Sexually transmitted diseases最新文献

Abstract: This study evaluates hepatitis C testing and referral for treatment among patients attending a public sexual health clinic. In patients with hepatitis C infection, progression from linkage to care to sustained virologic response was low. Innovative approaches are needed to optimally integrate hepatitis C care in sexual health clinics.

Abstract: We assessed mpox vaccine communication and sexual behavior among U.S. MSM during the 2022 mpox outbreak. Less than 40% of respondents asked a new male sex partner about their mpox vaccination status. Mpox vaccine communication was positively associated with condomless anal sex and group sex. Mpox vaccine communication is low but may inform and sexual behaviors among MSM.

Background: Neisseria gonorrhoeae is one of the recognised global antimicrobial resistance priorities. Extended spectrum cephalosporins, the last remaining reliable antimicrobial, increasingly fail to clear N. gonorrhoeae infections, especially pharyngeal gonorrhoea, leading to limited future treatment options.

Methods: We conducted a systematic review and meta-analysis of gonococcal treatment failures and compared the minimum inhibitory concentrations (MIC) of isolates from pharyngeal and extra-pharyngeal anatomical sites (PROSPERO registration: CRD42020189101).

Results: The overall pooled mean MIC for cefixime was 0.17 mg/L (95% [CI]: 0.07, 0.41) and ceftriaxone was 0.10 mg/L (95% [CI]: 0.05, 0.22). For cefixime, the mean MIC estimates for pharyngeal and extra-pharyngeal treatment failures were 0.05 mg/L (95% [CI]: 0.02, 0.14) and 0.29 mg/L (95% [CI]: 0.11, 0.81), and for ceftriaxone 0.09 mg/L (95% [CI]: 0.03, 0.22) and 0.14 mg/L (95% [CI]: 0.03, 0.73), respectively. The pooled mean MICs for pharyngeal isolates are below the phenotypic European Committee on Antimicrobial Susceptibility Testing (EUCAST) resistance breakpoint for both antimicrobials (>0.125 mg/L).

Conclusions: Our findings underscore the need to review the current resistance breakpoints used for pharyngeal infection and the urgency to establish international standards for MIC testing, and advance efforts of the World Health Organization's global action plan to control the spread and impact of antimicrobial resistance in N. gonorrhoeae. Ongoing susceptibility testing of gonococcal isolates and surveillance of treatment failures are central to informing appropriate public health responses.

Abstract: Background: Most Neisseria gonorrhoea (GC) and Chlamydia trachomatis (CT) infections in men who have sex with men (MSM) are diagnosed at extragenital sites. However, testing at these sites is often lacking. The purpose of this study was to determine if a standardized questionnaire administered by physicians and clinical assistants improves documentation of sex activity and increases extragenital testing and diagnoses of GC and CT among MSM.Methods: A standardized sexual history questionnaire was implemented on 11/1/2022. Electronic medical records of 664 MSM with HIV, including 1064 encounters, were reviewed to compare pre- and post- implementation sexual history documentation, adequacy of documentation, extragenital GC and CT testing, and GC and CT diagnoses. Analysis included Chi-square and exact tests and logistic regression adjusting for physician cluster effects.Results: The standardized questionnaire was used by 53.7% of physicians and 85.9% of coordinators. Documentation of whether sexual activity occurred increased from 79.3% [95%confidence interval (CI) 0.758- 0.828] in the pre-intervention pre-COVID-19 period to 95.2% (95% CI 0.925-0.970) in the post-intervention period with an adjusted odds ratio of 4.7 (95% CI 2.7-8.8). Specific questions about anal and oral sex increased from 42.0% to 88.1% (p < 0.001) and 23.7% to 88.7% (p < 0.001), respectively. Anal and pharyngeal testing increased from 14.4% to 20.2% (p = 0.040) and 17.2% to 23.3% (p = 0.045), respectively.Conclusions: This study demonstrates that using a standardized questionnaire during clinical encounters can improve documentation of sexual activity and testing for GC and CT at extragenital sites.

Background: Given the continued increases in rates of both Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection, additional diagnostic assays may be useful in increasing access to testing for these sexually transmitted infections. We evaluated the performance of the NeuMoDx™ CT/NG Assay 2.0 on the NeuMoDx-96 and NeuMoDx-288 Molecular Systems.

