Sexually Transmitted Infections最新文献

Objective: Various European countries noted increasing Neisseria gonorrhoeae (Ng) positivity among cis-gender women and heterosexual men. We assessed changes over time in Ng among men who exclusively have sex with men (MSM), men who exclusively have sex with women (MSW), men who have sex with men and women (MSMW), women and transgender and gender diverse people (TGP).

Methods: We analysed data collected between 2018 and 2023 at the Centre for Sexual Health, Amsterdam. We modelled temporal changes in Ng positivity rates (ie, number of positive results per 100 tests) using relative risk regression with a covariate representing three time periods: pre-COVID-19 (1 January 2018-12 March 2020), during COVID-19 (13 March 2020-1 March 2022), and post-COVID-19 (2 March 2022-31 December 2023).

Results: We included 110 878 consultations pre-COVID-19, 84 917 during COVID-19 and 108 282 post-COVID-19. Positivity rates of Ng went from 12.4% to 13.0% in MSM, 1.7% to 2.3% in MSW, 6.7% to 9.9% in MSMW, 1.3% to 2.9% in women and 8.1% to 10.4% in TGP pre-COVID-19 and post-COVID-19, respectively. Significant increases were observed among MSW (relative risk (RR)=1.31,95% CI 1.12 to 1.53), MSMW (RR=1.47, 95% CI 1.26 to 1.72) and women (RR=2.25, 95% CI 2.03 to 2.49). An increased number of sexual partners and inconsistent condom use were associated with an increased Ng risk.

Conclusion: A substantial relative increase in Ng risk among MSW, MSMW and women, but not MSM or TGP, was observed post-COVID-19. Changes in sexual behaviour were associated with these changes. Continuous surveillance of Ng in heterosexual individuals is needed to monitor changes, alongside implementing prevention strategies for sexually transmitted infections.

Objectives: The objectives are to explore the acceptability of online sexually transmitted infection (STI) testing services among young Australians (16-29 years) and how this may vary between sociodemographic populations.

Methods: A cross-sectional, online survey (using both closed and open-ended questions) of Australians aged 16-29 years. Of 905 participants, 781 (86%) responded to the question on preference for online versus in-person STI testing and are included in this analysis. Logistic regression was used to identify sociodemographic factors associated with STI testing preferences (online vs in-person). Adjusted ORs (AOR) are reported for each sociodemographic factor. Content analysis was used to code open-ended responses explaining the reasons for the participant's testing preference.

Results: Among the participants, 75% (588/781) preferred online testing over in-person testing. 677 (87%) provided reasons for their preference in an associated, open-ended question. Multivariable analysis found that the odds of preferring online services were significantly increased for those living in rural compared with metropolitan areas (AOR=1.7, 1.0-2.9). The odds of preferring online testing over in-person testing were significantly decreased for those of Asian descent (AOR=0.4, 0.2-0.6) and for those who reported having previously tested for an STI (0.6, 0.4-0.9). Convenience and privacy were key factors from the content analysis underlining preferences for online testing services but tended to be voiced by participants with certain sociodemographic characteristics (ie, men who have sex with men and older participants). Factors related to trust and convenience underscored preferences related to in-person testing.

Conclusions: It is clear that there is considerable interest among young people in using online STI testing, but it may not be right for all individuals. Understanding what factors associated with online testing are valued by young users can help inform marketing strategies that highlight these value propositions in their messaging. Further research is needed to engage young people and develop a high-quality, usable online service.

Background: Sexually transmitted infections (STIs) are a global health challenge. Testing is not routinely performed in low- and middle-income countries (LMICs), which bear a disproportionate burden of STIs. Self-collected penile-meatal swabs (SCPMS) are an alternative to urine for STI testing, but data from LMICs are limited.

Methods: Between October 2019 and September 2020, recruited participants with urethral discharge syndrome at government health facilities in Kampala, Uganda, provided urine and SCPMS. Samples were retrospectively analysed for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) using Aptima assays. Paired SCPMS and urine samples with discordant STI results were analysed using real-time PCR assays.

