WORLD HOSPITAL DIRECTORY
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Hon. H.E. Sir. Dr. Raphael Louis-PM Candidate (2015 - 2020)


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WORLD HOSPITAL DIRECTORY is the one and only largest database of hospitals around the world. There are over 35,000 plus records of hospitals across globe

WORLD HOSPITAL DIRECTORY has the World's largest online database of general, multispeciality, eye, dental, children, maternity, cardiac care, orthopedic, nephrology, neurology, diabetic, psychiatric, cancer, ENT, hospice, Rehabilitation, alternate medicine, veterinary hospitals across globe. Discover the complete list of hospitals available in North America, South America, Europe, Asia, Australia, New Zealand, rest of the world and online.

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1CEMIC
CEMIC
Category: General Hospitals
Argentina
South America, America
2Croydon Hospital (Tablelands HSD)
Croydon Hospital (Tablelands HSD)
Category: Mulispeciality Hospitals
Australia
Australia and New Zealand, Oceanic
3Regionaal Hospital Sint-Maria
Regionaal Hospital Sint-Maria
Category: Mulispeciality Hospitals
Belgium
Western Europe, Europe
4Bairro Passo D'areia Farmaconte Dist. Produtos Hospitalares Ltda.
Bairro Passo D'areia Farmaconte Dist. Produtos Hospitalares Ltda.
Category: Mulispeciality Hospitals
Brazil
South America, America
5BCIT - Technology Centre, Health Technology Research Group
BCIT - Technology Centre, Health Technology Research Group
Category: General Hospitals
Canada
North America, America

1.
Why Our Healthcare System Isnt Healthy
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2.
Stopping Hospital Infections
Stopping Hospital InfectionsEach year hospitals end up killing twice as many people than automobiles, some 90,000 deaths in the United States. It is not from malpractice, i
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3.
Protect Yourself Against the Flu Vaccine!
Protect Yourself Against the Flu Vaccine!<br />
The vaccine industry insists that their vaccines against the flu serve as the key to a healthy winter. Although there has
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4.
Chinese Medicine
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5.
Medical Billing Specialist
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6.
Nasonex And You: Breathe Easy, Not Sneezy
Nasonex And You: Breathe EasyWhile everybody else is wandering around enjoying the spring weather, are you hiding out in your hermetically-sealed house? Do you dread the star
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7.
Chronic Headaches and Pain Often Can Be Eliminated By A Special Dentist
Chronic Headaches Often Can Be Eliminated By A Special DentistDENVER ? Sometimes as Freud once said a good cigar is just a smoke. A headache, on the other hand, occas
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8.
Physicians, Chiropractors and Physical Therapist Agree on a New Treatment for Low Back Pain
New Treatment for Low Back Pain<br />
One of the most prevalent and difficult health conditions to treat in the physical medicine is low back pain. The difficulty in tre
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9.
Web Therapy: Enhancing Patient Communication with Web Access
Web Therapy: Enhancing Patient Communication with Web AccessAccording to Jennifer Lyons' chart, she's just a bad slip and fall who's lucky enough to be on her way to a full
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10.
Increasing Patient Care and Reducing Liability in Seven Simple Steps
Increasing Patient Care and Reducing Liability in Seven Simple StepsWhen an unconscious patient arrives in the ED, every hospital agrees that timely next of kin notificat
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11.
Cetyl Myristoleate Seperating Fact From Fiction
Cetyl Myristoleate Seperating Fact From FictionI am a strong believer in Cetyl Myristoleate for the treatment of arthritis. For the last three years I have been res
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12.
Medical Tests: What Does a Normal Range Mean?
Medical Tests: What Does a Normal Range Mean?We have a marvelous array of medical tests available to us. Many of them-typically blood-tests-even come with results expressed
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13.
CT and MRI Scans in Neurological Practice
CT and MRI Scans in Neurological Practice

Before computed tomographic (CT) scans became available in the 1970s, there was no good method for imaging the brain. The a
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14.
Alcohol Rehabilitation Centers - Take An Informed Decision
Alcohol Rehabilitation Centers - Take An Informed DecisionAlcohol rehabilitation centers in the United States offer a wide range of treatment programmes for your recovery f
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15.
Contact Lenses and Eye Glasses
Contact Lenses and Eye GlassesHow is Your Vision?
Notice friends getting contact lenses and pulling out eye glasses?

"What do you recommend?"

