Sexually Transmitted Infections最新文献

Objectives: African and Caribbean heritage (ACH) communities in the UK face disproportionately high rates of HIV and often experience delayed diagnoses, worsening health inequities. Increasing HIV testing in these communities is essential to address these disparities and support the UK's HIV reduction targets. This study examines barriers and facilitators to HIV testing among Bristol's ACH community, a high-prevalence area with significant rates of late diagnoses, filling a critical gap in context-specific data.

Methods: Using a mixed-methods approach, this study combined 29 in-depth interviews and 41 online surveys, capturing ACH community members' views on HIV stigma, healthcare trust and testing experiences. Data were thematically analysed and mapped to the Social Ecological Model (SEM) framework, with community researchers conducting data collection and analysis to enhance participants' engagement and trust and contribute to a deeper contextual analytical understanding.

Results: Findings highlight significant barriers across SEM levels: individual-level knowledge gaps and stigma, interpersonal confidentiality concerns within tight knit communities, community-level taboos and distrust and organisational barriers, such as discriminatory healthcare experiences. Effective facilitators included culturally specific services, flexible testing options, community-driven outreach and increased healthcare representation, all of which fostered greater trust and engagement in testing.

Conclusion: The study underscores the importance of culturally aligned interventions, including representation within and training in cultural competence for healthcare providers and community co-production in service design. Implementing such strategies could reduce late diagnoses and support the normalisation of routine HIV testing in ACH communities, ultimately contributing to health equity. Future research should explore gender and age-specific barriers, while assessing the long-term impact of community-led interventions to inform national HIV policy and public health strategies for marginalised communities in the UK.

Objectives: In Belgium, approximately a quarter of Mycoplasma genitalium infections are resistant to both macrolides and fluoroquinolones-termed multidrug-resistant (MDR) infections. The optimal treatment approach for these MDR infections remains uncertain. Combination therapy has shown promise in treating other MDR pathogens by enhancing efficacy and reducing resistance development. We report the first five cases of MDR M. genitalium urethritis successfully treated with a novel combination therapy regimen consisting of minocycline, metronidazole, methenamine and pristinamycin ('M3P').

Methods: We describe a case series of five individuals treated with M3P as salvage therapy for M. genitalium urethritis. Clinical data, laboratory findings, resistance profiles and treatment outcomes were reviewed.

Results: All five men with macrolide-resistant and fluoroquinolone-resistant M. genitalium urethritis received M3P for a minimum of 14 days. Two men received an extended 28-day M3P regimen, in which minocycline and methenamine were given for 28 days. All five patients experienced clinical and microbiological cure. Adverse effects were minimal and transient, with one patient reporting increased urinary frequency during treatment and another reporting mild dyspepsia.

Conclusions: This case series demonstrates the potential efficacy of M3P as a novel salvage therapy for MDR M. genitalium urethritis, particularly where standard therapies have failed. The combination of pristinamycin, methenamine, and other agents may synergistically reduce bacterial load and increase efficacy. Further, in vitro and clinical studies are required to assess the optimal treatment strategies for MDR M. genitalium.

Objectives: The New AntiBiotic treatment Options for uncomplicated GOnorrhoea trial compared the efficacy of gentamicin, ertapenem and fosfomycin with ceftriaxone. Ertapenem was non-inferior to ceftriaxone for treating Neisseria gonorrhoeae, but participants receiving ertapenem commonly reported having diarrhoea. We assessed diarrhoea trajectories, estimated the probability of remaining with diarrhoea over time and identified determinants of diarrhoea.

Methods: Participants were randomly assigned (1:1:1:1) to receive intramuscular 5 mg/kg gentamicin (maximum 400 mg), intramuscular 1000 mg ertapenem, oral 6 g fosfomycin or intramuscular 500 mg ceftriaxone (control group). Following antibiotic treatment, participants self-reported adverse events, including diarrhoea, in a paper diary until 30 days after treatment. In this secondary analysis, we assessed the frequency of diarrhoea in each study arm. Kaplan-Meier methods were used to estimate the probability of remaining with diarrhoea over time in each study arm. Determinants of diarrhoea in the ertapenem arm were assessed using relative risk regression.

