Sexually Transmitted Infections最新文献

Background: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are frequently asymptomatic in women, causing genital inflammation and increasing transmission and acquisition of HIV. The Genital Inflammation Test (GIFT) is a novel, point-of-care (POC) device under development for detecting genital inflammation in women. We aimed to obtain consensus to inform the integration of GIFT into STI management guidelines.

Methods: We employed a Delphi technique through two rounds of online surveys. Respondents included service providers, health programmers, researchers and policy makers. Round one questions generated ideas, and round two built consensus on strategies from round one. Survey sections included participant demographics and test implementation, integration into current guidelines and purpose. The round two survey employed a five-point Likert scale from strongly agree to strongly disagree. Consensus was reached if ≥70% of participants selected strongly agreed or agreed.

Results: We received 28 responses in the first round and 68 in the second. In both rounds, participants were healthcare providers (41%) or researchers (26%), residing in Africa (57%), Europe (21%) and America (10%). Most participants agreed that GIFT should be used as a screening tool to be followed by confirmatory STI testing before treatment: 75% (round 1), 69% (round 2). There was consensus that populations that would benefit most from GIFT would be young asymptomatic women (16-24 years) in high HIV prevalence settings and high-risk women of any age, such as female sex workers and those with multiple partners. Attributes of GIFT ranked as most important included ease-of-use, stability at room temperature and high diagnostic accuracy. Barriers were test stock-outs, complexity of use and high cost.

Conclusion: While Delphi consensus was for GIFT as a POC screening tool, factors such as supply chain, storage and stakeholder engagement are crucial for its integration into STI management guidelines.

Introduction: People from underserved groups experience disproportionately poor sexual health and challenges accessing care. Asynchronous online consultations (a user completes a health questionnaire online, which is reviewed by a clinician) are being used within sexual healthcare to prescribe chlamydia treatment. Users require sufficient health and digital literacy to access online services and use them safely.

Methods: We used the PROGRESS-Plus (PROGRESS: Place of Residence, Race/Ethnicity, Occupation, Gender/Sex, Religion, Education, Socio-economic Status, Social Network; Plus: e.g., Age, Sexual Orientation, Disability) framework to guide purposive recruitment of 35 participants from diverse underserved groups, from community settings and sexual health services in contrasting areas of the UK (15 October 2021-18 March 2022). We conducted qualitative semistructured interviews and thematic analyses to derive key barriers and facilitators to using asynchronous online consultations. We applied the Behaviour Change Wheel to specify recommendations to address them.

Results: Over half of participants were from the most deprived areas and 40% were from minoritised ethnic groups. Key barriers included: lack of familiarity with online healthcare; perceived need to see a healthcare professional in person; privacy concerns; concerns about difficulty interpreting the questions; discomfort answering personal questions online. Key facilitators included: familiarity with online consultations; perceived low sexually transmitted infection risk; perceived increase in convenience, control and privacy; simple wording and design; and support while completing them. Recommendations included: increasing awareness and familiarity by promoting them offline and online and providing demonstrations and instructions on how to use them; encouraging people to choose them by highlighting available support, equivalence to in-person consultations and privacy and convenience; and reducing attrition by using simple wording and design, providing additional explanations and offering audio and visual alternatives to text.

Conclusions: Incorporating these evidence-based, theoretically informed recommendations could widen access to underserved groups and increase the usability and safety of asynchronous online consultations for chlamydia treatment. Recommendations are likely to benefit all users and could be of use across health more broadly.

Objectives: The incidence of syphilis, caused by Treponema pallidum (TP), has increased significantly in recent years in Western countries, particularly among men who have sex with men (MSM). Recent data suggest that ongoing transmission may be facilitated by undetected mucosal excretion of TP. This study focuses on patients who had incident syphilis during the DOXYVAC study in order to evaluate oral and anal excretion of TP by molecular biology before, during and after infection.

Methods: During the DOXYVAC study, incident syphilis was defined as new TP haemagglutinations assay positivity or increased Venereal Disease Research Laboratory (VDRL) titres. Quantitative PCR tests were performed on stored oral and anal samples from the visit preceding the diagnosis, the diagnostic visit of syphilitic infection and the follow-up visit. For each TP-positive PCR sample, detection of 23S ribosomal RNA (rRNA) (azithromycin resistance) and 16S rRNA (doxycycline resistance) mutations was performed.

Results: Among the 556 participants, 44 cases of incident syphilis occurred in 43 patients. 11 patients (25%) had at least one PCR-positive site, including nine patients in the non-postexposure prophylaxis (PEP) group and two in the doxycycline PEP group. Eight patients had positive TP PCRs at diagnosis, two before diagnosis and one after. A total of eight anal samples and six oral samples tested positive. PCR-positive patients were more likely to be VDRL-positive with higher titres, suggesting more active infection. No mutations associated with doxycycline resistance were detected, while 75% patients had azithromycin-resistant TP strains.

Conclusions: This study shows that a significant proportion of patients have oral or anal TP excretion, sometimes several months before serological diagnosis, suggesting potential early asymptomatic transmission. The integration of the TP PCR assay into routine screening of high-risk MSM could enable earlier detection and treatment of these patients. The absence of doxycycline resistance is reassuring, but continued monitoring remains essential.

