Sexually Transmitted Infections最新文献

Objectives: Chlamydia and gonorrhoea have remained the most common nationally notifiable sexually transmitted infections (STIs) in the USA, demonstrating a need for more clarity on rates of testing and diagnosis. Behavioural changes (eg, declining condom use) may contribute to high cases, although sexual activity rates have decreased. Increased STI screening, especially among women, could also influence diagnosis rates. Research shows differences in infection rates by anatomical site (urogenital, oral, rectal) and the need for more comprehensive screening. This study aimed to explore how screening and diagnosis differ across sites in populations with exclusively opposite-sex sex partners.

Methods: This rapid review assessed the current landscape of screening and diagnosis of chlamydia and gonorrhoea in populations with opposite-sex sex partners, focusing on comparisons across anatomical sites. CENTRAL, PubMed and Embase were searched, and a risk of bias assessment was conducted to qualitatively examine potential bias across studies.

Results: A total of 25 studies from 2010 to 2023 were reviewed, focusing on chlamydia and gonorrhoea screening and diagnosis across urogenital, rectal and pharyngeal sites. Urogenital screening was most common, while pharyngeal screening was least common. Diagnosis rates varied. Median test positivity was 8.8% (women) and 2.1% (men) for rectal chlamydia, 2.9% (women) and 4.1% (men) for rectal gonorrhoea, 2.3% (women) and 1.1% (men) for pharyngeal chlamydia, and 2.6% (women) and 2.4% (men) for pharyngeal gonorrhoea. Women were more frequently screened for extragenital sites, rectal and pharyngeal diagnoses were more common in women, and urogenital diagnoses were slightly more common in men. Most studies found co-occurrence of infection at multiple sites or extragenital infection without urogenital infection.

Conclusion: This review highlights the current understanding of screening and diagnosis of chlamydia and gonorrhoea among populations with exclusively opposite-sex sex partners and supports the need for increased screening, particularly of extragenital sites, to reduce transmission rates.

Objectives: Despite the wide implementation of HIV oral pre-exposure prophylaxis (oPrEP), uptake, adherence and persistence issues remain. Long-acting injectable cabotegravir (CAB-LA) is a promising new PrEP HIV prevention option. However, little is known about oPrEP users' interest in it. We investigated men who have sex with men (MSM) oPrEP users' willingness to participate (WtP) in a CAB-LA PrEP study in France.

Methods: We designed a cross-sectional questionnaire ('NewPrEP') to evaluate attitudes to CAB-LA of daily and event-driven oPrEP users participating in the ANRS-PREVENIR cohort study (2017-2025). The outcome, WtP, was dichotomised into 'Willing' (absolutely/probably) or 'Unwilling' (probably not/absolutely not/I would like to discuss this with my doctor before making a decision). We used multivariate logistic Bayesian model averaging to estimate factors associated with WtP.

Results: Of the 1555 MSM followed in ANRS-PREVENIR in February 2023 with baseline data, 879 (57%) answered the NewPrEP questionnaire. Median age and follow-up time were 38 and 4.7 years, respectively; 37% and 22% were on daily- and event-driven oPrEP, respectively; 41% used a combination of both regimens. 64% had heard of CAB-LA PrEP, and 43% were WtP in a related study. Multivariate results showed that willing participants were younger and more likely to have heard of CAB-LA, to use daily oPrEP exclusively or in combination, to find it difficult to adhere to their regimen, to engage in chemsex, to trust their doctor and to be more interested in PrEP effectiveness than in the administration mode. They were less likely to perceive the obligatory 2-monthly hospital visits for CAB-LA PrEP as constraining, to be scared of injections and to fear long-acting medications.

Conclusions: WtP in a CAB-LA study among MSM oPREP users was moderate but concentrated among those with the greatest need. This highlights the need to enable free distribution. Future studies should evaluate adherence and retention in long-acting iPrEP.

Objectives: We investigated the costs and cost-effectiveness of screening and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae among asymptomatic pregnant women in Botswana to prevent preterm birth/low birth weight, compared with no microbiological screening.

