Sexually transmitted diseases最新文献

Introduction: Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis , Neisseria gonorrhoeae , and Treponema pallidum , have an important burden worldwide. The use of doxycycline as preexposure prophylaxis (PREP or doxy-PREP) or postexposure prophylaxis (PEP or doxy-PEP) might be effective as prophylaxis because it is effective against C. trachomatis and T. pallidum .

Aims: Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs ( C. trachomatis , N. gonorrhoeae , and T. pallidum ).

Methods: A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE (MEDlars online), Cohrane, Scientific Electronic Library Online (SciELO), and Latin America and the Caribbean Literature on Health Sciences ( Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS) databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials.

Main outcome measure: The primary end points were any incidence of bacterial STIs and individual STI infections.

Results: A total of 4 studies were included in the analysis, 3 of which evaluated doxy-PEP and 1 evaluated doxy-PREP. In the doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of doxy-PEP studies, the incidence of the first STI was lower in the doxy-PEP group (HR, 0.538 [95% CI, 0.337-0.859]; I2 = 77%; P < 0.05). Regarding individual infections, only 2 studies were included. In the doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared with controls (RR, 0.291 [95% CI, 0.093-0.911]) ( I2 = 89%; P < 0.05). Because only one study evaluated doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as PREP was associated with a decrease in the rate of any STI.

Conclusions: The use of doxy-PEP might reduce the first STI, mainly C. trachomatis , if used within 72 hours after condomless sex. The use of doxy-PREP might also decrease the chance of any STI; however, only 1 study was evaluated.

Background: Although self-sampling could help address anal cancer screening barriers, no studies have investigated annual engagement with this method or compared it with annual screening with a provider. Building on our baseline article, we compared annual anal screening engagement between home-based self-sampling and clinic-based clinician sampling.

Methods: The Prevent Anal Cancer Self-Swab Study recruited and randomized sexual and gender minority individuals 25 years and older who have sex with men to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, whereas clinic-based participants were asked to schedule and attend 1 of 5 participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints.

Results: More than half (58.8%) of participants completed annual (median = 370 days) anal screening. In the home arm, 65.0% of participants engaged in annual screening compared with 52.5% of clinic-based participants ( P = 0.049). When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening ( P < 0.001). Non-Hispanic Black participants participated more in home-based annual anal screening (73.1%) than annual clinic screening (31.6%; P = 0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported "some" prior anal cancer knowledge, preferred an insertive anal sex position, and reported any prior cancer diagnosis.

Conclusions: Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm.

Background: There is growing interest in novel sexually transmissible infection (STI) prevention strategies, including doxycycline postexposure prophylaxis (doxy-PEP). We assessed interest in doxy-PEP and other STI prevention strategies among gay and bisexual men and nonbinary people in Australia, as well as prior antibiotic use for STI prevention, and knowledge of antimicrobial resistance (AMR).

Methods: We conducted a national, online survey in June to July 2023. Multivariable logistic regression was used to identify factors associated with the acceptability of doxy-PEP.

Results: Of 2046 participants, 26.9% had been diagnosed with an STI in the previous year. Condoms were rated as an acceptable STI prevention strategy by 45.1% of the sample, STI preexposure prophylaxis by 54.0%, and doxy-PEP by 75.8%. Previous antibiotic use for STI prevention was reported by 7.5% of the sample, and 2.6% were currently using antibiotics for STI prevention. Over half the sample (62.1%) had some knowledge of AMR. Of those who knew something about AMR, 76.2% were concerned about it. Interest in using doxy-PEP was independently associated with previous use of antibiotics for STI prevention (adjusted odds ratio, 3.09; 95% confidence interval, 1.78-5.35; P < 0.001), whereas those who were concerned about AMR were less interested in it (adjusted odds ratio, 0.51; 95% confidence interval, 0.36-0.72; P < 0.001).

Conclusions: Doxycycline postexposure prophylaxis was highly acceptable to gay and bisexual men and nonbinary people in Australia, and few factors distinguished between interest in using it or not. We recommend community and professional discussion and education about the effective use of doxy-PEP, AMR, and who would most benefit from doxy-PEP.

Background: Although some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus-associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy.

