Sexually Transmitted Infections最新文献

Introduction: This study aims to investigate the epidemiology, clinical manifestations, and diagnostic and management patterns of ocular syphilis in South Korea.

Methods: This retrospective nationwide cohort study analysed health claim data from 2010 to 2019 for individuals aged ≥20 years diagnosed with syphilis, with follow-up through 2021. Age- and sex-adjusted incidence and prevalence rates were calculated for ocular conditions including anterior uveitis, posterior uveitis, panuveitis and optic neuritis. Diagnostic and management trends were evaluated, and multivariate Cox regression analyses assessed the impact of demographic factors and comorbidities.

Results: From 2010 to 2019, the incidence rate of syphilis increased from 99.1 to 136.1 per 100 000. Among the 448 085 syphilis cases, 5118 developed anterior uveitis, 777 posterior uveitis, 551 panuveitis and 80 optic neuritis. While all types of uveitis showed increasing trends, anterior uveitis exhibited the steepest rise from 0.18 per 100 000 in 2010 to 1.40 per 100 000 in 2021. Diagnostic practices for ocular syphilis included 80.4% for dilated fundus examination, 73.7% for fundus photography and 11.0% for fluorescein angiography. Laser photocoagulation and vitrectomy were performed in 5.7% and 4.5% of patients with uveitis, respectively. Multivariate analyses showed that each additional year of age increased the risk for anterior and posterior uveitis by 4% and optic neuritis by 2%. Hypertension, diabetes mellitus and dyslipidaemia increased the risk of one or more ocular syphilis manifestations.

Conclusion: In 2010-2019, the incidence of syphilis in South Korea significantly increased, with rates higher than previous studies. Age, sex and metabolic comorbidities were associated with an increased risk of ocular syphilis. These results indicate the need for vigilance in screening for ocular syphilis, and the importance of comprehensive eye examinations in patients with syphilis.

Objectives: Sub-Saharan African immigrants are particularly affected by HIV in France, with many acquiring the infection after migration due to precarious circumstances that increase their vulnerability. This study aimed to explore the association between HIV risk perception, knowledge of biomedical HIV prevention methods and sexual behaviours among sub-Saharan African immigrants living in precarious conditions in the greater Paris area.

Methods: This cross-sectional study analysed data from 614 participants in the MAKASI project, conducted in the greater Paris area (2019-2020). Sociodemographic characteristics, living conditions, knowledge of biomedical HIV prevention methods (postexposure prophylaxis, treatment as prevention and pre-exposure prophylaxis (PrEP)) and sexual behaviours were described by sex using Pearson's χ² tests. HIV risk perception, defined as self-reported exposure to HIV comparable to or greater than the general population, was analysed by participant characteristics. A multivariable logistic regression model identified factors associated with HIV risk perception using variables with a significance threshold of 20%.

Results: Most participants (76.5%) were men, with a median age of 34 years (IQR: 29-41) and living in precarious conditions. Forty-one per cent of respondents reported perceiving their HIV exposure risk as comparable to or greater than the general population. Participants aware of PrEP (adjusted OR (aOR) =2.60 (1.17-5.80); p<0.020) and those who had sex with occasional partners without a condom within in the 3 months preceding the survey (aOR=1.89 (1.12-3.18); p<0.017) were more likely to report the same or greater risk of HIV exposure.

Conclusions: Our findings reveal that PrEP knowledge and sex with occasional partners, particularly participants who did not use condoms, are associated with increased HIV risk perception among sub-Saharan African immigrants. Further research should explore the relationship between PrEP uptake and HIV risk perception in this population.

Trial registration number: NCT04468724.

Objective: British guidelines advise treatment of Mycoplasma genitalium (Mgen) infection using the results of macrolide resistance-associated mutation (MRAM) assays. Limited data informs management when patients fail MRAM-guided treatment. This study evaluates current management strategies employed for cases of Mgen infection with MRAM-guided treatment failure.

Design: This retrospective analysis reviewed laboratory and clinical data pertaining to all positive Mgen results between 28 May 2020 and 05 November 2022 across three London sexual health clinics. Treatment failure was defined as microbiological or clinical failure, despite appropriate MRAM-guided treatment with full compliance and no re-infection risk. Where MRAM status was unable to be determined, samples were excluded.

Results: 340 samples were included from mostly male (74.4%) patients with a mean age of 30 years. The majority of tests were sent for urethritis (63.8%), and most infections were present without concurrent STIs (83.5%). 183 (53.8%) samples were MRAM positive; 157 (46.1%) were wild type. 152/183 (83.1%) received MRAM-guided treatment. 49/152 (32.2%) cases of MRAM-guided treatment failure were identified. 32/49 (65.3%) achieved either microbiological or clinical cure through a variety of treatment regimens. 66.6% of nine patients who received pristinamycin achieved microbiological cure; two patients were cured by minocycline. Many patients received multiple courses of moxifloxacin despite previous failures.

