Sexually transmitted diseases最新文献

Background: The 2030 United Nations Agenda for Sustainable Development includes targets to end sexually transmitted infections (STIs) as a major public health threat. STI prevalence data to inform strategies towards this goal are lacking in middle and low-income countries, especially among men.

Methods: Data from Seroprevalence and Behavioral Epidemiology Risk Surveys (SABERS) conducted among militaries in Cameroon, Chad, Democratic Republic of the Congo (DRC), Ethiopia, Liberia, Malawi, Republic of the Congo (ROC), and Sierra Leone during 2013-2018 were used to estimate the prevalence of presumed active syphilis among active-duty military men. Associations of active syphilis infection with age, education, marital status, and rank for each country were assessed.

Results: The prevalence of active syphilis was less than 1% among men in Cameroon (2018), Ethiopia (2018), Liberia (2018), Malawi (2013), ROC (2014), and Sierra Leone (2013). In Chad (2014), 6.2% (95% CI 5.2%-7.4%; n = 121/1949) of men tested positive for active syphilis. In DRC (2014), the prevalence of active syphilis was 15.5% (95% CI 14.1%-16.9%; n = 404/2611) among men. Active syphilis was associated with older age in DRC (p < 0.01), with less education in Chad (p = 0.03) and DRC (p < 0.01), and with rank in DRC (p = 0.048).

Conclusions: These data help address a paucity of information on STI prevalence in sub-Saharan Africa and demonstrate the need for improved surveillance among men.

Conclusions: Substantial gaps in reporting gonorrhea treatment and prompt ES treatment were observed. Practice-level interventions to facilitate reporting gonorrhea treatment and provide prompt ES treatment are needed.

Introduction: Follow-up testing is recommended three months after patients initially test positive with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Follow-up testing adherence in the United States has been reported below one third of women, even in universally insured populations. We assessed both the positivity of CT and GC infections in female basic military trainees and the rates of follow-up testing for those who tested positive.

Methods: Between January 1, 2006-December 31, 2021, female Air Force Basic Military Trainees were universally screened with urinary nucleic acid amplification testing for CT and GC. Those who tested positive were evaluated to determine demographic information as well as follow-up testing rates. Patients who were evaluated with a repeat CT/GC NAAT test within 12 months after a positive CT/GC test result were considered to have received appropriate follow-up.

Results: 5,022 (5.2%) of 97,168 trainees tested positive for only-CT (4,749 (4.8%)), only GC (138 (0.1%)) or both CT/GC (135 (0.1%) during the study period. Those at increased risk of infection were those <24 years of age, Hispanic and Black individuals, high school education level, and single women. Of the 4,687 still in the military at three months after diagnosis, 3,268 (69.7%) had repeat testing within 12 months. There was no significant difference in follow-up testing by age, race, educational level, marital status, or organism causing original infection.

Conclusion: Follow-up testing among female USAF basic military trainees is higher than in other universally insured populations. This study demonstrates remaining barriers to adherence to recommended guidelines.

Background: Despite accounting for approximately 20% of new HIV diagnoses in the United States, cisgender women are consistently under-represented and under-engaged in HIV prevention services such as HIV testing and pre-exposure prophylaxis (PrEP). Black and Latina cisgender woman (BLCW) are disproportionately impacted by HIV, and face additional barriers to accessing prevention services due to racial/ethnic bias, sexism, and their intersection. Offering self-testing for sexually transmitted infections (STIs) and HIV is one potential strategy for increasing access to-and engagement in-preventative sexual health care among BLCW.

Methods: We conducted a study in consultation with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and their collaborators in order to identify preferences for sexual health kits-including HIV and STI tests-among BLCW in New York City.

Results: We assessed the extent to which BLCW would be willing to accept and use HIV and STI self-testing. Additionally, we identified the components of potential sexual health kits that would make them most attractive and would most increase the reach of a sexual health kit program in NYC. Finally, we examined differences in acceptability and preferences (by demographic factors, sexual behavior, and past service utilization) that may impact the development of future programs and interventions.

Conclusions: Self-testing for STIs and HIV represents a promising strategy for engaging BLCW in preventative sexual health services and increasing access to care.

Abstract: Over the past two decades, congenital syphilis cases have risen 11-fold in the United States. While disparities across geography, race, and ethnicity exist, lack of timely screening or treatment is identified in 88% of cases nationally. Congenital syphilis is a public health and medical problem rooted in systematic and societal structural determinants of health and healthcare limitations. Early syphilis in pregnancy leads to congenital syphilis if untreated in 50 - 70% of cases, with risk for fetal demise, and among survivors, congenital anomalies, organ damage, and central nervous system disease. Prevention of congenital syphilis lies in early detection and treatment in pregnant persons. In this narrative review, we describe the evolving epidemiology of syphilis and congenital syphilis, highlighting unique aspects among women. We explore the role of novel screening and treatment strategies, public health policy, and medical considerations in terms of congenital syphilis prevention. Readers of this review will understand CS as a complex public health and medical disease that can be prevented through innovative and coordinated strategies in public health policy, expanded screening and research opportunities.

Background: Lack of point-of-care testing (POCT) for sexually transmitted infections (STIs) is a continuing missed opportunity in Sub-Saharan Africa. We assessed feasibility and acceptability of STI POCT in Eswatini.

