Sexually Transmitted Infections最新文献

Objectives: Trans and/or gender diverse (T/GD) people in the UK are less likely to access sexual health services (SHS) than cisgender people and are more likely to report negative experiences. The British Association for Sexual Health and HIV (BASHH) developed expert recommendations for T/GD-inclusive SHS, but these lack service user perspectives. This study addressed this gap by asking T/GD people how SHS could be T/GD-inclusive.

Methods: Semistructured interviews (n=33) and focus groups (n=26) were conducted with T/GD people aged 17-71 years old recruited through community organisations and social media, exploring experiences of SHS and inclusivity. Study design, materials and analysis were informed by T/GD people and an advisory committee of charities and sexual health clinicians. Data were analysed using thematic analysis, managed using NVivo.

Results: Participants often expected that SHS were not set up for T/GD people. This was reinforced by poor experiences in other healthcare settings and the lack of information on NHS websites. Some participants had been denied care because they were 'too complex'. Participants wanted to know that SHS had engaged with the needs of T/GD people and looked for hallmarks of inclusivity, such as Trans Pride flags in reception areas. Some participants wanted specialist T/GD services, but others preferred to access general SHS. Staff attitudes were a key factor underpinning inclusivity. Anticipating having their identity questioned or needs dismissed, participants sought kindness and openness. Although the needs of T/GD people are diverse and different from cisgender service users, participants stressed that SHS staff already had the skills to deliver sensitive person-centred care and emphasised the value of inclusive SHS.

Conclusion: These findings provide insight into what a sample of T/GD people in the UK consider important for T/GD-inclusive SHS. Participants' suggestions align with and reinforce BASHH expert recommendations. Importantly, they highlight the need for ongoing engagement to deliver T/GD-inclusive SHS.

Background: Human papillomavirus (HPV) is a common infection of the anogenital tract. Although most infections clear, persistent infections with oncogenic types can predispose to cancer. While the natural history of anogenital HPV infection in cisgendered women is relatively well understood, there are significant knowledge gaps regarding HPV prevalence and clinical implications of genital HPV infection in transgender women (TGW) with neovagina(s).

Methods: A systematic review, including meta-analysis, of studies available in the literature with data on HPV prevalence in TGW with neovaginas was performed. Additionally, a narrative analysis of the clinical manifestations of genital HPV infections in TGW with neovagina(s) was performed.

Results: 21 studies were included; six focused on the prevalence of HPV in TGW, and data were pooled in a meta-analysis of prevalence; 15 were case reports/series, which were included in a narrative analysis of clinical implications. The meta-analysis showed the prevalence of genital HPV in TGW with neovaginas was 15% (95% CI 9% to 21%). The most frequently detected HPV type was HPV 16. 18 TGW were included in case reports/series and the median age was 42; 12 presented with condylomata acuminata and six had squamous carcinoma.

Conclusion: Data on genital HPV prevalence in TGW with neovaginas are sparse, with many studies having small denominators. We report higher HPV prevalence compared with cisgendered women. Symptomatic genital HPV infection in TGW with neovaginas was largely associated with benign condylomata, although some carcinoma was detected. Future longitudinal studies are required to elucidate the clinical impact of genital HPV infection and examine its implications in TGW with neovaginas in order to inform prevention and management strategies.

Background: Chemsex engagement is known to be associated with higher-risk sexual behaviour, HIV and sexually transmitted infection (STI). To reduce HIV infection risk, pre-exposure prophylaxis (PrEP) is increasingly used in the men who have sex with men (MSM) community. This study aims to examine the interrelationship between chemsex engagement and PrEP use in MSM.

Methods: This is a cross-sectional study with the recruitment of MSM in the community in Hong Kong. Participating MSM were invited to complete an online survey which included PrEP (experienced or naïve) use, chemsex engagement history and HIV test results. Chemsex engagement referred to use of specific drugs (methamphetamine and/or gamma-hydroxybutyrate) before and/or during sex. Characteristics of MSM with and without history of chemsex engagement were examined in bivariable and multivariable logistic regression. In a case-control analysis with a 1:1 ratio of PrEP-naïve and PrEP-experienced MSM, the association of chemsex engagement with history of PrEP use was examined in bivariable and multivariable logistic regression.

