Sexually transmitted diseases最新文献

Purpose: Incidence rates of syphilis have significantly increased in Western countries since 2000, particularly among men who have sex with men (MSM). This study aimed to analyze trends and characteristics of syphilis cases diagnosed by a sentinel center for the surveillance of sexually transmitted infection (STI) in Italy, over a 30-year period.

Methods: Demographical, behavioral, and clinical characteristics of syphilis cases diagnosed from 1991 to 2022 were analyzed, overall and by transmission category. Temporal trends in syphilis cases, overall and by transmission category, were assessed using joinpoint regression model. Multivariable logistic regression was performed for the last decade of observation (2011-2022) to assess the associations between syphilis diagnoses and transmission category, nationality, and HIV status.

Results: A total of 3093 syphilis cases were diagnosed, most of which among MSM (1994, 64.5%). HIV prevalence was significantly higher among MSM than men who have sex with women (MSW) and women who have sex with men (WSM; 30.8% vs. 12.7% and 5.8%, respectively). Joinpoint regression analysis highlighted a significant increase in syphilis cases during 2000-2005 both overall and among MSM ( P < 0.01), non-Italian born ( P = 0.02), and people living with HIV ( P < 0.01). In terms of age, STI, and HIV history, MSM with syphilis differed significantly from non-MSM. Among syphilis cases, people living with HIV were more likely to be MSM, older, and with previous STI.

Conclusions: Syphilis still represents a major public health concern, particularly among MSM. Even populations with lower transmission rates, such as WSM and MSW, experienced increasing trends in diagnoses, potentially promoted by epidemiological bridging mechanisms involving MSM and MSW. Global efforts are still required to end this epidemic.

Background: Patient-delivered partner therapy (PDPT) is a presumptive treatment mechanism for sexual partners of patients diagnosed with chlamydia and/or gonorrhea; however, successful implementation to sexual minoritized men (SMM) is impeded by concerns about missed opportunities for HIV and syphilis testing. As such, we explored barriers and facilitators of including a dual HIV and syphilis self-testing device with PDPT among SMM residing in Oklahoma.

Methods: In 2023, in-depth interviews were conducted with HIV-negative or unknown status SMM ( n = 20; mean age, 33.4; 90% cisgender; 45% Black, Latino, or multiracial) eliciting responses about access to care, at-home HIV/sexually transmitted infection (STI) testing, and PDPT. Data were analyzed using the rigorous and accelerated data reduction technique.

Results: Sexual minoritized men reported inadequate access to culturally competent providers. Despite mixed perceptions, altruism led most participants to indicate the importance of notifying a partner of a bacterial STI diagnosis. Delivering PDPT with an HIV and syphilis self-testing kit was perceived to increase confidentiality, improve access to appropriate care, decrease time to partner treatment, reduce exposure to antigay and HIV/STI stigmas, and avoid insurance and cost challenges. Participant intervention requests included the need for multimodal educational materials, a letter from a health care provider with contact information, medication and safety information, discrete packaging, and a communication guide.

Conclusions: Intervention requests by SMM will be important for maximizing successful uptake of PDPT with partner HIV and syphilis self-testing. Additional research with health care providers is needed to identify potential implementation strategies to support prescribing behaviors.

Abstract: Monkeypox virus is a DNA virus in the orthopoxvirus family, and a multicountry outbreak was declared a Public Health Emergency of International Concern both in 2022 and 2024. Myocarditis is a known complication of many viral infections, and chest pain and electrocardiogram changes may occur from 1 to 4 weeks post-infection. We present 2 clinical cases of mpox-related myocarditis from Canada. We identified 19 additional cases of myocarditis and/or pericarditis in the literature, and data were synthesized with our 2 cases. All 20 patients with available data were hospitalized, 6 of whom were admitted to an intensive care unit. Median time of cardiac symptom onset after initial mpox symptom onset was 5 (range, 0-14) days, elevated troponin was present in 19 of 19 cases (range, 165-21,200 ng/L), arrhythmias were described in 1 patient with Mobitz type 1 and 2 atrioventricular blocks, and echocardiograms showed reduced ejection fraction in 4 of 15 patients. There were no deaths reported. Management of mpox involves symptom control and anti-inflammatories. Recent trials have not shown benefit of tecovirimat compared with placebo in shortening time to lesion resolution; however, in this article, we discuss nuances regarding antivirals in the setting of mpox-related myocarditis.

Abstract: We examined racial differences in willingness to use doxycycline post-exposure prophylaxis (doxy PEP) to prevent sexually transmitted infections (STIs) among men who have sex with men (MSM) who have not heard of or used doxy PEP before taking this survey. Most MSM in our study were willing to use doxy PEP. Black, non-Hispanic MSM and Hispanic MSM were more willing to use doxy PEP than White, non-Hispanic MSM. Doxy PEP is an acceptable STI prevention approach among MSM, especially among racial/ethnic minority MSM who are disproportionately affected by bacterial STIs.

Background: Partner services (PS) are a cornerstone of syphilis control efforts in the United States, facilitating exposed partner treatment and interrupting onward transmission of infection. However, current data on their effectiveness in Georgia are limited, despite persistently high syphilis rates and evolving sexual networks.