Results: Of the 250 participants, 66.8% (n=167), 22.8% (n=57), 12.8% (n=32) and 2.4% (n=6) tested positive for NG, CT, MG and TV, respectively, on testing of their SCPMS and urine samples. The overall agreement between urine and SCPMS for all STIs using the Aptima assays was 98.7% (987/1000). After adjudication with PCR assays, the agreement between urine and SCPMS for NG, CT, MG and TV was 100% (250/250), 97.6% (244/250), 99.6% (249/250), and 99.6% (249/250), respectively. There was no significant difference between SCPMS and urine (p=0.9996). For paired samples with one STI (n=164) or ≥2 STIs (n=39), concordance was 100% (656/656) and 97.2% (175/180), respectively. There was no association between number of STIs and agreement between sample types (p=0.8606).

Conclusions: This study revealed a high level of agreement between SCPMS and urine for detection of STIs in symptomatic Ugandan men, even in the presence of multiple concurrent STIs. SCPMS may be a suitable alternative to urine, with ease of collection, transporting, and processing of samples.

Syphilis is a re-emerging disease, and suspicion of syphilis infection should be considered in all cases with atypical skin manifestations, mainly when there is a history of unprotected sexual intercourse. Here, we describe a case of secondary syphilis in a woman aged 42 years, who presented with an atypical, painful and itchy skin rash with vegetative cerebriform lesions, which resolved after the administration of penicillin. Multiplex PCR targeting Treponema pallidum on vaginal and lesion swabs, along with syphilis serology, confirmed the diagnosis.

Objectives: In sub-Saharan Africa, approximately 86% of HIV infections in adolescents aged 15-19 years occur among girls. Their heightened susceptibility is likely influenced by converging sociobehavioural and biological factors, although the relative contributions remain unclear. To address this, we compared known and hypothesised risk factors for HIV between cisgender adolescent girls and adult women in South Africa and evaluated the relationships between these factors and sexually transmitted infection (STI) status.

Methods: This cross-sectional observational study included adolescent (n=305; 14-19 years) and adult females (n=114; 25-35 years) in two South African provinces (Western Cape (WC), KwaZulu-Natal (KZN)). Demographic and sociobehavioural data were collected by questionnaire. Colposcopy was conducted to identify cervicovaginal abnormalities, and tests for bacterial vaginosis (BV), Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were performed.

Results: Adults reported higher risk sexual behaviour than adolescents across multiple variables, although adolescents were more likely to have STIs than adults (62.8% vs 34.0%, respectively, p=0.0010 for WC; 42.5% vs 16.4%, respectively, p=0.0002 for KZN). Adolescents did, however, report earlier sexual debut (16 years old vs 17 years old, p<0.0001 for both sites) and KZN adolescents were more likely to use intravaginal sexual enhancers than adults (34.6% vs 20.6%, respectively, p=0.0417). Numbers of sexual partners (β-coefficient: 0.34, SE: 0.12, p=0.0054) and sex acts within the previous 3 months (β-coefficient: 0.25, SE: 0.09, p=0.0062) were associated with STIs in adolescents and trended to significance for adults. Intravaginal sexual enhancer use (KZN only; β-coefficient: 0.95, SE: 0.38, p=0.0118) and biological risk factors, including BV Nugent score (β-coefficient: 0.09, SE: 0.04, p=0.0257) and signs of cervicovaginal injury/inflammation (β-coefficient: 1.07, SE: 0.45, p=0.0171), were associated with STIs in adolescents but not adults.

Conclusions: Risk factors for STIs including HIV may differ between age groups of girls and women, and mitigation interventions may need to be tailored accordingly.

