Are we there yet? A roadmap from a statewide population-based analysis of STI patterns among people with HIV, with implications for morbidity, transmission and ending the HIV epidemic.

Artificial intelligence and sexual health in the USA

IssueAlmost all the patients who presents to the hospital with symptoms and/or signs of sexually transmitted infection have been engaged with unprotected sexual intercourse, thus they are predispose to contacting...

This study aimed to compare the frequency and characteristics of sexually transmitted infections (STI) between people with HIV (PWH) and pre-exposure prophylaxis (PrEP) users. A retrospective analysis was conducted using nucleic acid amplification techniques (NAAT) for Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium in rectal, urine, and pharyngeal samples, as well as serological tests for syphilis. The samples were collected and analysed as part of routine clinical care and sent to the microbiology department between Jan 1 2023, and May 31 2023. Multivariable logistic regression was performed to identify factors associated with STI diagnosis; adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported. A total of 459 samples from 450 participants (277 PWH and 173 on PrEP) were included in the analysis. Overall, 144 (32%) participants tested positive for at least one STI. PrEP users had a lower median age (35 vs. 42 years; p < 0.01), were more frequently born in Spain (77.5% vs. 57.6%; p < 0.01), had a higher level of education (university 62.4% vs. 48.4%; p < 0.01), and had a higher prevalence of chemsex use (18.4% vs. 12.9%; p < 0.01). The prevalence of STIs was significantly higher among the PrEP users (38.2% vs. 28.2%; p = 0.027). However, this difference was insignificant after multivariable adjustment (aOR 1.09, 95% CI 0.6–1.7). Neisseria gonorrhoeae was the most common pathogen among PrEP users, while Chlamydia trachomatis and Mycoplasma genitalium were more frequent in PWH. Independent factors associated with STI diagnosis included chemsex use (aOR 1.9, 95% CI 1.1–3.3) and higher educational level (aOR 2.4, 95% CI 1.7–3.4). STIs were commonly diagnosed among PWH and PrEP users, particularly in individuals engaging in chemsex. The different bacterial profiles of STI between PWH and PrEP users underline the importance of continuous STI surveillance. Not applicable.

Treatments for HIV and other STIs are not readily available in sub-Saharan Africa and other resource-limited areas, where the prevalence of HIV and other STIs is high. In the absence of treatment and laboratory infrastructure to monitor treatment efficacy, increasing awareness of STIs and STI screening are crucial components of STI prevention programs. In the current study, we sought to estimate the awareness of STIs in resource-limited countries and evaluate the strength of the association between the awareness of STIs and STIs infection. We did a secondary analysis of data obtained from 2019 women and 794 men enrolled in a community-based study that was conducted from November 2002 to March 2003 in the Moshi Urban District of Northern Tanzania. We found gonorrhea, syphilis, and HIV/AIDS were well-known among the study participants. However, their awareness of other STIs, including herpes, was very low. We also found that the awareness of STIs was not associated with STIs in men, but women who had prior knowledge of gonorrhea, syphilis, and HIV had a twofold higher risk of testing positive for an STI. Education programs aimed at increasing awareness of STIs are needed in the region. The majority of the existing STI education programs in the region focus exclusively on HIV/AIDS. The expansion of the existing AIDS/HIV education programs needs to be strengthened to include information about other STIs.

The Ending the HIV Epidemic (EHE) initiative aims to reduce new HIV infections by 90% by 2030 in the United States (US). However, rising sexually transmitted infection (STI) rates exacerbate the bidirectional infection risk between HIV and STIs. Most research on STIs among people with HIV (PWH) has focused on high-risk groups, resulting in limited data on broader populations. This study addresses that gap by examining the incidence and risk factors for gonorrhea, chlamydia, and syphilis in a statewide cohort of PWH in South Carolina. Data from South Carolina’s HIV and STI surveillance systems were linked, and all PWH aged 18 and older who were diagnosed with HIV between 2007 to April 2018 were included. Cohort demographics were analyzed using descriptive statistics and chi-squared tests, and a Cox Proportional Hazards model examined time to first STI after HIV diagnosis. The study found an increase in the incidence of gonorrhea, chlamydia, and syphilis over the study period. Young adults, men, Black individuals, MSM, and urban residents were found to be at increased risk for STI diagnosis. Clinical risk factors associated with increased STI risk included lower initial CD4 counts, and higher initial viral loads. The findings underscore a considerable STI burden among PWH in South Carolina. To mitigate STI transmission in the context of HIV, targeted interventions for high-risk populations are needed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-025-04744-5.

