Sexually transmitted diseases最新文献

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.

Background: Developments in natural language processing (NLP) and unsupervised machine learning methodologies (e.g., clustering) have given researchers new tools to analyze both structured and unstructured health data. We applied these methods to 2019 Ohio disease intervention specialist (DIS) syphilis records, to determine whether these methods can uncover novel patterns of co-occurrence of individual characteristics, risk factors, and clinical characteristics of syphilis that are not yet reported in the literature.

Methods: The 2019 DIS syphilis records (n=1,996) contain both structured data (categorical and numerical variables) and unstructured notes. In the structured data, we examined case demographics, syphilis risk factors, and clinical characteristics of syphilis. For the unstructured text, we applied TF-IDF (term frequency multiplied by inverse document frequency) weights, a common way to convert text into numerical representations. We performed agglomerative clustering with cosine similarity using the CLUTO software.

Results: The cluster analysis yielded six clusters of syphilis cases based on patterns in the structured and unstructured data. The average internal similarities were much higher than the average external similarities, indicating that the clusters were well-formed. The factors underlying three of the clusters related to patterns of missing data. The factors underlying the other three clusters were sexual behaviors and partnerships. Notably, one of the three consisted of individuals who reported oral sex with male or anonymous partners while intoxicated, and one was comprised mainly of males who have sex with females.

Conclusions: Our analysis resulted in clusters that were well-formed mathematically, but did not reveal novel epidemiological information about syphilis risk factors or transmission that were not already known.

Background: ChatGPT, a large language model artificial intelligence platform that uses natural language processing, has seen its implementation across a number of sectors, notably in healthcare. However, there remains limited understanding regarding the efficacy of ChatGPT in addressing commonly asked questions on public health subjects. This study aimed to investigate whether ChatGPT could appropriately answer frequently asked questions related to sexually transmitted diseases (STDs).

Methods: Ten frequently asked questions on STDs were gathered from 25 different government agency websites. The questions were inputted into ChatGPT and subsequent responses were analyzed for accuracy, clarity, and appropriateness using an evidence-based approach on a 4-point grading scale.

Results: Of the responses provided by ChatGPT, four were determined to be excellent requiring no clarification and six requiring minimal clarification. No responses were graded as unsatisfactory. Additionally, the responses appropriately emphasized consulting a healthcare specialist.

Conclusion: While the majority of responses required minimal clarification, ChatGPT has the potential to be an effective supplementary tool for patient education. Additional research is necessary to explore possible public health strategies that incorporate artificial intelligence to address concerns related to STDs.

Background: Doxycycline post-exposure prophylaxis (doxy-PEP) reduces chlamydia, gonorrhea, and syphilis infections among men who have sex with men (MSM) and transwomen (TW). Perspectives of health care providers (HCPs) regarding doxy-PEP can inform implementation efforts.

Methods: From August 2022 to January 2023, HCPs were recruited from 13 cities with high sexually transmitted infection (STI) rates for semi-structured, in-depth interviews about their awareness of and attitudes towards doxy-PEP for STI prevention. HCPs were purposively sampled to include people with experience prescribing PrEP and provision of care to MSM. Interviews were conducted virtually via Zoom. Transcripts and debrief reports were analyzed using a directed content analysis approach to explore knowledge, attitudes, and beliefs about doxy-PEP.

Results: Among 30 HCPs, almost half (47%) were between 31-40 years of age, 53% identified as male, and 47% reported their sexual orientation as gay or queer. Half (53%) of participants practiced in the South, 43% had >100 MSM in their clinic panel, and 17% had previously prescribed doxy-PEP. We identified four overarching themes: 1) HCPs expressed positive attitudes towards doxy-PEP; 2) antimicrobial resistance concerns limit enthusiasm for some HCPs; 3) additional data about the long-term safety of doxy-PEP would improve their confidence; and 4) development of guidelines would facilitate the prescription of doxy-PEP, including eligibility, dosing instructions, and treatment management.

Conclusion: HCPs were motivated to prescribe doxy-PEP with almost 20% already having prescribed it. Guidelines and data about long-term safety, especially antimicrobial resistance, would facilitate introduction of doxy-PEP into clinical practice.

Abstract: Gonorrhea is a sexually transmitted infection. Manifestations include asymptomatic infection and disseminated, life-threatening disease. We present two cases of mitral valve gonococcal endocarditis and discuss epidemiologic trends in disseminated gonococcal infection, acknowledging antimicrobial resistance, genetic variability in gonococcal strains, and contextual factors related to the COVID-19 pandemic and STI control.

Abstract: Congenital syphilis (CS) continues to pose a significant global challenge. There has been a marked increase in reported cases in the US, with 102.5 cases per 100,000 live births in 2022 compared to 11.6 cases per 100,000 live births in 2014. CS can lead to a range of severe complications, including premature birth, intrauterine growth restriction, miscarriage, perinatal death, stillbirth, and postnatal complications that may persist into later life. Maternal/parental factors such as age, race/ethnicity, occupation, income level, access to healthcare services, and incarceration have been linked to higher rates of CS. Additionally, pregnant individuals who engage in high-risk behaviors such as sex work, having multiple sexual partners, or substance use are at a higher risk of exposure and subsequent infection. Routine screening for syphilis during pregnancy is crucial for its detection, timely management, and prevention of CS. The asymptomatic nature of the latent stage of syphilis further underscores the importance of prenatal syphilis screening. Studies in various countries have shown that early or first antenatal care visit screening for CS is cost-effective. This review article critically evaluates the current knowledge of CS in the US, including its prevalence, social determinants of health, prevention efforts, challenges, the significance of screening, and the call to action to address the rising trend.

