International Journal of STD & AIDS最新文献

Angiokeratoma of Fordyce is a benign vascular lesion characterized by the dilation of blood vessels within the papillary dermis, accompanied by epidermal acanthosis and hyperkeratosis. This report presents two clinical cases: a 22-year-old woman with a solitary, prominent nodular lesion on the clitoris and a 26-year-old man with asymptomatic violaceous papules on the glans penis. Both cases underscore the clinical presentation, differential diagnoses, and histopathological findings associated with angiokeratoma. The first case was diagnosed through excisional biopsy, revealing orthohyperkeratosis, parakeratosis, and dilated vascular channels, while the second case was confirmed via punch biopsy. Although angiokeratomas are typically asymptomatic, they may occasionally present with bleeding, highlighting the necessity for clinical vigilance. The rarity of these lesions in the genital region emphasizes the importance of accurate diagnosis and management, as they can mimic more serious conditions, including melanoma.

Urethritis is a frequent lower urinary tract infection often linked to sexually transmitted infections (STIs). While Neisseria gonorrhoeae and Chlamydia trachomatis are the main pathogens, other microorganisms such as Mycoplasma genitalium, Trichomonas vaginalis, and Ureaplasma urealyticum may also be involved. In over half of non-gonococcal urethritis (NGU) cases, no causative agent is identified. We present the case of a 37-year-old man with scrotal pain, painful ejaculation, dysuria, and urethral discharge following a single unprotected sexual encounter. Initial STI PCR was positive for Ureaplasma urealyticum, and azithromycin was prescribed. Symptoms persisted, and a urethral culture revealed Streptococcus urinalis, confirmed by MALDI-TOF MS and 16S rRNA sequencing. Gram staining showed numerous leukocytes and Gram-positive cocci in chains. A second urethral swab yielded the same organism. The isolate was fully susceptible to all tested antibiotics. Although S. urinalis has been described in urinary tract infections and sepsis, to our knowledge, this is the first reported case suggesting a possible role in male urethritis. While prostatitis or epididymitis cannot be ruled out, the repeated isolation of S. urinalis and persistent symptoms support its potential pathogenicity. This case adds to growing evidence implicating S. urinalis in genitourinary tract infections.

BackgroundNew guidelines recommend anal cancer screening for priority populations with increased likelihoods of anal cancer including people with a history of HIV, gynecologic cancers, condyloma acuminata, and solid organ transplantation. However, little is known about U.S.-based screening practices prior to these guidelines.MethodsWe examined outpatient clinical encounters between 01/01/2015 and 08/01/2022 and analyzed provider characteristics and screening behaviors in an urban medical system in Boston, U.S. We used chi-squared tests and logistic regression to identify provider factors associated with anal cancer screening.ResultsOf 1098 providers, 48.5% completed at least one screening, including 93.8% (n = 75/80) of infectious disease (ID) providers, 54.6% (n = 372/681) of primary care providers (PCPs), and 28.3% (n = 41/145) of obstetrician/gynecologists (OBGYNs) (p < 0.001). Annual screening of priority populations was most common among providers trained in high-resolution anoscopy (19.8%-27.9% screened), and less common among ID providers (4.4%-8.7%), PCPs (0.4%-1.4%), and OBGYNs (0.1%-0.8%). In multivariate analysis, providers treating proportionately more cisgender women (adjusted odds ratio [aOR] = 0.988; 95% confidence interval [CI] 0.982-0.995), more non-white patients (aOR = 0.984; 95% CI 0.976-0.992), or fewer people with HIV were less likely to be screeners.ConclusionsMost providers caring for priority populations did not complete anal cancer screenings, and annual screening levels were low across disciplines. Strategies are needed to optimize anal cancer screening practices, particularly for patients who are HIV-negative, non-white, and cisgender women.

