Sexually transmitted diseases最新文献

Abstract: We analyzed syphilis case notifications in reproductive age women during 2013-2022. Late/unknown duration syphilis grew faster after 2020 (45.8% versus 17.9% annual growth pre-2020). Increased screening, inaccurate staging, delayed diagnosis, or increased incidence following clinical and partner services gaps during 2020 may contribute to rises in late/unknown duration cases.

Background: The etiology of nongonococcal urethritis (NGU) is incompletely understood. We sought to determine if genitourinary bacterial diversity or specific taxa were associated with incident NGU.

Methods: From August 2014-July 2018, men who have sex with women attending a sexual health clinic were clinically evaluated, including Mycoplasma genitalium (MG) and Chlamydia trachomatis (CT) testing, at enrollment and six monthly visits. New cases of NGU (≥5 PMNs/HPF in urethral exudates plus either symptoms or visible discharge) and their visit preceding NGU diagnosis were matched 1:1 to two sequential visits without NGU (controls). We determined associations with incident NGU and applied broad-range 16S rRNA gene polymerase chain reaction and sequencing to urine samples from each visit. We used conditional logistic regression to evaluate the association of Shannon Diversity Index (SDI), species richness, Haemophilus influenzae, Fannyhessea vaginae, Lactobacillus iners, and Streptococcus mitis group with incident non-CT-non-MG-NGU (NCNM-NGU).

Results: Of 62 matched case-control pairs, median age was 32. Higher SDI the previous month was associated with higher odds of incident NCNM-NGU (adjusted odds ratio [aOR] = 2.8 per unit increase; 95% CI = 1.03-7.47), as was F. vaginae at NGU diagnosis (aOR = 5.1; 95% CI = 1.28-20.15), F. vaginae acquisition (aOR = 13.8; 95% CI = 1.96-97.33) and consistent carriage of F. vaginae (aOR = 16.1; 95% CI = 1.66-156.29). Odds of NCNM-NGU were higher when L. iners cleared between visits (aOR = 18.0; 95% CI = 1.08-299.24). Neither H. influenzae nor S. mitis group were associated with incident NCNM-NGU.

Conclusions: F. vaginae acquisition/detection and L. iners clearance were associated with urethritis. This merits investigation in larger longitudinal studies using species-specific detection methods.

Background: Adult and congenital syphilis rates are rising in the US. The aim of this pre- and post-implementation study was to determine whether implementation of an opt-out laboratory-based and rapid syphilis point-of-care testing program in the emergency department (ED) improves the detection and treatment of syphilis during pregnancy in a high-prevalence region.

Methods: This pre-and post-implementation study was conducted at the University of Texas Health Science Center, Houston, TX. During the pre-implementation phase (11/01/2023 - 02/29/2024), pregnant patients presenting to the ED underwent lab-based syphilis testing using the reverse algorithm only when clinically indicated. In the post-implementation phase (03/01/2024 - 06/25/2024), pregnant patients without prenatal care or with no documented syphilis result underwent opt-out syphilis testing using the Syphilis Health Check (SHC) point-of-care test and the lab-based reverse syphilis testing algorithm. Patients with positive syphilis test results were treated by providers. All results were confirmed with the lab-based test and patient follow up was scheduled.

Results: During the pre-implementation period, 302 pregnant patients presented to the ED, and only 6 (2%) underwent syphilis lab-based testing, none of which yielded positive results. In the post-implementation period, 322 pregnant patients presented to the ED and 202 (62.7%) were approached. Of these, 114 (56.4%) were tested using either the SHC or lab-based reverse algorithm (p < 0.001). Four patients tested positive for syphilis, indicating a prevalence of 3.5%.

Conclusions: An opt-out and rapid syphilis testing program for pregnant individuals visiting the ED increased syphilis screening from 2% to 56.4%, and detected syphilis that might have otherwise been missed.

Background: Identify opportunities to improve syphilis screening by describing changes in patient characteristics and risk factors among individuals with syphilis and by comparing cases with and without an indication for syphilis screening.

Methods: This retrospective cohort study used Colorado public health surveillance data to identify 8,326 syphilis diagnoses from 2011-2020. Demographics, clinical characteristics, and risk factors were compared across 2-year groups and between individuals with and without an indication for screening. Indications for screening were based on national guidelines and included men who have sex with men, persons living with HIV, pregnant individuals, those who test positive for chlamydia, gonorrhea, or HIV, and partners of those who test positive for syphilis.

Results: Across study years, there was a 234% increase in the proportion of syphilis cases that were females (5.3% to 17.7%; p < .01), a 78% increase in the proportion of cases living in rural areas (3.6% to 6.4%; p < .01), and a 15% increase in the proportion of cases among non-White individuals (47.9% to 54.9%; p < .01). The proportion of patients that had a guideline-recommended indication for screening decreased from 88% in 2011-2012 to 59% in 2019-2020 (p < .01). Females represented 5.5% of cases with an indication for screening and 29.8% of cases without an indication for screening (p < .01).

