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STIRIG About
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STIRIG
Sexually Transmitted Infections Research Interest Group

LSHTM is a world-leader for STI research, and a WHO Collaborating Centre for Sexually Transmitted Infections.

STIRIG aim to:

  • raise awareness of STI-related research being conducted at LSHTM
  • increase cross-disciplinary and cross-Faculty work on STIs
  • develop internal and external collaborations
  • maximise funding opportunities

Who we are
STIRIG Members 2 columns
STIRIG Members
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Leadership team

Sarah Harman

Sarah Harman
Co-Director of STIRIG

Faculty of Epidemiology and Population health

Emma Harding-Esch

Emma Harding-Esch
Co-Director of STIRIG

Faculty of Infectious and Tropical Diseases
Suzanna Francis

Suzanna Francis
Co-Director of STIRIG

Faculty of Epidemiology and Population health
Daniel McCartney

Daniel McCartney
Student Representative

Faculty of Infectious and Tropical Diseases

Peter Weatherburn

Peter Weatherburn
Steering Committee Member

Faculty of Public Health and Policy

Richard Hayes

Richard Hayes
Steering Committee Member

Faculty of Epidemiology and Population health

Philippe Mayaud

Philippe Mayaud
Steering Committee Member

Faculty of Infectious and Tropical Diseases

Caroline Gotsche

Caroline Gotsche
Student Representative

Faculty of Infectious and Tropical Diseases

Aoife Doyle

Aiofe Doyle
Steering Committee Member

Faculty of Epidemiology and Populations Health

Matthew Chico

Matthew Chico
Steering Committee Member

Faculty of Infectious and Tropical Diseases

 

Matthew Quaife

Matthew Quaife
Steering Committee Member

Faculty of Public Health and Policy

Amanda Gabster

Amanda Gabster
Student Representative

Faculty of Infectious and Tropical Diseases

Membership list

Name Title  Department
Alec Miners Associate Professor Department of Health Services Research and Policy
Axel Schmidt Assistant Professor of Sexual Health and STIs  
Amaya Bustinduy Associate Professor Department of Clinical Research
Anna Last Associate Professor Department of Clinical Research
Aoife Doyle Assistant Professor Department of Infectious Disease Epidemiology
Bernadette Hensen Assistant Professor Department of Clinical Research
Brian Rice Associate Professor Department of Public Health, Environments and Society
Caroline Free Professor Department of Population Health
Christopher Obermeyer Research Degree Student Department of Global Health and Development
Cicely Marston Professor Department of Public Health, Environments and Society
Clare Tanton Assistant Professor Department of Infectious Disease Epidemiology
Daniel Mccartney DrPH Student Department of Clinical Research
David Mabey Professor Department of Clinical Research
Deborah Watson-Jones Professor Department of Clinical Research
Eimhin Ansbro Research Fellow Department of Non-Communicable Diseases
Elizabeth Fearon Assistant Professor Department of Global Health and Development
Emily Trautner Student  
Emma Harding-Esch Associate Professor Department of Clinical Research
Emma Wilson    
Fadi Al-Geriass MSc Student  
Fern Terris-Prestholt Associate Professor Department of Global Health and Development
Ford Hickson Assistant Professor Public Health, Environments and Society
Helen Kelly Assistant Professor Department of Clinical Research
Helen Weiss Professor Department of Infectious Disease Epidemiology
Janet Seeley Professor Department of Global Health and Development
Jason Ong Associate Professor Department of Clinical Research
Joe Tucker Associate Professor Department of Clinical Research
Judith Glynn Professor Department of Infectious Disease Epidemiology
Kathryn Risher Research Fellow Department of Population Health
Kaye Wellings Professor Department of Social and Environmental Health Research
Kimberley Potter Trial Assistant Department of Medical Statistics
Lauren Jerome Trial Assistant Clinical Trials Unit
Loraine Bacchus Associate Professor Department of Global Health and Development
Lori Miller   Department of Infectious Disease Epidemiology
Mansi Baxi   Department of Population Health
Mark Pakianathan MSc Student  
Martin Holland Professor Department of Clinical Research
Matthew Chico Assistant Professor Department of Disease Control
Matthew Quaife Assistant Professor Department of Global Health and Development
Michael Marks Assistant Professor Department of Clinical Research
Milly Marston Assistant Professor Department of Population Health
Paul Mee Research Fellow Department of Global Health and Development
Peter Weatherburn Associate Professor Department of Public Health, Environments and Society
Philippe Mayaud Professor Department of Clinical Research
Rashida Ferrand Professor Department of Clinical Research
Rebecca French Associate Professor Department of Public Health, Environments and Society
Rebecca Geary Assistant Professor Faculty of Public Health and Policy
Rebecca Handley Research Assistant Department of Clinical Research
Richard Hayes Professor Department of Infectious Disease Epidemiology
Richard Stabler Associate Professor Department of Pathogen Molecular Biology
Rosanna Peeling Professor Department of Clinical Research
Ruth Ponsford Research Fellow Department of Health Services Research and Policy
Sam Miles Research Fellow Department of Public Health, Environments and Society
Sarah Harman Research Programme Manager Department of Infectious Disease Epidemiology
Sergio TorresRueda Research Fellow Department of Global Health and Development
Sujit Rathod Assistant Professor Department of Population Health
Suzanna Francis Assistant Professor Department of Infectious Disease Epidemiology
Taane Clark Professor Department of Pathogen Molecular Biology
Department of Infectious Disease Epidemiology
Victoria Miari  Principal Scientific Officer & Clinical Scientist Department of Pathogen Molecular Biology
Wendy Macdowall Assistant Professor Department of Public Health, Environments and Society
Events
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Updates

Check out our newsletter

Each issue spotlights our research on sexually transmitted infection, and the latest STI-related news.