Results: Between February 2022 and January 2024, 338 eligible MSM were recruited. A higher proportion of MSM engaged in chemsex reported history of PrEP use and group sex. Prevalence of ever chemsex engagement was significantly higher in PrEP-experienced (29%) than PrEP-naïve MSM (9%) (adjusted OR=2.69, 95% CI 1.28 to 5.67), after adjustment for confounders of age, history of STI testing, multiple sex partnership and inconsistent condom use. The history of chemsex engagement in the past 6 months was associated positively with ever and recent (6 months) use of PrEP. Five out of seven PrEP-naïve MSM who had engaged in chemsex in the past 6 months indicated their intention to take PrEP.

Conclusions: Chemsex engagement was positively associated with PrEP use while most of the PrEP-naïve MSM who had recently engaged in chemsex expressed interest to start PrEP. PrEP service could be an important community platform for chemsex intervention.

Objectives: The decennial National Surveys of Sexual Attitudes and Lifestyles (Natsal) provide general population prevalence estimates in Britain for key sexually transmitted infections (STIs) through biosampling. Since methodological choices can impact acceptability and response rates, we evaluated processes for Natsal-4, including face-to-face and remote interview arrangements, non-return of test results and vaginal swab collection in two pilot studies.

Methods: The pilots were conducted during June to August 2021 and February to March 2022. Participants aged 16-59 years were invited to provide urine samples (cisgender men and trans/gender diverse) or three vaginal swabs (cisgender women; urine was requested if vaginal swabs were declined) following interview. Samples were self-collected at home and posted to the laboratory by the interviewer if the interview was face to face, or by the participant if they preferred to collect the sample later or the interview was remote. Process feedback was collected after the first pilot via qualitative interviews with participants and after both pilots through informal interviewer debriefing.

Results: Of 261 participants interviewed (pilot 1=130; pilot 2=131), 161 (62%) consented to biosampling, of which 129 (49%) provided samples. A sample was received from 78/153 (51%) of women, of whom 60 (77%) provided vaginal swabs and 18 (23%) provided a urine sample. A urine sample was received from 51/108 (47%) cisgender men or trans/gender diverse participants. All samples collected immediately after face-to-face interviews were received (n=77), while 64% of samples from participants consenting to post samples after face-to-face interviews and 60% after remote interviews were received. Process feedback confirmed our methods were broadly acceptable.

Conclusions: We demonstrated that our approach to biosampling and STI testing for a national sexual health survey was reasonably acceptable and feasible in the period coming out the COVID-19 pandemic. Self-collection of vaginal swabs for research, which provide higher testing sensitivity than urine, was feasible and acceptable in a home setting.

Background: Pre-exposure prophylaxis (PrEP) is a medicine that can reduce HIV transmission. Given the disproportionate impact of HIV on minority communities, health equity is an important consideration in PrEP research. We aimed to assess equity reporting in systematic reviews of PrEP using the PROGRESS Plus framework.

Methods: We conducted a systematic search of PubMed (MEDLINE), Embase and Cochrane databases for systematic reviews or meta analyses of PrEP usage. We then used the PROGRESS Plus framework to extract inclusion of the following domains: place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital, age and disability.

Results: After screening search articles, our sample included 36 systematic reviews and meta-analyses (SRMAs). 24 (66.7%) were conducted within the USA. Few (2/36, 5.6%) were found to mention adherence to any equity reporting framework. Place and gender/sex were the most reported elements of the framework with inclusion in 34 of 36 studies. Age (30/36, 83.3%) and race/ethnicity (24/36, 66.7%) were also commonly reported. All other criteria were reported in less than half of included SRMAs; religion had the lowest inclusion at 0/36 (0%), followed by disability (1/36, 2.8%). Among the 36 SRMAs, 19 (52.78%) did not conduct any subgroup analyses among domains; those most commonly analysed were gender/sex and age.

