Sexually transmitted diseases最新文献

Background: Sexual health clinics (SHCs) were frontline providers in the 2022 US mpox public health response, although data on clinic-based mpox vaccine scale-up, diagnoses, and treatment are limited. We describe the role of a public health SHC in King County's mpox response between May 23, 2022, and October 31, 2022.

Methods: In July 2022, the SHC implemented a dedicated vaccine clinic and presumptive tecovirimat treatment (before laboratory confirmation) with on-site dispensation. We describe SHC's vaccine scale-up and contribution to clinical care by calculating the weekly number of vaccines administered by SHC and the total number of patients diagnosed and treated for mpox within SHC, and by comparing with countywide data. We calculated time from symptom onset to testing and time from testing to treatment, and assessed temporal changes in these metrics using linear regression.

Results: The SHC provided ≥1 vaccine doses to 7442 individuals (10,295 doses), administering 42% of the 24,409 vaccine doses provided countywide, with the greatest contribution in the first week of August (n = 1562, 58% of countywide vaccinations that week). Of 598 patients evaluated for mpox and tested, 178 (30%) tested positive (37% of countywide cases), and 152 (85% of SHC patients with mpox) received tecovirimat (46% of treatment countywide). Median time from symptom onset to testing decreased from 12 to 6 days ( P = 0.045); time from testing to treatment decreased from 4.5 to 0 days ( P < 0.001).

Conclusions: The SHC was central to mpox vaccination and treatment scale-up, particularly in the first months of the 2022 epidemic.

Background: Measuring condom use accurately is important to understanding sexual behaviors; however, there is still no consensus on the criterion standard of condom use measurement. In this study, authors aimed to investigate if nonresponse rates were higher when absolute or relative frequency condom use questions were used.

Methods: This study used Check It study data of Black men who have sex with women aged 15 to 26 years in New Orleans, LA. All men underwent a survey of sexual behavior, which included questions on condom use. From January 2017 to August 2019, participants were asked for the number of sex acts during which they had used a condom (absolute frequency question), and after August 2019 until March 2020, this was changed to response options of "never," "sometimes," or "always" (relative frequency question). Participants could refuse to answer the question; the rate of refusal was tabulated by question type to determine if nonresponse rates differed.

Results: There were 1907 participants included in the study, with data on 2957 partnerships. Of those asked the relative frequency question, 92.7% responded compared with 86.1% who were asked the absolute frequency. In generalized estimating equation modeling, those asked the relative frequency question had 2.42 (95% confidence interval, 1.42-4.13; P < 0.001) greater odds of response than those asked the absolute frequency question.

Conclusions: Relative frequency questions may be more likely to elicit a response, in research among this population.

Key message: There is no current criterion standard for measuring condom use in surveys. This study demonstrated that asking participants about their condom use qualitatively (i.e., whether they use condoms "never," "sometimes," or "always"), as opposed to asking them to provide the number of sex acts during which they used a condom, was associated with lower rates of nonresponse. Investigators should consider using qualitative condom use questions to maximize response rates.

Background: In the 4 largest cities in the Netherlands, an estimated 400 people live with undiagnosed HIV, including 170 in Amsterdam. Amsterdam targets having zero new HIV infections in 2026. Undocumented migrants are disproportionately affected by HIV and often contract HIV after migration. Moreover, they often experience difficulties accessing health care. The aim of this study was to analyze the outcomes of an HIV/sexually transmitted infection testing program for undocumented migrants through community based testing.

Methods: Between May 2021 and January 2022, data for this cross-sectional study were collected during outreach testing activities of the Amsterdam Center for Sexual Health of the Public Health Service, and the NGO Doctors of the World. Activities were organized in collaboration with migrant partner organizations. Participants were tested free-of-charge for HIV, syphilis, gonorrhea, chlamydia, and, if indicated, hepatitis B and C. Before testing, a health care provider-administered questionnaire was filled out.

Results: A total of 126 people from 22 countries were tested for HIV during 28 outreach activities. Mean age was 37 (IQR 32-43). Forty-nine people (39%) were additionally tested, (through self-sampling) for chlamydia, gonorrhea and syphilis, 42 (33%) for Hepatitis B and 14 (11%) for Hepatitis C. We found zero new HIV infections and 5 positive chlamydia cases.Reaching 52 HIV first time testers and 19 first time testers since migration shows the importance of these activities. The number of participants tested were lower than initially expected due to lower attendance per testing day for various reasons.