Updates List Block
STI & HIV 2019 World Congress

 Joint Meeting of the 23rd ISSTDR & 20th IUSTI Congress 14-17 July, 2019 in Vancouver, Canada.

  • Abstract Submission Deadline: EXTENDED to 1 February 2019 (23:59 PST)
  • Scholarship Application Deadline: January 25, 2019 (23:59 PST)

Learn more

STI resources

The STIRIG resource web page has links for STI-related guidelines, trainings, conferences, professional societies and more!

Upcoming STIRIG Seminar! 

Thursday 11 July, 12:45-2pm
John Snow A

Bending the HIV epidemic in rural South Africa: Why we should be paying attention to young people's psychosocial and sexual well-being by Dr Maryam Shahmanesh from UCL and the Africa Health Research Institute.

This event is co-sponsored with MARCH and will be livestreamed.

Missed a previous STIRIG Seminar?
BASHH Annual Conference in Birmingham

30 June - 2 July

Registration is OPEN! Natsal at BASHH: The Natsal team will be hosting a stand at the BASHH Annual Conference. As part of preparations to ensure the new wave of Natsal is ‘fit-for-purpose’ ahead of interviews starting in 2021, we’re keen to get stakeholders’ input – so we need you!

Please do pop by to find out more about this internationally-renowned study, what the new wave will focus on, how it will be done – and why, and importantly, to add your voice as to the questions that you think Natsal-4 needs to ask. If you can’t make it to our stand, then you can still participate in Natsal’s online consultation which will be going live in July.

IUSTI-Europe

Tallinn, Estonia
5-7 September 2019

The 33rd IUSTI-Europe Congress on Sexually Transmitted Infections.

IPVC2020

23-27 March 2020
Barcelona, Spain

The 33rd International Papillomavirus Conference & Basic Science, Clinical and Public Health Workshops.

Abstract Submission is open. The deadline is 10 September 2019.

WHO & Find public consultation

The WHO and Find (Foundation for Innovative New Diagnostics) are having a public consultation.

They are requesting feedback on two target product profiles for improved antimicrobial stewardship of gonorrhea treatment.

Vacancy: Sexual Health Improvement Programme (SHIP) project manager (2-8 hours per week depending on the grade)

SHIP was set up as a Bristol Health Partners Health Integration Team in 2013. It brings together UK experts from across disciplines to improve the sexual health of people in the region and reduce STIs. The team supports the commissioning of evidence-based sexual health services.

SHIP and STIRIG are strategic partners. Read about our 2018-19 successes.

To enquire about the role, please email Katy Turner.

How should sexual health services be improved?

The Health and Social Care Committee has made five recommendations for a new national strategy to the government. 

Sexual Health journal Special Issue on gonorrhoea!
Mycoplasma Study Group

European Society for Microbiology and Infectious diseases (ESCMID) has extended their Mycoplasma Study Group to include chlamydia in 2019. Members of this group can (i) receive information related to this study group, (ii) increase their chlamydia network, and (iii) be eligible for opportunities linked to the ESCMID study group, such as specific grants for starter projects as well as postgraduate courses. You must be a member of ESCMID before joining the group. 

Call for applications for an STI PhD studentship

Call for applications for an STI PhD studentshipThe Sexually Transmitted Infections Research Foundation (STIRF) has awarded a 3-year PhD studentship at the University of York, called “HPV vaccination for preventing cervical and other HPV-associated cancers: Comparing the knowledge and understanding of factors influencing initiation and completion of the UK and Ugandan school-based vaccination programme”. Deadline for applications 14th March 2019.

STIRIG Student Logo Competition!

We are delighted to introduce our logo competition for all students at the School, both in London and around the world. The deadline for entries is 15 December 2018 and all entries should be sent to stirig@lshtm.ac.uk. See here for more information and the competition rules.

Call for applications for a STI PhD studentship

The Sexually Transmitted Infections Research Foundation (STIRF) has awarded a 3-year PhD studentship at the University of York, UK called “HPV vaccination for preventing cervical and other HPV-associated cancers: Comparing the knowledge and understanding of factors influencing initiation and completion of the UK and Ugandian school-based vaccination programme”.

Sexual Health Improvement Programme (SHIP) Bristol open meeting

The Sexual Health Improvement Programme (SHIP), which Dr Emma Harding-Esch is Honorary Co-Director of, co-hosted with BASHH an open meeting in Bristol on “Preparing Sexual Health Services for the Challenge of Antimicrobial Resistant (AMR) bacteria”.

Read about the meeting and recommendations

Research & collaborations

STI-related research projects and collaborations at LSHTM

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Collaborations

WHO Collaborating Centre for Sexually Transmitted Infections

The Department of Clinical Research in ITD is a World Health Organization (WHO) Collaborating Centre for Sexually Transmitted Infections. LSHTM carries out three activities in collaboration with the WHO:

  1. Support the STI point of care testing (POCT) initiative (advise on research/validation, support normative work, and training on STI POCTs in LMICs.
     
  2. Develop and evaluate new strategies for STI control in key populations.
     
  3. Evaluate and promote new strategies to improve the health of women and children particularly in the area of dual elimination of mother to child transmission of HIV and Syphilis (eMTCT) and prevention of cervical cancer.