Methods: A health systems perspective and microcosting approach were used to estimate the costs of screening, treatment and partner treatment. Cost, epidemiological and effectiveness data were collected alongside the Maduo Study, a non-randomised cluster-controlled trial in Gaborone, Botswana evaluating the effect of C. trachomatis and N. gonorrhoeae screening on health outcomes among asymptomatic pregnant women and infants. We developed a decision tree to model a hypothetical cohort of 50 000 pregnant women receiving screening at first antenatal care and third trimester visits. We defined cost-effective as having an incremental cost per disability-adjusted life year (DALY) averted <$3625 (50% of Botswana's 2023 gross domestic product per capita).

Results: The cost per person screened was US$23.67. Additional costs of C. trachomatis and N. gonorrhoeae treatment were US$3.44 and US$4.60, respectively. The total cost of implementing the intervention among 50 000 pregnant women would be US$2 363 665. Compared with the standard-of-care, we projected an incremental cost per preterm birth/low birth weight outcome averted of US$962.56. Screening and treatment for C. trachomatis and N. gonorrhoeae were projected to be cost-effective with an incremental cost per DALY averted of US$580.51. However, the incremental cost-effectiveness ratio (ICER) was highly uncertain in sensitivity analyses, and assumptions about intervention effectiveness were highly influential on the ICER.

Conclusions: Screening for C. trachomatis and N. gonorrhoeae infections has the potential to prevent serious adverse birth outcomes that contribute to childhood mortality, morbidity and high costs to the healthcare system. Additional research on the effectiveness of screening and treatment for these infections on preventing adverse birth outcomes is necessary to provide robust evidence that can inform cost-effectiveness analyses and decision-making.

Objective: To evaluate the outcomes of a street medicine intervention offering syphilis testing and treatment to people experiencing homelessness in South Los Angeles, California-a population disproportionately affected by syphilis and underserved by traditional healthcare systems.

Methods: From September 2024 to January 2025, a multidisciplinary street medicine team provided testing and treatment for syphilis during outreach visits to patients experiencing homelessness. A total of 99 patients were tested using the reverse syphilis testing algorithm. Demographic data included gender, race/ethnicity, substance use disorder, mental illness and HIV status. χ² tests were used to evaluate associations between syphilis diagnosis and each demographic characteristic.

Results: Thirty-six (36.4%) of the 99 patients had reactive syphilis test results, with 94.4% (n=34) classified as late-stage infections. Of those diagnosed, 72.2% (n=26) were treated during follow-up visits. Statistically significant associations were found between syphilis diagnosis and gender (p=0.002), substance use disorder (p=0.008) and HIV status (p=0.020). Patients identifying as female or transgender female, and those with cooccurring substance use disorder or HIV, were more likely to be diagnosed with syphilis.

Conclusions: This study demonstrates the feasibility and outcomes of delivering sexually transmitted infection care through street medicine. The high prevalence of late-stage syphilis and its syndemic overlap with substance use disorder and HIV underscores the need for low-barrier, community-based services. Street medicine interventions should be recognised and resourced as essential tools in public health responses to rising syphilis rates, particularly among unhoused populations.

Objectives: Syphilis infections are high among men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP). Point-of-care (POC) testing may improve diagnosis and treatment. We performed a field evaluation of the Chembio dual path platform (DPP) Syphilis Screen and Confirm treponemal/non-treponemal POC test within an HIV PrEP programme in Hanoi, Vietnam.

Methods: From December 2023 to July 2024, males aged ≥16 years enrolled in the HIV PrEP programme who reported sex with men in the last year were enrolled. Specimens were tested using the Chembio DPP syphilis screen and confirm test and reference treponemal (Abbott Bioline or Determine) and non-treponemal (rapid plasma reagin (RPR)) tests. Positive per cent agreement (PPA), negative per cent agreement (NPA), positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa were calculated comparing the DPP versus reference tests.