Conclusions: To increase the likelihood of reaching undocumented migrants for HIV/sexually transmitted infection testing and linkage to care, focus should be on on-site provider-initiated testing, e.g. during outreach health care activities, and on easy access to centers for sexual health. Collaboration between health care providers and community stakeholders is essential.

Background: Syphilis epidemics among women and men who have sex with men (MSM) may be connected, but these connections are poorly understood. Using egocentric network data from a US urban MSM cohort, we examined sociodemographics, behaviors, and syphilis positivity among MSM with (1) direct (MSM who report sex with women, MSMW); (2) indirect (MSM who only report male partners, some of whom are MSMW, MSMO/W); and (3) no (MSM who only report male partners and whose partners only have sex with men, MSMO/O) connection to women.

Methods: Sexually active MSM aged 18 to 45 years were administered behavioral and network interviews (recall period: 3 months) and syphilis/HIV testing. Syphilis positivity was defined as rapid plasma reagin titer ≥1:8. Modified Poisson regression was used to test for differences across groups.

Results: Among 385 MSM, 14.5% were MSMW and 22.3% were MSMO/W. MSMW and MSMO/W were significantly more likely than MSMO/O to report sex behaviors associated with increased syphilis acquisition/transmission risk, including ≥2 sex partners (MSMW: adjusted prevalence ratio [aPR], 1.28 [0.98-1.68]; MSMO/W: aPR, 1.35 [1.09-1.69]) and concurrent sex partners (MSMW: aPR, 1.50 [1.17-1.92]; MSMO/W: aPR, 1.39 [1.11-1.74]), and for MSMW only, transactional sex (aPR, 2.07 [1.11-3.88]). Syphilis positivity was 16.4% and was lower among MSMW (9.4%) and MSMO/W (14.1%) than MSMO/O (18.5%), but differences were not significant.

Conclusions: There may be considerable connectivity between MSM and female sex partners that could facilitate syphilis transmission, and behaviors that increase acquisition/transmission risk among MSMW and MSMO/W may be distinct from MSMO/O. Future work should focus on examining the context and temporal patterns of sex partnerships among MSMW and MSMO/W.

Background: Mycoplasma genitalium causes a sexually transmitted infection and is also emerging as an important antimicrobial resistant pathogen. Data on M. genitalium infections among men who have sex with men (MSM) in low-resource settings are sparse.

Methods: From January to December 2022, participants in an HIV pre-exposure prophylaxis (PrEP) program in Hanoi, Vietnam were enrolled into the study. Demographic, behavioral, and clinical characteristics were collected. Self-collected urine, rectal, and pharyngeal specimens were tested for M. genitalium using the Alinity m STI Assay (Abbott Molecular, USA). Univariate and multivariate logistic regression were performed to assess for factors associated with infections.

Results: Among 477 participants, the median age was 25.3 years (21.7-29.6) and 92.2% (n = 440) identified as MSM; 48.6% had ≥2 sex partners and 38.1% reported condomless anal sex in the prior month. The overall prevalence of M. genitalium infection was 10.9% (52/477); 7.3% (34/464) rectal, 3.2% (15/476) urethral, and 1.9% (9/476) pharyngeal. Infections were asymptomatic in 71.2% (37/52). Among those with M. genitalium , 30.7% (16/52) were co-infected with either Neisseria gonorrhoeae or Chlamydia trachomatis. Among those reporting rectal (n = 51) or urethral (n = 35) symptoms, but without C. trachomatis or N. gonorrhoeae co-infections, five (9.8%) had rectal infections and one (2.9%) had urethral infection. Participants with M. genitalium were more likely to be asymptomatic than participants without M. genitalium (adjusted odds ratio, 1.93; 95% confidence interval, 1.01-3.71).

Conclusions: Mycoplasma genitalium infections were common among primarily MSM engaged in an HIV PrEP program in Vietnam. The prevalence was highest in rectal specimens and nearly three quarters of M. genitalium infections were asymptomatic. Testing for M. genitalium infections among those with symptoms is important to enable pathogen-directed therapy. Additional research on antimicrobial resistance and treatment strategies for M. genitalium in low-resource settings is needed.

Background: Chlamydia trachomatis (CT) acquired orally may survive passage through the gastrointestinal tract and establish an infection in the rectum, but how often this occurs is unknown.