Methods: The clinical sensitivity and specificity of the assay was assessed when used with: 1) endocervical swabs; 2) self-, and clinician-collected vaginal swabs; and 3) first-catch urine specimens (female and male). Results were compared to a patient infection status based on US Food and Drug Administration (FDA)-cleared assays.

Results: The NeuMoDx CT/NG Assay 2.0 demonstrated high sensitivity and specificity in both symptomatic and asymptomatic participants. All specimen types other than endocervical swabs had >95% sensitivity and > 99% specificity for both pathogens. For endocervical samples, sensitivity was 93.2% and 93.3% for CT and NG, respectively. There was no difference in performance based on platform. The frequency of invalid results was low (<1%).

Conclusions: The NeuMoDx CT/NG Assay 2.0 demonstrated performance similar to currently FDA-cleared assays, with the added choice of a moderate- (96-sample) or a high-throughput (288-sample) platform. The system therefore offers solutions to laboratories running lower volumes of testing that may obviate the need for outsourcing to larger reference laboratories.

Background: Men who have sex with men (MSM) using HIV Pre-Exposure Prophylaxis (PrEP) are a vulnerable population with a high prevalence of sexually transmitted infections (STIs). Self-collection of specimens could improve STI testing, yet implementation in low-resource settings is limited. The study aimed to assess the feasibility and acceptability of self-collection for STI testing and to understand STI testing preferences among PrEP clients in Hanoi, Vietnam.

Methods: From January to December 2022 MSM aged 16 and older, participating in a clinic-based HIV PrEP program were enrolled. Participants self-collected pharyngeal, anal, and urine samples for Chlamydia trachomatis and Neisseria gonorrhoeae testing. Testing preferences were assessed through conjoint analysis using eight hypothetical testing profiles across five testing attributes; each profile was rated on a Likert scale (0-5) to create an impact score. Differences between attributes were assessed using a two-sided, one-sample t-test of the impact score.

Results: There were 529 participants enrolled; all were male. Specimens from three sites were provided by 97.9% (518/529). Mean satisfaction with self-collection was 4.3 (SD: 1.0), 99.4% reported they would perform again. In conjoint analysis, cost (free vs. $17USD) had the highest impact on testing preference (Impact Score: 25.2; p = <0.001). A one-week time to test result notification was preferred to 90 minutes (Impact Score: -0.8; p = 0.03).

Conclusion: We found high acceptability of self-collection for STI testing among HIV PrEP clients in Vietnam. Cost was the most important factor affecting testing uptake. Expanding self-collection and lowering costs could improve STI testing in HIV PrEP programs.

Background: In preparation for a prospective syphilis network study of sexual minority men, we conducted a mixed-methods formative study with the following objectives: ( a ) assess acceptability of respondent-driven sampling, ( b ) assess acceptability of study procedures, ( c ) social network seed selection, and ( d ) pilot an ecological momentary assessment (EMA) study to assess social networking, sexual, and substance use behaviors.

Methods: We conducted in-depth interviews with 8 providers serving sexual minority men and 5 focus group discussions with 34 sexual minority men, prioritizing 4 target populations: (1) young Black sexual minority men, (2) on preexposure prophylaxis, (3) living with HIV, and (4) not engaged in care. The 4-week EMA pilot was conducted with 40 sexual minority men. Ecological momentary assessment survey responses were analyzed to evaluate how different compensation levels influenced response rates. Brief exit surveys were used to assess EMA app acceptability.

Results: Primary themes identified through qualitative data collection: (1) importance of developing trust and maintaining confidentiality during proposed recruitment activities, (2) importance of compensating participants appropriately for study activities, and (3) cultural considerations for increasing visibility and participation of young Black sexual minority men. All EMA participants reported being "completely comfortable" reporting sexual behavior through the app. Most (78%) preferred the app to in-person interviews. Several participants identified technical issues with the app, including not receiving push notifications and spontaneous closure.

Conclusions: This mixed-methods formative study allowed for adjustments to and tailoring of the planned network study, including recruitment protocols, compensation type and amount, and EMA survey wording and response items.