Sexually transmitted diseases最新文献

Abstract: We conducted a case-control analysis to evaluate the determinants for initiating long-acting injectable cabotegravir (LACAB) as preexposure prophylaxis (PrEP) in a real-world setting with limited drug access. Individuals selected for LACAB experienced more side effects from oral PrEP, riskier sexual behavior, longer prior PrEP use, and a significantly higher incidence of STIs during follow-up. Despite this, LACAB was well tolerated, and discontinuation rates were low. Our findings support prioritizing LACAB for individuals most exposed to HIV and with low adherence to oral regimens, especially in contexts where logistical or economic constraints limit universal access to PrEP.

Background: Individual food insecurity, defined as having limited or uncertain access to food of sufficient quality and quantity, is associated with increased sexual risk behavior and diagnosis of a sexually transmitted infection (STI), even after accounting for measures of socioeconomic status. Little is known about how food stress at the community level may exacerbate sexual and social vulnerabilities, or its potential association to a higher rate of STIs at the county level.

Methods: We conducted an ecological analysis of the association between county-level reported rates of chlamydia, gonorrhea, and primary and secondary syphilis, with rates of food insecurity net of socioeconomic controls in the United States. The moderating effect of county-level estimates of the Supplemental Nutrition Assistance Program (SNAP) adequacy-the SNAP meal gap-was assessed.

Results: The results show that food insecurity and the SNAP meal gap were both positively associated with bacterial STI burden at the county level, even after controlling for poverty and other sociodemographic characteristics. The association between food insecurity and STI rates is more pronounced in counties where the average SNAP allocation is inadequate to cover the cost of meals.

Conclusions: This study serves as a first step toward understanding how food insecurity may function as an additional stressor on communities struggling with high rates of STIs. These findings underscore the importance of considering food insecurity not only as an economic hardship but also as a potential contributor to community-level sexual health disparities. This study provides more evidence that food assistance programs may play a critical role in shaping population health outcomes.

Abstract: Persons in rural communities experience barriers to preventative sexually transmitted infection services, including screening. We calculated aggregated annual national rural and urban chlamydia and gonorrhea case rates for 2016 to 2022 and found that rates were consistently higher among urban counties. Trends in both urban and rural case rates followed a similar trajectory over time.

Background: Female sex workers (FSWs) in sub-Saharan Africa, including Nigeria, face disproportionately high risks of HIV acquisition. Although oral preexposure prophylaxis (PrEP) is highly effective, its uptake among FSWs remains low, especially in conservative, high-stigma settings like northern Nigeria. This study explored the multilevel barriers and enablers influencing PrEP uptake among this key population.

Methods: We conducted 13 semistructured interviews, including 10 in-depth interviews with brothel-based and non-brothel-based FSWs and 3 key informant interviews with PrEP program implementers from One-Stop Shop clinics. Participants were purposively sampled across Kano metropolis. Using reflexive thematic analysis, guided by the Social Ecological Model, we examined individual, interpersonal, community, and structural factors influencing PrEP decision making.

Results: Barriers to PrEP uptake included limited awareness, misconceptions regarding antiretroviral therapy, concerns about side effects, partner stigma, and service access constraints. The visual similarity between PrEP and antiretroviral therapy packaging reinforced stigma and fears of partner violence or rejection. Facilitators included peer-led sensitization, provider rapport, transport stipends, and decentralized community-based delivery. Female sex workers and implementers emphasized the need for discreet, long-acting PrEP options and identified brothel managers, intimate partners, and community health workers as key gatekeepers.

Conclusions: PrEP uptake among FSWs in Nigeria is influenced by interconnected individual, social, and structural barriers. Enhancing uptake requires multilevel interventions, such as differentiated service delivery, stigma-sensitive packaging, and peer- and partner-engaged outreach. Integrating PrEP into trusted, accessible services tailored to the realities of FSWs' lives can improve equity and ensure the sustainability of HIV prevention efforts in similar high-burden settings.

Abstract: This multicenter case series examines real-world use of doxycycline postexposure prophylaxis among persons assigned female at birth at 4 US sexual health clinics. Most cases were transgender men highly vulnerable to sexually transmitted infection acquisition. Findings highlight early implementation patterns and safety considerations and underscore the urgent need for doxycycline postexposure prophylaxis efficacy data in people assigned female at birth.

Background: In 2024, the Centers for Disease Control and Prevention recommended postexposure prophylaxis with doxycycline (doxy PEP) within 72 hours after sex for men who have sex with men and other selected populations diagnosed with one or more bacterial sexually transmitted infections (STIs) within the past 12 months. To determine if doxy PEP prescriptions can be identified using existing International Classification of Diseases, Tenth Revision ( ICD-10 ) codes, we assessed the utilization of several ICD-10 codes that document sexual behaviors and doxycycline prescriptions using a large electronic health record dataset.

Methods: We used 2018-2023 Truveta electronic health record data to analyze encounters indicating increased risk for HIV/STI ( ICD-10 codes: Z72.53 [high-risk bisexual behavior], Z72.52 [high-risk homosexual behavior], Z20.6 [exposure to HIV], Z20.2 [exposure to infections with a predominantly sexual mode of transmission], and Z29.81 [encounter for HIV preexposure prophylaxis]) among men aged 15 to 60 years and stratified by doxycycline prescription within 14 days of the encounter.

Results: Among 428,023 encounters coded for increased risk of HIV/STI among men aged 15 to 60 years, 78.2% were coded as Z20.2, followed by 10.4% as Z20.6, 9.9% as Z72.52, 1.2% as Z72.53, and 0.3% as Z29.81. The proportion of those encounters with doxycycline prescriptions was 16.1%. Among 68,891 encounters with doxycycline prescriptions, the top 5 ICD-10 codes associated an STI syndrome were symptoms of genitourinary system (R30-R39, 28.7%), diseases of urinary system (N30-N39, 9.9%), chlamydia (A74.9, 2.6%), gonorrhea (A54.9, 1.5%), and syphilis (A53.9, 1.2%), and the top 1 with a non-STI syndrome was asthma (J45, 5.9%).