Methods: Sexually transmitted infection POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was piloted among sexually active adults 18 to 45 years old attending 2 urban outpatient clinics offering integrated services. Women were randomized 1:1 to provide urine or vaginal swab, and all men provided urine samples for CT/NG testing using Cepheid CT/NG cartridges on existing GeneXpert platforms. Results were returned in-person or by telephone call. We assessed duration of procedures, participant and health care worker acceptability of services (5-point Likert scale), time spent on STI POCT services, and correlates of CT/NG infection.

Results: Of 250 adults triaged, 99% (248 of 250) accepted STI POCT, including 44% (109 of 248) people living with HIV. Sexually transmitted infection POCT procedures took a median of 3:22 hours. Most adults (90% [224 of 248]) received results within a day (61% same day, 29% next day). CT/NG was detected among 22% (55 of 248): 31 of 55 CT, 21 of 55 NG, and 3 of 55 coinfections. Youth 18 to 25 years old, history of any sexual intercourse, and condomless sex within the previous 7 days were significantly associated with CT/NG detected ( P < 0.05). Most adults with CT/NG were treated (51 of 55 [93%]). Most participants were satisfied with STI POCT (217 of 241 [90%]) and would accept again/recommend it. All 32 health care workers who participated were satisfied with STI POCT.

Conclusions: Sexually transmitted infection POCT was feasible, acceptable, and identified a high prevalence of STIs, highlighting the urgent need for this testing.

Abstract: We evaluated the proportion of patients with trichomoniasis and chlamydial infections who received recommended versus nonrecommended antibiotic therapy after the updated 2021 Sexually Transmitted Infections Guideline. Of 712 patients, 473 (66%) received recommended therapy. Receipt of emergency department care was independently associated with recommended therapy (adjusted odds ratio, 2.1; 95% confidence interval, 1.5-2.9).

Background: Consistent use of sexually transmitted infection (STI) prevention methods is proven to decrease transmission of STIs. However, rates continue to rise within the United States, particularly among high-risk populations. Women experiencing homelessness may face barriers to access reproductive health care. This quality improvement initiative sought to examine perceived barriers to STI prevention and opportunities for expanding STI prevention services and education for women experiencing homelessness.

Methods: Surveys were administered during a 1-day health event in August 2023 at a clinic that predominately serves persons experiencing homelessness in North Texas. Respondents included adult, nonpregnant, English-speaking individuals assigned female at birth with a history of homelessness. Demographic characteristics, sexual history, participants' knowledge of STIs, and perceived barriers to obtaining sexual health care were gathered. Participants had the opportunity to suggest methods for improving access to STI care.

Results: Among participants (n = 36), more than half (59%) were tested for STIs within the past year. Most preferred condoms for STI prevention. The average knowledge score among questions about STI transmission and methods of prevention was 65%, with the lowest scores observed among trichomoniasis (39% correct), preexposure prophylaxis (31%), and dental dams (25%). Common barriers included cost (33%) and side effects (33%). One-third (36%) of participants reported no barriers to the use of prevention products.

Conclusions: Findings highlight the need for educational opportunities among this population to increase knowledge of STI transmission and prevention. Patients may benefit from clinicians emphasizing education and increasing the visibility of services.

Background: Current guidelines recommend concurrent screening for HIV and syphilis with gonorrhea and chlamydia testing. Despite this, many patients are still not screened. This study describes trends in demographics and encounter locations associated with missed opportunities for HIV and syphilis screening among patients tested for gonorrhea or chlamydia.

Methods: This is a retrospective review of all encounters with gonorrhea or chlamydia testing in a large, urban hospital from November 1, 2018, to July 31, 2021. Demographic information and encounter location were extracted from the medical record. Encounters were categorized as including both HIV and syphilis (complete) screening, HIV screening only, or neither. Logistic regression was used to examine associations between demographics and encounter location and likelihood of complete screening.

Results: There were 42,791 patient encounters, of which 40.2% had complete screening, 6.2% had concurrent HIV screening only, and 53.6% had no concurrent screening. Increasing age, female sex (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.55-0.61; P < 0.01), non-Hispanic Black race (aOR, 0.52; 95% CI, 0.49-0.55; P < 0.01), and public insurance (aOR, 0.72; 95% CI, 0.69-0.75; P < 0.01) were associated with lower odds of complete screening. Emergency department (ED) encounters were most likely to include complete screening (aOR, 3.11; 95% CI, 2.96-3.26; P < 0.01).

Conclusions: This study found that a large proportion of patients tested for gonorrhea and chlamydia had missed opportunities for HIV and syphilis screening. Significant demographic disparities were found. The emergency department was most likely to screen for both HIV and syphilis. Decreasing disparities in screening could have profound effects on the HIV and syphilis epidemics.

Abstract: The New Pathways in Syphilis Vaccine Development meeting was held before the start of the STI & HIV 2023 World Congress as a pre-meeting symposium to highlight recent advances in the development of an effective syphilis vaccine and discuss the challenges still faced by investigators. Internationally renowned public health officials, clinical investigators, and basic researchers from academia, government, and community-based organizations met on July 24, 2023, in Chicago, Illinois. Four speakers discussed key research findings in syphilis vaccine development, which included antigen selection, identification of epitopes associated with protective immunity, and delivery platforms, with great emphasis on development of chimeric antigens. Significant progress was also shown on the elucidation of Treponema pallidum genomes from virtually all continents to assess the diversity in vaccine candidates of the syphilis spirochete.