Sexually Transmitted Infections最新文献

Objectives: Neisseria gonorrhoeae infection is a global health concern. An affordable and rapid point-of-care test is essential to optimise clinical care and could be used to detect and treat asymptomatic infection. Previously, a novel lateral flow assay for N. gonorrhoeae infection (NG LFA) met WHO test performance requirements in a symptomatic population. This study aimed to determine the performance of the NG LFA for detection of N. gonorrhoeae in people without symptoms.

Methods: In this cross-sectional study, we evaluated a novel N. gonorrhoeae lateral flow assay in urine from 500 asymptomatic men and vaginal swabs from 400 asymptomatic women in South Africa. Individuals visiting four primary healthcare facilities in the Buffalo City district, South Africa were enrolled if they were adults (18-49 years) and did not report any genitourinary symptoms, regardless of the reason for visiting the facility. First-void urine specimens and nurse-collected vaginal swabs were tested onsite with the NG-LFA and compared with the Xpert CT/NG assay. Discordant specimens were further investigated.

Results: Between March and July 2023, we enrolled 500 male and 400 female participants. The median age of male participants was 21 years (range: 18-49 years), and female participants, 32 years (range: 18-49 years). In urine specimens, NG-LFA sensitivity was 80.6% (Wilson 95% CI 63.7 to 90.8) and 81.8% in vaginal swab specimens (65·6-91.4). The specificity was 94.2% in urine specimens (91.8 to 96.0) and 98.1% in vaginal specimens (96.1 to 99.1). All NG-LFA positive/Xpert negative cases were negative for N. gonorrhoeae or other Neisseria species in additional molecular testing.

Conclusions: The NG LFA in vaginal swab specimens met WHO criteria for a screening test in low-resource settings. The NG LFA in male urine specimens met sensitivity criteria but did not meet the criteria for specificity.

Objectives: Sexually transmitted infections (STIs) are common in pregnant women. Effective partner treatment of women with an STI is essential to prevent reinfection. We evaluated the impact of partner notification and treatment based on the occurrence of repeat STIs in pregnant women in South Africa.

Methods: We used data from one of the intervention arms in a randomised clinical trial of STI diagnostic screening strategies in pregnancy. In this cohort, women were tested at their first antenatal care visit (<27 weeks gestational age) using onsite Xpert test assays (Cepheid, Sunnyvale, California, USA) for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Women with a positive STI result received pathogen-directed treatment, partner notification slips, and a test-of-cure visit was scheduled 21-35 days post-treatment. At the test of cure visit, sexual behaviour and partner treatment data were collected, and STI testing was repeated. Cure was defined as a negative result at the test-of-cure visit.

Results: Of 754 women tested, 193 (26%) tested positive for an STI and 183 (95%) received pathogen-directed treatment. A test-of-cure visit was attended by 108/183 (59%) women within the time window. Of those, 19/108 (18%) had a positive repeat STI result. Most women attending the test-of-cure visit (95%; 103/108) reported disclosure of their STI to their partner; however, only 44% (48/108) reported that their partner received treatment. Among those who reported partner treatment, the repeat STI positivity was 4% versus 27% in those with reported untreated partners (risk ratio 0.15 with 95% CI 0.03 to 0.7).

Conclusions: Reported partner treatment reduced the likelihood of a repeat positive test result in pregnant women. Strengthening partner notification and treatment is essential to prevent reinfection.

Background: Zimbabwe's national guidelines for sexually transmitted infection (STI) management recommend that high-risk women presenting with vaginal discharge syndrome (VDS) are prescribed antibiotics for gonorrhoea (Neisseria gonorrhoeae (NG)), chlamydia (Chlamydia trachomatis (CT)), trichomoniasis (Trichomonas vaginalis (TV)) and bacterial vaginosis (BV). The performance of this approach depends on its clinical interpretation and implementation. Here, we investigate the potential relative impact of an NG/CT/TV point-of-care (POC) test on undertreatment, overtreatment and disease burden in the context of different implementations of syndromic management of women with VDS.

Methods: We created an agent-based model with an age- and risk-stratified sexual network and modelled co-circulation of NG, CT and TV along with HIV and BV. We estimated symptomatic proportions and care-seeking rates under three different scenarios around the implementation of treatment guidelines, corresponding to all, most or half of women being treated for NG+CT upon presentation with VDS. For each implementation scenario, we estimated disease burden and over/undertreatment rates assuming continuation of the standard of care with/without a POC NG/CT/TV test available over 2027-2040.

