Sexually transmitted diseases最新文献

Abstract: Individuals attending mpox vaccine-only visits at a sexually transmitted infection clinic were more likely to be new patients with high socioeconomic status and identify as White than those vaccinated during non-mpox-related visits. A small number received HIV preexposure prophylaxis or testing following vaccination; this may represent a missed opportunity for HIV prevention.

Abstract: GetCheckedOnline.com is a digital sexually transmitted and blood-borne infection testing service provided in British Columbia, Canada. Using a micro-costing approach, we calculated the costs during the planning, development, and implementation phases of GetCheckedOnline.com . As more sexually transmitted and blood-borne infection tests were performed, the cost per test decreased, demonstrating economies of scale.

Background: Bacterial sexually transmitted infections (STIs) cause a substantial disease burden worldwide and disproportionately impact young people. In Australia, Aboriginal and Torres Strait Islander people are a priority population in STI testing guidelines.

Methods: The More Options for STI Testing trial evaluated whether providing an incentive impacted STI testing rates in select Central Australian communities. Aboriginal and Torres Strait Islander people aged 16 to 29 years were eligible for a A$30 phone voucher if they had an STI test at a participating Aboriginal community-controlled primary health care clinic. An interrupted time series analysis examined monthly STI test counts for chlamydia, gonorrhea, or syphilis from 2015 to 2020, to determine whether testing increased during the incentives phase (2018-2020).

Results: There were a total of 10,457 visits to the clinic in which an STI test was conducted, 5110 of which were during the incentives period. A total of 1526 incentives were provided to eligible clients. The baseline and incentives periods were each divided into 2 phases to account for new clinic openings and the COVID-19 pandemic. Among men, average monthly visits for an STI test were 32.6 (baseline phase 1), 44.1 (baseline phase 2), 50.8 (incentives phase), and 35.4 (incentives/COVID-19 phase). Women had 93.5, 111.3, 118.8, and 113.4 visits, respectively. No significant change in STI testing was observed during the incentives phase. The proportion of visits for an STI test where an incentive was paid (coverage) varied by month, from 36% to 76% of consultations.

Conclusions: The limited impact of incentives could be explained by low coverage or that the incentive was not motivating enough to overcome STI testing barriers. Future studies should investigate alternative methods of increasing STI testing in remote Central Australia, including through primary care clinics.

Background: Estimates of sexually transmitted infection (STI) testing and diagnoses among US transgender women are limited, despite being important to prevention and treatment efforts.

Methods: To evaluate self-reported bacterial STI testing and diagnoses in the past 12 months among sexually active transgender women, we surveyed a nationwide online sample of transgender women 15 years or older in 2022 to 2023. We calculated unadjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using log-binomial regression.

Results: Among 3057 transgender women, 1012 (33.1%) reported bacterial STI testing, and of these, 159 (15.7%) reported ≥1 bacterial STI diagnosis. Testing was positively associated with condomless anal sex (PR, 1.49; 95% CI, 1.35-1.65), gender identity disclosure to a health care provider (PR, 2.25; 95% CI, 1.80-2.81), and current gender-affirming hormone therapy (PR, 1.61; 95% CI, 1.41-1.82) but negatively associated with younger age (PR, 0.72; 95% CI, 0.61-0.85) and severe depression (PR, 0.74; 95% CI, 0.57-0.96). Diagnosis of STI was greater among Black, non-Hispanic (PR, 2.28; 95% CI, 1.58-3.29) and Hispanic transgender women (PR, 1.55; 95% CI, 1.01-2.38) compared with White, non-Hispanic. Condomless anal sex (PR, 1.52; 95% CI, 1.13-2.04), problem drinking (PR, 1.20; 95% CI, 1.20-2.27), and HIV (PR, 4.51; 95% CI, 3.34-6.09) were positively associated with STI diagnosis. Current gender-affirming hormone therapy (PR, 0.51; 95% CI, 0.39-0.69) was negatively associated with STI diagnosis.

Conclusions: Bacterial STI testing was low, but diagnoses were high in this sample of transgender women. Differences in testing and diagnoses were associated with sociodemographic and behavioral factors. Sexually transmitted infection interventions tailored to transgender women are needed to increase testing and detection, prevent transmission, and reduce racial/ethnic disparities.

