Sexually transmitted diseases最新文献

Background: Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus. Contemporary US population-based epidemiologic data on genital herpes are limited. This study aimed to provide nationally representative estimates of genital herpes prevalence and treatment using a large US health insurance claims database.

Methods: This observational cohort study used administrative claims data from HealthVerity. Crude and age- and sex-standardized prevalence rates of genital herpes and recurrent genital herpes were calculated for the years 2019 to 2021. The distribution of patients with prevalent genital herpes who received episodic or suppressive antiviral therapy was also estimated.

Results: From 2019 to 2021, the standardized prevalence of genital herpes and recurrent genital herpes ranged from 236 to 280 cases per 100,000 person-years and 81 to 98 cases per 100,000 person-years, respectively. The prevalence of genital herpes was highest among those aged 25 to 29 years (prevalence range, 497-582 years), female patients (prevalence range, 348-404 years), and those with a history of HIV infection (prevalence range, 1608-2080 years). The prevalence of recurrent genital herpes was also highest in these groups. From 2019 to 2021, two-thirds of patients (65%-68%) with prevalent genital herpes received antiviral medications; the majority received episodic therapy (80%) rather than suppressive therapy (20%).

Conclusions: The burden of genital herpes and recurrent genital herpes in the United States is substantial, with the highest rates observed in young adults, women, and immunocompromised individuals. About two-thirds receive antiviral treatment each year.

Background: This study aimed to assess the acceptability, feasibility, and preliminary effectiveness of a crowdsourced HIV partner services (PS) intervention among men who have sex with men living with HIV (MLWH) in China.

Methods: A pilot 2-arm randomized controlled trial was conducted in 3 HIV testing clinics in China. The control arm received conventional HIV PS, whereas the intervention arm received a crowdsourced intervention, including HIV self-testing kits for secondary distribution (HIVST-SD), digital education materials, and assisted PS. The intervention was developed through 2-phase crowdsourcing events including an open call and a Designathon. The primary outcomes were measured by the 3-month follow-up rate (i.e., the proportion of participants who completed the follow-up survey to report HIV PS outcomes 3 months after enrollment) and the frequency of using intervention components (feasibility), index evaluation of intervention components (acceptability), and the proportion of partners getting HIV testing (preliminary effectiveness).

Results: The study enrolled 121 newly diagnosed MLWH between July 2021 and May 2022. The 3-month follow-up rates were 93% (75 of 81) and 83% (33 of 40) in the intervention and control arms, respectively. Crowdsourced intervention components demonstrated feasibility, with all indexes using digital educational materials, 23 successfully using HIVST-SD, and 6 employing provider-referral to notify 9 sexual partners. Acceptability was high, with HIVST-SD and digital educational materials rated 4.4 and 4.1 out of 5. The proportion of partners receiving HIV testing was 11% higher in the intervention arm than in the control arm (marginal significance with 95% confidence interval, -2% to 24%; 38% vs. 27%).

Conclusions: The crowdsourced HIV PS intervention was acceptable and feasible, suggesting the potential to facilitate partner HIV testing among Chinese MLWH. Further implementation research is recommended to expand HIV PS among key populations in low- and middle-income countries.

Clinical trial registration id: NCT04971967 (Protocol ID: 19-0496).

Background: Syphilis coinfection among pregnant people living with HIV (PLH) may worsen pregnancy outcomes. We evaluated the impact of syphilis coinfection on pregnancies in south Brazil.

Methods: Data were extracted from hospital records between January 1, 2008, and December 31, 2018. Preterm birth (PTB), low birth weight (LBW <2500 g), and a composite adverse infant outcome (AIO: HIV vertical transmission, loss to follow-up before HIV diagnosis, stillbirth, congenital syphilis) were evaluated among pregnancies without HIV and syphilis (PWOH + S), PLH monoinfection, syphilis monoinfection (PLS), and PLH with syphilis (PLH + S).

Results: Among 48,685 deliveries where patients were tested for HIV and syphilis, 1353 (2.8%) occurred in PLH; of these, 181 (13.4%) were HIV/syphilis coinfected (PLH + S). Among PLH, 2.4% of infants acquired HIV and 13.1% were lost to follow-up before HIV diagnosis. Among all PLS, 70.5% of infants acquired congenital syphilis. Across the cohort, 1.2% stillbirths/neonatal deaths occurred. Thirty-seven percent of PLH + S did not initiate antiretroviral therapy versus 15.4% of PLH monoinfection ( P < 0.001). Less than half (37.6%) of PLH + S had VDRL titers ≥1:16 compared with 21.7% of PLS only ( P < 0.001). Among PLH, syphilis coinfection and unknown/high VDRL titers (≥1:16) increased AIO risk more (adjusted relative risk [aRR], 3.96; 95% confidence interval [CI], 3.33-4.70) compared with low VDRL titers (≤1:8; aRR, 3.51; 95% CI, 2.90-4.25). Unsuppressed viremia (≥50 copies/mL) was associated with risk of PTB (aRR, 1.43; 95% CI, 1.07-1.92) and AIO (aRR, 1.38; 95% CI, 1.11-1.70) but not LBW. Lack of prenatal care was significant in predicting PTB and LBW in all PLH and PLS monoinfection.