Results: Under a treat-all interpretation of the syndromic management guidelines, we estimate that 70%-80% of antibiotics for NG/CT would currently be given to women without these infections. Overtreatment would fall to less than 5% if a sensitive POC test for NG/CT/TV were available. However, if the implementation of the guidelines implies that only half of women seeking care for VDS are treated, then a POC test would also reduce undertreatment and disease burden, with >500 000 additional women correctly treated for NG and ~1.5 million correctly treated for CT and TV, and 24%/15% reductions in the number of women with NG/CT by 2040.

Conclusion: Improved data on the functioning of syndromic management in practice would help refine the estimates of the health impact and the overall value proposition of a highly sensitive POC diagnostic for NG/CT/TV. However, even without such data, our analysis demonstrates the potential for such a diagnostic to reduce overtreatment by >90% relative to plausible assumptions regarding the standard of care.

HIV infection is 100% fatal; however, antiretroviral therapy prevents illness, death and transmission-delaying access to treatment is a death sentence while also leading to the spread of HIV. More recently, antiretroviral chemoprophylaxis (commonly known as pre-exposure prophylaxis or PrEP) has been shown to prevent HIV infection among individuals at high risk. In 2003, President George W Bush established the President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to address a single disease. Over the last two decades, PEPFAR provided antiretroviral treatment to more than 20 million people, saved over 25 million lives, enabled more than 7 million babies to be born free of HIV and helped cut new HIV infections by half in the most impacted countries. Earlier last year, the US administration drastically cut overseas development funding, severely compromising PEPFAR's ability to deliver life-saving HIV services. UNAIDS modelling shows that if the funding permanently disappears, there could be an additional 6 million HIV infections and an additional 4 million AIDS-related deaths by 2029. We urge the US administration and the G7 leadership to reflect carefully on the likely and grave consequences of dismantling one of the most successful initiatives in the history of global health.

Objectives: The global burden of sexually transmitted infections (STIs) presents a challenge in the context of HIV pre-exposure prophylaxis (PrEP) programmes. We aimed to determine the prevalence and incidence of bacterial STI diagnoses and factors associated with STI incidence among key populations (KPs) initiating PrEP in Indonesia.

Methods: The Indonesia PrEP Pilot Programme (December 2021-December 2023), rolled out in 21 districts in 10 provinces, was a prospective, real-world implementation study providing oral daily or event-driven PrEP to KPs (men who have sex with men (MSM), female sex workers, transgender women and people who inject drugs). Participants at 60 healthcare facilities completed baseline and subsequent 3-monthly follow-up visits.

Results: A total of 4220 individuals were included in the analyses (median age 29 (IQR 25-34); 91% men, 81% MSM and 63% chose daily PrEP). The overall STI prevalence was 12.8%; it increased from baseline (10.3%) through month 12 (27.2%) (p<0.001). Among participants with no STIs at baseline (n=3787), 715 new STI diagnoses occurred over 2475 person-years (PYs); the overall incidence rate (IR) was 28.89/100 PYs (27.11-30.72). The highest IR was observed at month 3 (44.71/100 PYs; 41.53-47.93) and decreased over time. Incidence was significantly higher among MSM (age-adjusted IR ratio (aIRR) 2.31; 1.40-3.79 vs FSW), men (aIRR 1.63; 1.10-2.42 vs women), those who reported condomless sex (aIRR 1.67; 1.35-2.06), and those with more frequent sex (aIRR 1.93; 1.47-2.55). Among individuals with complete follow-up (n=464), 48% never acquired STIs during follow-up. The overall HIV incidence rate was 1.11/100 PYs (0.75-1.57); all infections occurred among non-adherent individuals. There were no associations found between HIV incidence and STI diagnoses (p=0.775).

Conclusions: Among KPs using PrEP in Indonesia, the highest STI IR was observed in the early months of implementation. The findings highlight the importance of offering PrEP users regular testing and effective STI counselling.

Objectives: Increasing ceftriaxone-resistant Neisseria gonorrhoeae is of public health concern. A cluster of ceftriaxone-resistant N. gonorrhoeae was identified in 2022, which was linked to heterosexuals from the Asia-Pacific region who were studying at UK universities. The possibility of further transmission within and beyond this network was of concern, particularly as not all gonococcal cases have a positive culture for antimicrobial susceptibility testing to be performed. We, therefore, undertook a case finding exercise using an N. gonorrhoeae penA real-time PCR to identify undetected transmission of ceftriaxone-resistant strains. The PCR detects penA-60.001, which is the most common gonococcal ceftriaxone-resistance mechanism. The aim of this Gonorrhoea Undetected Resistance Laboratory Study was to estimate the prevalence of undetected ceftriaxone-resistant N. gonorrhoeae in England.

