Sexually transmitted diseases最新文献

Abstract: In an urban sexual health clinic, a substantial portion of the clinic population initiated doxycycline postexposure prophylaxis (doxyPEP) for bacterial STIs in the first 12 months, and implementation of doxyPEP was associated with a subsequent decrease in clinic-level chlamydia and syphilis positivity, but no change in overall gonorrhea positivity.

Abstract: We examined alignment between sex of sex partners and sexual orientation in syphilis case notifications among men in 2022 to inform interpretation of sexual orientation data for notifiable conditions in the National Notifiable Diseases Surveillance System. Observed partial alignment underscores the importance of analyzing appropriate variable(s) for a given intervention.

Background: Prior studies have identified an association between rectal douching and prevalent rectal Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), but few studies have examined associations with incident infections.

Methods: We used data from ExGen, a 48-week cohort study conducted in Seattle, Washington, 2016 to 2018. Each week, participants completed a survey and self-collected rectal specimens, which were tested for CT/GC at the end of the study. Our primary analysis was a case-crossover analysis. We identified individuals with incident rectal GC or CT and included 1 case-week (the first week of the incident rectal infection) and 2 randomly selected control-weeks (weeks where the participant tested negative for rectal GC/CT). We used multivariate conditional logistic regression to estimate the association between douching and rectal GC/CT. In an exploratory analysis, we created a "synthetic" cross-sectional study of the longitudinal data to mirror the design of other studies.

Results: There were 140 individuals in ExGen. Our case-crossover sample comprised 17 GC case-weeks and 34 matched GC control-weeks, and 22 CT case-weeks and 44 matched CT control-weeks. Participants reported douching during 64.7% of GC case-weeks and 70.6% control-weeks (adjusted odds ratio, 0.47; 95% confidence interval, 0.07-3.10). Douching was reported at a similar frequency among CT case-weeks (45.5%) versus control weeks (47.7%; adjusted odds ratio, 1.16; 95% confidence interval, 0.26-5.07). In our exploratory synthetic cross-sectional study, rectal douching was significantly associated with rectal GC but not CT.

Conclusions: Douching was not associated with rectal GC/CT in this methodologically rigorous analysis. A better understanding of the mechanisms of douching products and impact of long-term use may be warranted.

Background: We examined HIV preexposure prophylaxis (PrEP) use among men who have sex with men (MSM) with repeat bacterial sexually transmitted infections (STIs) at 14 publicly funded clinics across 10 US jurisdictions participating in the STI Surveillance Network.

Methods: We identified MSM without HIV who had a diagnosis of rectal gonorrhea, rectal chlamydia, and/or syphilis in 2021 to 2022 and ≥1 diagnosis of these infections within the prior 12 months. We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to evaluate differences in PrEP use at time of most recent infection by demographics and sexual behaviors.

Results: We identified 542 MSM with repeat bacterial STI infections. Preexposure prophylaxis use at the time of repeat diagnosis was reported by 78% (421 of 542) overall; 76% (329 of 435) among patients with 1 prior STI infection and 86% (92 of 107) among those with ≥2 prior infections. Compared with non-Hispanic (NH) Black patients, those in other race/ethnicity groups had higher PrEP use prevalence (Hispanic: aPR, 1.37 [95% CI = 1.09-1.73]; NH-White: aPR, 1.31 [95% CI, 1.05-1.65]; NH-other race(s): aPR, 1.36 [95% CI, 1.07-1.72]). Preexposure prophylaxis use among those 25 to 34 years old (aPR, 1.73; 95% CI, 1.31-2.28) and >35 years old (aPR, 1.65; 95% CI, 1.08-1.59) was higher compared with those <25 years old. Among 97 MSM not on PrEP at the time of repeat diagnosis, 18% (n = 17) received PrEP on day of or in the following 30 days.

Conclusions: Although 8 in 10 MSM with a history of repeat bacterial STI were on PrEP, there were disparities among racial and age groups. Promoting awareness and equitable access are needed to address persistent barriers to PrEP use and encourage PrEP uptake and continuation.

Background: Men who have sex with men (MSM) and transgender women (TGW) are at elevated mpox risk; vaccination can greatly reduce that risk. We assessed mpox awareness and vaccine acceptability among MSM and TGW.

Methods: In 2022, hybrid-mode (offline/online) surveys were administered among 250 MSM and 251 TGW in Chennai, India. Robust Poisson regression models were used to identify predictors of mpox awareness and vaccine acceptability.

Results: Participants' mean age was 29.1 years; the mean monthly income was 192 in US dollars. More than half (54.5%) had a college/diploma degree, 29% of MSM and 90% of TGW reported engaging in sex work in the past month, and 49% of MSM and 86% of TGW reported inconsistent condom use with male partners. Overall, 59% had heard of mpox; 37% knew of its high burden among MSM/TGW. Vaccine acceptability was 36.7% (MSM, 53.6%; TGW, 19.9%). Mpox awareness was predicted by higher education (prevalence rate ratio [PRR], 1.18; P = 0.04), online recruitment (PRR, 1.28; P = 0.01), preexposure prophylaxis awareness (PRR, 1.30; P < 0.001), and more nonregular male sexual partners (PRR, 1.03 per 10-partner increment; P = 0.01). Mpox vaccine acceptability was positively associated with awareness about high mpox burden among MSM/TGW (PRR, 1.31; P = 0.04) and online recruitment mode (PRR, 1.52; P = 0.001), but negatively with depression (PRR, 0.68; P = 0.02) and inconsistent condom use (PRR, 0.68; P = 0.002). Transgender women were less willing than MSM (PRR, 0.43; P < 0.001).