Conclusions: Syphilis coinfection worsens AIOs in all women and compounds negative effects of HIV infection during pregnancy. Effective syphilis treatment and HIV viral load suppression are paramount for optimal obstetric care.

Background: The United States has seen a > 40% increase in syphilis cases since 2017. Early disease identification and treatment are crucial. This review sought to identify emergency department (ED) patients at risk for syphilis.

Methods: A 30-day retrospective review was conducted of visits to a single ED. Patient visits were assessed for predetermined syphilis "flags" to include a history of sexually transmitted infection (STI), current chief complaint or reason for visit (RFV) keyword(s) suggestive of potential STI or a positive pregnancy test result. Flagged charts were assessed for STI testing results within 6 months of ED visit. Data were analyzed using χ2 .

Results: There were 5537 total patient encounters, resulting in 455 flagged visits from 408 (8.4%) unique individuals, majority of whom were female (282, 69.1%; P < 0.001), Black (251, 61.5%; P < 0.001), aged 15 to 44 years (308, 75.5%; P < 0.001). Chief complaint was the most frequent flag (65.3%), followed by RFV (37.4%), prior STI (31.0%), and pregnancy (12.3%). Syphilis testing data were available for 120 flagged patients; 29 (24.2%) screened positive, including 11 (2.7% of total flagged cohort) with evidence for active infection. Among those, most were Black (90.9%), male (72.7%), aged 25 to 34 years (63.6%), and 9 (81.8%) had concomitant HIV. In active infection, prior STI flag was most common (72.7%), followed by chief complaint (54.5%) and RFV (45.5%).

Conclusions: This review demonstrates the performance of an electronic medical record-based "syphilis risk flag" screener applied to ED patients. Sex- and race-based discrepancies exist in flag rates, which may be reflective of sex- and race-based epidemiologic discrepancies in STI incidence.

Background: The 2022 mpox outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Mpox cases continue to be reported nationally. Vaccination is a tool to prevent the spread of and serious disease from mpox. To understand mpox vaccine uptake and hesitancy, a virtual focus group with unvaccinated GBMSM was conducted.

Methods: In November 2022, a 60-minute, virtual focus group was conducted within an artificial intelligence (AI) platform that engages participants in chat-based conversation. The AI system uses machine learning and natural language processing to analyze and provide results immediately to the moderator. Descriptive frequencies, cross-tabulations and qualitative themes were analyzed.

Results: Fifty-one GBMSM ages 18-55 participated, of whom 12 had attempted to get the mpox vaccine. The top barriers in accessing the vaccine included challenges in scheduling appointments (4/12), available vaccine locations (3/12), and transportation (2/12). Nine participants reported not wanting the vaccine and 22 were undecided; Of these, 15 (4/9 and 11/22, respectively) said they did not think they needed the vaccine due to low perceived risk or monogamy.. Among the undecided, after receiving health messaging about mpox, 12/22 said the messaging made them reconsider getting the vaccine.

Conclusion: During an outbreak, many unvaccinated GBMSM who may be at increased risk for mpox either wanted the vaccine or, with appropriate health messaging, may be open to getting the vaccine. Messaging about mpox vaccine efficacy, potential side effects, and how to access the vaccine may improve vaccine uptake especially as cases continue to occur.

Introduction: Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, have an important burden worldwide. The use of doxycycline as Pre-Exposure Prophylaxis (PREP or Doxy-PREP) or Post-Exposure Prophylaxis (PEP or Doxy-PEP) might be effective as prophylaxis since it is effective against C. trachomatis and T. pallidum.

Aims: Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs (C. trachomatis, N. gonorrhoeae, and Treponema pallidum).

Methods: A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE, Cohrane, Scielo, and LILACS databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard Ratios (HRs) and Risk Ratios (RR) with 95% CI were pooled across trials.

Main outcome measure: The primary endpoints were any incidence of bacterial STIs and individual STI infections.

Results: A total of four studies were included in the analysis, three of which evaluated Doxy-PEP and one evaluated Doxy-PREP. In the Doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of Doxy-PEP studies, the incidence of the first STI was lower in the Doxy-PEP group (HR = 0.538 [95% CI = 0.337-0.859]) (I2 = 77%; P-value <0.05). Regarding individual infections, only two studies were included. In the Doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared to controls (RR = 0.291 [95% CI = 0.093-0.911]) (I2 = 89%; P-value <0.05). Since only one study evaluated Doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as pre-exposure prophylaxis was associated with a decrease in the rate of any STI.

