Sexually transmitted diseases最新文献

Background: This study aimed to analyze differences in sexual health clinic service utilization by age and gender.

Methods: We analyzed data from 7949 visits by 4004 individuals at a Boston metropolitan sexual health clinic from January 2019 to June 2021. We stratified visits, sexually transmitted infections, HIV preexposure prophylaxis (PrEP) use, and health insurance by age and gender. We assessed predictors of PrEP prescription using multivariable Poisson regression. We defined our key analytic factor, PrEP indication, using US Centers for Disease Control and Prevention guidelines.

Results: At the visit level, attendees were 78% male, 50% White, and 13% uninsured; ≥1 sexually transmitted infection was recorded (using symptom, exposure, laboratory diagnosis, and treatment data) at 23% of visits. At the visit level, the youngest patients were significantly more likely to be uninsured (15-22 years: 15%, >22-26 years: 12%, >26-45 years: 14%, >45 years: 11%; P < 0.0001) and have no prior knowledge of PrEP (7%, 6%, 6%, 4%; P < 0.0001). Among visits at which a PrEP indication was identified (38%), PrEP was prescribed at 84% and 61% of visits attended by males and females, respectively. Women 26 years or younger versus women older than 26 years were 46% less likely to be prescribed PrEP.

Conclusions: Young people presenting for sexual health services in a Boston metropolitan area were more likely to be unaware of PrEP, and among those with indications, younger females were less likely to be prescribed PrEP.

Abstract: Guidelines for treating neonates exposed to perinatal syphilis are clear when treating neonates for confirmed proven or highly probable syphilis, but guidelines remain unclear when treating neonates deemed less likely to have congenital syphilis. This study aims to describe treatment patterns of neonates exposed to adequately treated perinatal syphilis.

Background: For infants born to those with infectious syphilis during pregnancy, guidelines recommend monitoring nontreponemal titers every 2 to 3 months until nonreactive. The primary objective was to determine when nontreponemal titers become nonreactive in this setting.

Methods: This retrospective cohort study included infants born to mothers in Alberta with infectious syphilis during pregnancy from January 1, 2015, to December 31, 2021, who had at least one follow-up rapid plasma reagin (RPR) beyond 1 month of age. Cumulative incidence curves for RPR, enzyme immunoassay, and Treponema pallidum particle agglutination seroreversion were examined.

Results: For 228 infants (46% female), a diagnosis of probable, possible, and less likely congenital syphilis was made in 13%, 32%, and 55%, respectively. Treatment with intravenous penicillin G was administered to 144 infants (63%), and 80 infants (38%) were not treated for congenital syphilis. A follow-up RPR performed at median 103 days of life (interquartile range, 86-143) was nonreactive in 174 infants (76%). Rapid plasma reagin, enzyme immunoassay, and T. pallidum particle agglutination seroreversion were documented in 96%, 40%, and 51% of cases, respectively. Rapid plasma reagin reactivity beyond 6 months of age was uncommon (1 of 80 untreated infants and 8 of 147 treated infants) and was associated with higher birth RPR.

Conclusions: Approximately three-quarters of infants born to persons with infectious syphilis during pregnancy will have RPR seroreversion by 3 months of age. A small percentage of treated and untreated infants will have a persistently reactive RPR at 6 months of age despite presumed adequate treatment.

Background: Nonbinary/genderqueer (NB/GQ) individuals represent a distinct population with unique sexual health care needs. We characterize trends in clinic attendance, sociodemographics, sexually transmitted infection (STI), and drug use among NB/GQ patients at an urban sexual health clinic (SHC).

Methods: We analyzed Public Health, Seattle & King County, Seattle (PHSKC) SHC visit data collected between January 2016 and October 2023. We used the Cochran-Armitage trend test to identify trends in reported gender identity and χ 2 tests to identify sociodemographic characteristics associated with cisgender, transgender, and NB/GQ. We evaluated the associations between gender identity and the prevalence of syphilis, urogenital gonorrhea, rectal chlamydia infection, methamphetamine, and nonprescribed injection drug use using generalized estimating equations.

Results: Of 82,384 visits, 1672 (2.0%), 867 (1.1%), and 79,845 (96.9%) were NB/GQ, transgender, and cisgender patients, respectively. From 2016 to 2023, the proportion of visits among NB/GQ and transgender patients increased from 0.7% to 3.5% and 0.7% to 1.7%, respectively ( p trend<0.001). NB/GQ identity was more common among patients assigned female versus male sex at birth (3.2% vs 1.8%, P < 0.001), younger vs older patients (14-25 years: 3.1% vs >46: 0.2%, P < 0.001), and white versus black patients (2.3% vs 1.0%, P < 0.001). Compared with MSM, NB/GQ patients had significantly lower odds of urogenital gonorrhea (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.32-0.80). The differences in rectal chlamydia (aOR, 0.78; 95% CI, 0.59-1.02) and syphilis (aOR, 0.96; 95% CI, 0.87-1.06) were not statistically significant. There were no significant differences between the NB/GQ and transgender visits.

