Sexually transmitted diseases最新文献

Abstract: Oral metronidazole (MTZ) is a widely used drug in the 5-nitroimidazole class effective against various anaerobic bacteria and protozoa. It has long been thought to cause a disulfiram-like reaction (DLR) when combined with alcohol, believed to result from inhibition of aldehyde dehydrogenase, leading to acetaldehyde accumulation and symptoms such as nausea, flushing, vomiting, and tachycardia. To assess the validity of this association, we reviewed the English-language literature in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1/1/1970-11/22/2024, using the broad search term "disulfiram-like reaction." Eleven studies met inclusion criteria. While all four case reports and one older clinical trial reported a potential link between some oral 5-nitroimidazoles and DLR, 3 clinical trials, one cross-sectional chart review, and 2 experimental animal studies did not. Thus, the available evidence does not strongly support a clinically significant interaction between alcohol and oral MTZ, calling into question the need for strict alcohol abstinence during treatment.

Background: We sought to determine real-world effectiveness of doxycycline postexposure prophylaxis (doxy PEP) in reducing sexually transmitted infections (STIs) among men who have sex with men attending an HIV preexposure prophylaxis (HIV PrEP) clinic in Philadelphia.

Methods: Data from eligible HIV PrEP patients who did and did not receive doxy PEP from September 1, 2019, to December 31, 2023, were analyzed. We used a cohort study design and Cox models to estimate the associations between doxy PEP receipt and incident gonorrhea (GC), chlamydia (CT), and/or syphilis. We also used a crossover design and Poisson models to estimate incidence rate ratios (IRRs) for any STI and each STI separately among individuals in the year before and after doxy PEP initiation.

Results: Among the 508 eligible men, most were young men of color, and 416 (82%) opted to receive doxy PEP. Receiving doxy PEP was associated with a reduction in any incident STI (hazard ratio, 0.61; 95% confidence interval [CI], 0.40-0.93) and any incident CT (hazard ratio, 0.40; 95% CI, 0.21-0.78). Participants experienced a 62% relative reduction in STI rates while taking doxy PEP (IRR, 0.38; 95% CI, 0.29-0.50), including a reduction in CT (IRR, 0.28; 95% CI, 0.20-0.39) and GC (IRR, 0.49; 95% CI, 0.37-0.65).

Conclusions: We observed a significant reduction in any STI and CT in both analytic arms, suggesting that doxy PEP is effective in real-world settings. Enhancing doxy PEP implementation would likely reduce community STI transmission.

Background: Arizona has had one of the highest rates of congenital syphilis in the nation in recent years. The purpose of this study was to evaluate compliance with mandated 3 time-point syphilis testing for pregnant women attending prenatal care, describe access to benzathine penicillin G (BPG) treatment, and assess receipt and use of Think Syphilis campaign materials in Maricopa County, AZ.

Methods: A facility-level cross-sectional survey was performed among prenatal care providers and clinical staff in 2022 to 2023. Responses from individual participants were applied to their facilities, including respective satellite offices within their corporations.

Results: Responses from 42 distinct health care facilities were included, representing 104 outpatient obstetrician-gynecologist clinical settings. These facilities represented 232 delivering providers accounting for 33,196 live births, approximately 68.0% of all reported live births in Maricopa County for 2021. Of the 42, 41 (97.6%) reported use of syphilis screening policies for pregnant women. Reported compliance with performing prenatal syphilis testing was 78.6% (33 of 42) for syphilis at first prenatal care visit and 73.8% (31 of 42) during the third trimester. Among providers with first-hand knowledge of hospital-based screening practices, 76.5% (13 of 17) reported syphilis screening at delivery. Only 11.9% (5 of 42) reported on-site clinic-based administration of BPG; 71.4% (30 of 42) reported referring syphilis patients to an external site for treatment with BPG. Barriers to on-site treatment included cost and perception of syphilis as rare. The Maricopa County STI Clinic was the most reported treatment referral site by 90.5% (19 of 21) of respondents. Regarding the Think Syphilis campaign, 21.4% (9 of 42) confirmed receipt of campaign materials, and of these 77.8% (7 of 9) shared materials with office staff.

Conclusions: Reported performance of 3 time point syphilis testing for pregnant women attending prenatal care in Maricopa County is substantial. However, clinic-based barriers to on-site BPG administration exist. This survey afforded an opportunity to educate providers and clinic staff on maternal syphilis testing and treatment using the Think Syphilis campaign.