Methods: We extracted outpatient clinical data for the aforementioned populations from January 1, 2015, to August 1, 2022, at 3 sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and human papillomavirus testing results. We used χ2 tests and logistic regression to assess for associations between patient characteristics and anal cancer screening.

Results: Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than White patients (95% confidence interval [CI], 0.40-0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% confidence interval, 0.20-0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings.

Conclusion: Only one-fifth of PWH received anal cancer screening, and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.

Background: Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STIs). Differences in clinical characteristics and STIs in men who have sex with men only (MSMO), with men and women (MSMW), and with women only (MSW) are not well described.

Methods: First visits to 2 Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared with an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included chlamydia, gonorrhea, nongonococcal urethritis, and primary or secondary syphilis. χ2 Tests and logistic regression examined associations.

Results: Among N = 1226 MSMO, N = 491 MSMW, and N = 1717 MSW, most identified as Black/African American; mean age (29.8 years) was similar across groups. The percentages of MSMW, MSMO, and MSW who reported ≥2 partners in the last 6 months were 73.5%, 67.2%, and 60.3%, respectively. "Always" condom use was reported by 20.4%, 17.4%, and 14.1% of MSMW, MSMO, and MSW. Overall HIV prevalence was 13.8%. Among those tested, urogenital chlamydia prevalence rates were 21.7%, 8.3%, and 3.9% ( P ≤ 0.01) in MSW, MSMW, and MSMO. Urogenital gonorrhea prevalence was 11.6%, 7.7%, and 8.3% in MSMW, MSW, and MSMO, respectively. Extragenital STI (range, 2.7%-21.9%), nongonococcal urethritis (25.2%), and primary or secondary syphilis (5.3%-5.7%) positivity was similar in MSMW and MSMO. Older age was inversely associated with STI diagnosis in MSW and MSMO only; consistent condom use was protective against aSTI in MSW (adjusted odds ratio, 0.60; P < 0.01) and MSMW (adjusted odds ratio, 0.54; P = 0.03) only.

Conclusions: Differences in behaviors and clinical characteristics associated with aSTI suggest that MSMO, MSMW, and MSW have diverse sexual health needs and may require tailored interventions to improve sexual health outcomes.

Background: Sexually transmitted infections, including syphilis, pose a significant public health challenge. The advent of social media platforms has revolutionized health information dissemination, with YouTube and TikTok emerging as prominent sources. However, concerns persist regarding the reliability of syphilis-related content on these platforms. This study aimed to evaluate the quality and accuracy of syphilis-related content on TikTok and YouTube, using established tools such as DISCERN, Accuracy in Digital-health Instrument (ANDI), and Global Quality Scale (GQS).

Methodology: We conducted a thorough search on TikTok and YouTube on November 26, 2023, using the keyword "syphilis." Inclusion criteria comprised videos in English, less than 20 minutes in duration, and relevance to syphilis. Two dermatologists independently rated 98 eligible videos using DISCERN, ANDI, and GQS. Statistical analyses included χ2 tests, mean comparisons, and interclass correlation.

Results: TikTok videos exhibited higher mean views (222,519 ± 412,746) compared with YouTube (127,527 ± 223,622). However, TikTok videos had lower mean GQS (2.3 ± 0.9), ANDI (2.19 ± 0.99), and DISCERN (28.7 ± 6.56) scores compared with YouTube (GQS: 2.9 ± 1.1, ANDI: 2.90 ± 0.97, DISCERN: 38.8 ± 9). Nonprofessional uploaders were 40.8% on TikTok, whereas the value was 53.1% on YouTube.

Conclusion: This study reveals disparities in the quality and accuracy of syphilis-related content on TikTok and YouTube. Despite higher popularity on TikTok, content quality, as assessed by DISCERN, ANDI, and GQS, was generally lower compared with YouTube. Targeted interventions are needed to improve the reliability of syphilis-related information on social media platforms.

Background: Sexual violence (SV) increases human immunodeficiency virus (HIV) susceptibility in a sustained manner. This study evaluated genital cytokines and colposcopy findings in women reporting both recent and more remote SV.

