Sexually Transmitted Infections最新文献

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.

Objective: To quantify how many people in England could benefit from using pre-exposure prophylaxis (PrEP) to prevent HIV acquisition (PrEP need), and of these, the number who did not access PrEP (unmet need) by population group and ethnicity.

Methods: An established multiplier method was applied using published data from a behavioural survey of gay, bisexual and men who have sex with men (GBMSM) and national data on UK-acquired new HIV diagnoses categorised by ethnicity and probable HIV exposure route.After calculating the number of GBMSM who could benefit from PrEP, the number of people in other groups who could benefit from PrEP was calculated using the relative proportion of new HIV diagnoses within each group. The proportion of new HIV diagnoses by ethnicity was then used to calculate the number of people who could benefit from PrEP by ethnicity.Within each subgroup (population group and ethnicity), the number with unmet need for PrEP was calculated by subtracting those who accessed PrEP at a specialist sexual health service (SHS) from the estimated number who could benefit from PrEP.

Results: In 2023, there were an estimated 485 335 people who could benefit from PrEP in England, 80.1% (n=388 773) of whom did not access PrEP from an SHS-and of these, 94.5% (n=367 444) did not attend an SHS. There were 129 359 heterosexual women with unmet PrEP need, 93 049 GBMSM and 88 204 heterosexual men. There were three ethnicities for which >85% of people with PrEP need did not access PrEP: Black African (98.6%), Black other (96.3%) and Black Caribbean (85.4%).

Conclusions: The findings indicate a considerable unmet need for PrEP in England. Most people with unmet need did not attend an SHS, highlighting an urgent need to raise awareness of the benefits of PrEP and expand PrEP access to additional settings.

Objectives: TESTATE STI is an online offer of self-sampling kits (SSKs) for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among gay, bisexual and other men who have sex with men (GBMSM) and transgender people (TG) in Catalonia. The aims of this study are: 1) to develop and evaluate the effectiveness, satisfaction and willingness of a pilot online intervention that includes the offer of SSKs for CT/NG screening with online consultation of subsequent results and (2) to analyse its potential as an effective strategy to encourage diagnosis, linkage to treatment and to describe contact notification by participants with a positive diagnosis.

Methods: The distribution of SSKs, which included a urine collection tube, a pharyngeal and a rectal swab, was conducted through two recruitment strategies: autonomously via social media and GBMSM or TG leisure spaces, or accompanied by community-based organisations. Participants completed a socio-demographic, biobehavioural and satisfaction survey.

Results: A total of 386 kits were tested in the laboratory. The estimated positivity rate for having at least one STI was 20.7%. TESTATE STI indicates that approximately 90.0% of positive participants were extragenital. 81.0% of positive cases were linked to the health system, and 96.9% of those were treated. We estimate that five kits must be performed to detect a positive CT/NG with the TESTATE STI intervention. Almost all participants (98.8%) would recommend taking the chlamydia and gonorrhoea self-sampling with TESTATE STI.

Conclusion: The TESTATE STI project concluded that the deployment of SSKs for the detection of CT/NG is a viable and feasible strategy for GBMSM and TG in Catalonia. TESTATE STI is an effective strategy for encouraging diagnosis, treatment linkage and contact notification. Implementing TESTATE STI would increase access to confidential testing and promote early STI detection.

Background: Clinical guidelines for sexually transmissible enteric infections can provide a framework for testing, management, antimicrobial stewardship and public health control. This review aimed to evaluate the currently available clinical guidelines and to highlight any areas for improvement.

Method: A comprehensive online search for clinical guidelines was performed and reported using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, followed by evaluation using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool by three independent reviewers. An AGREE II domain score of >60% is the threshold for sufficient quality, and each guideline was rated high, average or low based on the domain percentages (five domains scoring >60%=high, 3-4 domains scoring >60%=average and ≤2 domains scoring>60%=low). Two authors developed a bespoke quality framework for sexually transmissible enteric infection guidelines and this was used to evaluate each guideline.