Background: Changes in travelers' sexual behaviors, driven by opportunities during travel, contribute to the acquisition of sexually transmissible infections (STIs). However, research on travelers' risk perception, intentions regarding new sexual partners, and engagement in behaviors that may place them at potential risk of STI acquisition remains limited. This study aims to assess the risk perception and intended sexual behaviors associated with STI acquisition among Australian travelers.

Methods: A cross-sectional online survey was conducted from July 2023 to August 2024 among Australian residents (aged ≥18 years) planning to travel overseas within 6 months. The survey was distributed in 5 Travel Medicine Alliance clinics and at the Gladstone Road Medical Centre clinic. Sociodemographics, travel plans, sexual intentions, STI risk perception, and patterns of intended sexual behaviors were collected. Subgroup analysis was performed on participants traveling without a partner to estimate their intention to engage in new sexual encounters.

Results: Of the 205 respondents, 172 (83.9%) attended the Travel Medicine Alliance clinics and 33 (16.1%) the Gladstone Road Medical Centre clinic. The median age was 42.5 years (interquartile range, 28-56 years); 51% (n = 105) were female. Nearly a quarter (22.7% [n = 29]) intended to engage in sexual activity with new partners while traveling. Among these, 72.4% perceived their risk of contracting STIs as low, despite reporting intended sexual behaviors linked to STI acquisition risk such as no intention to use condoms (28.0%), intention to engage in sexual relationships with sex workers (24.1%), and plans to undergo posttravel STI testing (34.6%). Nearly half (41.4%) identified a need for better STI-related pretravel information.

Conclusions: A substantial proportion of surveyed travelers intended to engage in sexual activity with a new sexual partner while traveling, with many underestimating their STI risk and demonstrating intended sexual behaviors that increase their likelihood of STI acquisition. These findings underscore the need for comprehensive sexual health counseling during pretravel consultations, with a focus on STI risk awareness, preventive strategies, and posttravel STI screening.

Objective: To assess the impact of the implementation of an electronic medical record (EMR)-based sexually transmitted infection (STI) order set on human immunodeficiency virus (HIV) testing rates and the acceptability of status-neutral HIV Care in the emergency department (ED).

Methods: We developed and implemented an STI order set integrated into the EMR to streamline HIV testing and status-neutral care. The cohort included ED encounters from April 2022 to December 2023 in which patients were tested for chlamydia or gonorrhea. We measured the adoption and acceptability of the order set among clinicians through surveys and analyzed the impact on rates of HIV testing and referral to Infectious Diseases using regression models.

Results: Of 3922 ED encounters, 1161 (29.6%) included an HIV test. The introduction of the STI order set in February 2023 correlated with increased testing rates for all STIs, including a significant rise in HIV testing ( P < 0.001). Survey data indicated that a majority of attending ED physicians were aware of and had used the order set. Despite low overall usage (6.8%), the order set was perceived to improve efficiency. Male gender and Black/African American race were significantly associated with increased HIV testing.

Conclusions: The implementation of an EMR-based STI order set was associated with improved HIV testing rates in the ED and was well received by clinicians, although its low usage suggests a need for further promotion and training. The study highlights the potential of systems-based interventions to enhance status-neutral care and reduce missed opportunities for HIV diagnosis.

Background: In the United States, about 12,000 new cases of cervical cancer are diagnosed each year, largely due to limited screening access. Urine-based testing for human papillomavirus (HPV) offers a noninvasive, self-sampling method that could improve access to screening. We conducted a narrative review of urine-based HPV testing, focusing on diagnostic performance and feasibility.

Methods: Studies were identified through PubMed using combinations of search terms including "urine," "screening," "diagnostic tests," and "HPV" from January 1, 2006, to December 31, 2024. Studies reporting test performance for detecting HPV and acceptability of urine-based HPV testing compared with cervical specimens, vaginal specimens, or precancerous lesions were included. Weighted averages for sensitivity and specificity were calculated based on sample sizes.

Results: We identified 36 studies (N = 65 to N = 1952) evaluating test performance for detecting HPV in urine specimens. When compared with cervical specimens, vaginal specimens, and CIN2+-confirmed lesions, urine-based testing demonstrated a wide range of sensitivity (44.8%-98.6%) and specificity (61%-100%). Differences in assay technology, genomic target, and clinical context contributed to the variability in findings. Regarding acceptability (n = 10 studies), studies found participants to be comfortable with urine sampling due to its ease of collection.

Conclusions: Urine-based HPV testing is widely accepted but requires further standardization to improve performance and secure Food and Drug Administration approval for broader implementation.

Background: Secondary distribution of human immunodeficiency virus (HIV) self-testing (HIVST) kits offers a promising strategy to expand testing among marginalized men who have sex with men (MSM). We compared characteristics of kit distributors (index participants) and recipients, and identified predictors of HIV testing and kit distribution.