Conclusions: Suboptimal mpox awareness and vaccine acceptability among MSM and TGW highlight key vulnerabilities. Tailored, nonstigmatizing educational interventions delivered via community-based organizations, online platforms, and HIV services are needed to address informational and psychosocial barriers. For preparedness, enhancing equitable vaccine access and clinical vigilance may help strengthening India's mpox response.

Background: Sexual minority men (SMM) experience intimate partner violence (IPV) at elevated rates, which may be linked to an increased risk of sexually transmitted infections (STIs). This systematic review and meta-analysis aimed to provide evidence on the associations between IPV experiences and STI outcomes (e.g., syphilis, gonorrhea, chlamydia) among SMM and identify critical gaps in the literature to inform future STI prevention efforts.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we identified 10 published studies with available quantitative data from 27,241 individuals; nearly all (9 of 10) were cross-sectional in design.

Results: A meta-analysis using random-effects model indicated that IPV victimization was associated with higher odds of STI diagnosis, with a pooled odds ratio of 1.60 (95% confidence interval, 1.20-2.13) and I2 of 77% ( P < 0.01), reflecting significant variability among study results and relatively high divergence between individual study findings. Studies varied in IPV measures, recall periods, and STI outcomes, which were primarily self-reported. No study examined STI outcomes across the full IPV spectrum, including perpetration and bidirectional IPV, and there is a lack of qualitative evidence exploring how IPV experiences impact access to STI testing and treatment services.

Conclusions: This review highlights a significant association between IPV and STIs among SMM, underscoring the need for integrated interventions tailored to this group. Future research should use longitudinal, intersectional, and trauma-informed approaches to address overlapping stigmas and improve health outcomes, providing key insights to refine IPV screening and identify intervention targets.

Background: Electronic partner notification (ePN) for sexually transmitted infections (STIs) is a promising tool for linking exposed individuals to STI testing and treatment. Statewide ePN will target rising rates of chlamydia and gonorrhea in Massachusetts (MA).

Methods: We explored implementation factors and barriers and facilitators to ePN for priority populations using the Consolidated Framework for Implementation Research. We conducted in-depth interviews with men who have sex with men (n = 56) and transgender women (n = 4) recruited from sexual health clinics, community organizations, and online platforms in greater Boston, MA. Content analysis was used to organize implementation factors, barriers and facilitators, and innovation adaptations to mitigate barriers and emphasize facilitators.

Results: Participants' median age was 27.5 years (interquartile range, 23-33 years); 32% were White, 27% Black, and 22% Hispanic. Overall, participants reacted positively to ePN. Contextual factors include STI stigma and familiarity with contact tracing from the COVID-19 pandemic; barriers and facilitators-varying in direction-include the prevalence of anonymous sexual encounters, comfort with clinicians, and patterns of accessing sexual health services. Individual-level factors include privacy concerns and the nature of relationships between sexual partners. Individual-level facilitators include pre-existing knowledge of digital tools and sexual health services, notifiers' degree of motivation for using ePN, and the perceived value of partner notification. Trust in an ePN notification was identified as an important factor in determining whether individuals seek care.

Conclusions: Electronic partner notification is a promising tool to combat rising STI rates. Electronic partner notification implementors must recognize the importance of key barriers, facilitators, and trust.

Background: Neonatal syphilis-specific IgM immunoglobulins are fetal in origin and may reflect congenital syphilis. This pilot study aims to determine the test performance of a point-of-care antitreponemal IgM test for the diagnosis of congenital syphilis.

Methods: Sera from 2 uninfected and 29 pregnant patients with syphilis and 8 of their newborns with sonographic evidence of congenital syphilis were collected between May 2022 and June 2024. Duplicate 20 μL serum aliquots were tested using a research-use-only point-of-care lateral flow test developed by Diagnostics Direct, LLC (Stone Harbor, NJ) for the detection of antitreponemal IgM. Duplicate 50 μL serum aliquots from the samples were tested for treponemal IgM using 2 Commune-Europe-marked immunoblot tests as comparators (ViraMed, Planegg, Germany, and Euroimmun, Lübeck, Germany) and a commercial IgM ELISA (Euroimmun). The composite IgM reference comparator was based on these 3 tests. If at least 2 of 3 were positive, this was considered a positive reference comparator, and 2 negative test results constituted a negative comparator. Mother-baby dyads were staged for syphilis according to national guidelines.

Results: The positive percent agreement of the point-of-care test was 93% (confidence interval [CI], 68.0%-99.8%), and the negative percent agreement was 88% (CI, 87.5CI-97.3%) versus the composite IgM reference comparator. Based on combined maternal and infant clinical diagnosis, the positive percent agreement was 100% (73.5%-100%), and the negative percent agreement was 82% (CI, 61.9%-93.7%).

Conclusions: The syphilis point-of-care IgM test demonstrated very good preliminary test performance when compared with a composite reference comparator and specimens collected from mother-baby dyads. Further studies evaluating this point-of-care antitreponemal IgM test as a neonatal diagnostic test for congenital syphilis are warranted.