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16.
Death by Fluoride
Death by FluorideA wee bit of fluoride makes teeth and dentists happy, we're told. Dr. Happy Tooth's smiley face turns into a frown when his favorite decay buster is busted
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17.
10 Steps To Detoxification
10 Steps To DetoxificationTechnology. We live in a grand time of technological development. Computers, the Internet, cell phones, digital cameras and DVDs. But the human body h
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18.
New Surgical Treatment Options for Hernias
New Surgical Treatment Options for HerniasHernia repair is one of the most commonly performed surgical procedures worldwide. In fact, there are over 600,000 hernia repa
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19.
Arthritis Pain Relief : FAQ
Arthritis Pain Relief : FAQA great place to begin taking charge of you arthritis pain relief and prevention planning is by making an appointment with your healthc
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20.
A Surgical Robot Fixes Heart in Brazil
a Surgical Robot Fixes Heart in BrazilBrazilian surgeons used a multi-armed robot to repair a hole in a woman's heart in the first operation of its kind in Latin Americ
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21.
Root Canal Therapy:FAQ
Root Canal Therapy:FAQOverview

A diseased or injured nerve use to mean that you were likely to lose a tooth. This is no longer the case thanks to root
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22.
ADHD - Are there Treatment Options?
ADHD - Are there Treatment Options?As an ADD coach I am often asked about the treatment options available for Attention Deficit Disorder. Generally when someone says "ADD" the f
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23.
7 Tips to Keep Your Fluid Down on Dialysis
7 Tips to Keep Your Fluid Down on DialysisAs any dialysis patient will tell you, keeping your fluid gain between dialysis sessions in check is not only important to your lon
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24.
Testosterone Therapy in XXI Century
Testosterone Therapy in XXI CenturyNowadays many people are familiar with the appellation of "low testosterone level". What does it mean? It mean that male body p
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25.
Stem Cell Research
Stem Cell ResearchHow To Buy Your Way Out Of An Early Death From An Incurable Disease.

How?... With private stem cell research, of course!?Stem cell research
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1.
Maharashtra woos medical tourists
Maharashtra woos medical touristsMany people from the developed world come to India for the rejuvenation promised by yoga and ayurvedic massage, but few consider it a de
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2.
Medical tourism: Need surgery, will travel
Maharashtra woos medical touristsA worldwide market

What's called medical tourism – patients going to a different country for either urgent or elective
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3.
Medical Tourism is Becoming a Huge Industry in India
Diatance LearningMany types of medical treatment in India cost a fraction of what they do in the United States and other Western nations, and citizens from these c
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4.
Medical tourism set to take off in a big way
Medical tourism set to take off in a big wayWith world class healthcare professionals, nursing care and treatment cost almost one-sixth of that in the developed
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5.
India eyeing share in medical tourism pie
India eyeing share in medical tourism pie A NICE blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure forei
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6.
Are we ready for medical tourism?
Are we ready for medical tourism? The private healthcare industry is quietly facilitating a revolution to enable India to emerge as a health destination. Yet there are the
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7.
Is medical tourism worth the risk?
Is medical tourism worth the risk?Thousands of Britons are heading abroad for cut-price treatment. We investigate the health tourism boom and asks if the benefits o
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8.
Package holiday surgery to beat NHS queue
Package holiday surgery to beat NHS queueA holiday firm is offering 'sun and surgery' package deals to India for patients tired of waiting for the NHS.

Th
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9.
Choosing the right weight loss surgery abroad
Choosing the right weight loss surgery abroadThe reluctance of public healthcare systems and health insurers to fund weight loss surgery means that more and more people are
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10.
The forgotten medical tourism destination
The forgotten medical tourism destinationAn article by medical tourism specialist, Ian Youngman, on one of the world’s leading destinations for medical travelers which seems
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11.
Why medical tourism needs facilitators
Why medical tourism needs facilitatorsFollowing our recent article on "How can patients judge quality in medical tourism?", Caroline Ratner spoke to Mike Silford, who run
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12.
How can patients judge quality in medical tourism?
How can patients judge quality in medical tourism?There's much discussion and hype around the medical tourism world about “quality”. Every hospital, clinic, healthcar
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13.
The importance of social media and the web in medical tourism
The importance of social media and the web in medical tourismMore than most other industries, medical tourism agencies and international patient departments rely heavily on t
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14.
Medical Tourism Destinations: Places That Top The Charts
Medical Tourism Destinations: Places That Top The ChartsMedical tourism is a popular trend among people in the US nowadays. Many Americans are moving abroad to get tr
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15.
Plastic & Cosmetic Surgery Option In Malaysia
Plastic & Cosmetic Surgery Option In MalaysiaMedical Tourism Malaysia is growing at an exponential growth factor. Its enjoying medical tourist from UK, Australia, New Zealand
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16.
Samitivej Medical Tourism, A Lucrative Business
Samitivej Medical Tourism, A Lucrative BusinessSamitivej Wins 2 Prestigious HMA Awards 2008 Path to Being the Largest Medical Tourism

