Sexually transmitted diseases最新文献

Background: Outbreaks of lymphogranuloma venereum (LGV) have been reported among gay, bisexual, and men who have sex with other men (gbMSM) in Europe and North America. In Alberta, Canada, a universal surveillance program was initiated to assess LGV rates among gbMSM seen at provincial sexually transmitted infection clinics. Our study examines the epidemiological characteristics and treatment of cases.

Methods: We describe a prospective, multicenter LGV surveillance program using chlamydia-positive nucleic acid amplification test specimens from gbMSM collected at 3 sexually transmitted infection clinics between April 2018 and July 2022. Chlamydia-positive specimens from rectal, pharyngeal, and urine specimens were sent for LGV typing. Treatment and test of cure for LGV-confirmed cases were followed. Demographic variables were compared between LGV-positive and LGV-negative specimens using χ2 tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results: Eighty-five percent (n = 2333) of all chlamydia-positive specimens were tested for LGV, and 45 (1.9%; 95% confidence interval, 1.4%-2.5%) specimens were confirmed to be LGV. A majority (n = 1374) of specimens submitted for LGV testing were rectal swabs, of which 37 (2.7%) were positive. One-half (51.2% [22 of 43]) of cases were asymptomatic. Of the 22 cases with a negative test-of-cure result, 9 (40.9%) patients received doxycycline 100 mg twice a day for 21 days, 7 (31.8%) patients received azithromycin 1 g as a single dose, 5 (22.7%) patients received doxycycline 100 mg twice a day for 7 days, and 1 patient (4.6%) was treated with doxycycline 100 mg twice a day for 14 days.

Conclusions: Universal testing increased the detection of LGV among asymptomatic patients. Future research should consider the impact of asymptomatic LGV in transmission networks and the role of alternate, shorter treatment regimens than the recommended 21 days of doxycycline.

Background: In the U.S. Neisseria gonorrhoeae is the second most common reportable STI amassing 601,319 cases in 2023. Notably, N. gonorrhoeae has developed antimicrobial resistance, necessitating ongoing surveillance. In response to this threat, the U.S. Centers for Disease Control and Prevention (CDC) has established antimicrobial resistance surveillance networks including Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) and the Antibiotic Resistance Lab Network (ARLN). SURRG performs testing using a gradient strip method, the Etest, while ARLN labs perform testing by agar dilution, for determining MIC values for N. gonorrhoeae.

Methods: We compared the concordance of MIC values obtained using the Etest gradient strip method at a SURRG site in North Carolina compared to ARLN using the agar dilution method for three antibiotics: azithromycin, cefixime, and ceftriaxone.The MIC values and the corresponding interpretations for each agent were analyzed according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) and CDC. The essential agreements were assessed.

Results: Between January 2018 and December 2024, a total of 1,951 N. gonorrhoeae had corresponding isolates from the ARLN lab available for comparison of which 1,892 had corresponding Etest and agar dilution results for all three antibiotics. We found high levels of MIC agreement between both testing methods for each antimicrobial agent tested (azithromycin 95%; cefixime 98%; ceftriaxone 95%) over six years including for strains isolated from distinct anatomical sampling sites.

Conclusions: The Etest method provides a robust alternative for accurately detecting antibiotic-resistant N. gonorrhoeae for public health surveillance, which may make them particularly useful in resource- or labor-limited settings.

Abstract: We analyzed the 2015-2019 National Survey of Family Growth to examine how odds of human papillomavirus (HPV) vaccination changed after partnership dissolution among reproductive-aged US women. Upon multivariable analysis, the odds of HPV vaccination increased in years after partnership dissolution compared to continual partnership (adjusted odds ratio: 3.37; p < 0.001).

Background: NB/GQ individuals represent a distinct population with unique sexual health care needs. We characterize trends in clinic attendance, sociodemographics, STI, and drug use among NB/GQ patients at an urban SHC.

Methods: We analyzed Public Health-Seattle & King County (PHSKC) SHC visit data collected between January 2016- October 2023. We used the Cochran-Armitage trend test to identify trend in reported gender identity and chi-squared tests to identify sociodemographic characteristics associated with cisgender, transgender, and NB/GQ. We evaluated the associations between gender identity and the prevalence of syphilis, urogenital gonorrhea, rectal chlamydia infection, methamphetamine, and non-prescribed injection drug use using generalized estimating equations.

