compared with individuals without any scar, individuals with a vaccinia scar had better survival (mortality rate ratio (MR) = 0.22 (95% CI 0.08–0.61)), the MR being 0.19 (95% CI 0.06–0.57) for women and 0.40 (95% CI 0.04–3.74) for men. Estimates were similar for HIV-2 infected and HIV-1 and HIV-2 uninfected individuals. The HIV-2 prevalence was higher among individuals with a vaccinia scar compared to individuals without a vaccinia scar (RR = 1.57 (95% CI 1.02–2.36)).ConclusionThe present study supports the hypothesis that vaccinia vaccination may have a non-specific beneficial effect on adult survival.

Kebaabetswe et al obviously believe the conventional wisdom that heterosexual sex is the major vector for the transmission/ reception of HIV, and that male circumcision is an effective deterrent to infection. 1 Based on that belief, they have constructed an elaborate and impressive study of the acceptability of circumcision as a prophylactic measure in Botswana. Furthermore, they argue for a programme of neonatal circumcision in Botswana in the hope of reducing the HIV infection rate 15 years later. 1 LETTERS If you have a burning desire to respond to a paper published in Sex Transm Inf, why not make use of our ''rapid response'' option? Log on to our website (www.stijournal. com), find the paper that interests you, click on ''full text'' and send your response by email by clicking on the ''eletters submit a response''. Providing it isn't libellous or obscene, it will be posted within seven days. You can retrieve it by clicking on ''read eletters'' on our homepage. The editors will decide, as before, whether to also publish it in a future paper issue. measure, male neonatal circumcision fails all tests. 26

Issues relating to non-disclosure and partner notification in HIV infected heterosexuals will need to be better understood to improve sexual health in this group and to reduce onward transmission of HIV.

Our analyses highlight the importance of distinguishing between black ethnic groups and the need for future studies to ensure sufficiently large samples to permit such analyses.

ObjectiveTo determine Mycoplasma genitalium infection and correlates among young women undergoing population-based screening or clinic-based testing for Chlamydia infection.DesignCross-sectional study.SettingNational Chlamydia Screening Programme (NCSP) and two London sexually transmitted infection (STI) clinics.Participants2441 women aged 15–64 years who participated in the NCSP and 2172 women who attended two London STI clinics over a 4-month period in 2009.Outcome measures(1) M genitalium prevalence in defined populations (%). (2) Age-adjusted ORs (aORs) for correlates of M genitalium infection.ResultsThe overall frequency of M genitalium and Chlamydia trachomatis was 3% and 5.4%, respectively. Co-infection was relatively uncommon (0.5% of all women); however 9% of women with C trachomatis also had M genitalium infection. M genitalium was more frequently detected in swab than urine samples (3.9 vs 1.3%, p<0.001) with a significantly higher mean bacterial load (p ≤ 0.001). Among NCSP participants, M genitalium was significantly more likely to be diagnosed in women of black/black British ethnicity (aOR 2.3, 95% CI 1.2 to 4.5, p=0.01). M genitalium and C trachomatis and were both significantly associated with multiple sexual partners in the past year (aOR 2.4, 95% CI 1.3 to 4.4, p=0.01 and aOR 2.0, 95% CI 1.4 to 2.8, p<0.01). Among STI clinic attendees, M genitalium was more common in women who were less than 25 years in age.ConclusionsM genitalium is a relatively common infection among young women in London. It is significantly more likely to be detected in vulvovaginal swabs than in urine samples. Co-infection with Chlamydia is uncommon. The clinical effectiveness of testing and treatment strategies for M genitalium needs further investigation.

The objective of this study was (1) to estimate the prevalence of recalcitrant Trichomonas vaginalis (TV) infection in a UK genitourinary medicine clinic; (2) to use a case series and literature review to suggest an algorithm for management of recalcitrant TV (rTV). A retrospective review of laboratory records, case-notes and literature review was conducted. Fifteen patients were studied, representing 1.16% of the cases presenting during the study period. A wide variety of therapeutic agents was used, the treatment regimen differed for each patient. No treatment was universally effective in achieving cure, but the use of acetarsol pessaries vaginally appeared to be the most frequently successful strategy. Based on these results, an algorithm for treatment of rTV is presented, although clinical trials will be needed to elucidate the best clinical approaches to this problem.