Read the LSHTM Collaborating Centre Annual Report (5/2017-5/2018) (pdf)

LSHTM investigators

David Mabey; Rosanna Peeling

Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections

The National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections is led by University College London in partnership with Public Health England and LSHTM. The unit aims to conduct state-of-the-art research to improve the health of the population, and to help develop practical policy guidelines for those working in health protection.

The NIHR HPRU has received almost £3.7 million to undertake collaborative research that addresses the key health protection priorities for the prevention and control of STIs and BBVs, notably understanding risk and risk reduction, reducing the burden of under-diagnosis, and improving care and management of those diagnosed with infections.

There are three research themes

  • Theme A: Understanding risk and risk reduction for STIs and BBVs
     
  • Theme B: Reducing the burden of undiagnosed STIs and BBVs
     
  • Theme C: Improving the care and management of people with STIs and BBVs

LSHTM investigators

Tim Rhodes; Peter Wetherburn

SHIP (Sexual Health Improvement Programme)

The Sexual Health Improvement Programme (SHIP) was set up as a Bristol Health Partners Health Integration Team in 2013. It brings together experts from across disciplines to improve the sexual health of people in the region and reduce STIs, supporting the commissioning of evidence-based sexual health services. Our priorities are: increasing uptake of HIV testing; improving STI testing and responding to antimicrobial resistant (AMR) infections; increasing patient and public involvement in sexual health and ending stigma; ending domestic violence; reducing health inequalities; implementing informatics and digital transformation; developing a national network for sexual health improvement. A major focus for the next three years will be evaluating and developing strategies, including vaccination, for combating the development of antimicrobial resistance (AMR) in STIs.

Stay up-to-date with our newsletter

LSHTM investigator

Emma Harding-Esch

The Applied Diagnostic Research and Evaluation Unit (ADREU)

The Applied Diagnostic Research and Evaluation Unit (ADREU) based at St George’s, University of London (SGUL) is a proven multi-institutional and multi-disciplinary group including experts in clinical medicine, diagnostic evaluations, epidemiology, public health, social science, basic and translational science. ADREU provides a comprehensive service to facilitate the development and evaluation of rapid diagnostics for STIs, other infectious diseases and antimicrobial resistance for both academic institutions and industry. ADREU offers bespoke diagnostic accuracy evaluations, from proof-of-concept projects to late-stage evaluations, providing data for regulatory approval for our collaborating partners in academia and industry. With close links to Public Health England and LSHTM, ADREU combines real word situations with leading academic insight to evaluate novel commercial technologies, providing feedback on the clinical and social impact that STIs and rapid STI diagnostics can have on all aspects of the healthcare system, from patients to healthcare professionals.

LSHTM investigator

Emma Harding-Esch

Staff-led research projects

safetxt: A randomised controlled trial of an intervention delivered by mobile phone messaging to reduce STI in young people

The NIHR-funded safetxt Trial is a single blind randomised controlled trial to evaluate the effect of a safer sex intervention delivered by text message on chlamydia and gonorrhoea infection at 12 months. The intervention targets partner notification, condom use and getting tested before unprotected sex with a new partner (1).
Over 5900 participants aged 16-24 have been recruited from 50 GU and Sexual and Reproductive Health services across the UK.
Full recruitment is crucial to provide trials with sufficient power to detect intervention effects, yet only 56% of publicly funded trials in the UK achieve their target sample size.

Mixed methods supported by evidence from behavioural science were used to maximise recruitment including meetings with site staff to enable new services to learn from experienced recruiters, monthly newsletters to highlight major achievements, competitions to develop engagement and motivation and certificates for staff who achieve recruitment milestones.

The questionnaire follow-up of participants is closely monitored and is currently 88.2% at 4 weeks and 77.1% at 1 year. The return of test kits at 1 year is 71.8%. Steps taken to improve follow up rates include: simplified test kit instructions, clear postage instructions, and a prize draw entry for participants who return test kits (2).

The safetxt collaboration between 50 GU and Sexual and Reproductive Health services and the trial management team is on target to recruit 6250 participants on time by December 2018.  The trial is due to report in 2020.

LSHTM investigators

Caroline FreeOna McCartney, Rebecca French, Kaye Wellings

References

Free C, McCarthy O, French RS, Wellings K, Michie S, Roberts I, et al. Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial. Health Technol Assess 2016;20(57)
McCarthy O, French RS, Roberts I, Free C. Simple steps to develop trial follow-up procedures. Trials. 2016;17:28. doi:10.1186/s13063-016-1155-1

TracVac: A phase I adjuvant Chlamydia trachomatis vaccine

TracVac builds on the results of a phase I clinical trial (NCT02787109) of an adjuvanted Chlamydia trachomatis vaccine (CTH522; Olsen et al 2015, JID PMID2578320) developed by Statens Serum Institut (SSI), Copenhagen. TracVac (www.trachoma-vaccine.org) is a 4 partner (LSHTM, Imperial College London, Commissariat à l’Energie Atomique et aux Energies Alternatives, Paris and SSI) EU sponsored consortium that will expand the C. trachomatis serotype coverage of CTH522 and investigate the immunization regimen required for the optimal induction of protective responses at mucosal surfaces that include the eye.  C. trachomatis infection of the eye causing trachoma remains the leading cause of blindness due to any infection. The immunological routes of C. trachomatis protection and pathogenesis in both the eye and urogenital tract are believed to share common features. There are currently no chlamydial vaccines licenced for human use. We expect that study of trachoma can serve as a useful and translatable model for C. trachomatis vaccine development in addition to the delivery of vaccine that protects against ocular infection. We are using novel Human B cell cloning technologies to select neutralizing and protective epitopes from trachoma ‘resistant’ individuals. We have identified ‘resistant’ individuals from longitudinal cohort studies. The selected epitopes will be incorporated into the next generation recombinant vaccine. Antibody neutralization and cellular responses to the vaccine constituents are being further tested on a wider scale in longitudinal trachoma cohort studies established LSHTM from The Gambia and Tanzania.  By the end of the study we aim to deliver a vaccine that covers both urogenital and ocular C. trachomatis infection for further clinical development in 2020.