Conclusions: The use of Doxy-PEP might reduce the first STI, mainly C. trachomatis, if used within 72 h after condomless sex. The use of Doxy-PREP might also decrease the chance of any STI, however, only one study was evaluated.

Background: While self-sampling could help address anal cancer screening barriers, no studies have investigated annual engagement with this method or compared it to annual screening with a provider. Building on our baseline paper,(7) we compared annual anal screening engagement between home-based self-sampling and clinic-based clinician sampling.

Methods: The Prevent Anal Cancer Self-Swab Study recruited and randomized sexual and gender minority individuals 25 years and over who have sex with men to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, while clinic-based participants were asked to schedule and attend one of five participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints.

Results: 58.8% of participants completed annual (median = 370 days) anal screening. In the home arm, 65.0% of participants engaged in annual screening compared to 52.5% of clinic-based participants (p = 0.049). When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening (p < 0.001). Non-Hispanic Black participants participated more in home-based annual anal screening(73.1%) than annual clinic screening(31.6%) (p = 0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported "some" prior anal cancer knowledge, preferred an insertive anal sex position, and reported any prior cancer diagnosis.

Conclusions: Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm.

Background: There is growing interest in novel sexually transmissible infection (STI) prevention strategies, including doxycycline post-exposure prophylaxis (doxy-PEP). We assessed interest in doxy-PEP and other STI prevention strategies among gay and bisexual men and non-binary people in Australia, as well as prior antibiotic use for STI prevention, and knowledge of antimicrobial resistance (AMR).

Methods: We conducted a national, online survey in June-July 2023. Multivariable logistic regression was used to identify factors associated with the acceptability of doxy-PEP.

Results: Of 2,046 participants, 26.9% had been diagnosed with an STI in the previous year. Condoms were rated as an acceptable STI prevention strategy by 45.1% of the sample, STI pre-exposure prophylaxis by 54.0%, and doxy-PEP by 75.8%. Previous antibiotic use for STI prevention was reported by 7.5% of the sample, and 2.6% were currently using antibiotics for STI prevention. Over half the sample (62.1%) had some knowledge of AMR. Of those who knew something about AMR,76.2% were concerned about it. Interest in using doxy-PEP was independently associated with previous use of antibiotics for STI prevention (adjusted odds ratio 3.09, 95%CI = 1.78-5.35, p < 0.001), while those who were concerned about AMR were less interested in it (AOR 0.51, 95%CI = 0.36-0.72, p < 0.001).

Conclusions: Doxy-PEP was highly acceptable to gay and bisexual men and non-binary people in Australia, and few factors distinguished between interest in using it or not. We recommend community and professional discussion and education about the effective use of doxy-PEP, AMR, and who would most benefit from doxy-PEP.

Background: While some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus (HPV)-associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy (HRA).

Methods: We extracted outpatient clinical data for the above populations from 01/01/2015 - 08/01/2022 at three sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and HPV testing results. We used chi-squared tests and logistic regression to assess for associations between patient characteristics and anal cancer screening.

Results: Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than white patients (95% confidence interval [CI] 0.40-0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% CI 0.20-0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings.

Conclusion: Only one-fifth of PWH received anal cancer screening and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.

Background: Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STI). Differences in clinical characteristics and STIs in men who have sex with men only (MSMO), with men and women (MSMW), and with women only (MSW) are not well described.

Methods: First visits to two Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared to an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included chlamydia, gonorrhea, nongonococcal urethritis (NGU), and primary or secondary syphilis (PSS). Chi-squared tests and logistic regression examined associations.

Results: Among N = 1226 MSMO, N = 491 MSMW and N = 1717 MSW, most identified as Black/African American; mean age (29.8) was similar across groups. 73.5%, 67.2%, and 60.3% of MSMW, MSMO, and MSW reported ≥2 partners in last 6 months. "Always" condom use was reported by 20.4%, 17.4 % and 14.1% of MSMW, MSMO and MSW. Overall HIV prevalence was 13.8%. Among those tested, urogenital chlamydia prevalence was 21.7%, 8.3%, and 3.9% (p ≤ 0.01) in MSW, MSMW, and MSMO. Urogenital gonorrhea prevalence was 11.6%,7.7%, and 8.3% in MSMW, MSW, and MSMO respectively. Extragenital STI (range 2.7-21.9%), NGU (25.2%), and PSS (5.3-5.7%) positivity was similar in MSMW and MSMO. Older age was inversely associated with STI diagnosis in MSW and MSMO only, consistent condom use was protective against aSTI in MSW (aOR:0.60, p < 0.01) and MSMW (aOR:0.54 p = 0.03) only.

Conclusion: Differences in behaviors and clinical characteristics associated with aSTI suggest that MSMO, MSMW and MSW have diverse sexual health needs and may require tailored interventions to improve sexual health outcomes.