Sexually Transmitted Infections最新文献

Objectives: Prevalences of Trichomonas vaginalis (TV) in Europe are low and consequently marginally tested by Dutch sexually transmitted infections (STI) clinics. We routinely tested all patients on all anatomical sites. We aimed to assess trends, prevalences among key populations and at different anatomical sites, as well as predictors of being TV positive to inform future testing practices and guideline development.

Methods: A retrospective cross-sectional study was performed between 2014 and 2022, using STI clinic data. Trends and positivity rates among key populations and anatomical locations were assessed using descriptive analyses. Sociodemographics and sexual behaviour variables were analysed to assess predictors of being TV positive, using multivariable regression analysis.

Results: A total of 37 577 consultations were performed in which patients were tested for TV; 16 075 among women and 21 502 among men. Overall TV positivity was 0.9% (145/16 075) among women and 0.3% (54/21 502) among men, and highest among women with a Netherlands Antillean ethnic background with 5.2% (11/212). TV positivity was lowest at the pharyngeal anatomical site (0.1%), followed by anorectal site (0.2%) and the urogenital anatomical site (0.5%).The following predictors of being TV positive were tested significant for men: being older (≥40 years, OR=5.1), having a Surinamese (OR=6.8) or Netherlands Antillean (OR=7.4) ethnic background and being gonorrhoea positive (OR=2.1). For women, the following predictors tested significant: being older (≥40 years, OR=3.3), having an Eastern European (OR=3.1), Western European (OR=2.2), Netherlands Antillean (OR=7.8) or Mid and South African (OR=4.0) ethnic background, having STI symptoms (OR=2.6) and being gonorrhoea positive (OR=2.6).

Conclusions: Based on our results of 9 years of screening in an STI clinic setting, routine universal testing for TV is unnecessary. Testing patients, particularly women, is only required in symptomatic cases and might be considered in cases with an Eastern European, Netherlands Antillean or Mid and South African ethnic background.

Objective: Partner-level sexually transmitted infection (STI) data from eastern Africa are rare, despite high STI burden. To address this gap, we examined STI prevalence and clustering among cohabiting couples in two high HIV-burden Ugandan communities, representing the largest population-based, couple-level STI study in the region.

Methods: We analysed data from the Sexually Transmitted Infection Prevalence Study (STIPS), a cross-sectional, population-based study in southern Uganda which tested participants for chlamydia, gonorrhoea, trichomonas, syphilis, high-titre syphilis and herpes simplex virus-2 (HSV-2). We restricted the present analysis to STIPS participants in a cohabiting sexual relationship. Poisson regression with robust standard errors was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs) of all STIs by partner's infection status.

Results: Among 423 cohabiting heterosexual couples, at least one partner tested positive for a curable STI (chlamydia, gonorrhoea, trichomonas or high-titre syphilis) in 37% of couples. STIs were strongly clustered within partner dyads. For example, female participants with male partners with gonorrhoea had increased prevalence of not only gonorrhoea (PR 10.4, 95% CI 6.4 to 16.8) but also HIV (PR 2.2, 95% CI 1.5 to 3.2), chlamydia (PR 2.5, 95% CI 1.1 to 5.7), trichomonas (PR 2.4, 95% CI 1.2 to 4.7) and HSV-2 (PR 1.3, 95% CI 1.1 to 1.7).

Conclusion: Partners of individuals with an STI are more likely to have a curable STI, which may be the same or may be a different pathogen; broad screening of partners could be essential to curbing transmission and preventing reinfection. Comprehensive couple-based approaches, including partner notification, treatment and counselling strategies, are critical for reducing STI disease burden.

Objectives: The restrictive chlamydia testing guidelines for asymptomatic individuals at Dutch sexual health centres (SHCs) since January 2025 may influence perceptions and attitudes towards testing for sexually transmitted infections (STIs). This study aimed to assess the potential impact of this guideline change on STI testing preferences among young people and to examine determinants and underlying motivations of these preferences.

Methods: Heterosexuals aged 16-34 in the Netherlands, recruited via social media and SHCs, completed an online survey (April-June 2024). STI testing preferences (SHCs, general practitioners (GPs), commercial self-sampling tests or not testing) before and after the anticipated guideline change were assessed in a hypothetical scenario involving condomless sex with a new partner without having STI-related symptoms after. Participants initially preferring SHCs were grouped according to post-change preferences. We used logistic regression to identify factors associated with preferences and thematic analysis to explore motivations.

