Sexually transmitted diseases最新文献

Background: Assisted partner services (APS) is an effective strategy for testing people with undiagnosed HIV, but there is limited information on the relative reach and effectiveness of phone versus in-person contact.

Methods: We analyzed data from 31 facilities in Western Kenya providing APS to female index clients newly HIV diagnosed, their male partners, and female partners of men newly HIV diagnosed. Assisted partner services providers attempted contacting partners using phone first and, if unsuccessful, in-person in the community. Using log-linear mixed models, we estimated relative risks (RRs) between phone being the final contact method and partner characteristics and HIV outcomes.

Results: From May 2018 to March 2020, 2534 female index clients named 7614 male partners, of whom 772 (10.1%) tested positive and named an additional 4956 non-index female partners. Of 11,912 (94.7%) partners reached, 5179 (43.5%) were via phone and 6733 (56.5%) in-person. Of 8076 testing-eligible partners, 99.7% tested and 11.2% first-time tested. Of those tested, 13.1% were newly diagnosed, of whom 87.0% linked to care. Newly diagnosed partners were less likely to have been reached by phone versus in-person (9.8% vs. 15.9%; adjusted relative risk, 0.61; 95% confidence interval, 0.53-0.70). Being reached by phone was not significantly associated with testing, first-time testing, or linkage to care.

Conclusions: In an APS program that reached 94% of elicited partners, fewer than half were successfully contacted by phone. A combined phone and in-person approach is likely essential for equitable, effective APS.

Background: Reportable sexually transmitted infections (STIs) have increased in California, with dramatic rises in prenatal and congenital syphilis. In response, in 2018 Planned Parenthood Northern California implemented 2 opt-out screening protocols: (1) HIV, chlamydia, gonorrhea, and syphilis co-screening for pregnant patients at pregnancy diagnosis and (2) linking HIV and syphilis screening for all patients.

Methods: Using qualitative analyses, we explored implementation barriers and facilitators that can be addressed by clinical leadership and staff to expand uptake of enhanced screening protocols. Sixteen staff were interviewed across 3 Planned Parenthood Northern California clinics. Primary thematic analysis followed by secondary subanalysis identified themes. Analyses of questions were only included for each interviewee if answered and applicable.

Results: Five themes of commentary emerged, featuring both facilitators and barriers for protocol implementation: patient education/communication, staff education/communication, workflow; patient willingness, and (for protocol 1 only) visit complexity at the time of pregnancy diagnosis. Additional findings included the following: 93% (13 of 14) stated protocols increased syphilis screening and identification; 100% (12 of 12) reported positive impacts on patient care; 42% (5 of 12) noted increases in staff workload, 25% (3 of 12) reported workload improvements over time, and 33% (4 of 12) reported no workload-related impacts; and 86% (13 of 15) reported decreased screening during the COVID-19 pandemic.

Conclusion: Addressing patient and staff education during the beginning stages of implementation may have positive impacts on willingness to adopt new protocols. Consideration of workflow and visit complexity at pregnancy diagnosis may also aid in successful implementation of expanded STI screening protocols in family planning clinics.

Background: Online support groups afford new opportunities to help individuals affected by HIV/AIDS to seek social support from peers. The study aimed to understand the willingness and associated factors of joining online support groups among men who have sex with men living with HIV.

Methods: The study followed a mixed methods approach, with qualitative in-depth interviews followed by a quantitative cross-sectional survey in 3 cities of Shandong Province, China, from 2019 to 2020. The in-depth interviews were audio-taped, transcribed verbatim, and analyzed using a thematic approach. In the quantitative analysis, explanatory variables included sociodemographic, behavioral, clinical, psychological, and demand factors. Univariate and multivariable logistic regressions were conducted to examine the associated factors of willing to join online support groups.