Methods: A cross-sectional study of HIV-1 negative Kenyan women who engage in sex work was performed. Cervicovaginal fluid was collected by menstrual cup and cytokines (IFNγ, TNFα, IL-1β, IL-6, IL-10, MIP-1α, MIP-1β, and CXCL10) measured using chemiluminescence. Cervical injury was assessed by colposcopy. Associations between recent (≤30 days prior), more remote (>30 days prior), and no (reference category) SV exposure and cytokine concentrations were evaluated using linear regression.

Results: Among 282 participants, 25 (8.9%) reported recent SV and 123 (43.6%) reported more remote SV. Only two cytokines (IL-10 and CXCL10) were associated with the 3-category SV variable in bivariable modeling at the prespecified cutoff ( P < 0.2) and carried forward. In multivariable analyses, more remote SV (β = 0.72; 95% confidence interval [CI], 0.06-1.38; P = 0.03), but not recent SV (β = 0.20; 95% CI, -0.99 to 1.39; P = 0.74) was associated with cervicovaginal IL-10 compared with no SV. Recent (β = 0.36; 95% CI, -0.94 to 1.67; P = 0.58) and more remote (β = 0.51; 95% CI, -0.21 to 1.24; P = 0.16) SV were not associated with CXCL10 compared with no SV. Cervical epithelial friability (χ 2 = 1.3, P = 0.51), erythema (χ 2 = 2.9, P = 0.24), vascular disruption (χ 2 = 1.4; P = 0.50), epithelial disruption (χ 2 = 2.6, P = 0.27), or any colposcopy finding (χ 2 = 1.2, P = 0.54) were not associated with SV category by χ 2 test.

Conclusions: The mechanism linking SV to sustained increases in HIV susceptibility may not be related to persistent genital inflammation or injury.

Background: The monkeypox (mpox) outbreak disproportionately affected sexually active gay, bisexual, and other men who have sex with men. To understand community-level changes in sexual behavior, we surveyed individuals in a semi-urban area in Southern California.

Methods: Participants were recruited between October 2022 and April 2023, using palm cards and geolocation-focused online advertisements on social media and dating apps. Eligible participants were male; 18 years or older; those who reported having sex with men; residents of San Bernardino or Riverside counties, California; human immunodeficiency virus (HIV) negative; and currently not taking preexposure prophylaxis. Descriptive analyses were performed. χ2 , Fisher exact, and Student t tests examined the association between group sex behaviors and demographics.

Results: We enrolled 91 gay, bisexual, and other men who have sex with men with a median age of 35 years (range, 18-70 years). Nearly half reported having participated in group sex in the past year. Overall, 48.9% of group sex participants reported changing their sexual behaviors to prevent mpox transmission, with limiting the number of sex partners being the most reported prevention strategy (47.6%). To prevent mpox infection, participants who engage in group sex reported limiting the number of sex partners (34.4%), using condoms for anal sex (16.7%), avoiding crowded social venues (14.3%), and asking partners about mpox symptoms before sex (9.5%).

Conclusions: Survey participants reported modest sexual behavior changes in response to the mpox outbreak. Group sex may increase the risk for mpox, human immunodeficiency virus, and other sexually transmitted infections; therefore, public health messages should include specific discussion of safer group sex practices in sexual health promotion.

Background: Despite the availability of curative penicillin treatment for syphilis during pregnancy, congenital syphilis (CS) cases have surged in the United States, including in Oregon.

Methods: We conducted a retrospective analysis of individual- and county-level predictors of CS among pregnant people with syphilis in Oregon from 2013 to 2021. Data were collated from surveillance reports, County Health Rankings, and other sources with upstream county-level data. We used multilevel Poisson regression models to assess associations between CS and individual- and county-level factors.

Results: Among 343 people with syphilis during pregnancy, 95 (27.6%) were associated with a case of CS. At the individual level, a history of injection drug use and a history of corrections involvement were associated with an increased risk of CS, whereas a recent gonorrhea diagnosis was associated with a decreased risk of CS. County-level violent crime rate, unemployment, income inequality, and adverse childhood experiences increased the risk of CS. Higher county-level socioenvironmental challenges exacerbated CS risk, particularly among people with corrections involvement.

Conclusions: Injection drug use, corrections involvement, and county-level socioenvironmental challenges increased CS risk among pregnant people with syphilis in Oregon. Urgent interventions are needed, including innovative care models, policy reforms targeting systemic issues, and enhanced collaboration with community services to address the escalating CS crisis.