Results: Of 1179 participants, 68% (95% CI 65% to 71%) initially preferred SHCs as a testing provider. After the guideline change, among this group, 24.2% (95% CI 21% to 27%) still preferred SHCs, 51.5% (95% CI 48% to 55%) switched to a preference for testing at GPs, 18% (95% CI 16% to 21%) to self-sampling and 6.2% (95% CI 5% to 8%) opted out. Switching to GPs was associated with younger age and high self-efficacy and control beliefs; choosing self-sampling with older age (>24) and university education; and opting out with inconsistent condom use and low health goals compared with preferring SHCs. Motivations included test costs, symptom absence and perceived chlamydia prevalence.

Conclusion: Changing chlamydia testing guidelines at SHCs may cause a shift in testing preferences to GPs or self-sampling and may discourage some from testing. These findings underscore the need for targeted communication and ongoing monitoring of STI testing behaviour to maintain STI testing uptake and are relevant for countries facing similar changes to chlamydia testing guidelines.

Objectives: Doxycycline as bacterial sexually transmitted infection (STI) postexposure prophylaxis (DoxyPEP) has shown high efficacy in clinical trials. We evaluated the impact of DoxyPEP on chlamydia (CT), gonorrhoea (GC) and syphilis incidence among pre-exposure prophylaxis (PrEP) users in a sexual health clinic in San Francisco, California, USA.

Methods: DoxyPEP was offered to all PrEP clients at routine clinical visits starting on 30 November 2022. We included PrEP clients who received DoxyPEP (DoxyPEP users) or never initiated DoxyPEP (non-DoxyPEP users). Among DoxyPEP users, the 'pre-DoxyPEP' period was from 1 June 2022 until DoxyPEP initiation, and the 'post-DoxyPEP' period started after DoxyPEP initiation through 7 September 2023. STI testing included three sites-GC, CT and early syphilis testing. STI incidence rate ratios (IRRs) per quarter were evaluated using a pre-analysis, post-analysis and a controlled interrupted time series (CITS) analysis, with mixed-effects Poisson regression used to evaluate intervention effects.

Results: Among 3081 PrEP clients, 1209 (39%) initiated DoxyPEP. During the pre-DoxyPEP period, any STI, CT, GC and syphilis mean quarterly positivity was 18.1%, 9.2%, 8.1% and 2.2% among DoxyPEP users and 7%, 3.2%, 3% and 0.7% among non-DoxyPEP users, respectively. In pre-implementation and post-implementation analysis of DoxyPEP users, DoxyPEP was associated with lower STI incidence for any STI (IRR 0.42, 95% CI 0.24 to 0.74, p=0.003), CT (IRR 0.33, 95% CI 0.23 to 0.46, p<0.001) and syphilis (IRR 0.22, 95% CI 0.07 to 0.54, p=0.001), but not GC (IRR 0.89, 95% CI 0.69 to 1.15, p=0.383). In a CITS analysis, DoxyPEP was associated with a significant decline in any STI incidence (0.67, 95% CI 0.46 to 0.96, p<0.030).

Conclusions: Observed DoxyPEP uptake reflected strong demand among PrEP users when offered in a clinical setting. Overall, STI incidence declined rapidly after implementation, demonstrating the high impact of this intervention in a real-world setting. Continued evaluation of uptake, adherence and impact on bacterial STIs will be essential as DoxyPEP implementation expands.

Objectives: Following the fall in new HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) since 2015, the English government published an HIV Action Plan in 2021 committing to end HIV transmission by 2030. Underlying HIV transmission and access to testing influence diagnosis trends and may not reflect incidence as people could be living with undiagnosed HIV for many years. We derived HIV incidence by clinical risk markers and pre-exposure prophylaxis (PrEP) use.

Methods: Using GUMCAD STI surveillance data between 2014/2015 and 2022/2023, we calculated yearly HIV incidence among HIV-negative GBMSM attending sexual health services (SHS) in England with at least two HIV tests within 365 days ('repeat testers'). Annual incidence was stratified by clinical risk markers: bacterial sexually transmitted infection (STI) history and recent HIV test (from the previous year). Incidence was further stratified by PrEP use in 2022/2023.

