International Journal of STD & AIDS最新文献

Tofacitinib is a Janus kinase 3 (JAK3) inhibitor effective in treating alopecia areata (AA) by promoting hair regrowth. Its mechanism may involve upregulation of vascular endothelial growth factor (VEGF) and reduction of inflammation. However, the range of effects, particularly on hair growth in specific populations, remains under-investigated. We describe a patient with HIV, well-controlled on antiretroviral therapy, who developed hirsutism after starting tofacitinib for AA. This unexpected side effect of hypertrichosis was completely resolved after discontinuing the medication and undergoing a single session of laser hair removal (LHR). This case highlights the potential for unusual hair growth patterns associated with tofacitinib treatment in patients with immune dysregulation. Monitoring and management strategies for such side effects are discussed. This case highlights the potential for unusual hair growth patterns associated with tofacitinib treatment in patients with immune dysregulation. Monitoring and management strategies for such side effects are discussed. The case emphasizes the need for careful monitoring of hair growth and other potential side effects in patients on tofacitinib, especially those with underlying immune-modulating conditions. It also suggests that LHR can be an effective treatment for medication-induced hirsutism.

BackgroundThe management of vulval disorders in Genitourinary Medicine (GUM) clinics requires targeted approaches due to the wide range of conditions affecting the vulva. Vulval diseases encompass various aetiologies, including dermatoses, pain syndromes, and pre-malignant conditions, necessitating specialized care often involving multidisciplinary collaboration.PurposeThis guideline aims to provide evidence-based recommendations for the diagnosis and management of specific vulval conditions that may present in GUM clinics. The focus is on conditions commonly managed by Genitourinary Physicians, either independently or in partnership with other specialists, depending on available local expertise. Additionally, guidance on onward referral is included to ensure optimal patient care.Study SampleThe guideline primarily addresses the management of individuals aged 16 years and older presenting to GUM clinics with non-infective vulval conditions.Data CollectionRecommendations within this guideline are derived from a review of existing literature, clinical expertise, and consensus among specialists. Emphasis is placed on diagnostic tests and treatment regimens tailored to the following conditions: Lichen sclerosus, Lichen planus, Eczema, Lichen simplex, Psoriasis, Vulval high-grade squamous intraepithelial lesions (previously vulval intraepithelial neoplasia), Vulval pain syndromes, and Non-sexually acquired acute genital ulceration (Ulcer of Lipschütz).ConclusionsThis guideline offers practical recommendations for the effective management of specific vulval disorders in GUM settings. It is not intended to be a comprehensive review of all vulval diseases but rather a focused resource to assist clinicians in providing high-quality, patient-centred care. Onward referral pathways are also outlined to support collaborative and multidisciplinary management of complex cases.

BackgroundPregnant women living with HIV are known to be at higher risk of depression than pregnant women without HIV. Accompanied by a systematic literature review, the aim of this study was to determine the global prevalence of depression in pregnant women living with HIV.MethodsPubMed, Scopus, Google Scholar and Web of Science databases were searched. The references of the included publications and a similar meta-analysis study were also reviewed. The 19 included studies were assessed for quality using standard forms. Pooled prevalence was calculated using a random effects model. Heterogeneity and publication bias were assessed using various methods. Subgroup analyses and meta-regression were also performed.ResultsOf the 19 studies included in the review, six of the studies were published between 2008 and 2014, and 13 were published between 2017 and 2023. 15 studies were conducted in African countries. According to study type, eight studies were cross-sectional and seven were cohort studies. The pooled prevalence of depression was calculated to be 45%. The prevalence in African countries was 37.7%. The studies were found to be statistically significantly heterogeneous. Tests and funnel plots showed no publication bias in this meta-analysis. The variables place, study type and scale made the model significant in the meta-regression.ConclusionIn this meta-analysis, 6379 women aged 18 years and older were examined and their depression levels were found to be high. Taking steps to struggle with HIV and depression in people living with HIV seems important.

BackgroundThis study investigates the use of patient portals for disclosing sexually transmitted infection (STI) test result histories to sexual partners among men who have sex with men (MSM) in the United States.MethodsUsing data from the 2022-2023 American Men's Internet Survey, this cross-sectional analysis examined demographic, behavioral, and healthcare-related factors associated with MSM's utilization of patient portals for sharing STI test results. Participants (N = 2601) were surveyed on portal use, STI testing frequency, and partner disclosure practices.Results18% of survey participants used portals to disclose a STI test result to parrtners, with higher prevalences among individuals aged 16-37 years old versus 56 years and older, black non-Hispanic (26.4%) versus white non-Hispanic (16.8%), and those reporting nine or more times being tested for STIs (30.1%) versus 1 to 3 times (7.5%). Participants reporting sex work (33.3% vs 17.7%) and HIV pre-exposure prophylaxis (PrEP) use (24.2% vs 13.0%) also had a higher prevalence of portal use for disclosure. Multivariable Poisson regression analysis with robust error variance showed that sexual behavioral stigma from family and friends [adjusted prevalence ratio (aPR) = 1.11; p = .04] also, being tested for STIs four to 8 (aPR = 2.21; p < .001) and nine or more times aPR = 3.42; p < .001) were significantly associated with prevalence of portal-based disclosure.ConclusionFindings suggest patient portals may be viable tools for STI prevention in MSM communities, especially among individuals with increased vulnerability to STI acquisition. Addressing disparities in portal access and explaining patient portal capabilities may enhance the role of digital health in reducing STI transmission among MSM communities.