Conclusion: Whilst high compliance with recommended MRAM-guided therapy was identified, there were also high rates of quinolone therapy failure (32.2%). Barriers to appropriate treatment include a lack of quinolone resistance assays and the non-availability of sitafloxacin in Europe, along with the limited availability of pristinamycin and minocycline in the UK during the study dates. We recommend developing a standardised management pathway for treatment resistant cases.

Objectives: Migration is associated with increased risk of HIV infection in Africa, but evidence about non-HIV sexually transmitted infection (STI) burden among African migrants is limited.

Methods: We used data from the Sexually Transmitted Infection Prevalence Study, a cross-sectional population-based study of chlamydia, gonorrhoea, trichomoniasis, syphilis and herpes simplex virus type 2 prevalence in southern Uganda, to compare STI prevalence between adults aged 18 and 49 years with and without a recent history of migration. Migration status was determined using household census data, with a recent migration history defined as having moved into one's community of current residence within the last ~18 months. Unadjusted and adjusted modified Poisson regression models were used to compare individual STI prevalence risk by recent migration status with associations reported as adjusted prevalence risk ratios (adjPRRs) with 95% CIs. Adjusted models included participants' sex, age, community type, education, occupation and marital status.

Results: Among 1825 participants, 358 (19.6%) had a recent migration history. Overall, migrants exhibited a significantly higher combined prevalence of curable STIs (gonorrhoea, chlamydia, high-titre syphilis (rapid plasma regain ≥1:8) and trichomoniasis) as compared with long-term residents (34.4% vs 24.2%; adjPRR=1.23; 95% CI 1.03 to 1.47). Significant differences in curable STI prevalence by migration status were concentrated among persons living with HIV (49.4% prevalence in migrants vs 32.6% in long-term residents; adjPRR=1.42; 95% CI 1.10 to 1.85) and among women (38.8% in migrants vs 27.8% in long-term residents; adjPRR=1.26; 95% CI 1.01 to 1.58). High-titre syphilis prevalence was especially elevated among male migrants (11.2% in migrants vs 4.9% in long-term residents; adjPRR=1.82; 95% CI 1.06 to 3.13).

Conclusions: The prevalence of non-HIV STIs is higher among migrants. Tailored outreach and service delivery approaches that address the needs of mobile populations are crucial for integrated HIV and STI epidemic control in Uganda to optimise resources and reduce transmission risks.

Introduction: Nigeria has the fastest-growing HIV epidemic in West and Central Africa and key populations (KPs) bear a higher burden of HIV. This integrated biological and behavioural surveillance survey was conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) populations to understand the changing dynamics of HIV to improve HIV prevention efforts in Nigeria.

Methods: Using a cross-sectional design, data were collected between October and November 2020 in 12 states, from randomly selected KP members using multistage probability sampling. Behavioural data were collected using a structured questionnaire followed by three rapid HIV tests. The study was approved by ethical review boards in Nigeria and Canada and all ethical considerations including maintaining the privacy and confidentiality of all study subjects were followed.

Results: A total number of 17 975 KP members were interviewed, with a response rate of over 98.0%. A weighted HIV prevalence of 28.8% (95% CI 27.4% to 30.2%), 25.0% (95% CI 23.7% to 26.3%), 15.5% (95% CI 14.3% to 16.4%) and 10.9% (95% CI 9.9% to 11.8%) was found among TGs, MSMs, FSWs and PWIDs respectively. A high number of sex partners and consistent condom use were low for all types of KPs, especially with regular partners. Both MSM and TGs reported high rates of unprotected receptive anal intercourse ranging between 71.2% and 85.0%. Nearly 60.0% of PWID shared their used syringe with another PWID. Overall, 90.2% FSWs, 77.2% MSM, 81.9% TGs and 84.3% PWID were ever tested for HIV.

Conclusion: This study highlights the progressing trends of HIV prevalence among all KPs in Nigeria. A focused prevention approach is needed to control the emerging epidemic among KPs who constitute the epicentre of the HIV epidemic in Nigeria.

Objectives: Scabies infestation, caused by the Sarcoptes scabiei mite, has recently emerged as a public health concern in Western nations, with increased incidence worldwide. In Bologna, Italy, local health authorities report a rise in scabies diagnoses, although detailed data are limited. This study aimed to analyse the temporal trends of scabies cases diagnosed at S. Orsola Hospital's Dermatological Emergency Department, focusing on significant changes in incidence and seasonal variation over time.

Methods: A retrospective observational study was conducted using data from October 2013 to September 2024, extracted from hospital records using ICD-9 (International Classification of Diseases, Ninth Revision) codes. Variables included monthly case counts, discharge date, patient age and nationality. All pruritic cases from the emergency department were evaluated in the dermatology unit, with diagnosis confirmed via dermoscopic or microscopic examination. Only first visits were included, excluding follow-up visits or post-therapy controls to avoid duplication. Monthly cases were aggregated to identify annual and seasonal trends. χ² tests assessed nationality distribution differences, and linear regression analysed annual trends. Seasonal variation was evaluated with the Kruskal-Wallis test.