Results: The number of HIV-negative GBMSM attending SHS in England increased by 34% from 111 977 in 2014/2015 to 1 49 904 in 2022/2023, of whom repeat testers were 34% (37 576) in 2014/2015 and 38% (56 896) in 2022/2023. HIV incidence reduced by 93% overall (1.77/100 person-years (py) (95 CI 1.61 to 1.94) in 2014/2015 to 0.12/100 py (0.09 to 0.16) in 2022/2023). Incidence was reduced by at least 89% in all groups irrespective of clinical risk markers: with bacterial sexually transmitted infection (STI) history (3.68/100 py (3.17 to 4.27) to 0.26/100 py (0.18 to 0.38)); the subset with a rectal bacterial infection (5.18/100 py (4.13 to 6.49) to 0.58/100 py (0.36 to 0.93)) and with a recent HIV test (1.93/100 py (1.66 to 2.24) to 0.08/100 py (0.05 to 0.13)). In 2022/2023, using PrEP reduced HIV incidence by 86% (using PrEP: 0.05/100 py (0.03 to 0.08)) vs not using PrEP: 0.36/100 py (0.26 to 0.50)).

Conclusion: There was a sustained and large decline in HIV incidence among GBMSM, while incidence remains highest among those with a recent bacterial STI history. This analysis further highlights the real-world impact of PrEP and highlights the importance of equitable provision of HIV combination prevention interventions.

Objectives: Genital Chlamydia trachomatis (C. trachomatis) is the most prevalent bacterial sexually transmitted infection globally, with partner notification being a major challenge. This study combined partner notification and self-sampling to assess the C. trachomatis prevalence among sexual partners and assessed the association between partner positivity and age, symptoms and clinical department.

Methods: Conducted at Shaoxing Maternal and Child Health Hospital from 18 October 2023 to 29 April 2025, the cross-sectional study involved notifying 1543 women diagnosed with C. trachomatis to return for treatment. The hospital provided self-sampling test kits, free testing and treatment services for their male partners. We analysed the links between partner positivity and the age, symptoms and clinical departments of the diagnosed women.

Results: 1191 women returned to the clinic and received treatment, and 599 urine kits were distributed, 504 were returned, yielding an 84.1% return rate (504/599). Among the returned specimens, 220 (43.9%, 220/501, with three specimens excluded due to incomplete data) tested positive for C. trachomatis. Women aged 16-25 with a C. trachomatis diagnosis had the highest partner positivity rate at 53.5% (83/155), which is 3.17 times higher than those aged 41 and older (OR=3.17, 95% CI 1.52 to 6.59). The 26-40 age group had the second-highest rate at 41.5% (125/301), nearly double that of the 41+ age group (OR=1.95, 95%CI 0.97 to 3.93). The symptomatic status and the recruitment clinics of women diagnosed with C. trachomatis did not significantly affect partner positivity rates.

Conclusions: The prevalence of C. trachomatis infection was prevalent among partners of infected individuals, particularly those under 25 years of age, indicating a need for targeted interventions within this demographic.

Objectives: To determine whether intensifying therapy with three weekly doses of benzathine penicillin G (BPG) improves maternal serological response in early syphilis during pregnancy compared with the standard single dose.

Methods: In this randomised, non-blinded, single-centre study, 23 pregnant women with secondary or early latent syphilis and no previous history of the disease were enrolled. Participants were assigned to receive either a single intramuscular 2.4 million International Units (MIU) dose of BPG (n=12) or 3 weekly intramuscular doses of 2.4 MIU (n=11). Venereal Disease Research Laboratory (VDRL) titres were measured at baseline, delivery and 2 months postpartum. Serological change (ΔVDRL) was defined as the number of twofold dilution decreases between baseline and follow-up. Neonates underwent clinical and serological evaluation at birth and were followed up to 6 months.

Results: Median gestational age at treatment initiation was 16.5 weeks in the single-dose group and 19 weeks in the three-dose group. Baseline median VDRL titres were 1:16 and 1:8, respectively. By delivery, 60.9% of women showed no change in VDRL titre, and only a minority achieved a ≥2-dilution decrease. Two months postpartum, further declines were observed but most women still did not reach a fourfold decline. There were no significant differences in VDRL titres between groups at delivery (median 1:8 in both, p=0.66) or 2 months postpartum (median 1:4 in both, p=1.0). ΔVDRL was not associated with gestational age at treatment or treatment-to-delivery interval. All neonates were clinically healthy, had VDRL titres equal to or lower than their mothers at delivery and achieved complete seroreversion of both treponemal and non-treponemal tests by 6 months.

