IDAlert

June 1, 2008

PREVALENCE OF ANAL humanpapillomavirus (HPV) infection was24.8% among a study population of222 heterosexual men who confirmedthat they had never engagedin male-male sexual intercourse. Thestudy is scheduled to appear in TheJournal of Infectious Diseases and canbe viewed ahead of print at the journal'sWeb site.

Site-Specific Prevalenceand Risk Factors of HPVInfection in Men Elucidated

PREVALENCE OF ANAL humanpapillomavirus (HPV) infection was24.8% among a study population of222 heterosexual men who confirmedthat they had never engagedin male-male sexual intercourse. Thestudy is scheduled to appear in TheJournal of Infectious Diseases and canbe viewed ahead of print at the journal'sWeb site.

Of those infected, 33.3% had anoncogenic HPV type and were thusat risk for development of anal cancer(the incidence of which, thestudy authors pointed out, has beenincreasing over the past 3 decades).The risk of anal HPV infectionamong the study participants correlatedwith the number of female sexpartners they had had and the frequencyof sex with those partnersduring the month preceding thestudy.

Another study, published in theMarch issue of The Journal of InfectiousDiseases, showed that uncircumcisedmen were at higher risk forHPV infection than circumcisedpeers. The study analyzed specimensfrom 351 men (mean age, 29;76.5% heterosexual) to identify site specificprevalence of HPV infectionin outer male genitalia. The sitesmost frequently infected were the penile shaft (52%), scrotum (40%),and glans/corona (32%). Heterosexualbehavior was more strongly correlatedwith infection of the shaftand scrotum than was homosexualbehavior.

In uncircumcised men, prevalenceof infection of the glans/corona was46% and prevalence of infection ofthe foreskin was 44%, leading the researchersto conclude that circumcisionmay be somewhat protectiveagainst HPV infection. In addition tobeing at higher risk for HPV infectionof the glans/corona (and beingsubject to infection of the foreskin),uncircumcised men also were morelikely to be infected with oncogenicHPV genotypes and with multiplegenotypes.

For more information, see NyitrayA, Nielson CM, Harris RB, et al.Prevalence of and risk factors foranal human papillomavirus infectionin heterosexual men. J Infect Dis.2008 Apr 21 [Epub ahead of print]and Hernandez BY, Wilkens LR, ZhuX, et al. Circumcision and humanpapillomavirus infection in men: asite-specific comparison. J Infect Dis.2008;197:787-794.

Lipotourism Puts US Citizens at Risk for M abscessus Infections

TWENTY INCIDENTS of Mycobacteriumabscessus wound infections associatedwith abdominoplasty werereferred to as "the tip of the iceberg"by the multicenter team of clinicianswho culled the cases. US rates ofM abscessus infection following abdominoplastyand liposuction arenot known, although the correlationbetween incidence and travel to theDominican Republic for so-calledlipotourism has become conspicuousand, thus, is gaining attention.

Having identified 20 patients withM abscessus infections secondary toabdominoplasty, the investigativeteam discovered that 9 of the patientshad undergone surgery at thesame clinic in Santo Domingo. Furthermore,isolates recovered from 8of these patients were related.

Many presenting signs and symptomsof M abscessus infection arenonspecific, the study authors explained.Furthermore, low clinicalsuspicion regarding the organismcompromises microbiological diagnosisbecause M abscessus grows onmedia that are usually not used forinitial evaluations.

The authors warned that as lipotourismgrows in popularity, US clinicianscan expect to see more patientspresenting with surgicalwound infections. They recommendthat M abscesses infection should beincluded in the differential diagnosis.For more information, seeFuruya EY, Paez A, Srinivasan A,et al. Outbreak of Mycobacterium abscessus wound infections among"lipotourists" from the UnitedStates who underwent abdominoplastyin the Dominican Republic.Clin Infect Dis. 2008;46:1181-1188.

High Mortality and Inadequate Treatment Associated With Non-Food-Borne Vibrio Infection

HIGH MORBIDITY and mortalitywere associated with non-foodborne

Vibrio

infections (NFVIs), particularlythose associated with Vibriovulnificus. Analysis of 4754 casesof Vibrio infections reported to theCDC between 1997 and 2006 revealedthat 1210 (25%) were NFVIs.Of the 79 deaths attributable toNFVIs (of a total 369 deaths that occurredas a consequence of

Vibrio

infectionwith any species), 62 (78%)were associated with

V vulnificus

infection.Having liver disease was astrong risk factor.

V vulnificus

,which is endemic to the Gulf CoastStates, was found to be the mostcommon species associated withinfection.

Antibiotic therapy was administeredin 85% of the cases reported,but the study authors noted thatonly 31% of the patients received aneffective agent and only 14% of patientsreceived an effective agent asinitial therapy. The less likely it wasthat a person received effective antibiotictherapy within 24 hours ofclinical presentation, the more likelyhe or she was to die of Vibrio infection.Delayed hospitalizationalso was associated with death.

NFVIs were primarily associatedwith contamination of existing ornew wounds during marine recreationalactivities, fishing, and handlingseafood. For more information,see Dechet AM, Yu PA, KoramN, Painter J. Nonfoodborne Vibrioinfections: an important cause ofmorbidity and mortality in theUnited States, 1997-2006. Clin InfectDis. 2008;46:970-976.

Incidence of Group B Streptococcal Disease Decreasing Among Neonates; Increasing Among Adults

ALTHOUGH INCIDENCE of invasivegroup B streptococcal disease isdecreasing in newborns, it is substantiallyincreasing in adults. Ananalysis of cases reported from1999 through 2005 (N = 14,573) revealeda relative reduction in incidenceof 27% among newborns.This decrease in incidence may bethe consequence of adherence to the2002 revised CDC guidelines thatrecommended antenatal culture-basedscreening to identify candidatesfor chemoprophylaxis. Incidenceof invasive group B streptococcaldisease among neonates hadalready been dropping as an outcomeof earlier guidelines that recommendedscreening during pregnancyand intrapartum chemoprophylaxis,although the authors ofthe current study noted that intrapartumchemoprophylaxis does notprotect pregnant women againstlate-stage disease.

In contrast to the decrease in incidenceseen among infants, a relativeincrease in incidence of 48% occurredduring 1999 through 2005among persons aged 15 to 64 years.Among persons 65 years and older,the relative rate of incidence increasedby 20%.

All streptococcal isolates thatwere submitted for susceptibilitytesting (n = 4882) were susceptibleto penicillin, ampicillin, and vancomycin.About a third (1566) wereresistant to erythromycin, andabout a sixth (757) were resistant toclindamycin.

For more information, see PharesCR, Lynfield R, Farley MM, et al.Epidemiology of invasive group Bstreptococcal disease in the UnitedStates, 1999-2005. JAMA. 2008;299:2056-2065.