BackgroundHIV self-testing (HIVST) was endorsed by WHO in 2016 to expand access to HIV diagnosis, especially for young people. Kenyan youths, including university students, remain vulnerable to HIV, yet uptake of free HIVST kits is inconsistent. This study assessed determinants of HIVST utilization among health sciences undergraduates at the University of Nairobi.MethodsWe conducted a cross-sectional analytical study at the Chiromo and Faculty of Health Sciences campuses. Multi-stage cluster sampling yielded 412 students from Medicine, Pharmacy, Nursing, Dentistry and Medical Laboratory Science. Data on socio-demographics, sexual behaviour, stigma, and institutional access were collected via self-administered questionnaires and analysed in R. Associations were examined using χ²/Fisher's exact tests and Wilcoxon tests; variables with p < .05 entered a multivariable mixed-effects logistic regression model to account for clustering by course and year of study.ResultsOverall, 30.5% reported prior HIVST use. Uptake was higher among older students and those in advanced years. Being in a relationship and consistently using condoms were associated with lower HIVST uptake. Recency of the last HIV test strongly predicted use, with students tested within the preceding 3-6 months more likely to self-test. Residence and gender were not independent predictors after adjustment.ConclusionsHIVST uptake among Kenyan health sciences undergraduates is moderate but uneven. Age, academic seniority and recent HIV testing history increase uptake, whereas perceived low risk (e.g. condom use) reduces it. Universities and the Ministry of Health should pair easy kit access with messaging that encourages routine testing regardless of perceived risk to accelerate progress toward UNAIDS 95-95-95 targets.

Background/ObjectivesTransgender women in Mexico face a high HIV prevalence, yet they remain insufficiently engaged in pre-exposure prophylaxis (PrEP). This study aimed to evaluate willingness to use HIV pre-exposure prophylaxis (PrEP) and its connection to risk behaviors among transgender women in Mexico.MethodsIn 2021, a cross-sectional study was conducted among Mexican transgender women to assess HIV risk factors and willingness to use PrEP. We used Latent Class Analysis to cluster participants with similar HIV risk behaviors, and multivariable logistic regression to identify covariates of willingness to use PrEP.ResultsAmong 266 transgender women, 40% were aware of PrEP, yet 78% reported willingness to use it after a brief introduction. Only 25% of the participants perceived themselves at high HIV risk. Through Latent Class Analysis, three classes were identified: 1) transactional sex with lower risk (10%); 2) no transactional sex with higher risk (25%); and 3) transactional sex with higher risk (65%), with reported willingness to use PrEP at 61%, 66% and 85%, respectively. In the multivariable model, belonging to class 3 (vs class 1) was associated with higher willingness to use PrEP (aOR:3.3; CI:1.2-9.5).ConclusionsWillingness to use PrEP aligned with HIV risk in those with a higher risk (class 3) and lower risk (class 1), but not in those at higher risk despite not reporting transactional sex (class 2). Therefore, not all who could benefit from PrEP may want it. Strategies are needed to promote PrEP's awareness and willingness to use considering the needs of transgender women subgroups.

BackgroundCervical cancer (CC) is highly prevalent in Nigeria, with over 12,000 cases and 8000 deaths annually. Differences in diagnostic methods for human papillomavirus (HPV) genotypes have generated varied prevalence rates across populations.MethodsWe analyzed the prevalence and distribution of high-risk HPV (HR-HPV) genotypes among women with CC, comparing HIV-negative women and women living with HIV (WLWH), using data from a prospective Nigerian cohort study (2018-2022). High-throughput next-generation sequencing (NGS) of the HPV L-1 gene identified and classified genotypes.ResultsAmong 189 women tested for HR-HPV, 74.1% (140/189) were HIV-negative, and 25.9% (49/189) were WLWH. The median age was lower for WLWH at 48 years [IQR: 41-54] compared to HIV-negative women at 60 years [IQR: 49-69] (p < .001). The overall prevalence of HR-HPV was 64.6% (122/189; 95% CI: 57.4-71.1), with higher rates in WLWH (77.6%, 38/49) than HIV-negative women (60.0%, 84/140) (p < .001). Among HR-HPV-positive cases, HPV16 or HPV18 accounted for the highest proportion, representing 67.2% (95% CI: 58.3-75.0). The most prevalent HR-HPV types detected were HPV16 (46.7%), HPV18 (20.5%), HPV45 (9.8%), HPV35 (6.6%), and HPV52 (5.7%). Quadrivalent and nonavalent HPV vaccines would cover 67.2% (95% CI: 58.3-75.0) and 86.1% of HR-HPV infections, respectively.ConclusionOur NGS approach findings among women with CC identified HPV types not covered by the Gardasil-4 vaccine used in Nigeria. This highlights the need for broader vaccine coverage against most HR-HPV types, regardless of HIV status, in Nigeria.