LSHTM investigators

Martin Holland; Harry Pickering

iGugu: Prevalence of STIs among young people in South Africa: A nested survey in a health and demographic surveillance site

iGugu means precious, and is short for Ukuvikela impilo yetho yokuzalana eyigugu, Zulu for “protecting our precious reproductive health.”

Adolescents and young adults are particularly vulnerable to sexually transmitted infections (STIs). The first strategic direction of the WHO Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 is to collect information on STI prevalence and incidence across representative populations. There is also evidence that bacterial vaginosis (BV) is a risk factor for poor birth outcomes and STIs including HIV. The collection of BV prevalence may therefore also be important. However, developing new cohorts for dedicated STI/BV prevalence studies may not be realistic, particularly in sub-Saharan Africa, where the impact of STIs/BV and their consequences may be greatest. Therefore, nesting STI/BV surveys within networks of health and demographic surveillance sites (HDSSs) could be an efficient way of providing data to better understand STI epidemiology among adolescents and young people in high HIV prevalence settings.

We carried out a nested STI/BV survey among 1,342 adolescent and young people in an HDSS in KwaZulu-Natal, South Africa, between October 2016 and January 2017. Potential participants were contacted at home and invited to participate. Participants were interviewed, and samples were collected for STI/BV testing.

We showed that this study was feasible within the 3.5-month time period: 1,171/1,342 (87%) individuals had ≥1 attempted home visit, of whom 790 (67%) were successfully contacted (1).

The study was acceptable: among those contacted and eligible, 447/645 (69%) enrolled. Both men and women reported few problems with sample collection. We report a high burden of STIs/BV in this population, particularly of chlamydia (5% in men and 11% in women), herpes simplex virus type 2 (17% in men and 29% in women), and BV (42% in women).

Nested STI/BV surveys in HDSSs can be feasible and acceptable; however, more survey time is needed to ensure that all potential participants are visited and contacted.  These studies should be carried out in conjunction with studies to measure STI/BV prevalence in high-risk populations (e.g., female sex workers) to provide robust prevalence estimates.

These data are essential to advocate, fund, plan, implement, and evaluate interventions for STI prevention and control among adolescents and young people. Strategies for the prevention and control of chlamydia, herpes simplex virus type 2, and BV are needed in this population.

LSHTM Investigators

Suzanna Francis; Kathy Baisley

References

Francis SC, Mthiyane TN, Baisley K, Mchunu SL, Ferguson J, Smit T, Gareta D, Dlamini S, Mutevedzi T, Seeley J, Pillay D, McGrath N, Shahmanesh M. Prevalence of Sexually Transmitted Infections among Young People in South Africa: A Nested Survey in a Health and Demographic Surveillance Site. PLOS Medicine, 2018; 15(2):e1002512

Systematic Review: Novel testing technologies, strategies and approaches for testing populations at high risk of STIs in EU/EEA countries

In 2012, the European Centre for Disease Prevention and Control (ECDC) published the technical report “Novel approaches to testing for sexually transmitted infections, including HIV and hepatitis B and C in Europe”. This report was a comprehensive review of testing technologies and strategies across Europe. Almost six years later, there have been a number of developments in the field, and an updated review is required.

We are carrying out a critical appraisal via a systematic literature review of novel STI testing technologies, strategies and approaches for detecting Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Mycoplasma genitalium, and Trichomonas vaginalis, in at-risk populations. The objectives are to: describe novel (since 2011) STI testing strategies and approaches and determine how they impact on access to testing, testing coverage, and linkage to care; describe what testing technologies are used in these novel strategies and approaches; describe the impact of novel testing technologies, approaches and strategies on reporting to public health surveillance programmes; highlight quality assurance needs and risks; and highlight their feasibility and acceptability. Gaps in knowledge and data availability will also be identified to highlight future research needs.

LSHTM investigators: Emma Harding-Esch; Suzanna Francis

Research degree student projects

Factors associated with sexual behaviour and sexually transmitted infections among adolescents in Comarca Ngäbe-Buglé, Panama

 

PhD Student: Amanda Gabster

PhD supervisors: Philippe Mayaud and Beniamino Cislaghi

The aim of Amanda’s PhD is to describe the factors that contribute to sexual behaviour and sexually transmitted infections (STI) outcome among adolescents (14-19 years) of the indigenous region called the Comarca Ngäbe-Buglé (CNB), Panama, in collaboration with the Gorgas Memorial Institute for Health Studies in Panama. The PhD employs mixed methods. In the first stage, qualitative methods were used to describe gender norms, other social norms, and parenting styles of adolescent and parents of adolescents of CNB.  Results from this stage informed the study tools for the second stage. In the second stage was a cross-sectional study with two-stage cluster sampling. It was carried out with 700 adolescents to investigate the association of social norms, parenting styles, and sexual behaviours, with STIs. The prevalence of the following STIs and reproductive tract infections were measured: HIV, syphilis, hepatitis B virus, human T-lymphotrophic virus, herpes simplex virus type 2, chlamydia, gonorrhea, high-risk human papillomavirus (women only) and bacterial vaginosis (women only). This study is the first to explore the factors related to adolescent sexual health in CNB. Based on the results of this research, governmental and non-governmental agencies will work towards targeted, culturally competent, sexual health interventions for indigenous adolescents of the Comarca Ngäbe-Buglé. Funding for this project was obtained from Panama's National HIV/STI/Viral Hepatitis Program and support from the Gorgas Memorial Institute for Health Studies.

