Posts Tagged ‘STD’

A routine investigation by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) identified a nonpregnant woman in her twenties who reported she had engaged in a single event of condomless vaginal intercourse with a male partner the day she returned to NYC (day 0) from travel to an area with ongoing Zika virus transmission. She had headache and abdominal cramping while in the airport awaiting return to NYC. The following day (day 1) she developed fever, fatigue, a maculopapular rash, myalgia, arthralgia, back pain, swelling of the extremities, and numbness and tingling in her hands and feet. In addition, on day 1, the woman began menses that she described as heavier than usual. On day 3 she visited her primary care provider who obtained blood and urine specimens. Zika virus RNA was detected in both serum and urine by real-time reverse transcription–polymerase chain reaction (rRT-PCR) performed at the DOHMH Public Health Laboratory using a test based on an assay developed at CDC (1). The results of serum testing for anti-Zika virus immunoglobulin M (IgM) antibody performed by the New York State Department of Health Wadsworth Center laboratory was negative using the CDC Zika IgM antibody capture enzyme-linked immunosorbent assay (Zika MAC-ELISA) (2).

Seven days after sexual intercourse (day 6), the woman’s male partner, also in his twenties, developed fever, a maculopapular rash, joint pain, and conjunctivitis. On day 9, three days after the onset of his symptoms, the man sought care from the same primary care provider who had diagnosed Zika virus infection in his female partner. The provider suspected sexual transmission of Zika virus and contacted DOHMH to seek testing for the male partner. That same day, day 9, urine and serum specimens were collected from the man. Zika virus RNA was detected in urine but not serum by rRT-PCR testing at the DOHMH Public Health Laboratory. Zika virus IgM antibodies were not detectable by the CDC Zika MAC-ELISA assay performed at the New York State Department of Health Wadsworth Center. The CDC Arbovirus Disease Branch confirmed all rRT-PCR results for urine and serum specimens from both partners.

During an interview with DOHMH on day 17, the man confirmed that he had not traveled outside the United States during the year before his illness. He also confirmed a single encounter of condomless vaginal intercourse with his female partner (the patient) after her return to NYC and reported that he did not engage in oral or anal intercourse with her. The man reported that he noticed no blood on his uncircumcised penis immediately after intercourse that could have been associated either with vaginal bleeding or with any open lesions on his genitals. He also reported that he did not have any other recent sexual partners or receive a mosquito bite within the week preceding his illness.

Independent follow-up interviews with the woman and man corroborated the exposure and illness history. The patients were consistent in describing illness onset, symptoms, sexual history, and the woman’s travel. This information also was consistent with the initial report from the primary care provider.

The timing and sequence of events support female-to-male Zika virus transmission through condomless vaginal intercourse. The woman likely was viremic at the time of sexual intercourse because her serum, collected 3 days later, had evidence of Zika virus RNA by rRT-PCR. Virus present in either vaginal fluids or menstrual blood might have been transmitted during exposure to her male partner’s urethral mucosa or undetected abrasions on his penis. Recent reports document detection of Zika virus in the female genital tract, including vaginal fluid. A study on nonhuman primates found Zika virus RNA detected in the vaginal fluid of three nonpregnant females up to 7 days after subcutaneous inoculation (3), and Zika virus RNA was detected in specimens from a woman’s cervical mucous, genital swab, and endocervical swab collected 3 days after illness onset, using an unspecified RT-PCR test (4). Further studies are needed to determine the characteristics of Zika virus shedding in the genital tract and vaginal fluid of humans.

This case represents the first reported occurrence of female-to-male sexual transmission of Zika virus. Current guidance to prevent sexual transmission of Zika virus is based on the assumption that transmission occurs from a male partner to a receptive partner (5,6). Ongoing surveillance is needed to determine the risk for transmission of Zika virus infection from a female to her sexual partners. Providers should report to their local or state health department any patients with illnesses compatible with Zika virus disease who do not have a history of travel to an area with ongoing Zika virus transmission, but who had a sexual exposure to a partner who did travel.

Persons who want to reduce the risk for sexual transmission of Zika virus should abstain from sex or correctly and consistently use condoms for vaginal, anal, and oral sex, as recommended in the current CDC guidance (5). Guidance on prevention of sexual transmission of Zika virus, including other methods of barrier protection, will be updated as additional information becomes available (http://www.cdc.gov/zika).

Corresponding author: Sally Slavinski, sslavins@health.nyc.gov, 347-396-2672.

References
1.Lanciotti RS, Kosoy OL, Laven JJ, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14:1232–9. CrossRef PubMed
2.CDC. Zika MAC-ELISA: instructions for use. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM488044.pdf
3.Dudley DM, Aliota MT, Mohr EL, et al. A rhesus macaque model of Asian-lineage Zika virus infection. Nat Commun 2016;7:12204. CrossRef PubMed
4.Prisant N, Bujan L, Benichou H, et al. Zika virus in the female genital tract [Letter]. Lancet Infect Dis 2016. E-pub July 11, 20162016. CrossRef
5.Oster AM, Russell K, Stryker JE, et al. Update: interim guidance for prevention of sexual transmission of Zika virus—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:323–5. CrossRef PubMed
6.Hills SL, Russell K, Hennessey M, et al. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission—continental United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:215–6. CrossRef PubMed

Davidson A, Slavinski S, Komoto K, Rakeman J, Weiss D. Suspected Female-to-Male Sexual Transmission of Zika Virus — New York City, 2016. MMWR Morb Mortal Wkly Rep. ePub: 15 July 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm6528e2


Marta Orellana was experimented on when she was nine. Photograph: Rory Carroll/Guardian

Lawsuit with 800 plaintiffs seeks damages for individuals, spouses and children of people deliberately infected with STDs through US government program.