Results: Of 82,384 visits, 1672 (2.0%), 867 (1.1%), and 79,845 (96.9%) were NB/GQ, transgender, and cisgender patients, respectively. From 2016-2023, the proportion of visits among NB/GQ and transgender patients increased from 0.7% to 3.5% and 0.7% to 1.7%, respectively (p-trend<0.001). NB/GQ identity was more common among patients assigned to female vs. male sex at birth (3.2% vs 1.8%, P < 0.001), younger vs older patients (14-25 years: 3.1% vs >46: 0.2%, p < 0.001), and white vs black patients (2.3% vs 1.0%, p < 0.001). Compared with MSM, NB/GQ patients had significantly lower odds of urogenital gonorrhea (aOR 0.50; 95% Confidence Interval (CI) 0.32-0.80). The differences in rectal chlamydia (aOR 0.78; 95% CI 0.59-1.02) and syphilis (aOR 0.96; 95% CI 0.87-1.06) were not statistically significant. There were no significant differences between the NB/GQ and transgender visits.

Conclusions: Gender diversity among SHC attendees increased significantly over the eight years. Continues monitoring is essential for tailoring STI/HIV prevention strategies.

Background: Indigenous Peoples in the United States experience disproportionate burdens of sexually transmitted infections (STIs), HIV, and viral hepatitis, but data about associated testing behaviors are limited. Given that substance use is a risk factor for STIs and viral hepatitis, there is a need for more research on testing behaviors among Indigenous people who use drugs. This research examines correlates of STI, HIV, and hepatitis C virus (HCV) testing among a sample of people who use drugs in a northern Midwest Indigenous community.

Methods: This community based participatory research includes a survey among people who used drugs in a Northern Midwest reservation community (N = 227). We described when individuals were most recently tested for STIs, HIV, and HCV. We also examined correlates of past-year testing, including individual characteristics, drug use behaviors, sexual partners, and condom use.

Results: Most participants had been tested for STIs (63%), HIV (60%), and HCV (65%) in their lifetime, while a quarter had been tested STIs (33%), HIV (24%), and HCV (27%) in the past year. Recent testing for STI, HIV, and HCV was significantly associated with younger age, being a woman or gender minority, lifetime injection drug use, number of sex partners, and being willing to distribute HIV test kits.

Conclusions: This study is among the few to examine STI, HIV, and HCV screening behaviors in an Indigenous community, and found that screening rates were suboptimal. Culturally relevant, Indigenous-led programs are essential to increase awareness and access to screening and ultimately address critical public health disparities.

Abstract: We conducted a case-control analysis to evaluate the determinants for initiating long-acting injectable cabotegravir (LACAB) as PrEP in a real-world setting with limited drug access. Individuals selected for LACAB experienced more side effects from oral PrEP, riskier sexual behavior, longer prior PrEP use, and a significantly higher incidence of STIs during follow-up. Despite this, LACAB was well tolerated, and discontinuation rates were low. Our findings support prioritizing LACAB for individuals most exposed to HIV and with low adherence to oral regimens, especially in contexts where logistical or economic constraints limit universal access to PrEP.

Abstract: Jurisdictional health departments use public health information systems to maintain and transmit their surveillance data for national surveillance. We investigated if changes to a public health information systems had an impact on sexually transmitted infection case-based surveillance data and document short-term issues that resulted in decreased data quality.

Background: Chicago has high rates of sexually transmitted infections (STIs), disproportionately affecting vulnerable populations. Self-administered at-home testing (SAAHT) may improve access to STI testing. Before SAAHT services are made available at Chicago Department of Public Health (CDPH) STI clinics, understanding characteristics of persons who might be less likely to use SAAHT can help CDPH anticipate where extra effort might be needed to improve service utilization.

Methods: A cross-sectional survey was conducted from July to September 2023 at CDPH STI Specialty Clinics in Lakeview and South Austin. Participants (≥18 years of age) completed surveys on SAAHT acceptability. Factor analysis and modified Poisson regression identified factors associated with the likelihood of not using SAAHT.

Results: Reported unlikelihood of using SAAHT methods was more prevalent among person who were male, heterosexual, and non-Hispanic Black/African American, and those unemployed or without postsecondary education. Being unlikely to use SAAHT methods was inversely related to perceptions of SAAHT convenience, result trustworthiness, and self-confidence in using SAAHT methods.

Discussion: Findings indicate a general acceptability of SAAHT among CDPH clients, with respondents reporting being at least somewhat likely to use SAAHT regardless of the procedures involved. Unlikelihood of using SAAHT methods was related to demographic characteristics and perceptions of SAAHT, and associations differed according to method of collection, logistics of returning test kits, and mode of receiving results. Addressing method-specific concerns, providing culturally relevant education, and offering alternative sampling techniques could improve acceptability. Future efforts should explore preferences to better tailor interventions, ultimately enhancing SAAHT uptake and STI testing access in urban settings.