Objective:This study explores the potential contribution of a microbicide’s sexually transmitted infection (STI) efficacy in reducing a female sex worker’s (FSW) risk of STI and HIV infection. The study then...

We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May–December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/μL; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/μL. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/μL. PWH with CD4+T-cell < 200 cells/μL were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.

IntroductionThe global incidence of sexually transmitted infections (STIs) has been rapidly increasing over the past decade, with more than one million curable STIs being acquired daily. Young women in sub-Saharan Africa have a high prevalence and incidence of both curable STIs and HIV. The use of doxycycline as a prophylaxis to prevent STIs is promising; however, clinical trials, to date, have only been conducted among men who have sex with men (MSM) in high-income settings. We describe the characteristics of participants enrolled in the first trial to determine the efficacy of doxycycline post-exposure prophylaxis (PEP) to reduce STI incidence among women taking daily, oral HIV pre-exposure prophylaxis (PrEP).MethodsThis is an open-label 1:1 randomized clinical trial on the efficacy of doxycycline PEP compared with standard of care (e.g., quarterly STI screening and treatment) to reduce incident bacterial STIs – Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum – among Kenyan women aged ≥18 and ≤30 years. All were also taking HIV pre-exposure prophylaxis (PrEP). We describe the baseline characteristics, STI prevalence, and STI risk perception of participants.ResultsBetween February 2020 and November 2021, 449 women were enrolled. The median age was 24 years (IQR 21–27), the majority were never married (66.1%), 370 women (82.4%) reported having a primary sex partner, and 33% had sex with new partners in the three months prior to enrolment. Two-thirds (67.5%, 268 women) did not use condoms, 36.7% reported transactional sex, and 43.2% suspected their male partners of having sex with other women. Slightly less than half (45.9%, 206 women) were recently concerned about being exposed to an STI. The prevalence of STIs was 17.9%, with C. trachomatis accounting for the majority of infections. Perceived risk of STIs was not associated with the detection of an STI.ConclusionYoung cisgender women using HIV PrEP in Kenya and enrolled in a trial of doxycycline postexposure prophylaxis had a high prevalence of curable STIs and represent a target population for an STI prevention intervention.

We provided sexually transmitted infection (STI) screening and facilitated partner notification and treatment among women participating in a periconception HIV prevention program in southwestern Uganda to understand follow-up STI incidence. Women at-risk for HIV exposure while planning for pregnancy completed laboratory screening for chlamydia, gonorrhea, trichomoniasis, and syphilis at enrollment and 6months of follow-up and/or incident pregnancy; facilitated partner notification and treatment were offered for those with positive tests. We performed a logistic regression to determine correlates of follow-up STI. Ninety-four participants completed enrollment STI screening with a median age of 29 (IQR 26-34); 23 (24%) had ≥1 STI. Of the 23 participants with enrollment STI(s), all completed treatment and 19 (83%) returned for follow-up; 18 (78%) reported delivering partner notification cards and discussing STIs with partner(s), and 14 (61%) reported all partners received STI treatment. Of the 81 (86%) who successfully completed follow-up STI screening, 17 (21%) had ≥1 STI. The STI incidence rate was 29.0 per 100 person-years. In univariable regression analysis, enrollment STI, younger age, less education, and alcohol consumption were all significantly associated with follow-up STI. We demonstrated high enrollment and follow-up STI rates and moderate participant-reported partner treatment among women planning for pregnancy in Uganda despite partner notification and treatment. Novel STI partner notification and treatment interventions are needed to decrease the STI burden, especially among women planning for and with pregnancy.