Nearly 800 plaintiffs have launched a billion-dollar lawsuit against Johns Hopkins University over its alleged role in the deliberate infection of hundreds of vulnerable Guatemalans with sexually transmitted diseases, including syphilis and gonorrhea, during a medical experiment program in the 1940s and 1950s.

The lawsuit, which also names the philanthropic Rockefeller Foundation, alleges that both institutions helped “design, support, encourage and finance” the experiments by employing scientists and physicians involved in the tests, which were designed to ascertain if penicillin could prevent the diseases.

Researchers at Johns Hopkins School of Medicine held “substantial influence” over the commissioning of the research program by dominating panels that approved federal funding for the research, the suit claims.

The lawsuit asserts that a researcher paid by the Rockefeller Foundation was assigned to the experiments, which he travelled to inspect on at least six occasions.

The suit also claims that predecessor companies of the pharmaceutical giant Bristol-Myers Squibb supplied penicillin for use in the experiments, which they knew to be both secretive and non-consensual.

The experiments, which occurred between 1945 and 1956, were kept secret until they were discovered in 2010 by a college professor, Susan Reverby. The program published no findings and did not inform Guatemalans who were infected of the consequences of their participation, nor did it provide them with follow up medical care or inform them of ways to prevent the infections spreading, the lawsuit states.

Orphans, prisoners and mental health patients were deliberately infected in the experiments.

The plaintiffs’ case quotes the correspondence from one of the program’s lead researchers who tells another doctor that if it were discovered by “some goody organization” that the program was testing people who were mentally ill it would “raise a lot of smoke”. The manager continues: “I see no reason to say where the work was done and the type of volunteer.”

Baltimore-based attorney for the plaintiffs Paul Bekman told the Guardian that of the 774 claimants, about 60 were direct survivors of the program. Many have died as a result of deliberate infection and others had passed on disease to family members and partners.

“The people who are responsible [for carrying out the research] now are long dead,” said Bekman “But the records are there, and we have detailed documentation that supports the allegations in our complaint.”

Marta Orellana was a nine-year-old orphan when she was included in the experiments. In an interview with the Guardian in 2011 she recalled being forcibly examined by light-complexioned foreigners and a Guatemalan doctor in the orphanage infirmary.

“They never told me what they were doing, never gave me a chance to say no,” Orellana said. “I’ve lived almost my whole life without knowing the truth. May God forgive them.”

Included within the legal claim are graphic descriptions of some of the methods used by the researchers to infect their subjects:

During the experiments, the following occurred:
1.Prostitutes were infected with venereal disease and then provided for sex to subjects for intentional transmission of the disease;
2.Subjects were inoculated by injection of syphilis spirochaetes into the spinal fluid that bathes the brain and spinal cord, under the skin, and on mucous membranes;
3.An emulsion containing syphilis or gonorrhoea was spread under the foreskin of the penis in male subjects;
4.The penis of male subjects was scraped and scarified and then coated with the emulsion containing syphilis or gonorrhea;
5.A woman from the psychiatric hospital was injected with syphilis, developed skin lesions and wasting, and then had gonorrhoeal pus from a male subject injected into both of her eyes and;
6.Children were subjected to blood studies to check for the presence of venereal disease.

The then secretary of state Hillary Clinton apologised for the programme in 2010 after a presidential bioethics commission investigation found the experiments “involved unconscionable basic violations of ethics”.

A federal lawsuit for damages under the Federal Tort Claims Act failed in 2012 after a judge determined the US government cannot be held liable for actions outside the US. Bekman told the Guardian he believed the new lawsuit stood a greater chance of success as it was lodged in the state court of Maryland and against private entities.

Both Johns Hopkins University and the Rockefeller Foundation have vigorously denied any involvement in the experiments.

A spokeswoman for Johns Hopkins School of Medicine said the institute expressed “profound sympathy” for the victims of the experiments and their families, but added: “Johns Hopkins did not initiate, pay for, direct of conduct the study in Guatemala. No nonprofit university or hospital has ever been held liable for a study conducted by the US government.”

The university stated it would “vigorously defend” the lawsuit.

The Rockefeller Foundation issued a detailed response to the claim online, which it described as seeking to “improperly to assign ‘guilt by association’ in the absence of compensation from the United States federal government”.

The statement continued: “In the absence of a connection to the Rockefeller Foundation, the lawsuit attempts to connect the Foundation to the experiments through misleading characterizations of relationships between the Foundation and individuals who were in some way associated with the experiments.”

A spokeswoman for Bristol-Myers Squibb declined to comment.

http://www.theguardian.com/us-news/2015/apr/02/johns-hopkins-lawsuit-deliberate-std-infections-guatemala

Thank to Kebmodee.