Sexually transmitted diseases最新文献

Abstract: Doxycycline postexposure prophylaxis has demonstrated efficacy, but its effectiveness in areas with high sexually transmitted infection (STI) rates, like Chicago, is less understood. In 2024, 219 patients prescribed doxycycline postexposure prophylaxis at Chicago STI clinics observed a 77% reduction in bacterial STI positivity, highlighting its potential for STI prevention.

Background: This study evaluated the performance of the Alinity m sexually transmitted infection (STI) assay that can simultaneously detect Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) in comparison with other commonly used Food and Drug Administration-cleared assays and laboratory-developed tests in male urine specimens.

Methods: Urine specimens were collected from symptomatic and asymptomatic men across the United States. The Alinity m STI results were compared with the Composite Comparator Algorithm results established for each analyte.

Results: The prevalence of single infections ranged from 1.8% for NG and TV to 6.1% for CT, with 2.6% of individuals coinfected with at least 2 STI pathogens. The overall positive agreement was ≥97.5% for all 4 analytes, with MG showing the lowest agreement. The κ score ranged from 0.82 to 0.98 across all analytes.

Conclusions: The Alinity m STI assay showed excellent concordance with the comparator assays demonstrated by the strong κ scores in male urine specimens.

Background: Partner services (PSs) are a cornerstone of syphilis control efforts in the United States, facilitating exposed partner treatment and interrupting onward transmission of infection. However, current data on their effectiveness in Georgia are limited, despite persistently high syphilis rates and evolving sexual networks.

Methods: We analyzed early syphilis diagnoses (primary, secondary, early nonprimary nonsecondary) reported in the Georgia State Electronic Notifiable Disease Surveillance System, 2013-2024. We assessed PS engagement (interviews completed; partners reported, named, located, treated), following case assignment and patient contact attempts. The unlocatable partner pool (comprising partners mentioned without identifying details to enable treatment linkage and estimated unreported partners) was quantified. Associations with syphilis reinfection within 2 years were evaluated using multivariable Poisson regression adjusted for sex, age, and race/ethnicity.

Results: Of 38,118 eligible patients, 60% completed a PS interview, 51% reported ≥1 partner, 25% named ≥1 partner with sufficient information to enable outreach, and 9% had ≥1 partner treated. Of an estimated 150,720 potentially exposed partners, only 10% had sufficient identifying details for follow-up. The proportion of unlocatable partners increased from 86% in 2013 to 95% in 2023. Having ≥1 unlocatable partner was associated with a higher likelihood of syphilis reinfection within 2 years (adjusted prevalence ratio, 1.40; 95% confidence interval, 1.28-1.53).

Conclusions: Syphilis PSs face increasing challenges in reaching exposed individuals, with most exposed partners remaining unlocatable. Strengthening PS and incorporating innovative patient-centered strategies that better align with current sexual network dynamics may be important for reducing syphilis infections.

Background: The Alinity m STI is a nucleic acid amplification testing for the detection of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) in one assay. This study evaluated the performance of the Alinity m STI in comparison with other commonly used Food and Drug Administration-cleared assays and laboratory-developed tests across multiple female urogenital specimens.

Methods: Clinician-collected and self-collected vaginal swab, endocervical swab, and urine specimens were collected from symptomatic and asymptomatic women across the United States. The Alinity m STI results were compared with the Composite Comparator Algorithm to establish specimen-specific agreement with 6 Food and Drug Administration-cleared assays and 2 laboratory-developed test.

Results: In this study population, the prevalence of single infections ranged from 0.8% (NG) to 7.6% (TV), with 3.4% of individuals coinfected with at least 2 pathogens. The overall positive agreements for clinician-collected and self-collected vaginal swab and for endocervical swab were ≥97.5%, ≥98.0%, and ≥97.3%, respectively, for all 4 analytes, with TV showing the lowest agreement for these sample types. The overall positive agreement for urine was ≥99.2% for all 4 targets. The κ score ranged from 0.84 to 0.99 across all analytes and specimen types.

Conclusions: The Alinity m STI assay showed excellent concordance with the comparator assays, as demonstrated by strong κ scores in female urogenital specimens.

Background: Kenyan guidelines recommend syndromic management for sexually transmitted infections (STIs), which may miss many infections. We used nucleic acid amplification testing to screen for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at 3 anatomic sites among adolescents and adults with behavioral risk factors in Western Kenya.

