Sexually transmitted diseases最新文献

Background: Adolescents and young adults in South Africa have high burdens of sexually transmitted infections (STIs) and unintended pregnancy. We evaluated the impact of peer support and/or expanded sexual and reproductive health (SRH) services on STIs, contraception, and pregnancy in rural KwaZulu-Natal, South Africa.

Methods: We analyzed secondary outcomes from a 2 × 2 factorial randomized controlled trial conducted from March 2020 to August 2022 among 16- to 29-year-olds, comparing (1) enhanced standard of care (SoC), access to mobile youth-friendly HIV prevention (AYFS); (2) SRH, self-collected STI testing and referral to AYFS with expanded SRH services; (3) peer support, peer navigator facilitation of AYFS attendance; (4) SRH + peer support. At 12 months, all participants were offered STI testing; female participants self-reported contraceptive use and pregnancy.

Results: Among 1743 trial participants (51% female), 927 (53%) had 12-month STI results; 209 (22.5%) tested positive: 163 (17.6%) chlamydia, 54 (5.8%) gonorrhea, and 44 (4.8%) trichomoniasis. The prevalence of STI was somewhat lower among those exposed to peer support (adjusted odds ratio [aOR] adjusted for sex, age, location, 0.77; 95% confidence interval, 0.56-1.06) or SRH (aOR, 0.74; 0.56-1.06) and, compared with SoC, was reduced in those exposed to both (aOR, 0.59; 0.38-0.94). In SRH arms, 64 of 469 (13.6%) had a new STI at 12 months, with no difference by peer support ( P = 0.97). Among females, 336 of 634 (53.0%) reported using contraception and 47 of 667 (7.1%) reported pregnancy, with little difference by study arm.

Conclusions: Peer support and STI testing with expanded SRH each had no more than small effects on STIs, contraception, or pregnancy. Combined or more intensive interventions, for example, repeat screening, enhanced partner notification, and deeper understanding of structural drivers, are needed.

Background: Evidence suggests low diagnostic test utilization and high empiric prescribing rates for vaginitis symptoms. This study retrospectively assessed real-world bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) treatment patterns in the United States relative to test results and their timing.

Methods: Patients with vaginitis or related symptom diagnosis were identified between 2018 and 2023 in an ambulatory electronic medical record database linked to prescription and outpatient medical claims databases. Pregnant and nonpregnant subgroups were stratified by test type (nucleic acid amplification test [NAAT] panel [BV, VVC, and TV], direct probe, or traditional methods) up to first diagnosis date +2 days. Treatment claims before (empiric) and up to 7 days after (informed) the test result date were assessed.

Results: There were 1465 pregnant and 13,447 nonpregnant patients meeting selection criteria; 31.7%, 26.3%, and 2.0% of pregnant and 26.6%, 16.1%, and 2.0% of nonpregnant cohorts had positive results for BV, VVC, and TV, respectively. Empiric treatment was common across treated pregnant subgroups tested with laboratory NAAT panel (55.0%), direct probe (35.5%), and traditional methods (66.7%), and nonpregnant subgroups (55.7%, 52.2%, 74.2%, respectively). Many empiric treatments were not aligned to positive test results, including coinfections (e.g., 6.5%-8.2% of pregnant and 11.7%-13.0% of nonpregnant patients who tested BV positive by NAAT panel or direct probe were empirically treated with antifungal agents for VVC).

Conclusions: High empiric treatment rates and evidence of inappropriate treatment highlight the potential utility for rapid, accurate tests to diagnose common vaginal infections, to inform clinical decision making and results-guided prescribing at the point of care.

Background: Randomized control trials in sub-Saharan countries found that male circumcision may prevent high-risk human papillomavirus (HR-HPV) acquisition. Using 2013-2016 National Health and Nutrition Examination Survey data, we explored the association between circumcision and HR-HPV among sexually experienced 18- to 59-year-old men.

Methods: Self-collected penile specimens were tested for HPV DNA. We estimated weighted HR-HPV prevalence (positivity to ≥1 HR type: HPV-16/18/31/33/35/39/45/51/52/56/58/59/66/68) by circumcision status. The association between circumcision and HR-HPV was assessed using multivariable logistic regression models. Effect modification by circumcision on the association between number of lifetime sex partners and HR-HPV was explored.

