Sexually transmitted diseases最新文献

Background: Patients who test positive for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) should get retested to evaluate for reinfection. The US military has previously been reported to have high rates of CT and GC, but follow-up rates are unknown. This study evaluates factors associated with follow-up CT or GC testing in active-duty service members (ADSMs).

Methods: Positive cases of CT and GC among ADSM who were stationed at Joint Base San Antonio between January and June 2023 were evaluated in a retrospective chart review. A patient had follow-up testing if they had a repeat test within 3 to 12 months after their initial positive test result. Follow-up rates were compared among groups based on demographics, clinical setting of testing, and presence of symptoms.

Results: Of the 200 ADSMs who tested positive for CT or GC during the study period, 101 (51%) were men, and the median age was 23 (interquartile range, 20-26). One hundred forty (70%) were junior enlisted (E1-E4). Women received follow-up testing at a higher rate than men (71% vs. 51%; P = 0.003), without significant difference in follow-up testing by clinic, race, service, or organism. Women who were symptomatic at the time of initial test had a significantly higher rate of follow-up testing than did the symptomatic men (76% vs. 49%; P = 0.003).

Conclusions: Despite standardized follow-up testing recommendations, there were significantly lower follow-up testing rates in men, with the greatest difference in testing in patients who were symptomatic at presentation. Future work should standardize follow-up testing of CT or GC infections in men.

Background: Human papillomavirus (HPV) is a leading cause of 6 cancers. Despite effective vaccines, HPV vaccination rates remain suboptimal, standing at 26% of females and 9% of males, nationally in 2018. This study assessed factors associated with HPV vaccination uptake among patients at Chicago Department of Public Health (CDPH) sexually transmitted infection specialty clinics.

Methods: A cross-sectional survey was conducted at 2 CDPH sexually transmitted infection clinics. Of 332 surveys collected, 246 were analyzed after excluding individuals missing HPV vaccination data or those younger than 18 years. Bivariate and multivariable analyses were used to examine associations between HPV vaccination and sociodemographic factors, adjusting for sex, age, education, and sexual orientation.

Results: Human papillomavirus vaccination prevalence was higher among individuals assigned female at birth (65%) than male (46%). Male participants had a 36% lower prevalence of HPV vaccination compared with female participants (adjusted prevalence ratio [aPR], 0.64; 95% confidence interval, 0.47-0.86). Age was inversely associated with HPV vaccination as the proportion of vaccination decreased with older age groups. Individuals with a high school education or less had a 37% lower prevalence of vaccination compared with individuals with a college degree or higher (aPR, 0.63 [0.40-0.99]). Individuals identifying as bisexual had a 18% higher, and those identifying as gay or lesbian had a 51% higher prevalence of vaccination compared with heterosexual individuals (aPR, 1.18 [0.84-1.66]; 1.51 [1.07-2.12]).

Conclusion: The CDPH should prioritize HPV vaccination among individuals assigned male at birth, aged 25 years and older, and with high school education or less, and reduce the coverage gap between heterosexual patients and those of a sexual minority.

Background: Mailed self-collection kits for high-risk human papillomavirus (HPV) detection can increase access to cervical cancer screening among underscreened women. To design effective screening programs, it is necessary to evaluate women's understanding, reactions, and preferences for self-collected HPV test result delivery.

Methods: The My Body, My Test-3 trial assessed the effectiveness of mailed HPV self-collection kit outreach. Between 2016 and 2019, the trial enrolled low-income women aged 25 to 64 years in North Carolina overdue for cervical cancer screening. Our analytical sample included women from the intervention arm who conducted at-home self-collection, returned a self-collection kit, had a conclusive HPV result, and completed a follow-up survey after results were received by phone but before in-clinic screening. We evaluated women's understanding, reactions, and preferences for result delivery, stratified by result positivity.

Results: Among 296 diverse, low-income women, 16% (n = 47/296) had an HPV-positive result and 84% (n = 249/296) had an HPV-negative result. Most women understood their results as an indicator of cervical cancer risk, and 93% (n = 264/284 who responded) correctly recalled their results 1 week post-receipt. Women with a positive result more frequently reported feeling afraid and worried, and less frequently reported feeling relieved, compared with those with a negative result (all P < 0.001). Most women were comfortable receiving results by phone (HPV-positive result: 85%, n = 40/47; HPV-negative result: 96%, n = 238/249), although some with a positive result had remaining questions.

Conclusions: Although most women delivered their mailed, self-collected HPV result by phone understood their result, future US screening programs should provide educational support during and after HPV-positive result delivery.

Aim: Human papillomavirus (HPV) is a common sexually transmitted infection that often affects the reproductive system. Human papillomavirus infection can cause various cancers and clinical symptoms in women, impacting their sexual activity and quality of life. Hence, this study aimed to assess the impact of motivational interviewing on the sexual function of women with HPV.

Methods: This randomized controlled study used a pretest-posttest research design with a control group and involved 62 HPV patients from health care centers affiliated with the Babol University of Medical Sciences, Iran. The study was registered on the Iranian Registry of Clinical Trials (IRCT20230531058348N1) on June 11, 2023, after we received ethics code. The patients were divided into 2 groups: an experimental and a control group. The allocation to these groups was determined using the blocked randomized allocation technique based on pretest scores. The experimental group received the motivational intervention over 5 sessions, whereas the control group received routine intervention. All participants completed the Female Sexual Function Index questionnaire before and immediately after the interventions. Data were entered into SPSS 24 and were analyzed. Descriptive statistics included means and standard deviations for quantitative data and frequency percentages for qualitative variables. χ2 Tests and independent t tests were used to examine relationships and compare initial variables. Analysis of covariance was used to compare questionnaire scores between the 2 groups. The significance level was set at 0.05.