Results: Among 343 participants randomised, 2/102 (2.0%) in the gentamicin arm, 49/97 (50.5%) in the ertapenem arm, 32/37 (86.5%) in the fosfomycin arm and 11/103 (10.7%) in the ceftriaxone arm reported diarrhoea. Median duration of diarrhoea varied between 1 and 2 days across arms. In the ertapenem arm, only having an anal N. gonorrhoeae and/or anal Chlamydia trachomatis infection (prevalence ratio=2.29, 95% CI 1.04 to 5.02) was associated with increased diarrhoea risk.

Conclusions: Ertapenem was associated with high frequency of diarrhoea, which was mostly short-lived. Continued evaluation of the tolerability of ertapenem could help increase acceptability of this potential second-line treatment against N. gonorrhoeae.

Trial registration number: NCT03294395.

This case describes successful management of a man with perinatally acquired HIV complicated by incomplete adherence, multidrug-resistant HIV and opportunistic infections-cryptococcal meningitis and mycobacterium avium intracellulare. Initial treatment included antifungal and antimycobacterials with oral antiretroviral therapy (ART), but persistent high HIV viral load (>100 000 copies/mL) prompted initiation of long-acting injectable ART (LAI-ART) with cabotegravir and rilpivirine combined with adjunct oral nucleoside reverse transcriptase inhibitor therapy (emtricitabine/tenofovir). This combination is expected to have reduced antiviral activity secondary to resistant mutations; notably, high-level resistance to emtricitabine and intermediate resistance to rilpivirine. To attenuate further resistance, 4-weekly dosing of LAI-ART was used. This regimen led to viral suppression within 4 weeks, which remains suppressed (>1 year) and successful immune reconstitution (CD4 cell count of 209 cells/µL/18.7%), despite challenges with adherence to oral medications. This case highlights the feasibility and effectiveness of LAI-ART in managing complex resistance and adherence in perinatally acquired HIV.

Objectives: Among users of oral HIV pre-exposure prophylaxis (PrEP), condom use is low and incidence of sexually transmitted infections (STIs) is high, hence guidelines recommend STI screening every 3-6 months. Identifying individuals with higher asymptomatic STI risk for targeted screening may offer an opportunity to reduce the burden of STI screening.

Methods: In the Netherlands, PrEP has been offered through the National PrEP Pilot Program since 2019, which includes screening every 3 months. We included data of all individuals who received care through the PrEP programme between July 2019 and June 2022 and attended at least one PrEP care visit. STI-related symptoms and notification of possible STI exposure by sexual partners are recorded during each visit. We assessed the predictors of any chlamydia, gonorrhoea or syphilis infection diagnosed during routine asymptomatic STI screening (ie, no reported symptoms or partner notification) using logistic regression and calculated risk scores from coefficients of the multivariable logistic regression model. We estimated the sensitivity and specificity for the optimal prediction score cut-off.

Results: Among the 11 035 included individuals (97% men who have sex with men), 14 926 bacterial STIs (9114 diagnosed during routine asymptomatic screening) were diagnosed during a median of 24 months (IQR 15-30) of follow-up. We found that PrEP users who engaged in sex work, had condomless anal sex, participated in group sex or chemsex (ie, use of gamma-hydroxybutyrate/gamma-butyrolactone, mephedrone or crystallised methamphetamine during sex), injected drugs or used alcohol or non-chemsex-related drugs during sex had an increased risk of STIs diagnosed during routine asymptomatic screening. PrEP users born in the Netherlands and those who attended college or university had a lower STI risk. A risk score using these covariates resulted in a sensitivity of 0.55 (95% CI 0.54 to 0.56) and specificity of 0.55 (95% CI 0.54 to 0.55). Individuals eligible for STI screening accounted for 54% of STIs diagnosed during follow-up.