Methods: We analyzed early syphilis diagnoses (primary, secondary, early non-primary non-secondary) reported in the Georgia State Electronic Notifiable Disease Surveillance System, 2013-2024. We assessed PS engagement (interviews completed; partners reported, named, located, treated), following case assignment and patient contact attempts. The unlocatable partner pool (comprising partners mentioned without identifying details to enable treatment linkage and estimated unreported partners) was quantified. Associations with syphilis reinfection within two years were evaluated using multivariable Poisson regression adjusted for sex, age, and race/ethnicity.

Results: Of 38,118 eligible patients, 60% completed a PS interview, 51% reported ≥1 partner, 25% named ≥1 partner with sufficient information to enable outreach, and 9% had ≥1 partner treated. Of an estimated 150,720 potentially exposed partners, only 10% had sufficient identifying details for follow-up. The proportion of unlocatable partners increased from 86% in 2013 to 95% in 2023. Having ≥1 unlocatable partner was associated with higher likelihood of syphilis reinfection within two years (adjusted prevalence ratio: 1.40; 95% CI: 1.28 - 1.53).

Conclusions: Syphilis partner services face increasing challenges in reaching exposed individuals, with most exposed partners remaining unlocatable. Strengthening PS and incorporating innovative patient-centered strategies that better align with current sexual network dynamics may be important for reducing syphilis infections.

Abstract: We demonstrated no differences in susceptibility to penicillin G and ceftriaxone in three modern T. pallidum isolates (UW244B, UW249B, and UW330B), each carrying a variant of the penicillin-binding protein (PBP) Tp0705. This suggests that these polymorphisms should not be a reason for concern when β-lactams are prescribed for syphilis treatment.

Background: Individuals with multiple gonorrhea diagnoses (repeat-GC) may be a key group for STI prevention. We determined repeat-GC rates and associated characteristics by sexual orientation/gender identity within seven jurisdictions in the STI Surveillance Network.

Methods: We constructed a retrospective cohort of randomly-sampled, interviewed GC cases using enhanced surveillance data (01/01/2016-12/31/2021) and followed cases until the first repeat-GC date (diagnosis > 30 days after the interview-associated diagnosis) or 12/31/2022. We applied design weights with post-stratification adjustment for non-response by sex and age and calculated repeat-GC rates. We performed Poisson regression adjusted for follow-up time accrued during the COVID-19 pandemic to assess differences across characteristics.

Results: Among 21,743 interviewed individuals representing 577,719 gonorrhea diagnoses, 46.8% were men-who-have-sex-with-men (MSM), 21.6% men-not-reporting-male-partners, 30.9% women, and 0.7% transgender/gender-diverse persons (TG/GD). Repeat-GC rates per 1,000 person-years were: MSM: 182.3 (95% Confidence Interval (CI):173.8-191.0); men-not-reporting-male-partners: 64.5 (CI:58.2-71.7); women: 47.7 (CI:43.4-52.6) and TG/GD: 73.3 (CI:46.3-115.8). Repeat-GC was associated with prior gonorrhea diagnosis (past 12 m) [aIRR MSM: 1.58 (CI:1.42-1.75); men-not-reporting-male-partners: 1.37 (CI:1.01-1.84); women: 1.59 (1.24-2.02)]. Among MSM, repeat-GC was associated with an initial rectal [aIRR: 1.24 (CI:1.12-1.36)] or pharyngeal [aIRR: 1.14 (CI:1.04-1.25)] infection (versus other infection sites). Men-not-reporting-male-partners [aIRR: 1.57 (CI:1.18-2.12)] and women [aIRR: 1.92 (CI:1.11-3.30)] living with HIV (versus not) had higher rates.

Conclusions: Characteristics associated with repeat-GC (prior gonorrhea diagnosis, HIV status, anatomic site of infection) are available through routine STI surveillance and could be used to prioritize individuals for routine follow-up services and/or novel interventions to prevent repeat-GC.

Background: This study evaluated the performance of the Alinity m STI assay that can simultaneously detect Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) in comparison with other commonly used FDA-cleared assays and laboratory-developed tests (LDTs) in male urine specimens.

Methods: Urine specimens were collected from symptomatic and asymptomatic men across the US. The Alinity m STI results were compared to the Composite Comparator Algorithm (CCA) results established for each analyte.

Results: The prevalence of single infections ranged from 1.8% for NG and TV to 6.1% for CT, with 2.6% of individuals coinfected with at least two STI pathogens. The overall positive agreement was ≥97.5% for all four analytes, with MG showing the lowest agreement. The kappa score ranged from 0.82 to 0.98 across all analytes.

Conclusions: The Alinity m STI assay showed excellent concordance with the comparator assays demonstrated by the strong kappa scores in male urine specimens.

Abstract: Many immigrants coming to the United States (US) are screened for sexually transmitted infections (STIs) according to national professional agency guidelines. Some curable infections such as gonorrhea and syphilis can preclude entry to the US, while testing for other infections, such as chlamydia, are not required for immigration screening. We critically review the rationale for and the practice of immigration STI screening at a time when common STIs are both readily treatable and already widespread in the US and when many individuals resettling in the US migrate through irregular pathways. In addition, we provide suggestions to improve current practices for immigrants, with a focus on distress migration, which may be associated with hazards leading to sexual violence and stigmatization. Recent actions by the federal government have also compounded structural stigma regarding immigration and healthcare and could negatively impact broader public health goals.