Conclusion: Our study found nearly all SRMAs regarding HIV PrEP reported on gender/sex and age; however, other influential equity criteria were often overlooked. Further attention to the reporting of PROGRESS Plus items within these SRMAs may reduce barriers for PrEP utilisation, thus improving HIV prevention strategies.

Objective: Individuals from Black African and Black Caribbean communities (black communities) in the UK bear a disproportionate burden of HIV and sexually transmitted infections (STIs), while exhibiting lower testing rates. The aim of the scoping review was to summarise interventions developed to increase HIV/STI testing among black communities in the UK and describe the facilitators and barriers that influence testing uptake in these populations, according to the Capability Opportunity Motivation Behaviour (COM-B) approach.

Methods: Six databases were systematically searched to identify quantitative, qualitative and mixed-method studies evaluating the effectiveness of HIV/STI testing interventions among black communities in the UK, published from 2000 onwards. The review was conducted in accordance with the Joanna Briggs Institute Framework of Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Data were analysed using thematic analysis, and the factors were mapped onto the COM-B model components.

Results: Twenty-two studies, of which 11 were available as abstracts only, were included. Twelve studies included testing provision and health promotion, six studies testing provision only and four health promotion only. Nineteen studies looked at HIV testing interventions only. Facilitators to testing included interventions that provided an understanding of STI and HIV risk, assured privacy for testers and normalised testing through integration into existing services and delivery in non-traditional settings by appropriately trained staff. Barriers to testing included interventions that were stigmatising through the choice of intervention settings and/or targeting of groups, low perceived risk and limited knowledge about infections among people from black communities, and limited engagement and partnership working with relevant community organisations and groups.

Conclusion: Multifaceted interventions that include health promotion and opportunities for testing, co-designed with and by local communities, are crucial in addressing the range of barriers and facilitators experienced by people from black communities.

Objectives: Genital herpes simplex virus (HSV) type 1 and 2 infections are lifelong and can cause symptomatic genital ulcer disease (GUD). HSV-2 almost always causes sexually transmitted genital infection, while HSV-1 mainly causes oral infection but can be sexually transmitted to cause genital infection. This study estimated genital infection with both HSV types and associated GUD globally in 2020, breaking down the data by WHO region and sex for females and males.

Methods: A calibrated mathematical model was employed to generate estimates for the incidence and prevalence of HSV-2 infection, genital HSV-1 infection, and GUD caused by both HSV types. Estimates for non-genital infections caused by HSV-1 were also generated. Model input was derived from a comprehensive systematic review and meta-analyses of HSV prevalence data for all WHO regions.

Results: Globally in 2020 there were 25.6 million (95% uncertainty interval (UI) 23.1-29.4 million) people aged 15-49 years with new HSV-2 infections, and 519.5 million (95% UI 464.3-611.3 million), or 13.3% (95% UI 11.9-15.6%), with existing (prevalent) HSV-2 infections. In addition, there were 16.8 million (95% UI 10.6-22.4 million) people aged 15-49 years with new genital HSV-1 infections and 376.2 million (95% UI 235.6-483.5 million), or 10.2% (95% UI 6.4-13.1%), with prevalent genital HSV-1 infections. The estimated number of people aged 15-49 years with at least one episode of HSV-attributable GUD in 2020 was 187.9 million (95% UI 116.0-291.8 million) for HSV-2, and 16.7 million (95% UI 9.3-25.2 million) for HSV-1, totalling 204.6 million (95% UI 132.3-306.5 million).

Conclusion: Genital HSV infections have a high incidence and prevalence worldwide, contributing to a significant GUD disease burden. New prevention and treatment measures, such as prophylactic and therapeutic HSV vaccines, are needed critically to control HSV infections and reduce the associated disease burden.