Inflammation and the vaginal microbiota in Zambian Women with Female Genital Schistosomiasis and their potential role in HIV acquisition

 

PhD Student: Amy Sturt

PhD Supervisors: Amaya Bustinduy, Emily Webb and Suzanna Francis

The overall aim of Amy’s PhD research is to explore the potential role of female genital schistosomiasis (FGS), sexually transmitted infections (STI), and the vaginal microenvironment in HIV acquisition. Female genital schistosomiasis (FGS) affects over 45 million women worldwide, mostly in sub-Saharan Africa. FGS is caused by an infectious agent, the waterborne parasite Schistosoma haematobium. Genital tract morbidity is caused by inflammation from egg-deposition that leads to mucosal erosion and granulomatous reaction. There is cross-sectional evidence of increased HIV prevalence in S. haematobium infected women. Amy’s research takes place in Livingstone, Zambia where eligible women were recruited from communities within HPTN071 (PopART) that are also endemic for infection with S. haematobium. The vaginal microbiota in FGS have not yet been evaluated and literature evaluating the association of FGS and STI is limited. As non-optimal cervicovaginal microbiota and STI have both previously been associated with HIV acquisition, Amy is evaluating the association between FGS and vaginal dysbiosis or STI (including chlamydia, gonorrhea, trichomoniasis, infections with Mycoplasma genitalium and Herpes simplex virus types 1 and 2). This may provide further evidence to strengthen the understanding of the mechanism of the association of FGS with HIV acquisition. Amy also plans to evaluate HIV incidence rates in women with and without FGS.

The epidemiology of, and risk factors for, oro-genital and anal human papillomavirus infections among sexually active Nigerians: A mixed methods study

PhD Student: Imran Morhason-Bello

PhD Supervisors: Deborah Watson-Jones and Suzanna Francis

Imran’s PhD aims to describe risk factors for genital, oral and anal sexual intercourse, and association of these behaviours with the prevalence of genital, oral and anal human papillomavirus (HPV) infections among different heterosexual populations in Ibadan, Nigeria. The first part of the PhD was a systematic review of reported oral and anal sex among heterosexual adolescents and adults in sub-Saharan Africa. This review informed the mixed methods study which enrolled adolescent girls and young women from the general populations and brothel-based female sex workers (FSW). Stage 1 of the study included formative research to explore the knowledge, socio-cultural interpretations, local terminologies, and personal experiences with different sexual behaviours within the community.  Results from this stage informed the tools for Stage 2. Stage 2 was a cross-sectional survey using household sampling of adolescents/young adult females, and brothel sampling of FSWs. During the cross-sectional survey, face-to-face interviews, clinical examination and collection of samples were carried out. A blood sample was collected for HIV testing. Samples from the oral cavity, the genital area (vulva, cervix and penis) and anal canal was collected for HPV DNA genotyping in the laboratory. The research was support by University of Ibadan, Ibadan, Nigeria.

Detecting sexual bridges: rapid genome-mapping of sexually transmitted infections among female sex worker and non sex worker populations in Ecuador

PhD Student: Claire Broad

PhD Supervisors:  Phil Cooper (SGUL/LSHTM), Tariq Sadiq (SGUL), Ken Laing (SGUL)

Claire’s PhD is a part of the MRC London Intercollegiate Doctoral Training Partnership (MRC LID) between St George’s University of London (SGUL) and LSHTM. The aim of this project is to estimate the prevalence of sexually transmitted infections (STIs) among female sex workers in Quininde and Las Golondrinas, Ecuador, and to demonstrate a system of surveillance that identifies sexual transmission clusters and potential sexual transmission ‘bridges’ within the general population. In Latin America, like many low- and middle-income countries, control of STIs is limited to syndromic management and there are a lack of reliable testing platforms, lack of knowledge surrounding STIs and unregulated antibiotic usage, e.g. self-medication. In Ecuador, surveillance strategies are limited and rely on disease case reporting of STI syndromes; few laboratory diagnosed STI prevalence data are available for common infections such as chlamydia and gonorrhoea. It is important when implementing public health interventions to understand whether an outbreak in a high risk population, such as female sex workers, will lead to infection ‘bridging’ and affect the wider population. Surveillance systems that incorporate methods such as whole genome sequencing (WGS) can be used to identify strain types, geographical clustering and antimicrobial resistance patterns within a population. WGS enables targeted capture of specific bacterial genomes; however, culture is usually required to provide sufficient pathogenic material and reduce interference from other bacterial or human DNA. For STIs such as chlamydia and infection with Mycoplasma genitalium, culture techniques are specialised, expensive and have varying success rates. Enrichment methods (e.g. using hybridization or ‘bait’ capture, bypassing culture and amplifying bacterial genomes directly from clinical samples) are an attractive resource for field settings and LMICs. The main output from the thesis will be to optimise enrichment and amplification methods to allow direct sequencing from clinical samples which have been collected from sex worker and non-sex worker populations in rural regions of Ecuador.