BackgroundOur objective was to estimate for the first time the prevalence and determinants of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted infections (STIs) among male migrants in India.Methodology/Principal FindingsWe conducted a multi-stage stratified probability sample survey of migrant (defined as not born in Surat city) men aged 18 to 49 years working in the diamond and textile industries in Surat city. Behavioural and biological data were collected. Biological data included laboratory diagnosed herpes simplex virus type 2 (HSV-2), syphilis, chlamydia, gonorrhoea, Trichomonas vaginalis (together defined as ‘any STI’) and HIV-1. Likely recently acquired STIs included chlamydia, gonorrhoea, T.vaginalis and syphilis with rapid plasma reagin ≥1∶8. The response rate was 77% (845/1099). Among 841 participants, HIV-1 prevalence was 1.0%, ‘any STI’ prevalence was 9.5% and 38.9% of these STIs were likely to have been recently acquired. Being a diamond worker, Surat resident for 10+ years and recent antibiotic use were each associated with higher odds of ‘any STI’ (aORs 1.83 (95% CI 1.09–3.09), 1.98 (95% CI 1.22–3.22) and 2.57 (95% CI 1 .17–5.64), respectively) after adjusting for the other two factors and age. The main study limitation was social desirability bias for self-reported sexual behaviour; STIs were diagnosed in some self-reported virgins.Conclusions/SignificanceHIV and STI prevalence were lower than expected, but prevention interventions remain necessary in Surat since almost 40% of STIs among participants were probably recently acquired and sentinel surveillance HIV prevalence remains high. The participants had a similar HIV prevalence to Surat antenatal clinic attendees, a proxy for the general population. This suggests migrants are not always at higher risk of HIV compared to the general population in their migration destination. Our findings highlight the need to contextualise research findings from a specific setting with other local information to guide HIV/STI prevention interventions.

Condoms are a common denominator for three prestigious national prevention programmes in India, none of which has been a real success. The present study was undertaken to investigate prevalence of condom use and to assess knowledge about correct use of condoms among married, sexually active men, who had not adopted any permanent method of contraception. The study was conducted by a house-to-house survey in eight randomly selected villages of Anand, Gujarat (a 10% sample). All married men (ages: 18-55 years) were interviewed with the help of a pre-tested, structured questionnaire, comprising questions on: (a) their sexual practices; (b) knowledge about the correct use of condoms; and (c) reasons for their use/non-use. Respondents were evaluated for knowledge about correct use of condoms by scoring on a scale of 10. The sample consisted of 1,478 men whose mean age was 29.8 (± 6.75) years and mean duration of married life was 8.4 (± 6.25) years. Almost 52% (n = 771) were either illiterate or had been educated up to primary level; while 131 (8.8%) had university qualifications. More than 74% (n = 1,092) had never used condoms; 24.4% had used them irregularly and only 1.8% (n = 26) were using them regularly. The mean knowledge score for the correct use of condoms was 1.44 ± 2.29 on a scale of 10 and it was positively related to regularity of use and educational status of respondents (p < 0.001). Sixty-nine percent of the respondents did not know that condoms offer protection against STDs and/or AIDS. The most common mistakes related to incorrect use of condoms were use of oil-based lubricants with condoms, ignorance about the technique of putting on a condom, re-use of condoms, etc. The commonly cited reasons for non-use of condoms were interference with sexual activity; lack of privacy; fear of losing it inside the woman's body, and lack of confidence in its effectiveness as a contraceptive. To be effective as a contraceptive and to offer protection against sexually transmitted diseases and AIDS, condoms need to be used regularly and correctly. Distribution of condoms should be coupled with education about their correct use, and efforts should be made to dispel myths and misbeliefs associated with their use.