Methods: From December 2021 to April 2023, we enrolled participants without HIV who were aged 14 to 55 years and reported a recent history of an STI, transactional sex, condomless sex with multiple partners, injection drug use, and/or anal sex with male partners. Urine, oropharyngeal swabs, and anorectal swabs were tested using Xpert CT/NG (Cepheid). Multivariable robust Poisson regression models were used to estimate prevalence ratios and 95% confidence intervals for factors potentially associated with the prevalence of both STIs combined.

Results: Among 405 participants tested for CT/NG at enrollment, 324 (80.0%) were females, and 324 (80.0%) were aged 14 to 24 years. CT and/or NG was diagnosed in 143 participants (35.3%), including CT in 111 (27.4%) and NG in 76 (18.8%). Infections were most prevalent at the urogenital site, with 124 (30.6%) participants diagnosed with urogenital CT and/or NG. Anorectal CT/NG was observed in 117 (28.9%) and oropharyngeal CT/NG in 14 (3.5%). Females had higher prevalences than males of both urogenital (33.6% vs. 18.5%, P = 0.012) and anorectal CT/NG (31.8% vs. 17.3%, P = 0.015). A theoretical screening approach that only tested for urogenital infections would have missed 18.0% of CT cases and 18.4% of NG cases. In multivariable analyses, there were no statistically significant associations between sociodemographic variables and CT/NG prevalence.

Conclusions: Urogenital and anorectal CT/NG infections were common in 2 communities in Western Kenya with behavioral vulnerability but difficult to predict based on sociodemographic variables. Nucleic acid amplification testing-based urogenital and anorectal screening of sexually active adolescents and young adults could reduce CT/NG burden in this population.

Doxycycline post-exposure prophylaxis (doxyPEP) is proven to prevent syphilis and other bacterial sexually transmitted infections among persons who were assigned male sex at birth (AMAB). Diagnosis of syphilis requires interpretation of rapid plasma regain (RPR) titers and clinical assessments; however, doxyPEP may affect RPR titers. We describe syphilis diagnosis at a public health clinic following roll-out of doxyPEP among AMAB persons. Syphilis diagnoses among AMAB prescribed doxyPEP significantly decreased (3.4% to 1.5%), while rates remained constant among persons with no doxyPEP prescription (3.4% to 3.0%). Clinical diagnoses, without confirmed laboratory syphilis, occurred frequently in the pre and post doxyPEP periods. No changes in the median RPR (1:16) were observed in the pre and post period among all AMAB persons, including when stratified by stage of syphilis, but median RPR titer was fourfold lower (1:4) in the nine cases among those prescribed doxyPEP.

Syphilis remains a persistent global public health problem. Given that low-cost diagnostics and highly effective therapies have been available for decades, the current epidemic is driven by structural weaknesses in health systems, stigma, absence of political will and failures to integrate new technologies into routine care. At the Shanghai 2025 Syphilis Meeting, experts highlighted the evolving landscape of syphilis diagnostics. The presentations offered an overview of our changing understanding of seronegative primary disease, reinfection patterns, and asymptomatic mucosal shedding as well as the limitations of diagnostics for neurosyphilis and novel approaches that have shown promising performance. One presentation provided new insights into congenital syphilis by demonstrating significant changes seen on fetal ultrasound and compelling data suggesting a role for new point-of-care IgM tests for risk stratification of exposed newborns. Self-testing was highlighted as an emerging strategy that leverages community engagement, decentralization, and digital technologies to reach populations historically excluded from facility-based services. Finally, a global systems-level overview offered a summary of implementation barriers for diagnostic assays, the need for sustainable adoption of point-of-care tests, and the policy deficits that impede progress. The presentations collectively illustrated the complex interplay between technology, systems design, behavioral dynamics, and policy in shaping the global response to syphilis. The path forward requires an approach that integrates novel diagnostic and digital technologies with programs designed to strengthen health systems as well as community partnerships. Such cross-disciplinary frameworks have the potential to reduce diagnostic inequities and accelerate progress toward the elimination of syphilis worldwide.

We evaluated the performance of three machine-learning models for classifying 39 cases of primary and secondary syphilis using associated meta-data and clinical images. All three models correctly classified 33 images, with an overall precent agreement of 84.6% (95% CI 69.5-94.1%). Machine-learning models may support patient-driven symptom screening.

Professional organizations' syphilis screening guidelines are updated to align with evidence and need. Guideline awareness, current guideline dissemination sources, and future preferred sources were investigated among prenatal providers (n=225). Some providers lacked awareness of screening guidelines, and primary sources of guideline information were practice bulletins, professional organizations, and continuing education courses.