Results: The intervention (N = 31) and control (N = 31) groups had similar ages (33.58 ± 6.14 vs. 34.96 ± 7.04 years, P = 0.412). Sexual dysfunction occurred in 74.2% of HPV-positive women. Covariance analysis showed that motivational interviewing had a significant positive effect on overall sexual function in women with HPV ( η2 = 0.717, P < 0.001). Motivational interviewing with a large effect size also led to improved sexual desire ( η2 = 0.566), increased arousal ( η2 = 0.728), increased wetness ( η2 = 0.531), increased orgasm ( η2 = 0.525), increased sexual satisfaction ( η2 = 0.563), and reduced sexual pain ( η2 = 0.680; P = 0.001).

Conclusions: The results of the study suggested that offering counseling to women with HPV could improve their sexual functioning, leading to a better overall sexual experience and mental and emotional well-being, and ultimately strengthening their quality of life and marital connections. Moreover, this could influence how health care providers support and aid people with HPV.

Abstract: In an urban sexual health clinic, a substantial portion of the clinic population initiated doxycycline postexposure prophylaxis (doxyPEP) for bacterial STIs in the first 12 months, and implementation of doxyPEP was associated with a subsequent decrease in clinic-level chlamydia and syphilis positivity, but no change in overall gonorrhea positivity.

Abstract: We examined alignment between sex of sex partners and sexual orientation in syphilis case notifications among men in 2022 to inform interpretation of sexual orientation data for notifiable conditions in the National Notifiable Diseases Surveillance System. Observed partial alignment underscores the importance of analyzing appropriate variable(s) for a given intervention.

Background: Prior studies have identified an association between rectal douching and prevalent rectal Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), but few studies have examined associations with incident infections.

Methods: We used data from ExGen, a 48-week cohort study conducted in Seattle, Washington, 2016 to 2018. Each week, participants completed a survey and self-collected rectal specimens, which were tested for CT/GC at the end of the study. Our primary analysis was a case-crossover analysis. We identified individuals with incident rectal GC or CT and included 1 case-week (the first week of the incident rectal infection) and 2 randomly selected control-weeks (weeks where the participant tested negative for rectal GC/CT). We used multivariate conditional logistic regression to estimate the association between douching and rectal GC/CT. In an exploratory analysis, we created a "synthetic" cross-sectional study of the longitudinal data to mirror the design of other studies.

Results: There were 140 individuals in ExGen. Our case-crossover sample comprised 17 GC case-weeks and 34 matched GC control-weeks, and 22 CT case-weeks and 44 matched CT control-weeks. Participants reported douching during 64.7% of GC case-weeks and 70.6% control-weeks (adjusted odds ratio, 0.47; 95% confidence interval, 0.07-3.10). Douching was reported at a similar frequency among CT case-weeks (45.5%) versus control weeks (47.7%; adjusted odds ratio, 1.16; 95% confidence interval, 0.26-5.07). In our exploratory synthetic cross-sectional study, rectal douching was significantly associated with rectal GC but not CT.

Conclusions: Douching was not associated with rectal GC/CT in this methodologically rigorous analysis. A better understanding of the mechanisms of douching products and impact of long-term use may be warranted.

Background: We examined HIV preexposure prophylaxis (PrEP) use among men who have sex with men (MSM) with repeat bacterial sexually transmitted infections (STIs) at 14 publicly funded clinics across 10 US jurisdictions participating in the STI Surveillance Network.

Methods: We identified MSM without HIV who had a diagnosis of rectal gonorrhea, rectal chlamydia, and/or syphilis in 2021 to 2022 and ≥1 diagnosis of these infections within the prior 12 months. We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to evaluate differences in PrEP use at time of most recent infection by demographics and sexual behaviors.

Results: We identified 542 MSM with repeat bacterial STI infections. Preexposure prophylaxis use at the time of repeat diagnosis was reported by 78% (421 of 542) overall; 76% (329 of 435) among patients with 1 prior STI infection and 86% (92 of 107) among those with ≥2 prior infections. Compared with non-Hispanic (NH) Black patients, those in other race/ethnicity groups had higher PrEP use prevalence (Hispanic: aPR, 1.37 [95% CI = 1.09-1.73]; NH-White: aPR, 1.31 [95% CI, 1.05-1.65]; NH-other race(s): aPR, 1.36 [95% CI, 1.07-1.72]). Preexposure prophylaxis use among those 25 to 34 years old (aPR, 1.73; 95% CI, 1.31-2.28) and >35 years old (aPR, 1.65; 95% CI, 1.08-1.59) was higher compared with those <25 years old. Among 97 MSM not on PrEP at the time of repeat diagnosis, 18% (n = 17) received PrEP on day of or in the following 30 days.

Conclusions: Although 8 in 10 MSM with a history of repeat bacterial STI were on PrEP, there were disparities among racial and age groups. Promoting awareness and equitable access are needed to address persistent barriers to PrEP use and encourage PrEP uptake and continuation.