Methods: Sexually transmitted infection surveillance data (2017-2021) was combined with university data on student country of origin to identify sexual health services in English university towns with the highest number of gonorrhoea cases among those of Asian ethnicity born in selected countries of the Asia-Pacific region. Residual N. gonorrhoeae-positive molecular specimens from women (as a proxy for heterosexual behaviour) aged 18-30 years were sent to the UK Health Security Agency (UKHSA) for testing.

Results: Between February 2023 and March 2024, 921 specimens meeting the inclusion criteria were received, of which 661 were reconfirmed as N. gonorrhoeae. Of these, one was positive on the penA PCR, indicating ceftriaxone resistance; this specimen came from a previously identified case, therefore no 'undetected' cases were identified.

Conclusions: This case-finding exercise provided reassurance that ceftriaxone-resistant N. gonorrhoeae in England is currently adequately detected through the existing UKHSA-enhanced surveillance activities. The current penA PCR is a useful tool in the fight to keep gonorrhoea a treatable infection; however, it requires expansion as it does not currently detect all penA alleles responsible for ceftriaxone resistance.

Objective: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most commonly reported sexually transmitted infections globally. Anorectal CT/NG detection among men who have sex with men (MSM) and coinfections is common. Epidemiological studies suggest that CT/NG coinfections might result in greater bacterial load and transmissibility than single infection. The purpose of this study was to compare bacterial load and symptoms between CT/NG single and coinfections in MSM.

Methods: MSM positive for CT or NG on a triple swab (throat, urethra and rectal locations combined) were enrolled. Before treatment, they self-collected anorectal swabs. Bacterial loads for CT/NG were calculated using real-time PCR and compared between single or coinfected individuals, with or without rectal symptoms.

Results: We enrolled 382 MSM from December 2021 to December 2024. Among all samples: total CT (n=114), total NG (n=125), CT/NG coinfection 29/382 (7.6%). The bacterial loads in single and coinfected samples were comparable. The mean difference between CT alone and CT/NG was 0.40 target copies/mL (95% CI (-0.09 to 0.89), p value=0.107). The mean difference for NG alone and CT/NG was 0.24 copies/mL (95% CI (-0.49 to 0.99), p value=0.498). Among 382 MSM, 15.4% (n=59/382) experienced anorectal symptoms. There was no statistical difference in bacterial burdens between symptomatic and asymptomatic (CT difference of the means 0.52 copies/mL, 95% CI (-0.51 to 1.55); p value=0.313) (NG difference of the means 0.63, CI (0.01 to 1.28); p value=0.05).

Conclusions: In contrast to prior research, we found similar bacterial burdens in anorectal MSM samples with single CT/NG versus coinfection. Further research is needed to understand the clinical implications of CT/NG coinfections. Future studies should investigate factors influencing anorectal CT/NG bacterial burden, transmissibility and susceptibility, including the function of pre-exposure prophylaxis and the rectal microbiota.

HIV cases in the Philippines have surged dramatically, with 5101 new diagnoses reported in the first quarter of 2025-a 57% increase from the same period in 2024. Young individuals aged 15 to 34 years are the most affected, with 96% of new infections linked to sexual transmission. Alarmingly, there has also been a 12% rise in advanced HIV cases, reflecting delays in diagnosis and limited access to care. The country remains far from achieving UNAIDS 95-95-95 targets, with only 55% of people diagnosed, 66% on treatment and 40% achieving viral suppression. This letter calls for urgent public health action, including expanded testing, awareness campaigns, improved access to treatment and pre-exposure prophylaxis, and stronger surveillance systems. International collaboration is essential, and support from global health organisations is critical to reversing this trend and preventing wider regional consequences.

Injectable long-acting cabotegravir plus rilpivirine (CAB+RPV LA) is an effective treatment option for people living with HIV. Unlike regimens containing tenofovir with lamivudine (3TC) or emtricitabine (FTC), it lacks therapeutic activity against the hepatitis B virus, and hepatitis B vaccination is recommended for non-immune individuals. We present a case of acute hepatitis B after switching to CAB+RPV LA in a previously vaccinated individual.