The phenotypic and genotypic characteristics of Neisseria gonorrhoeae strains fluctuate over time both locally and globally, and highly discriminative and precise characterization of the strains is essential. Conventional characterization of N. gonorrhoeae strains for epidemiological purposes is mostly based on phenotypic methods, which have some inherent limitations. In the present study sequence analysis of porB1b gene sequences was used for examination of the genetic relationships among N. gonorrhoeae strains. Substantial genetic heterogeneity was identified in the porB genes of serovar IB-2 isolates (8.1% of the nucleotide sites were polymorphic) and serovar IB-3 isolates (5.2% of the nucleotide sites were polymorphic) as well as between isolates of different serovars. The highest degree of diversity was identified in the gene segments encoding the surface-exposed loops of the mature PorB protein. Phylogenetic analysis of the porB1b gene sequences confirmed previous findings that have indicated the circulation of one N. gonorrhoeae strain each of serovar IB-2 and serovar IB-3 in the Swedish community. These strains caused the majority of the cases in two domestic core groups comprising homosexual men and young heterosexuals, respectively, and were also detected in other patients. The phylogenetic analyses of porB gene sequences in the present study showed congruence, but not complete identity, with previous results obtained by pulsed-field gel electrophoresis of the same isolates. In conclusion, porB gene sequencing can be used as a molecular epidemiological tool for examination of genetic relationships among emerging and circulating N. gonorrhoeae strains, as well as for confirmation or discrimination of clusters of gonorrhea cases.

This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent repository link ABSTRACTThe purposes of the present study were 1) to assess the health related quality of life (HRQOL) and the subjective health status in a sample of HIV-infected persons, 2) to relate the results to different male population groups and 3) to investigate the relationship of medical and demographic variables with HRQOL. A total of 72 HIV-infected men were included. They answered the Swedish Health-Related Quality of Life Questionnaire and the Health Index.Demographic and medical data were obtained from the medical records. The data collection took place before entering a therapeutic HIV vaccine trial. The results showed a more negative impact on the HRQOL and subjective health status in the HIV-positive subjects, compared with male population groups.The dimensions of emotional well-being were most affected. When comparisons were made according to the medical and demographic variables for different subgroups within the HIV sample, differences in the physical-dimension scales were most prominent. Symptomatic HIV infection or AIDS, anti-retroviral treatment, sick leave or disability pension, low income and basic education were associated with worse HRQOL and health status. In conclusion, it is of the utmost importance to take into account aspects of the patients' emotional well-being in nursing, as well as in medical care and interventions. Moreover, individualised caring programs are needed since the disruptions in HRQOL fluctuated within the HIV sample.

An outbreak of lymphogranuloma venereum (LGV) infections has recently been reported from

In many ways our sexual and reproductive health reflects our way of life and living conditions. In a long-term perspective, advances in welfare combined with a well-developed health and medical care system, have meant that by international standards it is now rare for mothers to die during delivery and infant mortality continues to decline to new record lows. Pregnancy and childbirth, however, continue to be a time in a woman's life associated with many health problems, and absence from work due to illness is common. The age of parents at the birth of their first child is no longer rising; it has remained the same for women and men since 2004. The fact that more and more people are having children later in life means many people are compelled for a long time beforehand to take precautions to avoid unwanted pregnancies and sexually transmitted infections (STIs) that can put fertility at risk. This has been accompanied by a parallel trend: an increasingly liberal view of sex as an activity independent of permanent relationships. As a result of these developments, young people in particular tend to have more sexual partners than formerly. In addition, condom use has not increased, resulting in a rise in the number of unprotected encounters. The incidence of chlamydia, the most common notifiable sexually transmitted disease, has risen very rapidly in the last decade. In 2011, 37,000 cases were reported, most of them (86 %) among young men and women (15-29 years) irrespective of sexual orientation. Sweden, along with Finland, has one of the lowest percentages of HIV-infected people in Western Europe. Despite this, there are grounds for continued vigilance. The domestic spread of the disease among men who have sex with men climbed sharply in 2007. Another factor was a sudden outbreak of HIV among intravenous drug users. However, statistics from 2010 and 2011 shows a significant decline in notified cases among intravenous drug users after 2007 and a decreasing trend also among MSM. A sustained picture of the HIV epidemic in Sweden is that more than half (ca 55 %) the present incidence has been observed among migrants and ethnic groups closely connected to countries where there are generalised epidemics. This, combined with the growing trend towards unprotected sex, points to a risk of further transmission, even outside high risk groups. Cervical cancer is caused by a group of sexually transmitted viruses-collectively the human papillomavirus (HPV). At present there are vaccines against some types of HPV. A general vaccination programme for 12-year old girls has just started. Pap tests 1 will also continue to be needed to prevent cervical cancer since the vaccine does not cover all potential carcinogenic viruses. Involuntary childlessness affects an estimated 10-15 per cent of all couples. Women's fertility declines sharply at around the age of 35. Couples planning to have children do not appear to be sufficiently aware of this and thus risk being over-optimistic about the number of children they intend to have. The grow...

