Sexually Transmitted Infections最新文献

Objectives: Since 2018, Sexual Health London (SHL) has provided remote sexually transmitted infection (STI) testing services to London residents over 16 years of age. SHL was an asymptomatic screening service. In 2020, SHL widened access to non-urgent symptomatic testing. We undertook a 4-year evaluation on the uptake of SHL's online testing pathway and outcomes, including the association of positive chlamydia and gonorrhoea nucleic acid amplification test (NAAT) outcomes with user demographics and user utility.

Methods: This is a retrospective data analysis of routine SHL clinical data from 8 January 2018 to 31 March 2022 of all STI test kit orders, focusing on HIV, chlamydia and gonorrhoea outcomes. Descriptive analysis on uptake of each stage of SHL's clinical care pathway is provided, including HIV testing outcomes. Binary logistic regression was used to examine the association between SHL user-completed online consultation information, SHL uptake and chlamydia and gonorrhoea NAAT results (negative or positive).

Results: During the evaluation period, there were 1 476 187 orders made by 670 293 unique users. The return rate for chlamydia and gonorrhoea NAATs was 79.5% and 67.6% for HIV blood samples. The positivity rate from sufficient samples was 4.5% for chlamydia, 1.6% for gonorrhoea and 0.3% reactivity for HIV. There were increased odds of a positive chlamydia and gonorrhoea NAAT result in non-cisgender women, those with a high number of STI orders, non-UK born and those who collected an STI test kit from a clinic-based service.

Conclusions: To date, this is the largest number of orders in an evaluation of online postal sexual health infection testing in the UK, and highest return rate of samples, suggesting acceptability of SHL for STI testing. Positivity rates for chlamydia and gonorrhoea NAAT tests are lower than national figures, which may reflect asymptomatic screening prior to 2020 and testing of non-urgent symptoms since 2020.

Background: The decision to use a particular test to diagnose patients presenting with symptoms of vaginitis and/or STI is based primarily on the prevailing standards of care in the clinic at which the patient evaluation takes place. As a result, laboratory testing of vaginal samples for these patients often involves either an STI or a vaginitis test, but rarely both options simultaneously, which complicates the diagnosis and management of concurrent infections.

Methods: Using de-identified remnant vaginal specimens from symptomatic patients previously tested for STI (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and Trichomonas vaginalis (TV)) with the Becton Dickinson (BD) CTGCTV2 assay for BD MAX System, positivity for bacterial vaginosis (BV) and Candida spp (associated with vulvovaginal candidiasis (VVC)) were evaluated using the molecular-based BD MAX Vaginal Panel.

Findings: The rate of STI/BV co-infection was 79.4% (227/286) in this symptomatic population, while that of STI/VVC was 27.0% (77/285). Women diagnosed with any one of the three STIs tested had an OR 2.86 (95% CI, 1.99, 4.11; p<0.0001) for a concurrent BV infection and OR 0.96 (95% CI, 0.67, 1.37; p=0.8085) for infection with Candida species.

Conclusion: Our results suggest that women being tested for STI have a high prevalence of co-infection with BV and a lower, although appreciable, prevalence of co-infection with VVC. The detection of co-occurring vaginal infections can be facilitated by molecular testing using a single sample.

Objectives: DREAM-01 was an open label, dose-escalation and variable osmolarity study to identify a tenofovir HIV-prevention douche/enema that could achieve protective colon tissue cell concentrations and high acceptability. To assess impact on sexual enjoyment, iso-osmolar and hypo-osmolar placebo douches were provided for at-home use before receptive anal sex (RAS).

Methods: Eighteen HIV-uninfected men who have RAS were administered three tenofovir douches at the research clinic: Product A, an iso-osmolar dose; Product B, an iso-osmolar escalation dose; and Product C, a hypo-osmolar escalation dose. Following Products A and C, participants were given a saline douche of matching osmolarity to use at home before RAS. Participants reported acceptability via a computer-assisted self-interview and in-depth interview in this mixed-methods study.

Results: All three products were rated acceptable by 17 (95%) of the participants. A majority (94%) would be likely or very likely to use any of the three products before RAS. Of those who used the saline douches before RAS and then rated their sexual enjoyment, most reported that their sexual enjoyment was not affected. Interview data revealed that participants found the product easy to incorporate into their regular routine, but would prefer to use more liquid for cleansing.

Conclusions: These findings indicate that the hypo-osmolar Product C, which also provides the most rapid delivery of tenofovir for HIV prevention, is acceptable for future safety trials and that our sample reports high likelihood of using a rectal microbicide douche for HIV prevention. Our findings support continued pursuit of a tenofovir rectal microbicide douche.

Trial registration number: NCT02750540.

Objectives: Azoles have been the mainstay of recurrent vulvovaginal candidiasis (RVVC) for many years. Because of a recent anecdotal increase in non-Candida albicans yeasts (NCAY) and azole-resistant C. albicans cases, their prevalence was calculated from cultures for yeasts in women with complicated/RVVC over 3 years.

Methods: Retrospective data search of vaginal cultures from adult women in Leeds, UK between April 2018 and March 2021 was conducted. Samples with clinical details of complicated/RVVC had full yeast identification and antifungal susceptibility performed. Differences in prevalence between 12-month periods were determined using χ² tests.

