Sexually transmitted diseases最新文献

Background: Disseminated gonococcal infection (DGI) is a rare complication of Neisseria gonorrhoeae (Ng) infection, historically affecting 0.5% to 3% of individuals. In 2019, a DGI genomic cluster associated with the ST-7822 strain was identified in southwest Michigan. This study retrospectively assessed the persistence of this strain.

Methods: Ninety Ng isolates from disseminated sites of infection from Michigan (2019-2023) were sequenced; antimicrobial susceptibility testing was performed. Phylogenetic analysis was performed to assess genetic relatedness. Data from 370 ST-7822 urogenital and extragenital gonococcal infection (UGI) isolates were included in the phylogenetic analysis. The porB1A allele, a marker associated with DGI, and antimicrobial resistance markers were also analyzed.

Results: Phylogenetic analysis identified 7 DGI clades, with clade 7 (n = 26) containing the 2019 cluster (n = 11). Clade 7 isolates (mean SNP difference, 32) formed 2 subclusters from a single ancestor between 2019 and 2023 and clustered with local UGI isolates. All clade 7 DGI isolates and 82.7% of ST-7822 UGI isolates carried the porB1A allele. Among DGI isolates with antimicrobial susceptibility testing data (n = 88), all were susceptible to ceftriaxone; no mosaic penA alleles were identified.

Conclusions: The persistence of clade 7 associated with the 2019 Michigan DGI cluster suggests ongoing regional transmission of the ST-7822 strain type that has a high proportion with porB1A allele, which has been associated with invasive infection. The genetic similarity between DGI and UGI isolates suggests that DGI strains are not genetically distinct but derived from circulating strains causing mucosal infections. Continued genomic surveillance is essential to understand virulence factors contributing to disseminated infections.

Abstract: Doxycycline postexposure prophylaxis is a chemoprophylaxis that may reduce certain sexually transmitted infections in high-priority groups 18 years and older. This study utilized a cross-sectional survey among 167 pediatric providers in the United States, with ~40% reporting lacking comfort and familiarity with doxycycline postexposure prophylaxis, and various barriers to use.

Objectives: Intimate partner violence (IPV) and sexually transmitted infections (STIs) continue to be public health challenges globally and in South Africa. However, studies examining the relationship between IPV and STIs, and the potential age disparities among South African women are lacking. Therefore, this study aimed to determine the association between varying forms of IPV (sexual, physical, and emotional) and STI diagnosis among South African women and assess the potential age disparities in this relationship.

Methods: Data were obtained from the 2017 South African National HIV Prevalence, Incidence, Behaviour and Communication National Household Cross-sectional Survey (N = 8505). Crude and multivariable logistic regression models (adjusting for ethnicity, education, and region) were used to determine the association between different forms of IPV and STIs in the past year (N = 8505). Models were stratified by age group (15-24, 25-34, 35-44, 45-49 years).

Results: Sexual (adjusted odds ratio [aOR], 2.97; 95% confidence interval [CI], 1.78-4.95), physical (aOR, 2.45; 95% CI, 1.78-3.37) and emotional IPV (aOR, 2.70; 95% CI, 2.01-3.61) were associated with STIs in the overall study population. However, disparities by age group existed. Adolescent girls and young women aged 15 to 24 years and women aged 25 to 34 years who experienced sexual IPV were 4 times and 3 times as likely to report STIs compared with adolescent girls and young women and women aged 25 to 34 years who did not experience sexual IPV (aOR, 3.58 [95% CI, 1.14-11.3]; aOR, 2.65 [95% CI, 1.19-5.92], respectively). Older women, aged 45 to 49 years, who experienced sexual IPV were 7 times as likely to report STIs (aOR, 6.92; 95% CI, 1.58-30.4). Similar patterns were seen for women exposed to emotional and physical IPV.

Conclusions: Intimate partner violence interventions are warranted for women IPV survivors across the age spectrum, which may help to reduce the incidence of STIs.

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.

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).

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.

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.