Conclusions: Gender diversity among SHC attendees increased significantly over the 8 years. Continued monitoring is essential for tailoring STI/HIV prevention strategies.

Background: Indigenous Peoples in the United States experience disproportionate burdens of sexually transmitted infections (STIs), human immunodeficiency virus (HIV), and viral hepatitis, but data about associated testing behaviors are limited. Given that substance use is a risk factor for STIs and viral hepatitis, there is a need for more research on testing behaviors among Indigenous people who use drugs. This research examines correlates of STI, HIV, and hepatitis C virus (HCV) testing among a sample of people who use drugs in a northern Midwest Indigenous community.

Methods: This community-based participatory research includes a survey among people who used drugs in a Northern Midwest reservation community (N = 227). We described when individuals were most recently tested for STIs, HIV, and HCV. We also examined correlates of past-year testing, including individual characteristics, drug use behaviors, sexual partners, and condom use.

Results: Most participants had been tested for STIs (63%), HIV (60%), and HCV (65%) in their lifetime, whereas a quarter had been tested for STIs (33%), HIV (24%), and HCV (27%) in the past year. Recent testing for STI, HIV, and HCV was significantly associated with younger age, being a woman or gender minority, lifetime injection drug use, number of sex partners, and being willing to distribute HIV test kits.

Conclusions: This study is among the few to examine STI, HIV, and HCV screening behaviors in an Indigenous community and found that screening rates were suboptimal. Culturally relevant, Indigenous-led programs are essential to increase awareness and access to screening and ultimately address critical public health disparities.

Background: This study examined human immunodeficiency virus (HIV)-related health literacy and prevention among students at a Southeastern Historical Black College and University (HBCU) using the Integrative Health Literacy Model and the Consolidated Framework for Implementation Research.

Methods: Seven gender-specific focus groups (n = 20) were created between June and October 2023. The discussions explored health and HIV information-seeking behaviors, knowledge, prevention practices, and campus culture. Transcripts were analyzed using the domains of health literacy and the Consolidated Framework for Implementation Research.

Results: Participants primarily relied on social media and Google for health information, often passively encountering content rather than actively seeking it. Although most have basic knowledge of HIV, misconceptions persist regarding HIV transmission, prevention, and curability. Condom use and testing were endorsed but inconsistently practiced, and knowledge of preexposure prophylaxis (PrEP) was minimal. Female groups emphasized relational decision making and negotiation, whereas male groups raised more factual questions. Campus culture-including gossip, "dirty/clean" narratives, and sexual activity around events like homecoming-shaped both stigma and prevention behaviors. Barriers included comfort concerns regarding condom use, privacy concerns, judgmental staff, and uneven sexual health education before college.

Conclusions: The students highlighted the need for private, affordable, and culturally resonant preventive strategies. The Consolidated Framework for Implementation Research (CFIR) analysis identified opportunities for anonymous and bundled testing, peer-led education based on relationships and pleasure, and co-designed interventions that embed sexual health into campus life. Strengthening media literacy, promoting partner testing, and improving awareness of preexposure prophylaxis and rapid testing improve HIV prevention among HBCU students.

Background: Bacterial sexually transmitted infections (STIs) remain prevalent among men who have sex with men (MSM) and transgender women (TGW) in Peru. Doxycycline postexposure prophylaxis (doxy-PEP) is a promising prevention strategy, but data from Latin America remain limited.

Methods: We conducted 2 online surveys in Lima, Peru (September-October 2024). One assessed willingness to use doxy-PEP among MSM and TGW; the other assessed willingness to recommend doxy-PEP among health care providers (HCPs). Logistic regression evaluated correlates of high willingness.

Results: Of 730 eligible MSM and TGW, 447 completed outcome measures. Overall, 82.1% expressed willingness to use doxy-PEP, 34.2% expressed high willingness. High willingness was associated with ≥5 anal sex partners in the past 3 months (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.06-3.24), prior HIV preexposure prophylaxis use (aOR, 2.56; 95% CI, 1.40-4.71), living with HIV (aOR, 2.74; 95% CI, 1.44-5.24), and concern about needing a prescription (aOR, 3.33; 95% CI, 1.99-5.66). Concerns about side effects (aOR, 0.55; 95% CI, 0.31-0.98) and microbiome disruption (aOR, 0.51; 95% CI, 0.29-0.87) were negatively associated. Most participants preferred doxy-PEP over daily doxycycline (64.0% vs. 28.6%). Among 132 HCPs, 54.5% were involved in HIV/STI care; 87.1% expressed willingness to recommend doxy-PEP, and 89.4% would do so if included in national guidelines. Limited diagnostic capacity and risk of unofficial use were most frequently endorsed concerns.