Objectives: The HIV pre-exposure prophylaxis (PrEP) Impact Trial demonstrated the feasibility and effectiveness of PrEP in England, providing critical evidence to inform national commissioning. Using trial data, we assess regional variation in delivery and examine how service provision differences impacted outcomes across the PrEP Prevention Care Continuum (PPCC) (ie, those at risk of HIV acquisition, those eligible for PrEP, PrEP uptake and coverage).

Methods: We assessed PPCC outcomes among HIV-negative men who have sex with men (MSM) attending trial sexual health services (SHS) from October 2017 to February 2020. Outcomes were stratified by SHS region (London, Outside London) and MSM throughput, defined as the mean annual number of MSM attendees, to approximate differences in service structure and provision based on attendee composition. HIV incidence per 100 person-years was calculated for SHS in and outside of London, restricted to those with ≥2 visits during the study period.

Results: Across 157 trial SHS, 165 270 MSM attended during the study period, of whom 20 349 were enrolled in the trial. HIV incidence was calculated among 102 842 MSM, including 17 770 trial participants. PrEP uptake ranged from 42% to 92%, and coverage from 16% to 31%, varying by MSM throughput strata and consistently higher among London SHS. HIV incidence was significantly lower in trial participants (London: 0.07 (95% CI 0.04 to 0.14); Outside London: 0.22 (0.13 to 0.36)) versus non-trial attendees (London: 0.98 (0.88 to 1.10); Outside London: 0.93 (0.82 to 1.04)).

Conclusions: This analysis supports ongoing enhancements to PrEP delivery across England. Findings highlight the success of varied service models, including those not traditionally focused on MSM populations. High HIV seroconversions among individuals without clear markers of risk for HIV acquisition support the need for broader, less restrictive PrEP access, aligned with recent updates to national guidance. To evaluate the long-term impact of PrEP on HIV and sexually transmitted infection (STI) incidence, consistent, high-quality data reporting to national surveillance remains essential.

Objectives: The Centers for Disease Control guidelines recommend rescreening for chlamydia, gonorrhoea and trichomoniasis 3 months after treatment to detect reinfection. This intervention aimed to improve rescreening rates by removing multiple logistical and financial barriers to rescreening within our influence for the greatest possible effect.

Methods: For 1 year (2022, n=837), free (to the patient) rescreen tests were automatically mailed to all patients in 21 health centres 3 months after they were treated for chlamydia, gonorrhoea and/or trichomoniasis, unless they opted out or were rescreened sooner. Patients returned the completed mail-in self-collection kit in a prepaid envelope within 2-4 weeks. Rescreening rates were compared with a control period (2019, n=1743).

Results: A total of 2580 rescreen opportunities (intervention=837, control=1743) were tracked for rescreening. The median age was 23, 66% were female, 80% were white and 79% tested positive for chlamydia. The intervention increased rescreening rates from 22% to 26%, which was not statistically significant after adjustment (OR 1.20, 95% CI 0.98 to 1.48, p=0.08).

Conclusions: A 4% increase in rescreening rates did not justify programme continuation. While rescreening has been an important public health strategy to reduce sexually transmitted infections (STIs), this programme reveals that high rates of rescreening may not be possible. Recommending rescreening and making it free, convenient and automatic is not enough. Without new ideas and approaches to tackling this public health problem, STI reinfection and resulting reproductive health complications will persist.

Background: HIV pre-exposure prophylaxis (PrEP) programmes in Africa reach young women at risk of sexually transmitted infections (STIs). We evaluated curable STI prevalence, incidence and risk factors among women initiating PrEP.

Methods: From August to December 2022, sexually active women aged 16-30 years from 15 South African sites, and one site each in Eswatini, Kenya, Malawi, Uganda and Zambia were enrolled into the INSIGHT cohort and offered oral emtricitabine/tenofovir PrEP with follow-up at 1, 3 and 6 months. At each visit, STI symptoms were assessed and treatment provided based on syndromic management or diagnostic testing. Diagnostic tests included nucleic acid amplification for Chlamydia trachomatis and Neisseria gonorrhoeae, the rapid OSOM for Trichomonas vaginalis at enrolment and month 6, and serological testing for syphilis at enrolment using rapid plasma reagin with confirmatory Treponema pallidum particle agglutination. Prevalence and incidence of each STI were calculated, and predictors assessed using multivariable regression.

Results: Of 3087 participants offered daily oral PrEP with a median age of 23 (IQR 21-27), 3011 had STI results and 30.9% had one or more STIs, with 15.7% reporting symptoms. The prevalence of C. trachomatis, N. gonorrhoeae, T. vaginalis and syphilis was 20.8%, 6.8%, 6.0% and 4.4%, respectively. The incidence of one or more STIs (C. trachomatis, N. gonorrhoeae or T. vaginalis) was 49.3/100 person-years (95% CI 45.3 to 53.4) with 12.7% reporting symptoms. The incidence of C. trachomatis was 30.6/100 person-years (95% CI 27.5 to 33.7), N. gonorrhoeae 10.8/100 person-years (95% CI 9.0 to 12.6) and T. vaginalis 11.5/100 person-years (95% CI 9.7 to 13.4). An incident STI diagnosis was associated with low alcohol use (adjusted incidence rate ratio (aIRR) 1.3; 95% CI 1.0 to 1.6) and moderate alcohol use (aIRR 1.4; 95% CI 1.1 to 1.8), and having an STI diagnosed at enrolment (aIRR 1.8; 95% CI 1.5 to 2.1).