Conclusions: This is the first randomised study evaluating intensified therapy for early syphilis in pregnancy. Three weekly BPG doses did not improve maternal serological response or neonatal outcomes compared with a single dose. These findings support current recommendations for single-dose therapy in early syphilis during pregnancy.

Objectives: The presence of gonococcal strains carrying the penA-60.001 allele has been reported worldwide. These strains can be resistant to ceftriaxone (CRO), which often leads to treatment failure. However, this strain has not been reported in Japan since 2017; therefore, its recent spread is not understood. Here, we report the emergence of CRO-resistant Neisseria gonorrhoeae and the strain carrying the penA-60.001 allele in Japan in recent years.

Methods: N. gonorrhoeae strains were identified during routine surveillance in the Kyoto-Osaka area of Japan between 2018 and 2024. Antimicrobial susceptibility testing was performed using the agar dilution method. Whole-genome sequencing (WGS) was performed using the MiSeq platform. A phylogenetic tree was constructed based on the core genome using IQ-TREE V.2.0.0, with the best-fit nucleotide substitution model being selected using the Bayesian information criterion. Transformation experiments were conducted to confirm that the gDNA of the CRO-resistant strain of N. gonorrhoeae could generate a new CRO-resistant strain.

Results: Of the 1336 N. gonorrhoeae strains isolated in this study, 6 were resistant to CRO. WGS revealed that one of these CRO-resistant N. gonorrhoeae strains, IW642, exhibited multilocus sequence type (MLST) 9903. It also carried the penA-60.001. A similarity analysis of the penA-murE regions of IW642 and FC428 revealed complete sequence identity in the penA region. Through transformation experiments, we also demonstrated the ability of IW642 gDNA to produce new CRO-resistant strains of N. gonorrhoeae.

Conclusions: An N. gonorrhoeae strain carrying the penA-60.001 allele was identified in Japan again, after not being reported since 2017. Based on a phylogenetic analysis, the strain originated from a different lineage than that of the previously dominant MLST 1903 strain in Japan. Transformation studies showed that new CRO-resistant N. gonorrhoeae strains could emerge from the gDNA of the MLST 9903 strain that was isolated.

Objective: The incidence of anal cancer (AC) is higher in women with HIV than in women without HIV due to immunosuppression and persistence of human papilloma virus (HPV). Since 2024, the International Anal Neoplasia Society's and European AIDS Clinical Society (EACS) guidelines recommend annual AC screening of cisgender women (CW) of ≥45 years old, transgender women (TW) of ≥35 years old and women with previous vulvar high-grade squamous intraepithelial lesion (HSIL)/cancer regardless of age. This study describes current clinical practices and protocols for AC screening in women with HIV within healthcare settings across WHO European Region (WER).

Methods: Between November 2024 and January 2025, an anonymous online survey on AC screening and prevention in persons with HIV was disseminated among healthcare workers in the WER via the EACS website, social networks and e-mails.

Results: Among the 240 participants, 28.1% declared following national AC screening guidelines. Of those, 43.3%, 20.9% and 19.4% stated that CW, TW and women with previous vulvar HSIL/cancer, respectively, were not included in AC screening guidelines. Of those who answered the question, 37.7% respondents routinely asked CW about AC symptoms; 12.5% and 25.0% of respondents performed digital anal rectal examination annually in cis and trans gender women, respectively.Anal cytology was not routinely available in 23.2% and HPV genotyping in 20.8% of clinical settings. High-resolution anoscopy was not accessible for 37.2% of respondents and was more available in Western (68.2%) than in Central/Eastern Europe (44.6%). 26.4% of respondents did not routinely suggest HPV vaccination to adult CW. Main barriers to AC screening among women were lack of resources (47.9%), integrated resources (47.5%) and guidelines (46.6%).

Conclusion: Women with HIV are often omitted in national guidelines and practices for AC screening in Europe. Screening methods are often not accessible. More education of healthcare workers is needed about benefits of AC screening and HPV vaccination for women with HIV.