Samitivej, a leading pri
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17.
Jordan pushes medical tourism industry
Jordan pushes medical tourism industryAfter establishing itself as a popular destination for medical care among Arabs in the Middle East, Jordan is now looking to attract more
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18.
Some Frequently Asked Questions about Medical Tourism
Some Frequently Asked Questions about Medical TourismWhat is the quality of care that I can expect? Most of the healthcare centers abroad such as hospitals clinics and diagnostic
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19.
Infertility Treatment in India
Infertility Treatment in IndiaInfertility is the inability to conceive a child by natural means. When a couple finds it difficult to conceive naturally, medication and spe
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20.
Medical Tourism Thailand
Medical Tourism ThailandThailand has been a popular holiday destination of the East which is now a popular medical tourism destination as well. The Thai medical service is on
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21.
Medical Tourism India
Medical Tourism IndiaA medical tourist in India can get the best of both worlds- excellent medical service from experts in the field of medicine and a splendid experience of a
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22.
Digitizing Medical Documents
Digitizing Medical DocumentsIt is a common fact that hospitals and doctors need a patient’s detailed medical history before treating them. But when you have travele
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23.
Roux-en-gastric bypass in India: An Overview
Roux-en-gastric bypass in India: An OverviewRoux-en-gastric bypass in India is very economical and affordable. Low cost but quality treatment attracts many patients of a
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24.
Need a dentist? Come to Croatia
Need a dentist? Come to Croatia



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25.
India offers hope for those too sick to wait
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Highlights from this issue
<p>Whistlestop Tour goes to press just in time for us to reflect on the outcome of a Judicial Review on the role of England's National Health Services in commissioning PREP (Pre-Exposure Prophylaxis for HIV prevention). Many countries have already implemented PREP following a series of impressive trial results around the world. A ruling that NHS England has the power to fund PREP is a welcome outcome to the advocates, clinicians and organisations responsible for this review. However there is a long way to go before implementation, and much more to learn about what it will take to make this game-changing intervention as effective as possible at population level.</p> <p>By the time this issue lands on your doormat, holidaymakers will be returning home, and perhaps considering a visit to your clinic. We recently published an Australian study on seasonal variation in STIs,<cross-ref type="bib" refid="R1">1</cross-ref> and this month's issue follows this...


Genital dermatology special interest group
<p>The BASHH Genital Dermatology (GD) Special Interest Group (SIG) evolved from the Joint Colposcopy and GD group following the BASHH Spring meeting in New York in 2008. It was recognised that colposcopy was declining in genitourinary medicine (GUM) practice, and interest was increasing in the management of genital skin conditions, in which the colposcope could be used as a tool. Use of the colposcope for high-resolution anoscopy saw the colposcopy component being dropped<I>,</I> as the Human Papilloma Virus (HPV) Specialist Group were more appropriately placed to develop its use, but we continue to work closely together, having run joint BASHH scientific sessions over the recent years. The name of the SIG was changed to GD SIG in November 2013. The SIG aims to provide continuing medical education and thus improve quality of patient care.</p> <p>Further development of the group and redefining of its remit have seen some of the...


The Holy Grail of prevention of sexually transmitted infections in travellers
<p>In this issue of the journal, two articles<cross-ref type="bib" refid="R1">1</cross-ref> <cross-ref type="bib" refid="R2">2</cross-ref> provide new evidence on sexual behaviours among travellers.</p> <p>Tanton <I>et</I> <I>al</I> report the rate of new sexual relationships of British residents during travel abroad. They used the Britain's third National Survey of Sexual Attitudes and Lifestyles, a probability survey undertaken in the UK between 2010 and 2012, and analysed data from 12&nbsp;530 men and women aged 16&ndash;74&nbsp;years reporting &ge;1 sexual partner(s) in the previous 5&nbsp;years. They found that 9.2% of men and 5.3% of women reported new sexual partner(s) while overseas. Among those who reported new partners while overseas, 72% of men and 58% of women reported partner(s) who were not UK residents.</p> <p>In another article in this issue of the journal, Lewis and de Wildt report high proportions of backpackers, a younger, mobile population of travellers known to exhibit high risk-taking behaviour, engaging in unsafe...


Point-of-care tests using enzyme detection to diagnose Chlamydia trachomatis infection do not work. But when they fail in clinical trials, they reappear under different names
<p>While scanning De Baetselier and colleagues&rsquo; article evaluating an enzymatic <I>Chlamydia trachomatis</I> (CT) point-of-care assay (POC), I was struck by a feeling of d&eacute;j&agrave; vu.<cross-ref type="bib" refid="sextrans-2015-052508R1">1</cross-ref> They found the BioChekSwab Rapid Test performed poorly, missing all nine infections detected by PCR. This reminded me of a paper by Moi in 2007 reporting the very poor performance of a POC for CT, HandiLab-C.<cross-ref type="bib" refid="sextrans-2015-052508R2">2</cross-ref> Reading further, I realised this was not coincidence. The two assays seemed to use the same technology.</p> <p>BioChekSwab Rapid Test seems to be an updated HandiLab-C test that was widely available about 10&nbsp;years ago. Sold in at least 17 countries, it had a CE mark with approval for POC professional use and over-the-counter sale (meaning self-test).<sup>Web1</sup> In 2006, workers at the National Chlamydia Screening Programme, concerned about use of the test in England (it was for sale in pharmacies and supermarkets), asked me to...