Rates of sexually transmitted infections (STIs) have significantly increased in the United States. Per-capita estimates reveal approximately 68 million prevalent and 26 million incident STIs nationally. Gonorrhea, syphilis, and chlamydia—the three reportable STIs—reached levels not seen in the last fifty years and this resurgence is concurrent with increasing antimicrobial resistance and a dearth of viable candidates in the vaccine pipeline. A seminal report by the National Academies of Sciences, Engineering, and Medicine, Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, confirms that STIs rank among the most pressing and intractable public health threats. Furthermore, rising rates of STIs exact a substantial societal, medical, and economic burden that strain public health capacity, which has been substantially debilitated in the wake of the Covid-19 pandemic. STIs can have serious consequences for sexual, reproductive, and overall health. Untreated syphilis, for instance, is directly implicated in neurological, cardiovascular, and dermatological disease. Human papillomavirus is a known cause of cervical cancer and is the most common cancer among women globally. Hepatitis B increases risk for cirrhosis and primary liver cancer. Despite reductions in HIV transmission and improvements in prevention and treatment, infections among women, girls, adolescents, and mother-to-child transmission remain unacceptably high. Marginalized racial/ethnic minorities, LGBTQ persons, vulnerable at-risk adolescents and young adults, and other underrepresented populations are more susceptible to STIs as they negotiate an array of factors that can delay and even preclude access to preventive interventions. The United States spends substantially more on STI prevention and treatment yet it consistently bares a disproportionate burden of sexually transmitted infections compared to other Western industrialized nations. Access to healthcare, erosion and diversion of public health capacity, racism, discrimination, stigma, substandard education, and poverty have all been identified as important contributors to the trajectory of acute sexually transmitted infections. Furthermore, upstream drivers such as national, state, and local public health policies have been associated with population-level STI risk, prevention, and treatment and as such offer opportunities for ecological, observational, and multi-level analyses to assess their direct and indirect impact on sexual health outcomes. In this thematic collection, we aim to present an interdisciplinary collection of high-quality articles centered on the premise that the rise of emerging and re-emerging STIs can be attributed, in part, to a complex interaction of sociomedical factors beyond individual behavioral risk profiles. This Research Topic welcomes a variety of manuscript formats including original research, brief reports, systematic reviews, and perspective manuscripts involving sociomedical factors, social determinants of health, health disparities, infectious disease epidemiology, and other drivers including health policies that act as barriers and facilitators of effective STI prevention and treatment. Manuscripts that examine structural, community, institutional, interpersonal, and broad individual factors linked to STIs are very well suited for this collection. Topic areas include, but are not limited to: • Structural racism, discrimination, and stigma and their influence on prevention, treatment, and support services among vulnerable and marginalized populations; • Housing and income insecurity that impede sexual, reproductive, and overall health; • Biological factors that affect the spread of STIs including their asymptomatic nature and the influence of sex as a biological variable; • Intimate partner violence, harassment, and intimidation; • Substance abuse, sex work, sexual networks, and normative sexual attitudes and beliefs that impede the adoption of preventive health-promoting behaviors; • Priority populations including adolescents, men who have sex with men, youth who are LGBTQ, and the incarcerated; • Impact of HIV pre-exposure prophylaxis (PrEP) uptake on STI incidence; • Culturally-specific biopsychosocial, behavioral, and community-based STI interventions to treat and support those afflicted with STIs; • Community mobilization and community-based organization to reduce STIs; • Community-level prevalence of infectious agents; • Local and holistically-integrated STI clinics; • Public health STI workforce capacity; • Health in All Policies (HiAP) approaches to STI prevention and treatment. Christopher Williams is the Senior Vice President and Director of Research at National Health Promotion Associates, a private research and development firm that specializes in the development, testing and dissemination of evidence-based approaches to target behavioral risk factors associated with major chronic diseases, violence, accidents and preventable injuries. The other Topic Editors declare no competing interests with regard to the Research Topic subject.

It's Time to Act: Contextualizing the Prevalence of Sexually Transmitted Infections in Adolescents and Young Adults with Sickle Cell Disease

Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV

Sexually transmitted infections (STIs) are common in people with HIV (PWH). Cornerstones of STI prevention include safer sex practices, routine screening to identify asymptomatic infection, timely diagnosis, and appropriate treatment. This chapter reviews the established and evolving science regarding the diagnosis and treatment of the most prevalent STIs in PWH, including syphilis, gonorrhea, and chlamydia. Key information is provided on the clinical presentation of various STIs, including syphilis, gonorrhea, chlamydia, human papillomavirus, and genital ulcers. In addition, available diagnostic tests and tools important to clinicians in their daily practice are discussed. Finally, recommended therapies for each of the different STIs are reviewed.