Epidemiology of sexually transmitted infections (STIs) in a cohort of transgender women in São Paulo, Brazil

DrPH Student: Daniel McCartney

DrPH Supervisor: Philippe Mayaud

Daniel’s DrPH project aims to assess the prevalence and incidence of sexually transmitted infections (STIs) among transgender women in São Paulo, Brazil, including chlamydia, gonorrhoeae, trichomoniasis, Lymphogranuloma venereum (LGV) and infection with Mycoplasma genitalium through laboratory diagnosis of self-collected samples from anorectal, oropharyngeal and neovaginal sites. This project is nested within an ongoing cohort study of transgender women by the Santa Casa de São Paulo School of Medicine, and a preliminary study was conducted to assess the acceptability of providing self-collected samples among a sample of transgender women enrolled in the cohort study.

While recommendations for serologic screening (for HIV, syphilis and hepatitis) and management of confirmed STIs do not differ from those for non-transgender people, specific considerations are required when screening for other STIs, as transgender people differ in hormone use, history of gender-affirming surgical procedures, and patterns of sexual behaviours and practices. Often conflated with men who have sex with men (MSM), transgender women have been underrepresented in epidemiological studies of STIs.

Research findings will have important policy and public health implications in Brazil and internationally for improving STI screening of this often over-looked and underserved population and inform specific STI-related recommendations for transgender women including screening and syndromic management for anorectal, oropharyngeal and neovaginal infections and syndromes.

Assessing the effect of economic shocks on HIV, STIs and Risky Sexual Behaviours

PhD Student: Henry Cust

PhD Supervisors: Dr Tim Powell-Jackson (LSHTM), Dr Aurélia Lépine (University College London) and Dr Rosalba Radice (City, University of London)

Henry’s PhD aims to better understand the circumstances in which FSWs have unprotected (condomless) by modelling the decision to have unprotected sex as a rational economic decision to earn additional money in times of need among female sex workers (FSWs). Economic shocks, where the finances of a household dramatically changes due to a change in income or a change in expenditures is one explanation as to why FSWs choose to have unprotected sex. Additional money earned from unprotected sex is used to make up the difference between regular earning and their income after a shock. This “risk premium” for unprotected sex can be as high as 81% in low and middle income countries.

Henry’s PhD will contribute to this area of research by providing new evidence from two unique settings, one in urban Senegal with a dataset of FSWs collected in Dakar over a two-year period. Sex work is legal in Senegal on the condition FSWs attend and pass a monthly health check for STIs. He will explore the evidence that economic shocks lead to risky sexual behaviours and STIs. Second, Henry is using a dataset from Karnataka state in southern India, which collected information from a group of sex workers predominantly from the devadasi background where sex work is culturally accepted. He will study the effects of economic shocks in both of these settings, including the different responses when the shocks are anticipated and unanticipated to see how risky sexual behaviours differ. He will also evaluate the effectiveness of interventions designed to protect against economic shocks such as personalised savings accounts.

Pharyngeal gonorrhoea as a driver of antimicrobial resistance; how can we better control it?

PhD Student: Victoria Miari

PhD Supervisors: Richard Stabler & David Mabey

Vicky is a clinical scientist at LSHTM and carrying out a staff PhD. Her PhD has several strands, all relating back to pharyngeal gonorrhoea. She first looked at patients with multi-site gonorrhoea and found that 15% of those patients carried different gonococcal strains in different anatomical sites which has an impact on detection of antimicrobial resistant (AMR) gonococcal strains and surveillance of those strains. She is also in the process of evaluating antimicrobial compounds that could potentially treat gonorrhoea – some compounds are novel and some are existing ones used in a new way.

Antimicrobial resistant gonorrhoea has been on the public health radar for some time now. More recently, ‘super gonorrhoea’ has crossed into mainstream news, especially with the recent multi-drug resistant (MDR) case.  These MDR gonococcal strains have been surfacing spontaneously since 2011 and since then, no new antimicrobials have been approved to reliably treat gonorrhoea.  She has evaluated the activity of closthioamide (CTA), a new antimicrobial class, against several strains of N. gonorrhoeae, and although very effective in vitro, CTA is at the early stages of development and could be years before it is available as a treatment. This research was published in Antimicrobial Agents and Chemotherapy (found here). She is also evaluating chlorehexidine, readily available within dental mouthwashes, to be used topically as a gargle.

This is particularly important; pharyngeal gonorrhoea is difficult to treat. She has found that chlorhexidine has high efficacy against gonorrhoea; the median minimum bactericidal concentration is approximately 65 fold less than the concentration in commercial mouthwashes. Chlorhexidine also appears to be rapidly bactericidal against gonorrhoea, taking less than a minute to kill 10 million bacteria. Vicky is continuing to research chlorhexidine and the next stages will be to perform a randomised controlled trial of a gargle to treat pharyngeal gonorrhoea.

She has written an editorial for Sexually Transmitted Infections about the role of topical antiseptics. As a clinical scientist she is also developing a diagnostic molecular test, able to detect live bacteria in human specimens. She hopes that this test will enable clinicians to detect AMR strains much faster, by reducing the test of cure time period. Lastly, she is further interested in genetic exchange between N. gonorrhoeae and commensal Neisseria species in the pharynx and is preparing  cross sectional study to measure the carriage of resistant commensals in MSM.