Results: A total of 576 and 20 participants were included in the quantitative survey and qualitative interviews, respectively. Only 24.7% (142 of 576) of participants in the quantitative study were willing to join the online support group. Multivariable analysis showed that the associated factors included income level, sexual orientation, and availability of information. The barriers to joining online support groups included privacy disclosure concern and psychological pressure exposed to HIV-related information. Facilitators included information acquisition, mutual medication reminding, and emotional support.

Conclusions: Men who have sex with men living with HIV in China had relatively low willingness to join the online support groups. This study highlighted the importance of safeguarding privacy, involving professional mental health providers, and providing high-quality information when establishing online support groups for people living with HIV.

Background: Chlamydia and gonorrhea are 2 of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the United States. Incarcerated women have a particularly elevated risk of these infections, which can result in serious sequelae if left untreated. On December 13, 2021, the Los Angeles County Jail system began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated women.

Methods: We retrospectively analyzed electronic health record data for completed urogenital chlamydia/gonorrhea screening among newly incarcerated women between December 13, 2021, and May 31, 2023. We used multivariable logistic regression to examine the association of STIs and treatment non-initiation outcomes with various demographic and self-reported variables.

Results: Of the 13,739 female entrants offered STI testing, 10,717 (78%) completed screening, with 1151 (11%) having a chlamydial infection, 788 (7%) having a gonococcal infection, and 1626 (15%) having ≥1 infection. Sexually transmitted infection positivity was associated with age 18 to 34 years, reported houselessness, amphetamine use, and history of a positive prior treponemal antibody test result. Sexually transmitted infection treatment non-initiation was associated with shorter jail stay for both chlamydial (adjusted odds ratio, 87.4; 95% confidence interval, 34.2-223.2) and gonococcal (adjusted odds ratio, 9.0; 95% confidence interval, 5.2-15.7) infections.

Conclusion: The STI prevalence among female detainees tested was many-fold higher than that of the general population. The implementation of routine opt-out STI screening in carceral settings provides a unique opportunity to benefit the health of both the correctional population and potentially that of the surrounding community.

Background: In the United States, gaps in health care insurance coverage correlate with lower use of preventive care. We aimed to determine whether part-year or year-round uninsurance was associated with lower use of testing for sexually transmitted infections (STIs).

Methods: We identified women aged 19 to 49 years in the 2017-2019 National Survey of Family Growth. Completion of any STI testing in the past year and location of STI testing were regressed on pattern of insurance coverage, classified as continuous private, continuous public, part-year uninsured, or year-round uninsured.

Results: Based on the analytic sample (N = 4119), 12% of women aged 19 to 49 years experienced part-year uninsurance, and 8% experienced year-round uninsurance, whereas 31% received an STI test in the past year. On multivariable analysis, respondents with part-year uninsurance were the group most likely to have received STI testing (odds ratio compared with continuous private coverage, 1.56; 95% confidence interval, 1.09-2.23; P = 0.015), whereas respondents with year-round uninsurance were the group least likely to receive STI testing (odds ratio vs. continuous private coverage, 0.37; 95% confidence interval, 0.25-0.55; P < 0.001). Year-round uninsurance was associated with higher likelihood of receiving a test at locations other than public or private clinics, such as at a hospital or at an in-store clinic.

Conclusions: Low use of STI testing among women with year-round uninsurance indicates a need for expanded insurance coverage and greater access to STI testing. However, high rates of STI testing among women with part-year uninsurance challenge the presumed association of insurance continuity with higher uptake of preventive care.

Background: The incidence of sexually transmitted infections (STI) continues to increase worldwide. Patient incentives are one proposed intervention to increase STI testing and treatment.

Methods: We conducted a retrospective cohort study comparing incentivized versus routine care for STI outreach test and treat services between October 2018 and June 2019. Incentivized care included a $10 gift card for testing visits and an additional $10 gift card for results and/or treatment visits. Incentivized visits were offered to clients with a lack of housing, who were difficult to locate, or had a history of being lost to follow-up. All test and treatment visits included chlamydia, gonorrhea, syphilis, and HIV testing and/or treatment by Registered Nurses and outreach workers from an STI Clinic. Outreach visits were offered at subsidized housing locations, community-based organizations, and street outreach.