Methods: In 2019 to 2022, we enrolled individuals assigned male at birth who reported sex with men and denied receptive anal sex in the past 2 years. Participants enrolled at the Seattle Sexual Health Clinic or online. Participants completed a behavioral survey and self-collected rectal swabs for CT nucleic acid amplification testing (NAAT) and culture and viability polymerase chain reaction (vPCR). We defined oral exposures as fellatio, cunnilingus, and oral-anal (i.e., rimming).

Results: We enrolled 275 men; 60 (22%) reported only oral exposures in the past 12 months. Of these, 5 (8.3%) tested positive for rectal CT by NAAT; 1 (2%) had viable CT detected (culture positive; vPCR positive). Another 43 participants reported only oral exposures in the past 2 months, but rectal exposures 3 to 12 months ago. Of these, 4 (9%) tested NAAT positive for rectal CT; 1 had viable CT detected (culture negative; vPCR positive).

Conclusions: Passage of CT from the mouth to the rectum occurs but is most often nucleic acid remnants rather than viable bacteria. Nonetheless, it seems possible to establish a viable rectal CT infection via oral exposures.

Abstract: The San Francisco Department of Public Health was the first to issue guidance on the use of doxycycline for postexposure prophylaxis against sexually transmitted infections in at-risk populations. We investigated the association between the issuance of these guidelines and rates of male rectal chlamydia, male rectal gonorrhea, and adult male syphilis.

Background: Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa.

Methods: A search for studies published in PubMed, Embase, and Psych Info by March 2023 was done. Studies involving EmA (18-25 years), conducted in Africa, and reporting 1 or more of 7 SBs were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socioecological model.

Results: Overall, 143 studies were analyzed. Noncondom use had the highest pooled prevalence (47% [95% confidence interval {CI}, 42-51]), followed by study-defined SB (37% [95% CI, 25%-50%]) and concurrency (37% [95% CI, 21%-54%]), multiple sex partners (31% [95% CI, 25%-37%]), younger age at sexual debut (26% [95% CI, 20%-32%]), age-disparate relationships (24% [95% CI, 17%-32%]), and transactional sex (19% [95% CI, 13%-26%]). Heterogeneity was partially explained by sex, with female participants having higher pooled prevalence estimates compared with their male counterparts. In 4 of the 7 outcomes, alcohol/drug use was the most common risk factor.

Conclusions: Sexual behavior was common among EmA and differentially higher in emerging female adults. Noncondom use had the highest pooled prevalence, which may contribute to the transmission of HIV and other sexually transmitted infections. Interventions targeting emerging female adults and alcohol/drug use may reduce SB, which may in turn mitigate transmission of HIV and other sexually transmitted infections among EmA in Africa.

Abstract: We determined the in vitro minimum lethal concentration of secnidazole and assessed the correlation with clinical susceptibility among Trichomonas vaginalis isolates obtained from 71 women, of whom 66 were successfully treated with this medication. A minimum lethal concentration ≤12.5 μg/mL correlated with clinical susceptibility in this study.

Background: Disease burden of sexually transmitted infections such as chlamydia, gonorrhea, and syphilis is often compared across age categories, sex categories, and race and ethnicity categories. Missing data may prevent researchers from accurately characterizing health disparities between populations. This article describes the methods used to impute race and Hispanic ethnicity in a large national surveillance data set.

Methods: All US cases of chlamydia, gonorrhea, and syphilis (excluding congenital syphilis) reported through the National Notifiable Diseases Surveillance System from the year 2019 were included in the analyses. We used fully conditional specification to impute missing race and Hispanic ethnicity data. After imputation, reported case rates were calculated, by disease, for each race and Hispanic ethnicity category using Vintage 2019 Population and Housing Unit Estimates from the US Census. We then used case counts from subsets that contained only complete race and Hispanic ethnicity information to investigate if the confidence intervals from the multiply imputed data included the observed number of cases in each race and Hispanic ethnicity category.

Results: Among the 2,553,038 cases reported in 2019, race and Hispanic ethnicity were multiply imputed for 9% of syphilis cases, 22% of gonorrhea cases, and 33% of chlamydia cases. In the subset analyses, every nonzero rate of reported cases was contained within the confidence intervals that were calculated from multiply imputed data.

Conclusions: Confidence intervals that account for the uncertainty of the predictions are an advantage of multiple imputation over complete-case analysis because a realistic variance estimate allows for valid hypothesis testing results.