Conclusions: High willingness to use or recommend doxy-PEP was observed among clients and HCPs in Peru, providing evidence to guide integration into sexual health services in Latin America.

Background: In the United States, Neisseria gonorrhoeae is the second most common reportable sexually transmitted infection amassing 601,319 cases in 2023. Notably, N. gonorrhoeae has developed antimicrobial resistance, necessitating ongoing surveillance. In response to this threat, the U.S. Centers for Disease Control and Prevention has established antimicrobial resistance surveillance networks including Strengthening the US Response to Resistant Gonorrhea (SURRG) and the Antibiotic Resistance Lab Network (ARLN). The SURRG project performs testing using a gradient strip method, the Etest, whereas ARLN laboratories perform testing by agar dilution, for determining minimum inhibitory concentration (MIC) values for N. gonorrhoeae .

Methods: We compared the concordance of MIC values obtained using the Etest gradient strip method at a SURRG site in North Carolina compared with ARLN using the agar dilution method for 3 antibiotics: azithromycin, cefixime, and ceftriaxone.The MIC values and the corresponding interpretations for each agent were analyzed according to the recommendations of the Clinical and Laboratory Standards Institute and the Centers for Disease Control and Prevention. The essential agreements were assessed.

Results: Between January 2018 and December 2024, a total of 1951 N. gonorrhoeae had corresponding isolates from the ARLN laboratory available for comparison, of which 1892 had corresponding Etest and agar dilution results for all 3 antibiotics. We found high levels of MIC agreement between both testing methods for each antimicrobial agent tested (azithromycin 95%, cefixime 98%, ceftriaxone 95%) over 6 years including for strains isolated from distinct anatomical sampling sites.

Conclusions: The Etest method provides a robust alternative for accurately detecting antibiotic-resistant N. gonorrhoeae for public health surveillance, which may make them particularly useful in resource- or labor-limited settings.

Abstract:

Background: Preexposure prophylaxis (PrEP) is a medication that prevents HIV infection. However, PrEP is not equally used by all who would benefit. We examined PrEP disparities by comparing the number of sexually transmitted infections (STIs) and PrEP prescriptions across sex, race, and ethnic groups from 2 federally qualified health centers (FQHCs) in Pinellas County, Florida, and Chicago, Illinois.

Methods: We obtained limited electronic medical record data from January 1, 2023, to December 31, 2023, and identified STI diagnoses (gonorrhea, chlamydia, or syphilis) and PrEP initiation prescriptions. We calculated the PrEP initiation rate for different sex, race, and ethnicity groups; the rate difference in PrEP initiations for each demographic group compared with that in White men; and the ratio of PrEP initiations to STI diagnoses in each group.

Results: Out of a total of 63,591 patients, 1208 (1.9%) were diagnosed with an STI and 88 (0.1%) had PrEP initiation prescriptions. There was no rate difference per 100 people in PrEP initiation among Black and White men, but Hispanic men (-0.11), Black women (-0.14), White women (-0.24), and Hispanic women (-0.25) demonstrated PrEP disparities. When examining the ratio of PrEP initiations to STI diagnoses in each group, White men had (0.42) PrEP initiations per STI diagnosis, with much lower ratios seen for Hispanic men (0.2), Black men (0.13), Black women (0.04), White women (0.03), and Hispanic women (0.02).

Conclusions: White men had the highest rate of initial PrEP prescriptions. Men overall received PrEP between 3 and 21 times more frequently per STI diagnosis than women.

Background: Chlamydia is the most diagnosed sexually transmitted infection among young people in England. Repeat infections are common, and the risk of complications from chlamydia increases with the number of lifetime infections. National guidelines recommend retesting 3 to 6 months after treatment; however, retesting rates remain low at 10% to 14%. The objectives of this study were to explore barriers to, and identify potential interventions to improve, chlamydia retesting among young people in England, using the behavior change wheel.

Methods: Qualitative semistructured interviews were conducted with 22 people aged 16 to 24 years who had previously been diagnosed with chlamydia. Participants were recruited from sexual health services in London, the South West, and the North West of England. An inductive thematic analysis was conducted, followed by thematic categorization to the behavior change wheel.

Results: Barriers to retesting included low awareness and knowledge of the recommendation, and differences in how the term "retest" was interpreted. Participants' experience of the initial test influenced their willingness or intention to retest. Possible interventions to overcome barriers include routine discussions of retesting at diagnosis and the rationale behind the recommendation, retesting reminders from service providers, and opt-in self-sampling kits.

Conclusions: Lack of awareness and varied interpretations of retest present challenges to retesting. Interventions such as routine discussions, text reminders, opt-in self-sampling kits, and clear guidance could improve awareness and understanding, and streamline the process. Future strategies should be developed with stakeholders and patients and assessed for acceptability, practicability, effectiveness, affordability, side-effects, and equity to maximize their real-world implementation and public health impact.