Results: Over the 3 years, cultures were performed on 5461 vaginal samples from women with clinical information indicating they had complicated/RVVC, RVVC, with 1828 (33.5%) growing yeasts.Over 85% of yeasts each year were C. albicans, however the proportion declined yearly with an increase in NCAY species. Nakaseomyces glabrata was the most frequent NCAY species isolated, increasing from 2.8% in 2018-19 to 6.8% in 2020-21. Total NCAY species increased from 6.0% in 2018-19 to 12.6% in 2020-21. Fluconazole-sensitive dose-dependant (SDD) and resistant isolates increased from 3.5% in 2018-19 to 7.7% in 2019-20 and 9.6% in 2020-21. Most resistance was in C. albicans and the majority of cases were seen in primary care. Most fluconazole non-sensitive isolates were either SDD or resistant to itraconazole (77% and 23%, respectively) and were intermediate or resistant to voriconazole (36.4% and 60%, respectively).

Conclusion: There was a significant increase in the prevalence of NCAY and fluconazole-resistant C. albicans in complicated/RVVC cultures over these 3 years. Successful treatment of such cases can be very challenging. The exact reasons for this increase remain unclear but it follows a policy change that encouraged a clinical diagnosis and empirical treatment of vulvovaginal candidiasis, rather than fungal culture, in primary care.

Objective: To describe the sexual practices and behaviour towards HIV infection among Ecuadorian university students.

Methods: This was a cross-sectional, descriptive study carried out between February 2019 and August 2020 among university students from all over the country. Students aged 18 years and older of each participating institution were contacted by an official email account and invited to fill out a survey through Google Forms.

Results: Data from a total of 5677 sexually active participants were analysed. The majority were female (57.1%), 48.7% corresponded to the age range 18-20 years and nearly half studied in the field of health. Only 28.5% (n=1612) mentioned having ever been tested for HIV at least once. Regarding sexual behaviour, the vast majority reported having only one partner in the last 2 months. Condom use during the 'last' sexual contact was significantly lower in the never tested group (33.5% vs 43.3%, p<0.0001, respectively). Having a higher number of ever or current sexual partners (OR 0.94, 95% CI 0.78 to 1.13) and not using a condom (OR 0.73, 95% CI 0.64 to 0.82) were significantly related to having an HIV test performed. More than half of the participants indicated that they took the HIV test as part of their routine control, and nearly half mentioned not taking it because they felt sure they were free of HIV.

Conclusions: Behaviour towards testing for HIV in university students was related to their risky sexual practices and behaviour. Prevention campaigns focused on the general population as well as at-risk populations, including university students, are needed to curb the escalating incidence of HIV in Ecuador.

Objectives: Although the burden of syphilis is slightly increasing worldwide, there are a limited number of rapid, simple-to-use, accurate and cost-effective diagnostic tools available. Thus, we aimed to determine the diagnostic performance of the Treponema pallidum particle agglutination (TPPA) test (hereafter called index test) against an electrochemiluminescence immunoassay (ECLIA) (hereafter called reference test). We selected the available treponemal reference test (ECLIA) to evaluate the index test (TPPA) which is not currently in use in Ethiopia.

Methods: We conducted a multicentre cross-sectional study to evaluate the diagnostic performance of the index test against the reference test. We enrolled 581 syphilis-suspected cases from the five selected health facilities in Addis Ababa in this study. We collected data on sociodemographic and clinical characteristics and whole blood from each participant. We estimated the sensitivity, specificity and positive and negative predictive values of the index test.

Results: Of the 581 participants, 380 (65.4%) were female. The mean age of the participants was 39.7 years (±SD 16.6), with an age range of 18-94 years. The sensitivity of the index test was 99.4% (95% CI 96.4% to 100%), while the specificity was 100%. The positive predictive value of the index test was 100%, and the negative predictive value was 99.8% (95% CI 98.4% to 100%). There was no invalid test result.

Conclusions: The diagnostic performance of TPPA for syphilis was equivalent to that of ECLIA. Thus, TPPA can be used for the diagnosis of syphilis at the health facility level equivalent to a reference test.

Objectives Men who have sex with men (MSM) are disproportionally affected by HIV in the Netherlands. Partner notification (PN) is an important element in controlling the transmission of sexually transmitted infections (STIs) and HIV. We investigated the effects of improving PN on the transmission of HIV and Neisseria gonorrhoeae (NG) among MSM in the Netherlands. Methods We developed an agent-based model that describes the transmission of HIV and NG among MSM. In the baseline scenario, 14.3% and 29.8% of casual and steady partners of the index case get notified and tested for HIV/STI after 3 weeks (percentage notified and tested (PNT)). We examined the following scenarios: (1) increase PNT to 41% for both partner types; (2) decrease the time between the index and the partners tested to 1 week and (3) combine scenarios 1 and 2. Effects are expressed as cumulative change from the baseline simulation over 15 years. Results Increasing PNT could lead to a decrease in gonorrhoea cases of 45% (IQR 39.9% to 49.9%), with an increase in the number of HIV/STI tests of 4.4% (IQR 1.6% to 7.3%), but no change in HIV infections (-5.4%; IQR -21% to 7.9%). Decreasing the time between tests could lead to a change in new NG infections of -14.2% (IQR -17.2% to -10%), no change in HIV infections (8.2%; IQR -1.3% to 20%) or in the number of HIV/STI tests performed (-0.4%; IQR -1.5 to 0.6%). Scenario 3 led to a change in NG infections of -56.8% (IQR -63.8% to -47.4%), no change in HIV infections (11.5%; IQR -11.1% to 33.9%) or in the number of HIV/STI tests (-0.5%; IQR: -4.9% to 4.3%). Conclusions Increasing the percentage of sexual partners notified and tested for HIV/STI may have only a small effect on HIV but could reduce the number of new NG infections substantially. However, it could lead to an increase in the number of HIV/STI tests performed.