Results: We enrolled 400 participants; median age was 26.4 years (IQR 22.5-30.4); one invalid test was excluded. The prevalence of a reactive treponemal test was 35.3% (141/399). For the DPP treponemal test, PPA was 75.2% (95% CI 67.2% to 82.2%), NPA was 96.9% (95% CI 94% to 98.7%), PPV was 93% (95% CI 86.8% to 96.4%), NPV was 87.7% (95% CI 83.4% to 91%), and Cohen's kappa was 0.75. For the DPP non-treponemal test, PPA was 36.5% (95% CI 23.6% to 51%), NPA was 99.4% (95% CI 97.9% to 99.9%), PPV was 90.5% (95% CI 71.1% to 97.4%), NPV was 91.3% (95% CI 88% to 93.7%), and Cohen's kappa was 0.48 (95% CI 0.33 to 0.61). For RPR titres ≥1:8, PPA and Cohen's kappa increased to 85.7% (95% CI 57.2% to 98.2%) and 0.67 (95% CI 0.47 to 0.81), respectively.

Conclusions: Among MSM in an HIV PrEP programme with high syphilis prevalence, the DPP treponemal test performed well. While non-treponemal performance was lower, it was strong for RPR titres ≥1:8, suggesting it could aid in identifying high-titre syphilis infections more likely to be transmissible.

Background: In 2018, Rwanda incorporated oral pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine (Truvada) into national HIV guidelines as part of a comprehensive HIV prevention programme for female sex workers (FSWs). This study assessed the impact of PrEP on HIV incidence among FSWs in urban Rwanda.

Methods: We conducted a retrospective cohort study among HIV-negative FSWs aged≥18 years at 20 health facilities in Kigali from January 2019 to October 2021. All participants received standard HIV prevention services including routine condom distribution, peer education activities and the option to receive daily oral PrEP. Those who consented to receive PrEP formed the exposed group and those who declined or were not eligible to receive PrEP formed the control group. We used Cox regression to assess HIV seroconversion and logistic regression to assess retention in care.

Results: Among 1897 FSWs (median age 30.1 years, IQR: 25.2-35.6), 1129 (59.5%) initiated PrEP. The HIV incidence rate was 0.40 per 100 person-years (PYs) among FSWs in the PrEP group versus 1.83 per 100 PYs for those in the non-PrEP group. In multivariate analysis, PrEP was associated with a reduced risk of HIV seroconversion (adjusted HR: 0.25; 95% CI: 0.09 to 0.71). Retention in the HIV prevention programme at 12 months was 77.6% among FSW who used PrEP versus 73.6% among non-users (adjusted OR: 1.29 (95% CI: 1.03 to 1.60).

Conclusions: Oral PrEP was associated with reduced HIV risk of HIV seroconversion among FSWs in Kigali. However, the small number of HIV seroconversions and limitations of the observational design warrant cautious interpretation of study findings.

Objectives: There is limited evidence about the prevalence of oropharyngeal gonorrhoea (OPNG) in heterosexuals. To test the hypothesis that the oropharynx acts as a reservoir for gonorrhoea, potentially contributing to high rates of infection, we assessed OPNG positivity in self-sampling individuals.

Methods: From November 2023 to March 2024, SH:24, an online postal self-sampling service, expanded gonorrhoea (NG) nucleic acid amplification testing to include oropharyngeal swabs for heterosexual individuals aged 17-24 years in Northern Ireland and Ireland. Participants were included if they identified as heterosexual with no same or both-gender sexual partners. Positivity was compared by sex and infection site, with χ² tests. Island-of-Ireland weighted positivity with 95% CI was estimated.

Results: OPNG was detected in 92% (208/226) of NG cases, representing 2.9% (95% CI 2.6 to 3.4) of the tested population. Single-site OPNG infections accounted for 63% (143/226) of cases, corresponding to an overall single-site oropharyngeal positivity of 1.9% (95% CI 1.7 to 2.4). Genital-only infections occurred in 8% (18/226) of cases, while concurrent oral and genital (multisite) infections were identified in 29% (65/226). Overall NG positivity (across all anatomical sites) was 3.2% (226/7009; 95% CI 2.8 to 3.7). Of 12 011 individuals who requested a self-sampling kit, 7036 (58.6%) returned both oropharyngeal and genital swabs suitable for analysis, with valid test results available for 7009 individuals.

Conclusions: Our findings suggest the oropharynx is a common NG infection site among young heterosexuals, often occurring independently of genital infection. Most OPNG cases (63%) did not coincide with genital infection and would have been missed by testing protocols limited to urogenital sites. These results suggest a potential risk for onward transmission, the need to consider a review of testing guidelines in this population and further research to better understand behavioural risk factors associated with OPNG positivity.