How to use information technology in the clinic to improve patient experience
<sec> <p>The electronic patient record (EPR) software used by sexual and reproductive health (SRH) services has functionality that varies significantly and many are unable to meet all the patient and staff requirements; consequently, there is a real need to complement the EPR systems with additional information technology (IT) solutions. A successful IT solution needs to start with a pressing problem that can be clearly defined. <cross-ref type="tbl" refid="SEXTRANS2015052410TB1">Table&nbsp;1</cross-ref> shows nine different problems that have been addressed in the last 5&nbsp;years using a range of off-the-shelf and bespoke IT solutions.</p> <p> <tbl id="SEXTRANS2015052410TB1" loc="float"><no>Table&nbsp;1</no><tblbdy top-stubs="1"><r><c cspan="1" rspan="1">Problem</c><c cspan="1" rspan="1">Current solution</c><c cspan="1" rspan="1">IT solution (outside funding)</c><c cspan="1" rspan="1">Impact measured</c><c cspan="1" rspan="1">Future plans</c></r><r><c cspan="5" rspan="1"><b>Off-the-shelf solutions</b></c></r><r><c cspan="1" rspan="1">Difficulty providing appointments.</c><c cspan="1" rspan="1">Reception team answering phone. Accept negative feedback that the phone is frequently engaged.</c><c cspan="1" rspan="2">Online appointment service.<cross-ref type="bib" refid="R3">3</cross-ref></c><c cspan="1" rspan="1">Able to control when appointments posted.<br>Simple access to clinic appointments via...


Sexual behaviour of backpackers who visit Koh Tao and Koh Phangan, Thailand: a cross-sectional study
<sec><st>Objectives</st> <p>To measure the proportion of backpackers engaging in unprotected sex while travelling in Thailand and to identify predictors of unsafe sexual behaviour.</p> </sec> <sec><st>Methods</st> <p>A cross-sectional study using an anonymous questionnaire was performed. English-speaking backpackers, excluding US and Thai citizens, were recruited while travelling through the piers of Koh Tao and Koh Phangan between 25 January and 13 March 2013.</p> </sec> <sec><st>Results</st> <p>61.5% (1238/2013) respondents were travelling without a long-term sexual partner, of whom 39.1% (29.4% females; 51.9% males) reported intercourse with a new partner. 36.8% of these reported inconsistent/no condom use. Inconsistent condom use was independently associated with age &lt;25&nbsp;years, UK (vs Canadian) nationality and not bringing condoms from home. Backpackers who brought condoms from home were more likely to have sex with a new partner. Male gender and longer trip length increased the likelihood of new partner acquisition and overall risk of unsafe sex but were not associated with inconsistent condom use. New partners were most commonly backpackers from other countries. Men were more likely than women to have sex with a local person.</p> </sec> <sec><st>Conclusions</st> <p>Backpackers visiting Thailand frequently report unsafe sex. Partner demographics demonstrate a mechanism of international sexually transmitted infection (STI) transfer. In an era of growing antibiotic resistance and continuing HIV transmission, targeting unsafe sex in backpackers has the potential to reduce STI incidence internationally. These data highlight the need for innovative public health intervention. To focus such measures, future research may elucidate why certain groups are at higher risk.</p> </sec>


Forming new sex partnerships while overseas: findings from the third British National Survey of Sexual Attitudes & Lifestyles (Natsal-3)
<sec><st>Objectives</st> <p>Travelling away from home presents opportunities for new sexual partnerships, which may be associated with sexually transmitted infection (STI) risk. We examined the prevalence of, and factors associated with, reporting new sexual partner(s) while overseas, and whether this differed by partners&rsquo; region of residence.</p> </sec> <sec><st>Methods</st> <p>We analysed data from 12&nbsp;530 men and women aged 16&ndash;74&nbsp;years reporting &ge;1 sexual partner(s) in the past 5&nbsp;years in Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010&ndash;2012.</p> </sec> <sec><st>Results</st> <p>9.2% (95% CI 8.3% to 10.1%) of men and 5.3% (4.8% to 5.8%) of women reported new sexual partner(s) while overseas in the past 5&nbsp;years. This was strongly associated with higher partner numbers and other sexual and health risk behaviours. Among those with new partners while overseas, 72% of men and 58% of women reported partner(s) who were not UK residents. Compared with those having only UK partners while abroad, these people were more likely to identify as &lsquo;White Other&rsquo; or &lsquo;Non-White&rsquo; (vs White British ethnicity), report higher partner numbers, new partners from outside the UK while in the UK and paying for sex (men only) all in the past 5&nbsp;years. There was no difference in reporting STI diagnosis/es during this time period.</p> </sec> <sec><st>Conclusions</st> <p>Reporting new partners while overseas was associated with a range of sexual risk behaviours. Advice on sexual health should be included as part of holistic health advice for all travellers, regardless of age, destination or reason for travel.</p> </sec>