Results: Overall, 77.7% of men reported being circumcised, with large variation by race/ethnicity and country of birth. High-risk HPV prevalence was significantly higher among circumcised (25.7%) than uncircumcised (20.4%) men; this was attenuated after adjustment for lifetime and new past-year sex partners (adjusted prevalence ratio, 1.10; 95% confidence interval, 0.92-1.32). There was evidence that circumcision modified the association between lifetime partners and HR-HPV, but HR-HPV prevalence increased with increasing number of partners in circumcised and uncircumcised men.

Conclusions: Our observed lack of statistical association between circumcision and HR-HPV may differ from randomized trial results because of the differences between circumcised and uncircumcised men or differences in anatomic site sampled or timing of circumcision.

Abstract: A 21-year-old immunocompromised female (advanced HIV, CD4 count: 9 cells/μL) presented with painful genital ulcers. A multiplex PCR panel detected Trichomonas vaginalis in both vaginal and ulcer swabs, while tests for Neisseria gonorrhoeae , Chlamydia trachomatis , and Mycoplasma genitalium were negative. The patient was treated with metronidazole, resulting in significant clinical improvement. This case underscores the importance of considering Trichomonas vaginalis in the differential diagnosis of genital ulcers, particularly in immunocompromised individuals, and highlights the utility of molecular testing in atypical presentations.

Background: Research on condom failure among African men who have sex with men (MSM) is rare; therefore, we sought to identify multilevel correlates of condom failure.

Methods: Using logistic regression, we identified the associations of various participant, partnership, and sexual interaction characteristics with condom slippage and breakage among African MSM participating in HIV Prevention Trials Network (HPTN) 075, a 1-year, multinational, prospective cohort study (2015-2017).

Results: Of 401 participants, 387 (96.5%) reported at least one sexual interaction in which condoms were used. Condom slippage was reported in 194 (10.2%) of the 1908 sexual interactions reported by participants and breakage in 223 (11.7%) interactions. Both slippage and breakage were reported less frequently by participants in ongoing intimate relationships compared with those who were not (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.29-0.95; OR, 0.57; 95% CI, 0.34-0.93). Slippage and breakage occurred more frequently when sex happened under the influence of substances (OR, 1.67; 95% CI, 1.13-2.46; OR, 2.08; 95% CI, 1.48-2.93) or when sex was forced (OR, 3.18; 95% CI, 1.68-6.02; OR, 2.39; 95% CI, 1.41-4.04). Having experienced homophobia was also associated with slippage and breakage (OR, 1.32; 95% CI, 1.04-1.68; OR, 1.35; 95% CI, 1.10-1.65).

Conclusions: Ongoing condom failures suggest the importance of continued condom education of African MSM, addressing circumstances that promote or hinder optimal use, and increasing their control in sexual interactions. Experienced homophobia might as a distal factor also contribute to condom failure.

Background: The World Health Organisation recommends testing populations most affected by hepatitis C virus (HCV) infection, like people living with HIV. After screening with an Ab test, HCV RNA testing is required to identify active (viremic) infections. One could focus the HCV RNA testing capacity on true positive serological test results, by implementing serological HCV confirmation assays. Our goal was to evaluate the performance of 3 HCV confirmation assays in people living with HIV.

Methods: A total of 415 frozen plasma specimens collected in Cambodia (Sihanouk Hospital Center of HOPE) and Belgium (Institute of Tropical Medicine) were tested with Geenius HCV supplemental Assay (Bio-Rad, Marne la Coquette, France), HCV Blot 3.0 (MP Biomedical, Irvine, CA), and INNO-LIA HCV Score (Fujirebio, Ghent, Belgium). Results were compared against HCV RNA results and/or a composite reference standard.