ObjectiveThis narrative review examines the impact of the United States on the war against HIV/AIDS and thus the impact of political ideologies on the financing of the medical sector.DiscussionInitially marked by stigma, particularly in the early years of the epidemic, the US response was transformed with the launch of the Presidential Emergency Plan for AIDS Relief (PEPFAR) in 2003. PEPFAR has partnered with entities such as the Global Fund and the Joint United Nations Programme on HIV/AIDS (UNAIDS), retranslating global health governance. Despite this success, the global response remains dependent on the support of the United States. Political changes under the leadership of the conservatives have limited funding. Therefore, political polarization in the US is undermining long-term progress on HIV/AIDS prevention and treatment, particularly in low- and middle-income countries.ConclusionBy tracing historical developments and analysing current funding trends, the article highlights the urgent need for sustainable and depoliticized investments in global health systems. Without renewed bipartisan commitment and greater local ownership, the vision of eliminating AIDS as a public health threat by 2030 is seriously threatened.

We describe a case of human herpesvirus-8 (HHV8) associated extracavitary primary effusion lymphoma (PEL) in a 52-year-old man who initially presented with long-term nonproductive cough, fever, night sweats and loss of weight. Initial blood tests were positive for human immunodeficiency virus (HIV) with CD4 + T-lymphocytes count of 42/mm3. Respiratory opportunistic diseases were excluded. Additional investigation with bronchoscopy revealed a bronchial mass that was biopsied. Histology and immunohistochemical tests confirmed extracavitary PEL associated with HHV-8. Antiretroviral treatment and CHOP regimen chemotherapy was initiated with an effective response. Given its rarity and unusual presentation, this clinical case emphasizes the importance of considering PEL, along with other lymphoproliferative disorders, as a differential diagnosis in patients living with HIV with acquired immune deficiency syndrome (AIDS) with a bronchial mass.

BackgroundWe assessed the feasibility of point-of-care testing (POC) for Chlamydia trachomatis (CT) among Men who have Sex with Men (MSM) and Transgender Women (TGW) attending community-based clinics (CBOs) in Thailand.MethodsA secondary analysis using data from a study that enrolled participants aged ≥18 years who were at risk of HIV. They were tested for CT and Neisseria gonorrhoeae (NG) using Cepheid Xpert® POC tests. Behaviors were assessed using a questionnaire. Logistic regression was used to evaluate factors associated with CT infections.ResultsA total of 1885 participants were enrolled between 2019 and 2021, with 89.7% identifying as MSM. Of all participants, 15.9% were living with HIV (PLHIV), 20.6% initiated PrEP, 31.7% were already using it, and 31.8% had never used PrEP.Of all participants, 13.4% and 18.8% tested positive for NG and CT, respectively. CT prevalence was associated with age groups: 34.6% in 18-19 years (AOR 3.2), 24.1% in 20-24 years (AOR 1.7), compared to 14.5% in those ≥25 years. CT prevalence was higher in PLHIV (28.3%) compared to those who were HIV-negative and had never used PrEP (17.0%).ConclusionsAlmost one-fifth of Thai MSM and TGW had CT infection. POC testing is feasible and should be integrated into STI screening.

BackgroundSyphilis can cause significant clinical complications in adults and severe harm to fetuses and newborns through vertical transmission if it remains undiagnosed and untreated. With syphilis being on the rise in many countries, it causes a high and increasing burden of disease worldwide. Due to its high sensitivity and specificity, the TPPA (Treponema pallidum particle agglutination test) is considered the gold standard in serological syphilis diagnostic. However, the production of TPPA by the world's only manufacturer has stopped which has generated major gaps in diagnostic capabilities.MethodsFour polyvalent screening tests from Abbott, Roche, Diasorin and Euroimmun were evaluated on the base of negative, borderline and positive samples to develop an alternative diagnostic procedure of the highest possible quality. Additionally, alternative diagnostic threshold values of the test systems were evaluated for further optimization.ResultsA total of 1768 samples from different patient populations were analyzed. When performed according to the manufacturer's instructions, most tests achieved a high specificity. However, the sensitivity of the screening tests was not fully satisfactory, particularly in the early stages of infection, where sensitivity remained relatively low.ConclusionsBy lowering threshold values, the sensitivity could be significantly increased allowing for some of the evaluated assays to reach a test quality comparable to the TPPA, which is particularly relevant for samples from patients with higher risk of acquiring STIs. Moreover, the results of the polyvalent screening assays could also be used to monitor treatment success and detect possible re-infections.