 

Publications

STI-related publications since September 2018

Publications List Block
Reported oral and anal sex among heterosexual adolescents and adults in sub-Saharan Africa: A systematic review.
Morhason-Bello I, Kabakama S, Baisley K, Francis SC, Watson-Jones D.
2019
Reprod. Health 16, 48
Self-collection of vaginal swabs among adolescent girls in a school-setting in East Africa.
Francis SC, Miiro G, Nakuya K, Rutakumwa R, Nakiyingi-Miiro J, Nabaggala G, Musoke S, Namakula J, Tanton C, Torondel T, Ross DA, Weiss HA.
2019
Sexually Transmitted Diseases, 2019 May 5; 46 (5)
HPV prevalence around the time of sexual debut in adolescent girls in Tanzania.
Baisley, Kathy; Andreasen, Aura; Irani, Julia; Nnko, Soori; Changalucha, John; Crucitti, Tanya; Francis, Suzanna Carter; Hansen, Christian; Hayes, Richard; Buve, Anne; +1 more.
2019
Sexually Transmitted Infections. Published Online First: 13 April 2019
Identifying high risk subgroups of MSM: a latent class analysis using two samples
M Kumi, Smith; Stein, Gabriella; Cheng, Weibin; Miller, William C; Tucker, Joseph D
2019
BMC infectious diseases, 19 (1). p. 213
Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England. International journal of gynecological cancer.
Bains, Irenjeet; Choi, Yoon Hong; Soldan, Kate; Jit, Mark
2019
ISSN 1048-891X DOI: https://doi.org/10.1136/ijgc-2018-000161
Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis.
Warren-Gash, Charlotte; Forbes, Harriet J; Williamson, Elizabeth; Breuer, Judith; Hayward, Andrew C; Mavrodaris, Angelique; Ridha, Basil H; Rossor, Martin N; Thomas, Sara L; Smeeth, Liam
2019
Scientific reports, 9 (1). p. 4743.
Characterizing the transitioning epidemiology of herpes simplex virus type 1 in the USA: model-based predictions
Ayoub, Houssein H; Chemaitelly, Hiam; Abu-Raddad, Laith J
2019
BMC medicine, 17 (1). 57-. ISSN 1741-7015 DOI: https://doi.org/10.1186/s12916-019-1285-x
Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genital Mycoplasma genitalium infection
Harrison, Mark; Harding-Esch, Emma; Marks, M; Pond, MJ; Butcher, R; Solomon, AW; Zhou, L; Tan, NK; Nori, AV; Kako, H; +3 more.
2019
Sexually Transmitted Infections. Published Online First: 13 April 2019
Results from a cross-sectional sexual and reproductive health study among school girls in Tanzania: high prevalence of bacterial vaginosis
Francis, Suzanna C; Holm Hansen, Christian; Irani, Julia; Andreasen, Aura; Baisley, Kathy; Jespers, Vicky; Crucitti, Tania; Changalucha, John;Hayes, Richard J; Nnko, Soori
2018
Sexually transmitted infections. ISSN 1368-4973 DOI: https://doi.org/10.1136/sextrans-2018-053680
Autophagy-virus interplay: From cell biology to human disease
Ahmad, L; Mostowy, S; Sancho-Shimizu, V
2018
Frontiers in Cell and Developmental Biology, 6. p. 155. DOI: https://doi.org/10.3389/fcell.2018.00155
Human papillomavirus infection: protocol for a randomised controlled trial of imiquimod cream (5%) versus podophyllotoxin cream (0.15%), in combination with quadrivalent human papillomavirus or control vaccination in the treatment and prevention of recurrence of anogenital warts (HIPvac trial)
Murray, Macey L; Meadows, Jade; Doré, Caroline J; Copas, Andrew J; Haddow, Lewis J; Lacey, Charles; Jit, Mark; Soldan, Kate; Bennett, Kate; Tetlow, Michelle
2018
BMC medical research methodology, 18 (1). p. 125. ISSN 1471-2288 DOI: https://doi.org/10.1186/s12874-018-0581-z
Low chlamydia and gonorrhea testing rates among men who have sex with men in Guangdong and Shandong Provinces, China
Wu D, Li KT, Tang W, Ong JJ, Huang W, Fu H, Lee A, Wei C, Tucker JD
2018
Sex Transm Dis. 2018 Dec 7. doi: 10.1097/OLQ.0000000000000963
Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study
Li KT, Tang W, Wu D, Huang W, Wu F, Lee A, Feng H, Pan SW, Han L, Mak V, Yang L, Tucker JD
2018
Lancet Infect Dis. 2019 Jan;19(1):76-82. doi: 10.1016/S1473-3099(18)30556-5
Gonorrhea and chlamydia prevalence in different anatomical sites among men who have sex with men: a cross-sectional study in Guangzhou, China
Yang LG, Zhang XH, Zhao PZ, Chen ZY, Ke WJ, Ren XQ, Wang LY, Chen WY, Tucker JD
2018
BMC Infect Dis. 2018 Dec 18;18(1):675. doi: 10.1186/s12879-018-3579-6
The Web-Based Physician is Ready to See You: A Nationwide Cross-Sectional Survey of Physicians Using a Mobile Medical App to Evaluate Patients With Sexually Transmitted Diseases in China
Cao, B; Zhao, P; Bien-Gund, C; Tang, W; Ong, JJ; Fitzpatrick, T; Tucker, JD; Luo, Z
2018
JMIR mHealth and uHealth, 6 (10). e10531. ISSN 2291-5222 DOI: https://doi.org/10.2196/10531