Results: Overall, INNO-LIA had the highest sensitivity (97.0%; 95% confidence interval [CI], 94.0%-98.5%) and Geenius the highest specificity (98.2%; 95% CI, 93.7%-99.5%). In a subset of patients with active infection (n = 177), all 3 assays showed comparable sensitivity (99.0%; 95% CI, 96.0%-100.0%). Both for INNO-LIA (8.7% [36 of 415]) and HCV Blot (7.0% [29 of 415]), the indeterminate results were mostly negative and/or indeterminate (80.6% [29 of 36] and 93.1% [27 of 29], respectively) on the composite reference standard compared with only 26.3% (10 of 38) on Geenius.

Conclusions: All 3 antibody confirmation assays show comparable and high sensitivity in active HCV infections. Geenius potentially offers some advantages in ease of use, low turnaround time, and ruling out past infections. The added value of HCV antibody confirmation assays needs to be established in larger cost-effectiveness studies and is influenced by decreasing HCV prevalence and HCV RNA capacity.

Background: Patients reporting sexual contact with a person(s) with chlamydia (CT) and/or gonorrhea (NG) are at increased risk of acquiring these sexually transmitted infections (STIs). Presumptive antimicrobial therapy is recommended for sexual contacts, but concerns have been raised about unnecessary antibiotic use.

Methods: We reviewed visits of patients who reported sexual contact to a partner with CT or NG ("contacts") from January 2021 to October 2023 in 10 STI clinics. We calculated CT and NG positivity, stratified by 3 patient groups (women, men who have sex with men, and men who have sex with women only [MSW]) and symptomatic status.

Results: Overall, 11,072 (6.8%) CT and/or NG contacts were identified (7660 [4.7%] CT contacts and 4988 [3.1%] NG contacts). Chlamydia positivity among CT contacts was 35%; NG positivity among NG contacts was 31%. Chlamydia positivity did not differ by symptomatic status across patient groups. Gonorrhea positivity was higher for symptomatic versus asymptomatic men who have sex with men (34% [95% confidence interval {CI}, 31%-37%] vs. 28% [95% CI, 26%-30%]) and MSW (37% [95% CI, 33%-41%] vs. 23% [95% CI, 20%-27%]), but not in women (38% [95% CI, 33%-43%] vs. 37% [95% CI, 32%-42%]).

Conclusions: Substantial CT/NG positivity among sexual contacts to CT or NG was observed. Among CT contacts, CT infection was most often detected in MSW; among NG contacts, NG infection was most often detected in women. However, ~60% did not have either CT or NG. The use of point-of-care tests in this population may optimize antimicrobial use while prioritizing individual clinical care.

Background: Inoculation of the eye with monkeypox virus can cause vision-threatening disease necessitating hospitalization and urgent treatment. Ocular mpox is poorly understood, including who is most affected.

Methods: We performed a cross-sectional study comparing ocular and non-ocular mpox cases reported to the California Department of Public Health from May 1, 2022, to September 30, 2023. χ2 and t tests were used to compare between-group sociodemographic characteristics, HIV status, and vaccine status. Bivariate and multivariate logistic regressions adjusting for HIV and race/ethnicity were used to calculate odds ratios and 95% confidence intervals for the association between JYNNEOS vaccination and ocular mpox.

Results: Of 5878 mpox infections, 2403 (40.9%) had complete ocular symptom reporting and were included in this analysis. Of these, 260 (10.8%) were ocular cases. Among the 2403 included cases, most were cisgender men (94.6%) and reported male-to-male sexual contact (72.0%). The proportion of non-ocular versus ocular mpox cases differed significantly by race/ethnicity and HIV status ( P < 0.05), with more ocular cases being Hispanic/Latinx (50.8% vs. 41.8%), Black (14.2% vs. 8.9%), and with HIV (50.8% vs. 40.4%). After adjusting for race/ethnicity and HIV status, people with ≥1 dose of JYNNEOS had approximately half the odds of having ocular symptoms compared with people who were unvaccinated (adjusted odds ratio, 0.52; 95% confidence interval, 0.24-0.97).

Conclusions: A higher proportion of Black, Latinx, or people living with HIV had ocular mpox symptoms, suggesting that these groups may benefit from focused interventions to prevent infection and this complication. JYNNEOS before mpox exposure may protect against ocular complications, stressing the importance of vaccination to prevent severe sequelae, especially for vulnerable populations.