Background: Neonatal herpes simplex virus (HSV) infection is a relatively rare but devastating disease. Neonatal HSV infection is one of the most serious complications of genital HSV infection but is not reportable in most states and is severely undersurveilled. Estimates of neonatal HSV incidence using up-to-date, nationally representative data are lacking and are needed to inform public health intervention in this area.

Methods: We used data from the National Inpatient Sample collected by the Healthcare Cost and Utilization Project to estimate neonatal HSV cases and incidence in the United States from 2017 to 2021. We identified neonatal HSV cases using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We compared cases by region and over time using Wald tests, t tests, and linear regression. We used linear regression with an interaction term to assess whether incidence trends varied by region.

Results: From 2017 to 2021, 1895 neonates had a hospital discharge diagnosis of neonatal HSV for an average of 379 cases per year and a total overall incidence of 10.15 (95% confidence interval [CI], 9.70-10.62) cases per 100,000 live births. Nearly half (47.0%) of identified cases were in the South. From 2017 to 2019, neonatal HSV incidence per 100,000 live births decreased in the Northeast (slope = -1.56; 95% CI, -2.803 to -0.32) and increased in the Midwest (slope = 1.33; 95% CI, 0.09 to 2.57).

Conclusions: Neonatal HSV infection is an ongoing cause of perinatal infection and neonatal hospitalizations. Improved data sources and better surveillance are needed to monitor this disease and to identify areas for intervention.

Background: Patients who test positive for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) should get retested to evaluate for reinfection. The US military has previously been reported to have high rates of CT and GC, but follow-up rates are unknown. This study evaluates factors associated with follow-up CT or GC testing in active-duty service members (ADSMs).

Methods: Positive cases of CT and GC among ADSM who were stationed at Joint Base San Antonio between January and June 2023 were evaluated in a retrospective chart review. A patient had follow-up testing if they had a repeat test within 3 to 12 months after their initial positive test result. Follow-up rates were compared among groups based on demographics, clinical setting of testing, and presence of symptoms.

Results: Of the 200 ADSMs who tested positive for CT or GC during the study period, 101 (51%) were men, and the median age was 23 (interquartile range, 20-26). One hundred forty (70%) were junior enlisted (E1-E4). Women received follow-up testing at a higher rate than men (71% vs. 51%; P = 0.003), without significant difference in follow-up testing by clinic, race, service, or organism. Women who were symptomatic at the time of initial test had a significantly higher rate of follow-up testing than did the symptomatic men (76% vs. 49%; P = 0.003).

Conclusions: Despite standardized follow-up testing recommendations, there were significantly lower follow-up testing rates in men, with the greatest difference in testing in patients who were symptomatic at presentation. Future work should standardize follow-up testing of CT or GC infections in men.

Background: Human papillomavirus (HPV) is a leading cause of 6 cancers. Despite effective vaccines, HPV vaccination rates remain suboptimal, standing at 26% of females and 9% of males, nationally in 2018. This study assessed factors associated with HPV vaccination uptake among patients at Chicago Department of Public Health (CDPH) sexually transmitted infection specialty clinics.

Methods: A cross-sectional survey was conducted at 2 CDPH sexually transmitted infection clinics. Of 332 surveys collected, 246 were analyzed after excluding individuals missing HPV vaccination data or those younger than 18 years. Bivariate and multivariable analyses were used to examine associations between HPV vaccination and sociodemographic factors, adjusting for sex, age, education, and sexual orientation.

Results: Human papillomavirus vaccination prevalence was higher among individuals assigned female at birth (65%) than male (46%). Male participants had a 36% lower prevalence of HPV vaccination compared with female participants (adjusted prevalence ratio [aPR], 0.64; 95% confidence interval, 0.47-0.86). Age was inversely associated with HPV vaccination as the proportion of vaccination decreased with older age groups. Individuals with a high school education or less had a 37% lower prevalence of vaccination compared with individuals with a college degree or higher (aPR, 0.63 [0.40-0.99]). Individuals identifying as bisexual had a 18% higher, and those identifying as gay or lesbian had a 51% higher prevalence of vaccination compared with heterosexual individuals (aPR, 1.18 [0.84-1.66]; 1.51 [1.07-2.12]).

Conclusion: The CDPH should prioritize HPV vaccination among individuals assigned male at birth, aged 25 years and older, and with high school education or less, and reduce the coverage gap between heterosexual patients and those of a sexual minority.