Results: Six clinical guidelines were identified from the UK (British Association for Sexual Health and HIV (UK-BASHH)), USA (Centers for Disease Control and Prevention (USA-CDC)), Europe (International Union against Sexually Transmitted Infections (Europe-IUSTI)), Canada-government, Brazil-government and Australia (Australasia Society for HIV, Viral Hepatitis, and Sexual Health Medicine (Australia-ASHM)). The overall AGREE II score was 56% (IQR 43-67) (domain 1 (scope and purpose) 67% (IQR=42-67), domain 2 (stakeholder involvement) 46% (IQR 34-62), domain 3 (rigour of development) 42% (IQR 22-49), domain 4 (clarity of presentation) 80% (IQR 57-89), domain 5 (applicability) 23% (IQR 11-30) and domain 6 (editorial independence) 67% (IQR 56-84)). The median global scores (out of 7) and rating (low, medium and high) were UK-BASHH (5/7, high), USA-CDC (5/7, average), Europe-IUSTI (4/7, average), Canada government (4/7, low), Brazil government (3/7, low) and Australia-ASHM (1/7, low). All six guidelines recommended testing using molecular platforms: UK-BASHH, USA-CDC and Europe-IUSTI recommended offering sexual health interventions and STI testing; the UK-BASHH and Australia-ASHM did not recommend empirical antimicrobials, and the Europe-IUSTI and Brazil government guidelines made specific antimicrobial recommendations, including macrolides, quinolones and cephalosporins.

Conclusion: Future clinical guidelines for sexually transmissible enteric infections require consistency and to improve their applicability, rigour of development, stakeholder involvement and recommendations for sexual health interventions, sexually transmitted infection testing, partner notification, handwashing and food handlers' advice and antimicrobial treatment.

Introduction: The use of remote consultations, such as appointments via telephone, video, online or text in sexual and reproductive health services (SRHS) across the UK, has expanded in recent years. This review synthesises grey literature from different organisations to identify current practice and guidance for remote consultations.

Methods: We searched for a range of grey literature document types, including unpublished reports, evaluations, published standards, guidance, blogs and opinion pieces. The searches were conducted between March 2023 and July 2024 using Google, as well as the Healthcare Management Information Consortium database and preidentified organisational websites (eg, the British Association for Sexual Health and HIV, the Faculty of Sexual and Reproductive Healthcare). Data extracted included terminology, challenges to implementation and linked guidance and equity considerations in the use of remote consultations in SRHS. Narrative synthesis was used to analyse findings.

Results: The available guidance on implementing and delivering remote SRHS is modest in scope and volume and draws on a sparse evidence base. Existing guidance recommends the use of safeguarding assessments and checklists to support pathways from remote into in-person care. While remote consultations were seen as potentially enhancing equity, challenges included differences in technology access and digital literacy. Equity-related guidance included prioritising disadvantaged groups for in-person appointments and flexible care pathways.

Discussion and conclusions: The grey literature highlights the potential of remote SRHS to improve access and equity while also identifying risks in implementation and outcomes. There is an ongoing requirement for detailed, evidence-informed guidance that incorporates service user perspectives.

Pasteurella bettyae is suggested as an emerging sexually transmitted pathogen in men who have sex with men. We analysed 25 cases, revealing a wider distribution and frequent concomitant infections. Our findings challenge its primary pathogenic role, suggesting it may act as an opportunistic coloniser.

Background: Ongoing sexually transmitted infection (STI) transmission reflects inequitable access to sexual healthcare services. STI reinfection pre-HIV and post-HIV infection is a proxy measure of sexual behaviour for people with HIV (PWH). Surveillance data show that recommended screenings are not occurring, leading to missed opportunities. Gaps exist about the true picture of STI infection and reinfection among PWH from pre-HIV to post-HIV diagnosis. To end the HIV epidemic and achieve national HIV goals of preventing new infections, synergistic STI/HIV screening is important to limit coinfection and co-transmission of other STIs and HIV.

Methods: We describe changes in STI patterns of infection among a statewide cohort of PWH (n=6896) in South Carolina pre-HIV and post-HIV diagnosis using linked HIV and STI surveillance data. We used multinomial logistic regression to examine and compare differences in pre- and post-HIV diagnosis for three STIs, namely chlamydia (CT), gonorrhoea (GC) and syphilis.

Results: Overall, 17.22% of PWH exhibited increasing or persistently high patterns of STI infection. Young adults (18-29) represented the largest proportion of PWH experiencing increasing (66.78%) and persistently high (80.00%) STI infection. Racial and gender minorities were disproportionately affected, with males and black individuals comprising the majority of those with increasing (males: 90.03%, black: 77.30%) and persistently high (males: 83.51%, black: 79.65%) STI infections. Post-diagnosis, syphilis remained the most prevalent STI (35.56%), chlamydia increased to 32.84% from 28.11% prediagnosis, and triple STI infection nearly doubled to 4.19%, corresponding to an approximate 200% increase relative to pre-HIV diagnosis.

Discussion: The persistent patterns of STIs among PWH call for a renewed focus on STI treatment and prevention as a central component for ending the HIV epidemic at the state and national levels.