Methods: We analyzed data from a randomized controlled trial among MSM in Zhuhai, China (2019-2020). Regression models identified predictors of HIV testing and kit distribution.

Results: A total of 303 index participants and 264 recipients were included. Index participants were more likely than recipients to have previously tested for HIV (84.5% vs 62.5%), report recent (past 3 months) male-male anal intercourse (83.2% vs 60.6%), and have multiple male partners (52.8% vs 40.6%). Among index participants, HIV testing was associated with older age (per year increase: adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.05-1.24), higher education (college vs high school or below: aOR, 4.71; 95% CI, 1.94-11.6), and condomless sex (aOR, 3.90; 95% CI, 1.37-12.9). Among recipients, higher income ($451-750: aOR, 2.58; 95% CI, 1.11-6.00; $751-1200; aOR, 2.35; 95% CI, 1.04-5.36, vs <$450) was linked to prior testing. Approximately 45% of index participants distributed HIVST kits to recipients. Distribution was positively associated with older age (incidence rate ratio [IRR], 1.03; 95% CI, 1.00-1.07), graduate education (vs high school or below: IRR, 2.18; 95% CI, 1.05-4.54), and number of sexual partners (IRR, 1.09; 95% CI, 1.02-1.17).

Conclusions: Tailored HIVST interventions using social network-based distribution can enhance HIV testing coverage among MSM. This strategy may improve testing uptake in low- and middle-income countries but requires further investigation.

Background: Pleasure is a key component in sexual decision making. Doxycycline postexposure prophylaxis (doxy-PEP) is a novel intervention for sexually transmitted infection prevention for men who have sex with men (MSM) that may influence sexual experiences. Using the Sexual Health Model, we assessed whether doxy-PEP use influences intimacy and sexual pleasure among MSM.

Methods: From November 2021 to December 2022, we conducted individual interviews with MSM living with and without HIV enrolled in a clinical trial of doxy-PEP (NCT03980223). Participants were purposively sampled to capture a range of doxy-PEP use frequency. Interviews explored how doxy-PEP influenced sexual health and decision making, pleasure, intimacy, and relationships. Interview transcripts and debrief reports were thematically analyzed.

Results: We interviewed 43 DoxyPEP trial participants, of whom the median age was 38 years (interquartile range, 34-46 years), 63% identified as White, 18% as Black, and 38% as Hispanic. Nineteen (44%) were living with HIV. Participants reported that doxy-PEP use improved their quality of life by providing peace of mind and resulted in more enjoyable sex experiences and increased intimacy. Participants felt that doxy-PEP provided freedom to choose about condom use and selection of partners, and supported communication with sexual partners about sexually transmitted infection prevention. These positive experiences with doxy-PEP were similar in men living with and without HIV.

Conclusions: Men who have sex with men reported that doxy-PEP use improved their sexual pleasure and intimacy with partners. Recognizing these positive aspects of doxy-PEP is essential for tailoring messaging and counseling about doxy-PEP and could motivate doxy-PEP use.

Background: High and increasing syphilis rates among American Indian/Alaska Native communities and particularly among American Indian/Alaska Native women and infants call for immediate interventions to reach and offer syphilis testing to sexually active populations paired with timely treatment.

Methods: The Great Plains Tribal Epidemiology Center within the Great Plains Tribal Leaders Health Board partnered with a local nontribal health care facility to offer free community-based syphilis testing in Rapid City, South Dakota, starting in December 2022 through June 2024. Participants received cash incentive cards for undergoing testing for syphilis, human immunodeficiency virus (HIV), and hepatitis C virus.

Results: Fifteen community testing events were conducted. Laboratory-based syphilis testing was performed on 1434 unique individuals with an average age of 38.8 years. Seventy-six people were diagnosed with syphilis that had previously not been identified (prevalence, 5.3% [76 of 1434]; 51 [67.1%]) were female. Treatment was provided to 80.3% of people with syphilis (61 of 76) within an average of 36 days. In total, the 15 events cost $158,019 ($75,000 administrative staff time + $5100 laboratory staff time + $24,009 laboratory tests + $ 53,910 incentives) or $88 per test performed ($158,019 per 1797). The cost to identify a previously unidentified case was $2079 ($158,019 per 76 newly identified infected persons).

Conclusions: This community-based screening event revealed high prevalence of undiagnosed syphilis. Incentives supported community members to access screening services. Collaborations between clinical, tribal, and public health entities to bring diagnosis and treatment services to patients using a community-based approach have clear benefits but need ongoing supportive resources to be maintained.