Objectives: In England, infectious syphilis diagnoses have reached the highest annual number since 1948. Fifty per cent of syphilis testing is now provided through online postal self-sampling sexually transmitted infection (STI) testing services (OPSS). To reduce the burden of syphilis, we need to understand the syphilis prevalence and transition to treatment rates among service users of OPSS. This report aims to estimate syphilis prevalence among people accessing Sexual Health London (SHL), a regional, National Health Service (NHS)-funded OPSS.

Methods: Demographic, STI concurrency, sexual behaviour data and case outcomes were collected from SHL service users who received testing for syphilis between 8 March 2022 and 30 June 2023. Data were analysed to identify syphilis prevalence and transition to care rates.

Results: 458 520 syphilis tests were performed for 267 780 service users. 12 870 (2.8%) results were reactive. Their assigned case outcomes comprised: 10 048 (78.1%) past adequately treated syphilis; 971 (7.5%) treated for active syphilis; 1293 (10.1%) SHL results did not subsequently confirm and 558 (4.3%) had an unknown final outcome. Of unique users, 0.4% (940/267 780) received syphilis treatment at least once. They were: 89.3% aged ≥25 years, 87.3% male, 83.7% gay/bisexual. Co-infections identified were: chlamydia (14%), gonorrhoea (13.3%) and previously undiagnosed HIV (1.5%). 36.1% (339) took pre-exposure HIV prophylaxis, 30.1% engaged in sex parties/group sex and 26.8% had sex under the influence of drugs/alcohol. Individuals aged ≥35 years, of non-female gender, gay/bisexual, from indices of multiple deprivation (1-5) and from certain racially minoritised communities were statistically more likely to require treatment for syphilis than the overall testing population (p<0.05).

Conclusion: Estimated syphilis prevalence (0.4%) was comparable to rates within national sexual health clinics and the demographic characteristics of those most affected by syphilis were also similar. Further work is required to improve the integration between NHS OPSS and sexual health clinics and to enable OPSS to more accurately input data on treatment and diagnoses towards national surveillance statistics.

Background: Sexual health centres (SHCs) in the Netherlands report a surge in gonorrhoea, especially among young women (notably oropharyngeal) and men who have sex with women (MSW) since the second half of 2022. MSW are not routinely oropharyngeal tested, and women only when reporting oral sex. This cross-sectional study aimed to assess oropharyngeal gonorrhoea in MSW and women, and potential underdiagnosis.

Methods: From 10 August to 10 November 2023, the SHC in Rotterdam, the Netherlands, extended its gonorrhoea testing protocol, requiring oropharyngeal tests for all MSW and women. Positive cobas nucleic acid amplification test (NAAT) results were followed by culture sampling. Oropharyngeal infections were confirmed with a second NAAT (opa gene-based PCR), and for discrepancies a third NAAT (GeneXpert CT/NG test) was employed. The impact of extended testing on detection rates, along with the corresponding 95% CIs, was analysed.

Results: The overall gonorrhoea detection rate was 6.4% (95% CI 4.7% to 8.8%) among MSW and 6.0% (95% CI 4.8% to 7.6%) among women, compared with 3.6% (95% CI 2.3% to 5.4%) and 6.0% (95% CI 4.8% to 7.6%) without expanded testing. Oropharyngeal rates were 6.4% (95% CI 4.4% to 9.2%) for MSW and 4.3% (95% CI 3.2% to 5.7%) for women. Highest positivity was among individuals notified, <25 years, without migratory background, with lower educational levels and more sex partners. Oropharyngeal cultures confirmed viable gonorrhoea in 39.1% of MSW and 35.5% of women. False positives were 7.4% among MSW and 10.8% among women. Confirmed oropharyngeal gonorrhoea positivity rate was 5.9% (95% CI 4.0% to 8.6%) among MSW and 3.9% (95% CI 2.8% to 5.2%) among women.

Conclusion: Oropharyngeal gonorrhoea is common and currently underdiagnosed among MSW. The impact of this underdiagnosis on transmission dynamics under the current testing policy remains unclear. Further research is needed to inform prevention and control strategies, especially given the recent surge in gonorrhoea.