Client-perpetrated and husband-perpetrated violence among female sex workers in Andhra Pradesh, India: HIV/STI risk across personal and work contexts
<sec><st>Objectives</st> <p>This study examines violence experienced in work and personal contexts and relation to HIV risk factors in these contexts among female sex workers (FSW) in Andhra Pradesh, India.</p> </sec> <sec><st>Methods</st> <p>FSW at least 18&nbsp;years of age (n=2335) were recruited through three rounds of respondent-driven sampling between 2006 and 2010 for a survey on HIV risk. Using crude and adjusted logistic regression models, any sexual/physical violence (last 6&nbsp;months) perpetrated by clients and husbands were separately assessed in association with accepting more money for sex without a condom (last 30&nbsp;days), consistent condom use with clients and husbands (last 30&nbsp;days), and sexually transmitted infection (STI) symptoms (last 6&nbsp;months).</p> </sec> <sec><st>Results</st> <p>The mean age among participants was 32, 22% reported being currently married, and 22% and 21% reported physical/sexual violence by clients and husbands, respectively. In adjusted logistic regression models, FSW who experienced client violence were more likely to report accepting more money for unprotected sex trades (adjusted OR (AOR)=1.7; 95% CI 1.4 to 2.2), less likely to report consistent condom use with clients (AOR=0.6; 95% CI 0.5 to 0.7) and more likely to report STI symptoms (AOR=3.5; 95% CI 2.6 to 4.6). Women who reported husband violence were more likely to report accepting more money for unprotected sex trades (AOR=2.1; 95% CI 1.2 to 3.7), less likely to report consistent condom use with clients (AOR=0.5; 95% CI 0.3 to 0.8) and more likely to report STI symptoms (AOR=2.6; 95% CI 1.6 to 4.1).</p> </sec> <sec><st>Conclusions</st> <p>Among FSW, experiences of violence in <I>work</I> and <I>personal</I> contexts are associated with sexual HIV risk behaviours with clients as well as STI symptoms.</p> </sec>


Evaluation of an enzymatic Chlamydia trachomatis point-of-care rapid assay in Rwanda: the BioChekSwab Rapid Test
<sec><st>Objectives</st> <p>We evaluated the performance of an enzymatic point-of-care rapid test for <I>Chlamydia trachomatis</I> (CT) (the BioChekSwab CT Rapid Test, EnZtek Diagnostics, Rio Vista, California, USA), which detects CT's Peptidase 123CBV enzyme and provides a result 15&nbsp;min after specimen collection.</p> </sec> <sec><st>Methods</st> <p>Two endocervical swabs, including one BioChekSwab, per person were obtained from 137 women who participated in a reproductive health study in Rwanda. The BioChekSwab was processed according to the manufacturer's instructions. A substrate was squirted over the swab by the study physician immediately after collection, and another reagent was released over the swab tip at arrival in the laboratory. The test was considered positive if a blue colour developed within 2&nbsp;min. The other regular flocked endocervical swab was processed at the Institute of Tropical Medicine (ITM), Belgium, using a testing algorithm: Abbott RealTime CT/<I>Neisseria gonorrhoeae</I> (NG) assay with the confirmation of positive results by an in-house real-time PCR assay.</p> </sec> <sec><st>Results</st> <p>Of the 137 women, nine were CT positive by the testing algorithm. All nine positive results were missed by the BioChekSwab assay and four false-positive results were obtained. The sensitivity was therefore 0% (95% CI 0% to 33.6%) and the specificity was 96.9% (95% CI 92.2% to 99.1%).</p> </sec> <sec><st>Conclusions</st> <p>The BioChekSwab Rapid Test, although ISO13485 certified and Conformit&eacute;e Europ&eacute;enne (CE) labelled, lacked any sensitivity in our setting.</p> </sec>


Prediction of Chlamydia trachomatis infection to facilitate selective screening on population and individual level: a cross-sectional study of a population-based screening programme
<sec><st>Objectives</st> <p>To develop prediction models for <I>Chlamydia trachomatis</I> (Ct) infection with different levels of detail in information, that is, from readily available data in registries and from additional questionnaires.</p> </sec> <sec><st>Methods</st> <p>All inhabitants of Rotterdam and Amsterdam aged 16&ndash;29 were invited yearly from 2008 until 2011 for home-based testing. Their registry data included gender, age, ethnicity and neighbourhood-level socioeconomic status (SES). Participants were asked to fill in a questionnaire on education, sexually transmitted infection history, symptoms, partner information and sexual behaviour. We developed prediction models for Ct infection using first-time participant data&mdash;including registry variables only and with additional questionnaire variables&mdash;by multilevel logistic regression analysis to account for clustering within neighbourhoods. We assessed the discriminative ability by the area under the receiver operating characteristic curve (AUC).</p> </sec> <sec><st>Results</st> <p>Four per cent (3540/80&nbsp;385) of the participants was infected. The strongest registry predictors for Ct infection were young age (especially for women) and Surinamese, Antillean or sub-Saharan African ethnicity. Neighbourhood-level SES was of minor importance. Strong questionnaire predictors were low to intermediate education level, ethnicity of the partner (non-Dutch) and having sex with casual partners. When using a prediction model including questionnaire risk factors (AUC 0.74, 95% CI 0.736 to 0.752) for selective screening, 48% of the participating population needed to be screened to find 80% (95% CI 78.4% to 81.0%) of Ct infections. The model with registry risk factors only (AUC 0.67, 95% CI 0.656 to 0.675) required 60% to be screened to find 78% (95% CI 76.6% to 79.4%) of Ct infections.</p> </sec> <sec><st>Conclusions</st> <p>A registry-based prediction model can facilitate selective Ct screening at population level, with further refinement at the individual level by including questionnaire risk factors.</p> </sec>