Cytomegalovirus (CMV) pneumonia is an uncommon presentation of CMV among patients with HIV/AIDS, particularly in co-infection with Pneumocystis jirovecii pneumonia (PCP). A case was reported with a literature review, and a comprehensive literature search was performed using the PubMed/MEDLINE and Scopus databases. We report a 52-year-old male with AIDS presenting with progressively worsening dyspnea over 1 week. One month earlier, he had completed a 21-day course of PCP treatment, showed improvement and was discharged. Two weeks before presentation, he started antiretroviral therapy (ART), but his dyspnea worsened significantly 1 week later. Chest radiography showed bilateral ground glass opacities. Bronchoscopy and lung biopsy revealed nuclear enlargement with prominent intranuclear inclusions and marginated chromatin of alveolar cells on H&E staining, along with positive immunohistochemistry for CMV. Grocott's methenamine silver staining identified 3-5 μm irregular yeast-like organisms resembling crushed ping-pong balls, consistent with P. jirovecii. He was treated with intravenous ganciclovir for a total of 21 days, and his clinical and radiologic findings completely resolved. CMV pneumonia co-infection with PCP is extremely rare and should be considered among patients with severely immunocompromise with interstitial pneumonitis unresponsive to PCP treatment or recurring after treatment.

BackgroundDespite mounting evidence showing that kissing (tongue-kissing) may transmit gonorrhoea between men who have sex with men (MSM), little data exists on factors influencing the duration of kissing while they are above and/or lying underneath a partner for this population group.MethodsBetween May 2019 and March 2020, we invited MSM aged ≥18 years who attended the Melbourne Sexual Health Centre (MSHC) to participate in a survey about the duration of their kissing (minutes) and intimate position while kissing (i.e., kissing while above, or while lying underneath) their most recent partner. Univariable and multivariable negative binomial regressions were performed to examine the associations between the duration of kissing in different intimate positions, and demographic and behavioural characteristics (including age, region of birth, HIV status or PrEP use, and role in anal sex).ResultsOf the 965 men with a recent male kissing partner, 89.0% (n = 859) also had sex with that partner. Of the 166 men with a recent female kissing partner, 71.7% (n = 119) also had sex with that partner. Our adjusted analyses showed that, on average, men born in Asia (mean 8.52 vs 11.69 min, p < .001) and South America or the Caribbean (mean 8.61 vs 11.69 min, p = .022) spent less time kissing compared to men born in Oceania, and the same was also observed for kissing while above or lying underneath. Men who had only receptive anal sex spent less time kissing while above than those who only had insertive anal sex (mean 3.04 vs 5.86 min, p < .001).ConclusionOur study is the first to examine factors that influence duration of kissing in different intimate positions. These factors could be associated with oropharyngeal gonorrhoea if saliva transmitted gonorrhoea and if gravity played a role.

BackgroundMycoplasma genitalium (MG) is responsible for non-gonococcal urethritis. Our aim is to describe MG positivity rate and incidence in specific populations.MethodsRetrospective, surveillance study included all samples collected from 2018 to 2022. All samples were tested with Anyplex II STI7 (Seegene). Incidence rate (IR) was calculated, incidence rate ratios (IRRs) were assessed using Poisson regression model.ResultsThe study included 13,504 samples belonging to 7,692 individuals. Overall positivity rate was 2.9% (95%CI 2.6-3.2). Subgroups showed significant differences: 13.6% in PrEP users, 5.2% in STI clinic, 4.6% in people living with HIV (PLWH), 1.2% in Gynecology/Obstetrics Department, 0.5% in Fertility clinic, and 0.5% in the "Other" group (p < .001). A significant increasing temporal trend was registered for PLWH. Over a cumulative follow up of 2,554 years, 293 incident infections were registered with an IR of 11.5 per 100PYFU. Departments showed diverse IRs: 7.9 per 100PYFU for PLWH, 30.1 per 100PYFU for PrEP users, 22.7 per 100PYFU for STI clinic. Poisson regression model found a significant increase in incident rates over time in the overall study population driven by PLWH and PrEP users.ConclusionsMG is uncommon in the general population with stable trends, while PLWH and PrEP users exhibit increasing positivity rate and incidence.