Background: Mailed self-collection kits for high-risk human papillomavirus (HPV) detection can increase access to cervical cancer screening among underscreened women. To design effective screening programs, it is necessary to evaluate women's understanding, reactions, and preferences for self-collected HPV test result delivery.

Methods: The My Body, My Test-3 trial assessed the effectiveness of mailed HPV self-collection kit outreach. Between 2016 and 2019, the trial enrolled low-income women aged 25 to 64 years in North Carolina overdue for cervical cancer screening. Our analytical sample included women from the intervention arm who conducted at-home self-collection, returned a self-collection kit, had a conclusive HPV result, and completed a follow-up survey after results were received by phone but before in-clinic screening. We evaluated women's understanding, reactions, and preferences for result delivery, stratified by result positivity.

Results: Among 296 diverse, low-income women, 16% (n = 47/296) had an HPV-positive result and 84% (n = 249/296) had an HPV-negative result. Most women understood their results as an indicator of cervical cancer risk, and 93% (n = 264/284 who responded) correctly recalled their results 1 week post-receipt. Women with a positive result more frequently reported feeling afraid and worried, and less frequently reported feeling relieved, compared with those with a negative result (all P < 0.001). Most women were comfortable receiving results by phone (HPV-positive result: 85%, n = 40/47; HPV-negative result: 96%, n = 238/249), although some with a positive result had remaining questions.

Conclusions: Although most women delivered their mailed, self-collected HPV result by phone understood their result, future US screening programs should provide educational support during and after HPV-positive result delivery.

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 FDA-cleared assays and laboratory-developed tests (LDTs) across multiple female urogenital specimens.

Methods: Clinician-collect (CC) and self-collect (SC) vaginal swab, endocervical swab and urine specimens were collected from symptomatic and asymptomatic women across the US. The Alinity m STI results were compared to the Composite Comparator Algorithm (CCA) to establish specimen-specific agreement with six FDA cleared assays and two LDT.

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 two pathogens. The overall positive agreements (OPA) for CC and SC vaginal swab and for endocervical swab were ≥ 97.5%, ≥98.0% and ≥ 97.3%, respectively, for all four analytes, with TV showing the lowest agreement for these sample types. The OPA for urine was ≥99.2% for all four targets. The kappa 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 kappa scores in female urogenital specimens.

Aim: Human papillomavirus (HPV) is a common sexually transmitted infection that often affects the reproductive system. Human papillomavirus infection can cause various cancers and clinical symptoms in women, impacting their sexual activity and quality of life. Hence, this study aimed to assess the impact of motivational interviewing on the sexual function of women with HPV.

Methods: This randomized controlled study used a pretest-posttest research design with a control group and involved 62 HPV patients from health care centers affiliated with the Babol University of Medical Sciences, Iran. The study was registered on the Iranian Registry of Clinical Trials (IRCT20230531058348N1) on June 11, 2023, after we received ethics code. The patients were divided into 2 groups: an experimental and a control group. The allocation to these groups was determined using the blocked randomized allocation technique based on pretest scores. The experimental group received the motivational intervention over 5 sessions, whereas the control group received routine intervention. All participants completed the Female Sexual Function Index questionnaire before and immediately after the interventions. Data were entered into SPSS 24 and were analyzed. Descriptive statistics included means and standard deviations for quantitative data and frequency percentages for qualitative variables. χ2 Tests and independent t tests were used to examine relationships and compare initial variables. Analysis of covariance was used to compare questionnaire scores between the 2 groups. The significance level was set at 0.05.

Results: The intervention (N = 31) and control (N = 31) groups had similar ages (33.58 ± 6.14 vs. 34.96 ± 7.04 years, P = 0.412). Sexual dysfunction occurred in 74.2% of HPV-positive women. Covariance analysis showed that motivational interviewing had a significant positive effect on overall sexual function in women with HPV ( η2 = 0.717, P < 0.001). Motivational interviewing with a large effect size also led to improved sexual desire ( η2 = 0.566), increased arousal ( η2 = 0.728), increased wetness ( η2 = 0.531), increased orgasm ( η2 = 0.525), increased sexual satisfaction ( η2 = 0.563), and reduced sexual pain ( η2 = 0.680; P = 0.001).

Conclusions: The results of the study suggested that offering counseling to women with HPV could improve their sexual functioning, leading to a better overall sexual experience and mental and emotional well-being, and ultimately strengthening their quality of life and marital connections. Moreover, this could influence how health care providers support and aid people with HPV.