Conclusions: Syphilis cases increased annually from 2011-2020 yet the proportion of cases detected under current screening recommendations decreased. These findings reveal opportunities to expand syphilis screening.

Objectives: Women who report sex with women are thought to have lower risk for Chlamydia trachomatis (CT) infection than women who report sex with men only (WSM-only), but comparisons of lifetime burden are limited.

Methods: Among 1,418 sexually-experienced women aged 18-39 years participating in the National Health and Nutrition Examination Survey (2013-2016), we estimated weighted CT seroprevalence and Wald-based 95% confidence intervals (CI) in women who reported ever having sex with a woman (all reported having sex with men also) (WSWM) compared to WSM-only. We defined seropositivity as detection of Pgp3 antibodies and used stratified Poisson regression with robust standard errors to estimate prevalence ratios.

Results: Over half (58.3%) were White non-Hispanic; 16.2% were WSWM. WSWM were somewhat younger (mean = 27.8 vs. 29.0 years, p = 0.07), younger at sexual debut (mean = 15.6 vs. 17.5 years, p < 0.001), and had more lifetime male sexual partners (mean = 15.9 vs. 6.4, p < 0.001) than WSM-only. Weighted CT seroprevalence was 38.9% (95%CI = 30.4-47.4) in WSWM and 28.6% (95%CI = 24.4-32.9) in WSM-only. Correlates of higher CT seroprevalence in both groups were Black non-Hispanic race/ethnicity, Hispanic ethnicity, and CT infection in the prior year. Having ≥5 lifetime male partners compared to 1-2 partners was associated with higher seroprevalence among WSWM (PR = 4.5; 95%CI = 1.77-11.44) and WSM-only (PR = 2.7; 95%CI = 1.87-3.69). Among WSWM, bisexual identity was associated with lower seroprevalence. Among WSM-only, low income and younger age at sexual debut were associated with higher seroprevalence.

Conclusion: Lifetime CT burden was higher in WSWM than WSM-only. Number of lifetime male partners was the strongest predictor of seropositivity for WSWM.

Background: Partner services (PS) have been integral to syphilis control in the U.S. since the early 20th century but have not been evaluated in a controlled study.

Methods: We compared PS outcomes among gay, bisexual, and other men who have sex with men (GBMSM) diagnosed with syphilis from May 2020-June 2021 for whom health department staff initiated PS efforts (PS group) and a randomly selected control group for whom no PS efforts were initiated. We interviewed participants about partner outcomes and used chi-square tests and Poisson regression to test for differences in outcomes between groups.

Results: We attempted to contact 350 GBMSM and offered participation to 184 men, of whom 92 (51%) participated, including 41 men in the PS group and 51 controls. The percentage of participants who reported notifying >1 sex partner after diagnosis was similar in the PS and control groups (83% vs. 80%, p = 0.80). Mean number of partners notified or tested did not differ between PS and control groups (notified mean[range]: 2.5 [0-10] vs 3.3 [0-20], p = 0.16; tested mean[range]: 1.2 [0-8] vs. 1 [0-10], p = 0.66); multivariate results were similar. Among those contacted for PS, approximately half (48%) reported PS staff helped them with medical care for syphilis, and 31% said that PS staff connected them to PrEP.

Conclusions: This small, controlled evaluation suggests that syphilis PS may have no impact on partner treatment among GBMSM, though most men support the intervention. A randomized trial is needed to definitively define the contemporary effectiveness of syphilis PS among GBMSM.

Background: Infection with Chlamydia trachomatis (CT) can have distinct clinical presentations, such as trachoma, or lymphogranuloma venereum (LGV). Certain populations are at greater risk for LGV acquisition and transmission, which requires a longer duration of therapy than other urogenital CT sexually transmitted infections (STIs). Commercial assays are not available in the United States to distinguish LGV from non-LGV serovars.

Methods: LGV real-time PCR was performed on rectal CT-positive samples (N = 93) obtained from men (N = 80) who ordered from a mail-in self-collection STI service between April 2021 and February 2024. pmpH gene sequencing was performed on all samples to confirm LGV versus non-LGV, and multi-locus sequence typing (MLST) was performed on LGV-positive samples (N = 7) for additional confirmation.

Results: LGV was detected in 7.5% (7/93) of samples by real-time PCR, with pmpH sequencing and MLST confirming 100% (7/7) of these results. Overall, pmpH sequencing data was obtained for 92% (86/93) of samples with the following serovar distribution based on BLAST analysis: 54% (47/86) J, 28% (24/86) F, 9% (8/86) E and 8% (7/86) L. No individual had more than one LGV positive sample. No statistically significant associations with demographic factors were identified.