Results: A total of 1192 cases were diagnosed. The nationality distribution remained stable, with no significant differences between Italian-born and other nationalities. A significant upward trend in incidence was observed in recent years, with seasonal variation showing higher case counts in February, March and April, and the lowest in July and August.

Conclusions: The increase in scabies cases in recent years and distinct seasonal peaks suggests that environmental and social factors may contribute to transmission in Bologna. Without demographic changes and known drug resistance, factors such as the rise in tourism and suboptimal accommodation conditions may play a role in transmission. Enhanced public health monitoring, awareness and targeted interventions are recommended to manage this trend effectively.

Objectives: This systematic review aimed to identify the efficacy, adherence, safety and impact on antimicrobial resistance of postexposure prophylaxis with doxycycline (Doxy-PEP) in different populations.

Methods: We searched MEDLINE (via PubMed), Embase and Cochrane CENTRAL databases from inception to 29 May 2024. Two reviewers independently screened the studies and extracted data. We included randomised clinical trials that evaluated the efficacy of Doxy-PEP within 72 hours after condomless sex. A random-effects meta-analysis was conducted to compare the risk of bacterial sexually transmitted infections (STIs) between Doxy-PEP and no prophylaxis. The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported.

Conclusion: Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. This strategy seems promising for some high-risk groups; however, there is still a lack of information on the induction of bacterial resistance and long-term adverse events.

Prospero registration number: CRD42023454123.

Objectives: We aimed to assess the awareness, willingness to use and use of doxycycline post-exposure prophylaxis (doxyPEP) among men who have sex with men (MSM) and transgender women (TGW) in Belgium. Additionally, we aimed to identify factors associated with doxyPEP use and concerns regarding antimicrobial resistance (AMR).

Methods: Cross-sectional online survey among MSM and TGW in Belgium in April 2024. Participants were recruited through sexual networking applications and social media of community-based organisations. Numerical variables were compared with Wilcoxon rank-sum test and categorical variables with χ² or Fisher's exact tests. Factors associated with doxyPEP use were assessed using logistic regression. Willingness to use doxyPEP and concerns about side effects/AMR were assessed before and after presenting a brief paragraph on the potential effects of doxyPEP on AMR.

Results: 875 individuals initiated the survey. Almost all identified as men (860/875, 98.3%) with a median age of 40 years (IQR 32-48), 40.4% (n=352/875) had heard of doxyPEP and 9.4% (n=82/875) had used it, among whom the majority used it within the previous 6 months (70/81, 86.4%). In multivariable logistic regression, doxyPEP use was associated with reporting ≥1 sexually transmitted infection (STI) in the previous 12 months, engagement in chemsex, HIV status and pre-exposure prophylaxis use, and education level.About 80% of the participants initially reported being willing to use doxyPEP, and about 50% reported being concerned about side effects. After reading about the potential effects of doxyPEP on AMR, willingness to use decreased to 60% and concerns of side effects/AMR increased to around 70%.

Conclusions: Approximately 1 in 10 MSM in Belgium reported using doxyPEP. A recent history of STIs and STI risk factors were positively associated with doxyPEP use. Importantly, concerns about AMR and side effect influenced willingness to use doxyPEP. If doxyPEP is introduced, informing patients about doxyPEP benefits and risks is crucial to enable informed decision-making.

Objectives: Partner notification (PN) is a key component of sexually transmitted infection control. British Association for Sexual Health and HIV guidelines now recommend partner-centred PN outcomes using a five-category partner classification (established, new, occasional, one-off, sex worker). We evaluated the reporting of partner-centred PN outcomes in two contrasting UK sexual health services.

Methods: Using the electronic patient records of 40 patients with a positive gonorrhoea test and 180 patients with a positive chlamydia test, we extracted PN outcomes for the five most recent sexual contacts within the appropriate lookback period.

Results: 180 patients with chlamydia reported 262 partners: 220 were contactable (103 established, 9 new, 43 occasional, 52 one-off, 13 unknown/unrecorded). 40 patients with gonorrhoea reported 88 partners: 53 were contactable (7 established, 1 new, 14 occasional, 10 one-off and 21 unknown/not recorded). No sex worker partners were reported. Most established partners of people with chlamydia (96/103) or gonorrhoea (7/7) were notified but fewer (60/103 and 6/7, respectively) attended for testing. Of those, 39 had a positive chlamydia test and two had a positive gonorrhoea test. For both chlamydia and gonorrhoea, most occasional and new partners were reported to be notified but there was a sharper decline in those tested. For both infections, one-off partners had the lowest rates of accessing services and testing. For chlamydia, 81% were notified (42/52), 23% accessed services (12/52) and 21% tested (11/52). However, 91% of those tested were positive (10/11). The number of contactable one-off gonorrhoea contacts was small and few attended.

Conclusions: Measuring partner-centred PN outcomes was feasible. There were differences in partner engagement with PN between the different infections and partner types. If these findings are replicated in larger samples, it suggests that interventions to target one-off partners who have low rates of PN engagement yet high levels of positivity could play a key role in reducing infection at population level.