Examination by means of PFGE indicated that one N gonorrhoeae clone each of the serovars IB-2 and IB-3 created the majority of the two core groups of domestic cases.

The aim of this study was to compare epidemiological data with antibiotic susceptibility patterns, so as to characterize the risk of infection with a highly resistant Neisseria gonorrhoeae strain. N. gonorrhoeae strains isolated in Sweden from February 1998 through January 1999 were tested for antibiotic susceptibility. Epidemiological data were received from each clinician reporting a case of gonorrhoea and these data were linked to the N. gonorrhoeae strains. A total of 348 N. gonorrhoeae isolates, representing 89% of all Swedish cases diagnosed during the 12-month period, were tested for antibiotic susceptibility. Of all isolates, 24% were beta-lactamase-producing, and 18% had decreased susceptibility to ciprofloxacin (MIC>0.064 mg/l). All isolates were fully susceptible to ceftriaxone and spectinomycin. More than 99% of the isolates were fully susceptible to azithromycin. The antibiotic susceptibility varied with the places where patients were exposed to infection. When exposed in Asia, 63% of the isolates showed reduced susceptibility to ciprofloxacin, compared with 0-8.5% of the isolates from patients exposed in other places (RR=8.5, P<0.001). Ciprofloxacin cannot be recommended as the first choice of treatment if the place of exposure was in Asia.

Aims and objectives To explore motivators and barriers to HIV testing and to assess the factors associated with testing among men who have sex with men. Background Previous research has considered fear, worries and structural barriers as hindrances to HIV testing among men who have sex with men. However, few studies have included assessments of actual HIV testing when exploring barriers or motivators for such testing. Design The design of the study was a stratified cross‐sectional online survey (n = 2373). Method Factor analysis was conducted to analyse the barriers and motivators for HIV testing. Logistic regression analysis was conducted to assess predictors for HIV testing. Results Many men who have sex with men test for HIV regularly, and specific reasons for testing were having unprotected sex or starting/ending a relationship. A lack of awareness and a perception of being at low risk for exposure were common reasons for never being tested. Fear and anxiety as well as barriers related to the use of test services remain important hindrances for testing. Predictors associated with having been tested within the past 12 months were: younger age (15–25 years old compared with 47+); knowledge on where to take an HIV test on short notice as well as having talked with a counsellor, having received condoms for free, or having had unprotected anal intercourse with casual partners within the last 12 months. Conclusion Easily accessible test services offering testing and counselling on short notice should be available for all men who have sex with men. Outreach activities, distribution of free condoms and testing at venues where men who have sex with men meet are important prevention add‐ons that can contribute to increased awareness about HIV and testing. Relevance to clinical practice Test services must ensure confidentiality and health care professionals who meet men who have sex with men for testing need competency with regards to men who have sex with men sexual health needs.

The modern medical treatment of HIV with antiretroviral therapy (ART) has drastically reduced the morbidity and mortality in patients infected with this virus. ART has also been shown to reduce the transmission risk from individual patients as well as the spread of the infection at the population level. This position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy is based on a workshop organized in the fall of 2012. It summarizes the latest research and knowledge on the risk of HIV transmission from patients on ART, with a focus on the risk of sexual transmission. The risk of transmission via shared injection equipment among intravenous drug users is also examined, as is the risk of mother-to-child transmission. Based on current knowledge, the risk of transmission through vaginal or anal intercourse involving the use of a condom has been judged to be minimal, provided that the person infected with HIV fulfils the criteria for effective ART. This probably also applies to unprotected intercourse, provided that no other sexually transmitted infections are present, although it is not currently possible to fully support this conclusion with direct scientific evidence. ART is judged to markedly reduce the risk of blood-borne transmission between people who share injection equipment. Finally, the risk of transmission from mother to child is very low, provided that ART is started well in advance of delivery.