Conclusions: LGV was detected in CT-positive rectal swabs from users of an online, mail-in, self-collect STI testing platform in Maryland. These data suggest that increased LGV reflexive testing may be warranted. These data also illustrate that mail-in programs for routine STI testing may be leveraged for public health surveillance purposes.

Abstract: Millions of people in the United States are affected by sexually transmitted infections (STIs) every year, with profound consequences for the individual, their community, and society at large. In this review, we aim to summarize the epidemiology of four STIs: C. trachomatis, N. gonorrhoeae, T. pallidum, and HSV, and to highlight the consequences of those infections among individuals and the healthcare system. Untreated N. gonorrhoeae, C. trachomatis, T. pallidum, or HSV infection can result in female infertility, stillbirth, premature birth, and low birth weight. As many as 10% of incident HIV infections among men who have sex with men in the United States have been attributed to either N. gonorrhoeae or C. trachomatis infection. In one year in the United States, incident C. trachomatis infection resulted in $824 million lifetime medical costs and a loss of 1,541 lifetime quality-adjusted life years (QALYs) among men and 111,872 among women, while incident N. gonorrhoeae infection led to $323 million in lifetime medical costs, and a loss of 386 QALYs among women and 12,112 among men. Incident T. pallidum infection in one year resulted in $206 million in medical costs and a loss of 13,349 QALYs among both men and women, while genital herpes led to $107 million in medical costs and a loss of 33,100 QALYs. STI-attributable infertility alone resulted in more than $190 million in direct medical costs. Cumulatively, STIs lead to substantial financial costs to individuals and the health system, as well as long-term reductions in quality of life.

Abstract: Introduction: Understanding levels of HIV testing among populations at risk for acquisition is essential to meeting the goal of the United Nations that 95% of individuals living with HIV know their status. This study assessed HIV testing prevalence among men who had sex with men (MSM), characteristics of MSM who have never tested for HIV, and missed testing opportunities in Hanoi, Vietnam.Methods: We measured the prevalence of never testing for HIV and missed opportunities for testing in the baseline data of a cohort study of MSM recruited in 2017-2019 in Hanoi. Logistic regression analysis characterized MSM who had never tested prior to cohort participation.Results: Of 1,893 MSM enrolled in the cohort, 39.4% had never previously tested for HIV. MSM with children (aOR 1.75, 95% CI 1.09-2.82) and those who did not know or remember having a male partner living with HIV (aOR 1.41, 95% CI 1.07-1.84) were more likely to have never tested. Older age, university education, higher income, and having a male partner living with HIV were associated with a lower likelihood of never having been tested. The most common missed testing opportunities to test MSM who had never been tested were when receiving free condoms from health educators (35.3%), testing for other sexually transmitted infections (STIs) (23.3%), reporting their MSM status to healthcare workers (16.4%), and receiving an STI diagnosis (13.0%). The most common barriers identified by MSM who had never tested were fear of seeking health care due to their sexual orientation (82.7%) and having been refused healthcare due to their sexual oreitnation (76.2%).Conclusions: Facilitating provider-initiated HIV testing in STI clinics and other healthcare services, community-based testing, and HIV self-test kits should enhance HIV testing options for young MSM, especially those with lower education and income.

Background: Syphilis rates in the United States have dramatically increased in recent years and are high among young men who have sex with men and transgender women. Yet, few studies have examined a wide-range of risk factors for syphilis incidence prospectively in young sexual and gender minority (YSGM) populations in the U.S. One framework which may have utility in understanding syphilis risk factors is syndemics, which focuses on co-morbid factors and their mutual influence. The current analysis examines demographic, comorbid health and socio-structural risk factors for syphilis in YSGM assigned male at birth including applying a syndemic framework.

Methods: Participants were part of a Chicago-based prospective cohort called RADAR (n = 738). All participants were YSGM. Syphilis cases were identified by serologic screening with a reverse-sequence testing algorithm. Risk factors included demographics, indicators of sexual risk, mental health, substance use, and violence victimization. Syndemic component score was calculated by adding the number of syndemic conditions. Analyses included multivariable logistic regressions.

Results: In multivariable predictive modeling, Black identity, childhood sexual abuse and alcohol problems predicted incident syphilis. Though roughly 37% of participants were indicated as having at least 2 syndemic conditions, the syndemic component did not predict syphilis incidence.

Conclusions: Syphilis incidence is high in this sample of YSGM. Additional research is needed to better understand mechanisms driving associations between childhood sexual abuse and syphilis incidence as well as to develop interventions improve testing and treatment among Black YSGM, YSGM who experience childhood sexual abuse, and YSGM who experience alcohol problems.