Conclusions: Before Centers for Disease Control and Prevention recommendations for doxy PEP, most encounters for potentially eligible patients were not explicitly among men who have sex with men, and doxycycline was prescribed broadly for various indications. A new ICD-10 code is needed for monitoring doxy PEP prescriptions with administrative data.

Background: Misalignment between self-perceived and objectively measured risk may contribute to ongoing engagement in high-risk behaviors and impede the uptake of human immunodeficiency virus (HIV) prevention services. We aimed to investigate the concordance between self-perceived and objectively measured HIV risk and to identify factors associated with risk underestimation among men who have sex with men (MSM) in Qingdao, China.

Methods: A cross-sectional study design was used, with snowball sampling to recruit MSM from April 2023 to July 2024. Face-to-face interviews were used to collect demographic and behavioral information, self-perceived HIV risk, and utilization of HIV prevention services. Objectively measured HIV risk was calculated using an HIV risk assessment tool, and self-perceived risk was collected through self-reporting. The kappa consistency test was used to compare the differences between objectively measured risk and self-perceived HIV risk. Logistic regression analysis was performed to identify the factors associated with risk underestimation.

Results: A total of 653 participants were included in the study. A profound mismatch was observed: 78.3% of participants were classified with high objective measured risk, yet 87.6% perceived their risk as only moderate, resulting in poor agreement between the two measures. Multivariate analysis showed that lower monthly income, seeking sexual partners via Internet, engagement in commercial sex, condomless anal intercourse (CAI), and group sex were associated with risk underestimation. Although not statistically significant in multivariate models, univariate analysis suggested lower prevention service uptake among those who underestimated risk, such as HIV self-testing, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP).

Conclusion: Human immunodeficiency virus risk underestimation was highly prevalent among MSM in Qingdao, China. Future efforts should focus on enhancing health education for MSM and developing behavioral intervention programs aimed at reshaping risk perception to foster accurate risk awareness and improve cognitive accuracy.

Background: Sexually transmitted infections (STIs) disproportionately affect socially vulnerable populations. Expedited partner therapy (EPT) reduces reinfection rates by treating partners without requiring a medical visit yet remains underutilized in the electronic prescription era. Studies show low pharmacist awareness of EPT, with limited research on its real-world availability in pharmacies or variability by Social Vulnerability Index (SVI) factors. This study assessed pharmacist awareness and willingness to fill hypothetical nameless electronic EPT prescriptions in New York City pharmacies and examined variations by SVI.

Methods: A cross-sectional audit survey of 335 New York City pharmacies used a telephone-based secret shopper approach. Pharmacist awareness of EPT, willingness to fill, and insurance acceptance were evaluated. Multivariable logistic regression examined associations with SVI, adjusting for pharmacy type, location, and local chlamydia rates.

Results: Of surveyed pharmacies, 40% were aware of EPT, with significantly lower awareness in nonchain pharmacies than national chains (34% vs. 54%, P = 0.02). Only 28% of pharmacists stated they would be willing to fill nameless prescriptions. Most prescriptions (34%) would be filled under the index patient's name, and 86% would accept insurance. Common reasons for refusal included unfamiliarity with EPT (62%) and misconceptions about legal name requirements (28%). Awareness was higher in pharmacies located in the highest SVI quartile (odds ratio, 3.7; 95% confidence interval, 1.3-10.8), but willingness to fill did not vary by SVI ( P = 0.35).

Conclusions: Despite greater EPT awareness in socioeconomically vulnerable areas, pharmacist willingness to fill nameless EPT prescriptions remains limited across areas. Efforts to educate pharmacists and standardize e-prescribing processes are needed to expand EPT access and reduce STI disparities.

Background: Extragenital (oropharyngeal and anorectal) Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (or gonococci [GC]) infections are underdiagnosed. Here we report sensitivity and specificity estimates that were obtained from the multiplex, polymerase chain reaction-based BD CTGCTV2 (CTGCTV2) assay, which simultaneously detects CT and GC from extragenital specimens on the high-throughput BD COR (COR) system.

Methods: Testing on the index assay used remnant (collected during a predicate, registrational trial) oropharyngeal (n = 2318) or anorectal (n = 2292) specimens, stored in PreservCyt ThinPrep liquid-based cytology media, from sexually active individuals (≥15 years of age). A composite comparator algorithm was used to define infectious status in the predicate study, which consisted of a 2 out of 3 agreement from Food and Drug Administration-cleared CT/GC molecular assays for a reference-positive or reference-negative result. Results obtained from the CT/GC assay on the COR were compared with the predefined composite comparator algorithm.

Results: Testing for CT on COR had an estimated sensitivity of 100% (95% confidence interval, 86.2%-100%) and 97.7% (93.5%-99.2%) from oropharyngeal and anorectal specimens, respectively. GC testing on COR resulted in sensitivity estimates of 92.8% (85.8%-96.5%) and 95.8% (89.7%-98.4%) from oropharyngeal and anorectal specimens, respectively. Specificity estimates for CT were 99.8% (99.5%-99.9%) and 99.4% (99.0%-99.7%), respectively. For GC, specificity estimates were 99.5% (99.1%-99.7%) and 99.8% (99.5%-99.9%) for oropharyngeal and anorectal specimens, respectively.

Conclusions: CTGCTV2 performance on COR was accurate when testing oropharyngeal and anorectal specimens.