“Test n Treat” (TnT): a cluster randomised feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges
Oakeshott, Pippa; Kerry-Barnard, Sarah; Fleming, Charlotte; Phillips, Rachel; Drennan, Vari M; Adams, Elisabeth J; Majewska, Wendy;Harding-Esch, Emma; Cousins, Emma C; Planche, Tim
2018
Clinical Microbiology and Infection. ISSN 1198-743X (In Press)
Vaccine programme stakeholder perspectives on a hypothetical single-dose human papillomavirus (HPV) vaccine schedule in low and middle-income countries
Gallagher, KE; Kelly, H; Cocks, N; Dixon, S; Mounier-Jack, S; Howard, N; Watson-Jones, D
2018
Papillomavirus research (Amsterdam, Netherlands). ISSN 2405-8521 DOI: https://doi.org/10.1016/j.pvr.2018.10.004
Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study
Wang, Q; Ma, X; Zhang, X; Ong, JJ; Jing, J; Zhang, L; Wang, LH
2018
Sexually transmitted infections. ISSN 1368-4973 DOI: https://doi.org/10.1136/sextrans-2018-053636
Why large icosahedral viruses need scaffolding proteins
Li, S; Roy, P; Travesset, A; Zandi, R
2018
Proceedings of the National Academy of Sciences of the United States of America. ISSN 0027-8424 DOI: https://doi.org/10.1073/pnas.1807706115
Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India
Torondel, B; Sinha, S; Mohanty, JR; Swain, T; Sahoo, P; Panda, B; Nayak, A; Bara, M; Bilung, B; Cumming, O
2018
BMC infectious diseases, 18 (1). p. 473. ISSN 1471-2334 DOI: https://doi.org/10.1186/s12879-018-3384-2
Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India
Beksinska, A; Prakash, R; Isac, S; Mohan, HL; Platt, L; Blanchard, J; Moses, S; Beattie, TS
2018
BMJ open, 8 (9). e021389. ISSN 2044-6055 DOI: https://doi.org/10.1136/bmjopen-2017-021389
Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees
Huntington, SE; Burns, RM; Harding-Esch, E; Harvey, MJ; Hill-Tout, R; Fuller, SS; Adams, EJ; Sadiq, ST
2018
BMJ open, 8 (9). e020394. ISSN 2044-6055 DOI: https://doi.org/10.1136/bmjopen-2017-020394
Cost-benefit analysis of vaccination: a comparative analysis of eight approaches for valuing changes to mortality and morbidity risks
Park, M; Jit, M; Wu, JT
2018
BMC medicine, 16 (1). p. 139. ISSN 1741-7015 DOI: https://doi.org/10.1186/s12916-018-1130-7
Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. Health technology assessment
King, Carina; Llewellyn, Carrie; Shahmanesh, Maryam; Abraham, Charles; Bailey, Julia; Burns, Fiona; Clark, Laura; Copas, Andrew; Howarth, Alison; Hughes, Gwenda; +7 more
2019
23 (12). pp. 1-122.
HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Human Vaccines & Immunotherapeutics
Karafillakis, Emilie; Simas, Clarissa; Jarrett, Caitlin; Verger, Pierre; Peretti-Watel, Patrick; Dib, Fadia; De Angelis, Stefania; Takacs, Judit; Ali, Karam Adel; Pastore Celentano, Lucia; +1 more
2019
pp. 1-13. ISSN 2164-5515 DOI: https://doi.org/10.1080/21645515.2018.1564436
Cross-sectional analysis of chemsex drug use and gonorrhoea diagnosis among men who have sex with men in the UK
Kohli, Manik; Hickson, Ford; Free, Caroline; Reid, David; Weatherburn, Peter;
2019
Sexual Health. DOI: https://doi.org/10.1071/SH18159
Acceptability and predictors of uptake of anti-retroviral Pre-Exposure Prophylaxis (PrEP) among fishing communities in Uganda: a cross-sectional discrete choice experiment survey. AIDS and behavior
Kuteesa, Monica O; Quaife, Mathew; Biraro, Sam; Katumba, Kenneth R; Seeley, Janet; Kamali, Anatoli; Nakanjako, Damalie
2019
AIDS Behav. 2019 Feb 8
High Clustering of Acute HCV Infections and High Rate of Associated STIs Among Parisian HIV-Positive Male Patients
Todesco, Eve; Day, Nesrine; Amiel, Corinne; Elaerts, Stéphane; Schneider, Véronique; Roudiere, Laurent; Hue, Stéphane; Liotier, Jean-Yves; Bottero, Julie; L'yavanc, Thomas; +11 more
2019
International journal of antimicrobial agents. 2019 May;53(5):678-681
Epidemiology of genital warts in the British population: implications for HPV vaccination programmes
Sonnenberg, Pam; Tanton, Clare; Mesher, David; King, Eleanor; Beddows, Simon; Field, Nigel; Mercer, Catherine H; Soldan, Kate; Johnson, Anne M;
2019
Sexually transmitted infections. ISSN 1368-4973 DOI: https://doi.org/10.1136/sextrans-2018-053786
The Denominator problem: estimating the size of local populations of men-who-have-sex-with-men and rates of HIV and other STIs in Switzerland
Schmidt, Axel Jeremias; Altpeter, Ekkehardt;
2019
Sexually transmitted infections. ISSN 1368-4973 DOI: https://doi.org/10.1136/sextrans-2017-0533
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