Conclusion: The high prevalence and incidence of STIs among African women initiating PrEP, most of whom did not report symptoms, highlights the need for aetiologic testing to detect STIs, guide treatment and reduce reproductive health sequelae and risk of transmission.

Trial registration number: clinicaltrials.gov NCT05746065.

Syphilis is a sexually transmitted infection caused by Treponema pallidum It progresses through three clinical stages and shows various oral symptoms, mainly during the secondary stage. The disease can resemble other common oral mucosal conditions, such as infections with nonspecific pharyngitis, tonsillitis and laryngitis, as well as neoplastic and immune-mediated ulcers. This report discusses a heterosexual couple with rare manifestations of primary and secondary syphilis involving oropharyngeal lesions and an extragenital chancre, highlighting the diagnostic challenge and the importance of clinical awareness for early detection and treatment.

Objectives: The global rise in Neisseria gonorrhoeae (NG) infections, particularly oropharyngeal cases, drives treatment failures from antibiotic resistance. However, infection dynamics within oropharyngeal sites remain unclear. We developed an in vitro model using three human oropharyngeal epithelial cells to investigate infection dynamics and evaluate treatment strategies.

Methods: Tonsillar, floor of mouth (FOM) and gingival cell lines were infected with NG strains: antimicrobial-susceptible FA1090 and antimicrobial-resistant WHO-R. Oral commensal Neisseria oralis served as a bacterial negative control. Infected cells were treated with antibiotics known to cure NG strains (ie, ciprofloxacin/azithromycin/ceftriaxone/cefixime) and an antimicrobial negative control that does not cure NG strains (ie, tetracycline) at 1×, 2× and 3× the minimum inhibitory concentration for 30, 60 and 120 min. Post-treatment, cells were treated with gentamicin to eliminate extracellular bacteria, lysed and internalised NG quantified.

Results: NG invasion for both strains was highest in tonsillar cells and lowest in FOM cells. Gingival cells only demonstrated high invasion by FA1090. Validation experiments confirmed FA1090 clearance was highest with azithromycin, ceftriaxone and ciprofloxacin, while cefixime and tetracycline showed variable efficacy. No tested antibiotics cleared WHO-R from all cell lines. Gentamicin consistently failed to clear infections. There was minimal invasion of N. oralis across all cell lines.

Conclusions: NG demonstrates site-specific and strain-specific invasion of oral cells, targeting tonsils and gingiva. The model's validity is supported by drug efficacy results aligning with clinical data and limited invasion by N. oralis. This model provides a basis for developing a three-dimensional system to better understand oropharyngeal NG infections and identify and evaluate novel treatments.

Objectives: Effective surveillance of antimicrobial-resistant Neisseria gonorrhoeae (Ng) is crucial, but culturing is labourious and costly. Focusing culturing efforts on high-yield subpopulations can enhance resource utilisation without compromising data quality or care. This cross-sectional retrospective study aims to pinpoint a nucleic acid amplification test (NAAT) cycle threshold (Ct) value for effective Ng surveillance culturing.

Methods: Surveillance and laboratory data from 3042 sexual health clinic clients in the Netherlands (December 2018 to October 2023) were analysed to determine correlations between Ng culture positivity and NAAT Ct value, culture timing and anatomical location. Fisher's exact χ² test assessed associations between culture recovery and time intervals between NAAT and culture collection. Receiver operator curves and Youden's J statistic were applied to determine an optimal Ct value cut-off.NAAT was performed on 6346 swabs from urogenital (urethra; 1389/vagina; 482) and extragenital (oropharynx; 2306/rectum; 2169) sites using the cobas CT/NG assay on the 6800 platform (Roche Molecular Systems). Culture plates were inoculated on the initial test day for clients treated presumptively (symptoms or notified for Ng) or during treatment consultation after positive NAAT results.

Results: Mean Ct values differed for positive and negative cultures (negative: Ct 33.0 (IQR 24.2-41.9); positive: Ct 25.4 (IQR 20.0-30.3); p<0.001). Oropharyngeal samples had the lowest culture positivity rate (22.0%). Culture positivity particularly declined when NAAT to culture intervals exceeded 14 days. Only 0.8% (11/1389) of urethral culture samples were positive above Ct 30. Between Ct 34 and 35, overall culture positivity dropped from 23.0% to 13.9%. A Ct value cut-off at 34 would reduce basic culturing costs by 25% while missing only 4.2% (108/2603) of positive cultures.

Conclusions: Establishing an NAAT Ct value cut-off can reduce both labour and costs without compromising vital surveillance data. Assay-specific validation is recommended prior to broader application.