Results: From October 2018 to June 2019, 2384 outreach clients were reached: 453 (19.0%) received incentives and 1931 (81.0%) received routine care. There were no significant differences in case-finding rates for chlamydia (4.8%), gonorrhea (2.9%), and HIV (0.1%); however, there was for syphilis (3.8% for incentivized vs. 1.9% for routine visits; P = 0.02). All newly diagnosed infections identified in the incentivized group received treatment compared with routine visits (chlamydia 100% vs 79.1%, P = 0.008, gonorrhea 100% vs 59.7%, P = 0.002, and syphilis 100% vs. 86.7%, P = 0.08).

Conclusions: Incentives were associated with increased case-finding rates of syphilis and were associated with 100% treatment rates. Incentives are a promising approach to decreasing the burden of STI among outreach populations.

Background: Stigmatization of sexually transmitted infections (STIs) threatens provider-patient relationships and contributes to the underutilization of STI services. Media can shape public attitudes toward health care topics by perpetuating or reducing stigma. Given the high prevalence of STIs and the widespread consumption of media, it is essential for health care providers to be cognizant of factors influencing societal perceptions of STI symptoms, transmission, diagnosis, and treatment.

Methods: This study is a scoping review of popular films depicting STIs. Full-length English-language narrative films featuring characters with confirmed or suspected STIs were included. Descriptive statistics were used to determine the proportion of characters accurately portrayed with STI symptoms, transmission, diagnosis, and treatment.

Results: The final analysis comprised 128 characters from 77 films, with human immunodeficiency virusbeing the most frequently featured STI (42 films, 54.5%). The overall accuracy across all 4 clinical variables of symptoms, transmission, diagnosis, and treatment was 87.4%. Transmission was the most depicted clinical variable, represented in 74 characters (57.8%). All 4 clinical variables were simultaneously depicted in only 4 (3.1%) characters, with 2 characters portraying all 4 clinical variables accurately. Death occurred in 39 characters (30.5%), with human immunodeficiency virus accounting for the majority (82.1%).

Conclusions: Most films accurately portrayed STI clinical variables, including symptoms, transmission, diagnosis, and treatment. Rates of individual variable depiction were inconsistent, whereas death secondary to STIs was common. Understanding the portrayal of STIs in popular films can provide valuable insights for clinicians, enabling them to effectively address patient misconceptions and knowledge gaps.

Background: The Gonococcal Isolate Surveillance Project (GISP) was established to monitor antimicrobial resistance (AR) in N. gonorrhoeae in the United States. Isolates collected in GISP undergo antimicrobial susceptibility testing allowing for estimates of resistance, based on exceeding minimum inhibitory concentrations (MICs), to be calculated.

Methods: We estimated the annual number and proportion of gonococcal infections with antibiotic resistance or elevated MICs (AR/eMICs) against six antibiotics for men and women aged 15 to 39 years in the US using male urethral specimens collected in GISP during 2008-2019. Although GISP only measured MICs for male gonococcal infections, this study estimated AR/eMICs in women using data from men with female sex partners. GISP data were weighted against national gonorrhea case report data based on four variables (age group, year of report, US Census region, and race/Hispanic ethnicity) to estimate annual, national proportions of gonococcal infections with AR/eMICs. These weighted proportions were then multiplied by national estimates of incident gonococcal infections to calculate the number of incident gonococcal infections with AR/eMICs nationally.

Results: Women had a higher estimated number of cases with AR/eMICs compared with men (440,900 vs. 387,200 in 2019) although the estimated percentage of gonococcal infections with AR/eMICs was lower in women (50.7% vs. 54.4% in 2019). Elevated MICs to ceftriaxone remained below 1% throughout the study period.

Conclusions: Our analysis indicates that there are more women with AR/eMICs gonorrhea than men. Although the proportion of cases that are resistant to any one antimicrobial is increasing, eMICs to ceftriaxone remains low.