Background: Sexually transmitted infections (STIs), including syphilis, pose a significant public health challenge. The advent of social media platforms has revolutionized health information dissemination, with YouTube and TikTok emerging as prominent sources. However, concerns persist regarding the reliability of syphilis-related content on these platforms. This study aimed to evaluate the quality and accuracy of syphilis-related content on TikTok and YouTube, employing established tools such as DISCERN, Accuracy in Digital-health Instrument (ANDI), and Global Quality Scale (GQS).

Methodology: We conducted a thorough search on TikTok and YouTube on November 26, 2023, using the keyword "syphilis." Inclusion criteria comprised videos in English, less than 20 minutes in duration, and relevance to syphilis. Two dermatologists independently rated 98 eligible videos using DISCERN, ANDI, and GQS. Statistical analyses included Chi-square tests, mean comparisons, and interclass correlation.

Results: TikTok videos exhibited higher mean views (222,519 ± 412,746) compared to YouTube (127,527 ± 223,622). However, TikTok videos had lower mean GQS (2.3 ± 0.9), ANDI (2.19 ± 0.99), and DISCERN (28.7 ± 6.56) scores compared to YouTube (GQS: 2.9 ± 1.1, ANDI: 2.90 ± 0.97, DISCERN: 38.8 ± 9). Non-professional uploaders were 40.8% on TikTok, while YouTube were (53.1%).

Conclusion: This study reveals disparities in the quality and accuracy of syphilis-related content on TikTok and YouTube. Despite higher popularity on TikTok, content quality, as assessed by DISCERN, ANDI, and GQS, was generally lower compared to YouTube. Targeted interventions are needed to improve the reliability of syphilis-related information on social media platforms.

Background: COVID-19 stay-at-home orders and research restrictions halted recruitment and follow-up of clinical research patients. Although clinical research has resumed, it is an open question whether research participation has returned to levels similar to those before COVID-19.

Methods: We used data from the TECH-PN (NCT No. NCT03828994) study, a single-center randomized controlled trial enrolling 13- to 25-year-olds with mild-moderate pelvic inflammatory disease (PID) receiving ambulatory care. We examined enrollment patterns before COVID-19 and during/after COVID-19 among those assessed for eligibility by estimating the average rate of recruitment visits for each period. We focused on this monthly rate by pandemic status, the length of stay (LOS) by pandemic status, as well as the relationship between the LOS and patient demographics. Descriptive analyses were conducted, including Student t test to compare rates between time periods and a χ2 test to compare the proportion refusing enrollment.

Results: The monthly enrollment rate during/after the pandemic was significantly lower than before COVID-19 (4.8 per month compared with 7.4 per month, P < 0.001). However, eligible participants' age, race, and insurance type were similar before and during/after the pandemic. Among eligible patients, LOS for receiving PID care was slightly increased, from a median of 5.4 to 6.4 hours ( P = 0.650), and the rate of refusal to participate among those eligible was similar (23% vs. 27%, P = 0.362). There were a similar number of ineligible patients because of inpatient admissions during both periods.

Conclusion: COVID-19 pandemic restrictions negatively impacted recruitment into this randomized controlled trial. Enrollment differences may reflect ongoing perceptions of restrictions in care access or a hesitancy to use health services. More research is needed to stabilize access to ambulatory sexually transmitted infection/PID care and access to clinical trials.

Background: Point-of-care (POC) tests for sexually transmitted infections (STIs) permit delivery of results during the patient's emergency department (ED) encounter. We evaluated performance, patient acceptability, and feasibility of a new duplex POC test, Chembio Dual Path Platform HIV-Syphilis Assay, in an urban ED setting.

Methods: Convenience sampling approach prioritizing those considered at increased risk for an STI and/or with a history of HIV. For the performance evaluation, participants were tested for HIV/syphilis with the Chembio POC assay and the reference laboratory tests; sensitivity and specificity were determined. For the patient acceptability evaluation, participants completed pre- and post-user surveys. For the feasibility evaluation, ED clinical technicians completed a survey evaluating their perceptions regarding feasibility of use of this POC test.

Results: A total of 327 patients were consented and enrolled. The diagnostic sensitivity and specificity of the Chembio POC assay for HIV were 96.5% (95% confidence interval [CI], 90.1%-99.3%) and 99.6% (95% CI, 97.7%-100.0%), respectively, and for syphilis, the values were 93.9% (95% CI, 85.0%-98.3%) and 99.6% (95% CI, 97.9%-100.0%), respectively. Regarding patient acceptability, 87% trusted the result, and 93% reported that they were more likely to seek treatment if they received a positive STI test result in the ED rather than after the ED visit. Regarding feasibility, 90% of the technicians reported that they would recommend using the test in EDs.

Conclusions: The Chembio Dual Path Platform HIV-Syphilis POC Assay had excellent performance characteristics when evaluated in an ED population, as well as high perceived acceptability from patients, and feasibility for ED use from clinical technicians. The test may have utility for HIV-syphilis screening among high-risk ED patients.