Conclusions: Using routinely available demographic and behavioural data, it was not possible to construct a well-performing risk score to identify individuals at high risk of STIs diagnosed during routine asymptomatic screening. Other factors, methods or ways to analyse data may be needed to increase predictive capacity for STI risk scores.

Objectives: The study aimed to explore the acceptability of reducing the frequency of asymptomatic Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) screening among gay, bisexual, and other men who have sex with men (GBMSM)(Although the term GBMSM is used for convenience, the study also includes nonbinary people who were assigned male at birth who have sex with men.). Additionally, it sought to identify barriers and facilitators to implementing such changes and to develop potential interventions that could support a shift in current screening guidelines.

Methods: This qualitative study explored stakeholder perspectives on reducing screening frequency and identified potential interventions that could support future guideline changes of this kind. Semistructured interviews were conducted with 22 GBMSM and 8 professional stakeholders. Data were thematically analysed using the Capabilty, Opportunity, Motivation - Behaviour (COM-B) and Theoretical Domains Framework (TDF). TDF domains were mapped to behaviour change techniques to inform intervention development. Candidate interventions were refined based on acceptability, practicability, effectiveness, affordability, side effects, equity.

Results: Overall, GBMSM stakeholder responses to discontinuing asymptomatic Ng and Ct screening tended to be negative, while professional stakeholder opinions were mixed. Reducing the recommended screening frequency to 6 monthly was generally more acceptable to both groups. Barriers and facilitators to guideline changes included issues of knowledge and trust, social influence and identity, context and resources, concerns about consequences and emotional responses and habit. Ten candidate interventions were suggested. These involve providing information, social support, behavioural substitutions and feedback as well as facilitating discussions to resolve concerns.

Conclusion: Any reduction in the recommended frequency of asymptomatic screening will encounter a range of interrelated barriers, including knowledge gaps, social influences and emotional factors. We identified evidence-based interventions that could improve acceptance and minimise unintended consequences. Future research should incorporate stakeholder workshops to refine these strategies.

Background: Bacterial sexually transmitted infections (STIs) remain a growing public health challenge globally, with gay, bisexual and other men who have sex with men (gbMSM) disproportionately affected. Doxycycline postexposure prophylaxis (DoxyPEP) has been shown in clinical trials to reduce syphilis and chlamydia, and has been incorporated into US and UK guidelines. However, community-level data in many European countries remain scarce. This study aimed to assess awareness, attitudes and early use of DoxyPEP among gbMSM in Ireland.

Methods: An anonymous, cross-sectional online survey was conducted between May and June 2025. Eligible participants were aged ≥18 years, identified as male (cis or trans) or non-binary/gender diverse and reported sex with a man in the past 12 months. The questionnaire covered demographics, sexual behaviours, STI/HIV history, awareness and use of antibiotics for STI prevention and attitudinal measures. Descriptive statistics summarised findings, and logistic regression identified predictors of DoxyPEP use.

Results: A total of 149 participants completed the survey, with a mean age of 36.4 years (range: 22-67); 92.6% were cisgender men and 86.6% identified as gay. Awareness of antibiotic STI prophylaxis was high (83.2%), and 69.1% expressed strong interest in future use. Over one-quarter (29.5%) reported DoxyPEP use in the past 12 months, almost exclusively at the recommended 200 mg dose. DoxyPEP use was associated with previous HIV PEP use (adjusted OR (AOR) 3.02 s, 95% CI 1.35 to 6.73) and group sex (AOR 3.27, 95% CI 1.26 to 8.59). Most participants reported sourcing antibiotics informally, including online or through friends. Antimicrobial resistance was the most common concern reported (69.8%).

Conclusion: Despite the absence of national guidelines on the use of DoxyPEP for STI prevention, over one-quarter of participants reported using DoxyPEP, with high awareness and demand for structured access. These findings highlight the urgency for evidence-based, internationally aligned policies that ensure safe and equitable delivery, integrated within sexual health services and underpinned by antimicrobial stewardship.