Sexually Transmitted Infections最新文献

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.

Objectives: Describe the clinical, phenotypic and genomic characteristics of ceftriaxone-resistant Neisseria gonorrhoeae from Scotland.

Methods: Cases were identified in routine care from 2018 to 2024. Minimum inhibitory concentrations were determined for seven antimicrobial agents. Whole genome sequencing was performed with Illumina and Oxford Nanopore Technology instruments. A phylogeny containing global ceftriaxone-resistant genomes was generated with Parsnp. A collection of ST8780 genomes was also analysed to give further context using reference-based mapping with Snippy.

Results: There were five cases of ceftriaxone-resistant N. gonorrhoeae detected. One case (multilocus sequencing typing (MLST) ST1903) clustered within the FC428 lineage in a returning traveller from an Asia-Pacific country. Two cases belonged to the recently described extensively drug-resistant MLST ST16406, a returning traveller from an Asia-Pacific country and a sexual contact within Scotland. The final two cases were a resident of an Asia-Pacific country and a sexual contact within Scotland, both belonged to MLST ST8780. These were distinct from other publicly available ST8780 genomes, suggesting a novel introduction of the mosaic penA-60.001 allele. All cases were initially treated with ceftriaxone-based regimes, four returned for test of cure and showed clearance of infection.

Conclusions: As ceftriaxone resistance is increasingly identified, multiple public health interventions are required to reduce the impact of resistance on gonorrhoea treatment globally.

Objectives: Mycoplasma genitalium (MG) STIs represent a global concern, especially considering its rapid ability to acquire antimicrobial resistance. The objective of this study was to investigate the epidemiology of MG and antibiotic resistance among the general female and male populations in northern Spain.

Methods: Between April 2019 and May 2023, individuals attending healthcare facilities for STI screening were tested for MG and macrolide and fluoroquinolone resistance mutations. Phylogenetic analysis was conducted using single-locus sequence-based typing of the mgpB gene and complemented by dual-locus sequence-based typing combining the mgpB and MG309 genes.

Results: Of the 6350 people tested for MG during the study period, 5269 (83%) were women. Macrolide resistance mutations were identified in 25.4% of cases, with a higher prevalence in men (40% vs 17.14%) and coinfection with Chlamydia trachomatis was found predominantly in women (18.6% vs 7.5%). Phylogenetic analysis revealed two distinct epidemiological clades strongly correlated with gender. Clade A predominantly involved men with higher rates of HIV and syphilis history and detection of resistance mutations, while clade B exclusively comprised women, with only one case of macrolide resistance.

Conclusions: The predominance of women in STI screening requests reflects local trends in screening patterns and underscores the importance of understanding MG infection in women in our region. The clear separation of clades suggests two independent sexual networks, with clade A representing a high-risk population and dense connectivity. This research provides a foundation for future studies on the prevalence, transmission dynamics and impact of MG infection, particularly among the female population, where understanding remains limited.

Objectives: Syphilis remains a public health challenge, particularly among people with HIV (PWH). This study aimed to examine the trends of syphilis and associated factors among PWH in Taiwan, 2016-2023, before the implementation of doxycycline postexposure prophylaxis (DoxyPEP).

Methods: PWH aged 18 years or older who sought HIV care at a university hospital and had at least two serological tests for syphilis during the study period were included. Annual incidence rates of syphilis were calculated as the number of new syphilis cases per 100 person-years of follow-up (PYFU), while the prevalence was defined as the proportion of PWH who had a positive rapid plasma reagin (RPR) titre. Reinfection was defined as a ≥4 fold increase in RPR titre following a prior syphilis diagnosis. Multivariable logistic regression was used to identify factors associated with syphilis acquisition.

Results: Among 3828 PWH, a total of 3201 incident syphilis cases were recorded during a total of 23 385.1 PYFU. The incidence rate decreased significantly from 16.78 per 100 PYFU in 2016 to 11.14 per 100 PYFU in 2023, a 33.6% reduction. The prevalence peaked at 45.0% in 2019 before declining to 41.6% in 2023. Reinfections constituted 66.3-85.0% of incident cases annually. Factors associated with acquiring syphilis included younger age (adjusted OR (AOR), per 10-year increase, 0.71; 95% CI, 0.67 to 0.75), men who have sex with men (AOR, 1.75; 95% CI, 1.32 to 2.32), a previous syphilis history (AOR, 7.26; 95% CI, 6.48 to 8.14) and no follow-up RPR data in the preceding year(s) (AOR, 3.02; 95% CI, 2.08 to 4.38).

Conclusions: While the declines in incidence and prevalence of syphilis among PWH before the implementation of DoxyPEP were likely driven by an ageing population in Taiwan, regular serological testing for syphilis remains imperative for early diagnosis and treatment of syphilis to prevent further transmission.

Objectives: Αn HIV-1 outbreak was identified among people who inject drugs (PWID) in Thessaloniki, Greece, during 2019-2021. We aimed to investigate the characteristics of this outbreak by means of molecular epidemiology.

Methods: We analysed 57 sequences from PWID sampled in Thessaloniki during 2019-2023. Phylogenetic trees were inferred using all subtype A sequences from PWID sampled since 1999 in Greece and reference sequences (n=4824). Phylodynamic analysis was performed using the Bayesian birth-death skyline serial model.

Results: Most of the 57 study sequences belonged to sub-subtypes A6 (49, 86%) and A1 (4, 7%). Phylogenetic analysis revealed that two (50%) A1 sequences clustered together and 47 (95.9%) A6 sequences fell within three PWID-specific phylogenetic clusters. The 99.6% and 77.9% of pairwise genetic distances within the largest and second largest PWID clusters were lower than 0.015 substitutions/site. Using a more stringent threshold (0.0015 substitutions/site), we identified five networks of sequences from PWID infected within 1 year. The effective reproduction number (R_e) started to increase at the beginning of 2019 and remained high almost until the end of 2021. The estimated time from HIV-1 infection to diagnosis showed an increasing trend during 2020-2023 (p<0.001).

Conclusions: The regional clustering of the PWID sequences and their low genetic divergence confirm its local spreading and the recent nature of the outbreak. Using a stringent genetic distance threshold, we showed that HIV-1 transmission occurred among large groups of PWID. The time of epidemic growth coincided with the time of the initial identification, and HIV-1 transmission continued at high rates until 2021.