Understanding sexuality: are the common sexuality descriptors useful for a sexual health clinic?
<sec> <p>Sexuality is a complex topic in sociology and healthcare. It is multifactorial, combining gender, sex, sexual orientation and erotic desires. In some sexual health clinics in the UK, three common sexuality descriptors are used: heterosexual, bisexual and homosexual. Kinsey <I>et al</I><cross-ref type="bib" refid="R1">1</cross-ref> proposed the idea that sexuality exists along a continuum:<qd><p>The world is not to be divided into sheep and goats. Not all things are black nor all things white. (....) The sooner we learn this concerning human sexual behaviour the sooner we shall reach a sound understanding of the realities of sex.</p> </qd></p> <p>We reviewed if the common descriptors matched patients&rsquo; described behaviours in a sexual health clinic. This was a service evaluation assessing the utility of our sexual orientation classifications.</p> <p>We reviewed 300 patients presenting to a UK sexual health clinic between April 2013 and September 2013. Patients were asked to select their sexuality descriptor...


Identification of novel microbes associated with pelvic inflammatory disease and infertility
<sec><st>Objectives</st> <p>As pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae.</p> </sec> <sec><st>Methods</st> <p>Fastidious bacterial vaginosis (BV)-associated bacteria (<I>Sneathia (Leptotrichia) sanguinegens</I>, <I>Sneathia amnionii</I>, <I>Atopobium vaginae</I> and BV-associated bacteria 1 (BVAB1)), as well as <I>Ureaplasma urealyticum</I> and <I>Ureaplasma parvum</I> were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility.</p> </sec> <sec><st>Results</st> <p>Persistent detection of BV-associated bacteria was common (range 58% for <I>A. vaginae</I> to 82% for BVAB1) and elevated the risk for persistent endometritis (RR<SUB>adj</SUB> 8.5, 95% CI 1.6 to 44.6) 30&nbsp;days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RR<SUB>adj</SUB> 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RR<SUB>adj</SUB> 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest.</p> </sec> <sec><st>Conclusions</st> <p>To our knowledge, this is the first prospective study to demonstrate that <I>S. sanguinegens</I>, <I>S. amnionii</I>, BVAB1 and <I>A. vaginae</I> are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.</p> </sec>


Heterogeneity of HIV incidence: a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control
<sec><st>Objectives</st> <p>To describe HIV heterogeneity in rural Uganda using incidence data collected between January 2012 and December 2014 among fishing cohort (FC) and in an adjacent rural general population cohort (GPC).</p> </sec> <sec><st>Methods</st> <p>In the FC, eligible HIV high-risk adults aged 18+ years were enrolled, followed and HIV tested every 3&nbsp;months. Demographic and sexual behaviour data were also collected. The GPC, approximately 47&nbsp;km away from the FC, was followed through annual surveys, and sociodemographic and behavioural data collected. A subset of GPC with comparable risk profiles to the FC was selected. We presented sociodemographic and risk profiles and also computed stratified HIV incidence. Cox regression was used to assess factors associated with HIV incidence.</p> </sec> <sec><st>Results</st> <p>Overall HIV incidence was higher in the FC than in the &lsquo;high-risk&rsquo; GPC, 6.04 and 0.56 per 100 person years at risk, respectively, with a rate ratio (RR) of 10.83 (95% CI 6.11 to 19.76). This was higher among those aged 18&ndash;24&nbsp;years, unmarried and those with more than two sex partners in the past year, RR of 15.44, 22.99 and 19.29, respectively. In the FC, factors associated with high incidence in multivariate analysis were duration in the community and unprotected sex. The factors in the GPC were ethnicity, marital status and duration in the community.</p> </sec> <sec><st>Conclusions</st> <p>We have observed a substantial heterogeneity in HIV incidence. The high incidence in fishing communities is contributing greatly to the overall HIV burden in Uganda, and thus urgent combination prevention efforts are needed towards national goal to reduce HIV epidemic.</p> </sec>


Sexualised drug use in people attending sexual health clinics in England
<p>Recent evidence highlights an increase in &lsquo;chemsex&rsquo;, the use of recreational drugs during sex, in men who have sex with men (MSM) and an association with risky sexual behaviours and outbreaks of STIs.<cross-ref type="bib" refid="R1">1</cross-ref> However, the extent of sexualised drug use in people attending sexual health clinics (SHCs) is unknown.</p> <p>STI surveillance in England is performed by Public Health England (PHE) using a disaggregated patient-level dataset of all diagnoses and services at SHCs.<cross-ref type="bib" refid="R2">2</cross-ref> This is a minimum dataset with key demographic and clinical variables, but lacks behavioural data. To address this gap, PHE piloted a surveillance enhancement to collect behavioural data, including sexualised drug use (an affirmative response to "were you under the influence of recreational drugs (before or during sex) with any partner in the last 3&nbsp;months?"). A pilot in six SHCs throughout England took place from August 2013 to April 2014; at each clinic,...


Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys
<sec><st>Objective</st> <p>To examine sociodemographic and behavioural differences between men who have sex with men (MSM) participating in recent UK convenience surveys and a national probability sample survey.</p> </sec> <sec><st>Methods</st> <p>We compared 148 MSM aged 18&ndash;64&nbsp;years interviewed for Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) undertaken in 2010&ndash;2012, with men in the same age range participating in contemporaneous convenience surveys of MSM: 15&nbsp;500 British resident men in the European MSM Internet Survey (EMIS); 797 in the London Gay Men's Sexual Health Survey; and 1234 in Scotland's Gay Men's Sexual Health Survey. Analyses compared men reporting at least one male sexual partner (past year) on similarly worded questions and multivariable analyses accounted for sociodemographic differences between the surveys.</p> </sec> <sec><st>Results</st> <p>MSM in convenience surveys were younger and better educated than MSM in Natsal-3, and a larger proportion identified as gay (85%&ndash;95% vs 62%). Partner numbers were higher and same-sex anal sex more common in convenience surveys. Unprotected anal intercourse was more commonly reported in EMIS. Compared with Natsal-3, MSM in convenience surveys were more likely to report gonorrhoea diagnoses and HIV testing (both past year). Differences between the samples were reduced when restricting analysis to gay-identifying MSM.</p> </sec> <sec><st>Conclusions</st> <p>National probability surveys better reflect the population of MSM but are limited by their smaller samples of MSM. Convenience surveys recruit larger samples of MSM but tend to over-represent MSM identifying as gay and reporting more sexual risk behaviours. Because both sampling strategies have strengths and weaknesses, methods are needed to triangulate data from probability and convenience surveys.</p> </sec>


A 'test and treat prevention strategy in Australia requires innovative HIV testing models: a cohort study of repeat testing among 'high-risk men who have sex with men
<sec><st>Objectives</st> <p>HIV diagnoses among men who have sex with men (MSM) in several high-income countries, including Australia, have increased substantially over recent years. Australia, in line with global prevention strategies, has emphasised a &lsquo;test and treat&rsquo; HIV prevention strategy which relies on timely detection of HIV through frequent testing by those at risk. We examined trends in repeat testing among MSM defined as &lsquo;high-risk&rsquo; according to Australian testing guidelines.</p> </sec> <sec><st>Methods</st> <p>HIV test records from MSM attending high caseload clinics in Melbourne 2007&ndash;2013 and classified as high-risk were analysed. Binary outcomes of &lsquo;test within 3&nbsp;months&rsquo; and &lsquo;test within 6&nbsp;months&rsquo; were assigned to tests within individuals&rsquo; panel of records. Negative binomial regressions assessed trends in overall HIV testing and returning within 3 and 6&nbsp;months. Annualised proportions of return tests (2007&ndash;2012) were compared using two-sample z tests.</p> </sec> <sec><st>Results</st> <p>Across 18&nbsp;538 tests among 7117 high-risk MSM attending primary care clinics in Melbourne (2007&ndash;2013), the number of annual HIV tests increased (p&lt;0.01). Between 2007 and 2012 annualised proportions of tests with a subsequent test within 3 and 6&nbsp;months also increased (p&lt;0.01); however, by 2012 only 36.4% and 15.1% of tests were followed by another test inside 6 and 3&nbsp;months, respectively.</p> </sec> <sec><st>Conclusions</st> <p>Repeat testing among high-risk MSM in Australia remains unacceptably low, with recent modest increases in testing unlikely to deliver meaningful prevention impact. Removing known barriers to HIV testing is needed to maximise the potential benefit of test and treat-based HIV prevention.</p> </sec>


Comparison of urine samples and penile swabs for detection of human papillomavirus in HIV-negative Dutch men
<sec><st>Objectives</st> <p>Penile swab sampling is the method of choice when testing for human papillomavirus (HPV) in men. Urine sampling is already used in routine sexually transmitted infections (STI) diagnostics and could provide a less invasive sampling method in men to detect HPV. Therefore we compared detection of HPV types in urine samples and penile swabs by the highly sensitive SPF<SUB>10</SUB>-LiPA<SUB>25</SUB> system.</p> </sec> <sec><st>Methods</st> <p>First void urine and self-obtained penile swab samples were collected from 120 men, with a mean age of 29.4&nbsp;years, visiting a STI clinic in South Limburg, the Netherlands. In total 111 of 120 men were included in the analysis. Broad-spectrum HPV DNA amplification and mucosal HPV genotyping were performed using the SPF<SUB>10</SUB> DEIA-LiPA<SUB>25</SUB> system (SPF<SUB>10</SUB> HPV LiPA, V.1).</p> </sec> <sec><st>Results</st> <p>In total 75 (68%) men were positive for HPV in the combined analysis. Sixty-six (59%) paired samples were concordant in being positive or negative. In 39% of the men HPV DNA was detected only in the penile swab. In 2% of the men HPV DNA was detected only in the urine sample. Considering penile swabs as the gold standard, a sensitivity of 41% (95% CI 30% to 53%) and a specificity of 95% (95% CI 81% to 99%) was found. In 6 (5%) urines high risk types were repeatedly found that were not detected in the matching swab.</p> </sec> <sec><st>Conclusions</st> <p>Urine samples are not comparable to penile swabs in the detection of HPV in men. However, the addition of urine samples to penile swabs could be of use in epidemiological or clearance studies.</p> </sec>


Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation
<sec><st>Background</st> <p>An estimated one in eight men who have sex with men (MSM) in London lives with HIV, of which 16% are undiagnosed. It is a public health priority to minimise time spent undiagnosed and reduce morbidity, mortality and onward HIV transmission. &lsquo;Dean Street at Home&rsquo; provided an online HIV risk self-assessment and postal home HIV sampling service aimed at hard-to-reach, high-risk MSM.</p> </sec> <sec><st>Objectives</st> <p>This 2-year service evaluation aims to determine the HIV risk behaviour of users, the uptake of offer of home sampling and the acceptability of the service.</p> </sec> <sec><st>Methods</st> <p>Users were invited to assess their HIV risk anonymously through messages or promotional banners on several gay social networking websites. Regardless of risk, they were offered a free postal HIV oral fluid or blood self-sampling kit. Reactive results were confirmed in clinic. A user survey was sent to first year respondents.</p> </sec> <sec><st>Results</st> <p>17&nbsp;361 respondents completed the risk self-assessment. Of these, half had an &lsquo;identifiable risk&rsquo; for HIV and a third was previously untested. 5696 test kits were returned. 121 individuals had a reactive sample; 82 (1.4% of returned samples) confirmed as new HIV diagnoses linked to care; 14 (0.25%) already knew their diagnosis; and 14 (0.25%) were false reactives. The median age at diagnosis was 38; median CD4 505 cells/&micro;L and 20% were recent infections. 61/82 (78%) were confirmed on treatment at the time of writing. The post-test email survey revealed a high service acceptability rate.</p> </sec> <sec><st>Conclusions</st> <p>The service was the first of its kind in the UK. This evaluation provides evidence to inform the potential roll-out of further online strategies to enhance community HIV testing.</p> </sec>


Knowledge of human papillomavirus and the human papillomavirus vaccine in European adolescents: a systematic review
<sec><st>Background</st> <p>The human papillomavirus (HPV) vaccine is recommended for adolescent girls in many European countries, however there is huge variation in vaccine uptake.</p> </sec> <sec><st>Methods</st> <p>A mixed methods systematic review to ascertain the level of HPV and HPV vaccine knowledge that exists among European adolescents. Two electronic databases, Ovid Medline and PsychInfo, were searched from origin to September 2014. Meta-analysis was performed for the two primary outcome measures (&lsquo;have you heard of HPV?&rsquo; and &lsquo;have you heard of the HPV vaccine?&rsquo;), assessing for the correlation between gender and knowledge. This was supplemented with meta-synthesis for the remaining associations and secondary outcomes.</p> </sec> <sec><st>Results</st> <p>18 papers were included in the final review. Overall European adolescents had poor understanding of basic HPV and HPV vaccine knowledge. Meta-analysis identified that female adolescents are more likely to have heard of HPV (n=2598/5028 girls versus n=1033/3464 boys; OR 2.73, 95% CI 1.86&ndash;3.99) and the HPV vaccine (n=1154/2556 girls versus n=392/2074 boys; OR 5.64, 95% CI 2.43&ndash;13.07), compared to males. Age, higher education and a positive vaccination status were also associated with increased awareness. There was limited appreciation of more detailed HPV knowledge and uncertainty existed regarding the level of protection offered by the vaccine and the need for cervical screening post vaccination.</p> </sec> <sec><st>Conclusions</st> <p>The delivery of HPV education to European adolescents needs to be re-evaluated, since at present there appears to be significant deficiencies in their basic knowledge and understanding of the subject. Increasing HPV knowledge will empower adolescents to make informed choices regarding participation with HPV related cancer prevention health strategies.</p> </sec>


Clinical round-up
<sec id="s1"><st>Do men and women differ in their HIV outcomes?</st> <p>Numerous studies have explored gender-related differences in HIV outcomes, and a meta-analysis of heroic scale (over 100 studies in the final evidence synthesis) recently combined these results.<cross-ref type="bib" refid="R1">1</cross-ref> Their main finding was that men with HIV experience greater mortality (risk ratio (RR) for all-cause mortality 1.23, 95% CI 1.17 to 1.29) and faster disease progression (RR 1.11, 95% CI 1.02 to 1.21) compared to women. The large number of studies in the analysis allowed detailed exploration of factors that may explain the heterogeneity between cohorts. This can explain why a higher mortality in men is not familiar to many clinicians from their daily practice. It appeared that the gender-related difference in risk of death was largely confined to low-income and middle-income countries, patients on antiretroviral therapy (ART), and those younger than 50&nbsp;years old. In high-income countries, patients older...