Background. Adequate knowledge of sexually transmitted infections (STIs) is critical for effective control of disease. Health education/counselling at the point of care provides ample opportunities to improve knowledge of patient seeking treatment. There is no study from Nigeria that investigates association between sources of previous point of care of STI and quality of knowledge of people on STI. We hypothesised that previous treatment of STI will be associated with better knowledge of STI and HIV infection. Methods. Three consecutives nationally representative cross-sectional surveys on HIV and AIDS Reproductive Health in Nigeria, conducted in 2005, 2007, and 2012 were analysed. Outcome measures were knowledge of STI only, and a combined knowledge of STI and HIV transmission and prevention. We designed a knowledge scale of 14-item questions for STI and 41-item questions for STI and HIV. Logistic regression was used to identify risk factors at 5% significance level. Results. Knowledge of STI increased from 13.4% in 2005 to 15.0% in 2007 to 26.5% in 2012. Respondents that received treatment from pharmacy and patient medicine vendors had higher odds of good knowledge of STI than those who did not receive any treatment (aOR = 2.55) in 2005. In 2012, respondents treated at health facilities were over two times likely to have good knowledge of STI and HIV transmission and prevention (aOR = 2.35). STI positive individuals in the highest economic class were two times likely to have good knowledge of STI and HIV transmission and prevention than those in the lowest class. Conclusion. Participants that previously sought care from health facilities, pharmacy, and patient medicine vendors had better knowledge of STIs and HIV infection prevention and transmission than those who sought care from unorthodox sources. We recommend a national awareness creation on STI prevention including provision of information on safe point of care for STIs in Nigeria.

Source: Gao R, Liu B, Yang W, et al. Association of maternal sexually transmitted infections with risk of preterm birth in the United States. JAMA Netw Open. 2021;4(11):e2133413. doi:10.1001/jamanetworkopen.2021.33413Investigators from multiple institutions conducted a retrospective study to assess the association between maternal sexually transmitted infections (STI) during pregnancy and premature birth. For the study, they reviewed data on birth certificates of children born by singleton birth between 2016 and 2019 in all 50 states and the District of Columbia. Data abstracted from birth certificates included demographic information, maternal pregnancy history, and estimated gestational age at birth. Also included on the birth certificates was a history of maternal infection with chlamydia, gonorrhea, and/or syphilis at the time of the diagnosis of pregnancy or during pregnancy. The primary study outcome was premature birth, defined as gestational age <37 weeks. Secondary outcomes included extremely premature birth (<28 weeks), very preterm birth (28-31 weeks), and moderately preterm birth (32-36 weeks). The association between maternal STI and these outcomes were assessed with logistic and multinomial regression, after adjustment for multiple confounders. Models that included any of the assessed STIs, and specific STIs were conducted. In addition, analyses stratified by maternal age or race/ethnicity were performed.Data on 14,373,023 singleton births were included in the analyses. The mean age of the mothers of these infants was 29 ± 5.8 years. A total 267,260 (1.9%) mothers had chlamydia, 43,147 (0.3%) had gonorrhea, and 16,321 (0.1%) had syphilis. Among the study newborns, 1,146,800 (8.0%) were born prematurely. In the multivariate model, any maternal STI was associated with an increased risk of premature birth (OR, 1.06; 95% CI, 1.05, 1.07); infection with chlamydia (OR, 1.03; 95% CI, 1.02, 1.04), gonorrhea (OR, 1.11; 95% CI, 1.08, 1.15), and syphilis (OR, 1.17; 95% CI, 1.11, 1.22) were each individually associated with an increased risk of premature birth. Maternal STI was associated with an increased risk of very premature birth (OR, 1.07; 95% CI, 1.03, 1.12), and moderately preterm birth (OR, 1.06; 95% CI, 1.05, 1.08), but not extremely premature birth (OR, 1.00; 95% CI, 0.95, 1.05). There was a small but statistically significant (P <0.001) increase in the risk of premature birth associated with maternal STI among women ≥35 years old (OR, 1.09), and those 25-34 years old (OR, 1.08), compared to those <25 years old (OR, 1.06). There was a statistically significant increased risk of premature birth associated with maternal STI among women who were white (OR, 1.10; 95% CI, 1.08, 1.13), Black (1.04; 95% CI, 1.02, 1.06) and Hispanic (OR, 1.06; 95% CI, 1.03, 1.09), but not Asian (OR, 1.01; 95% CI, 0.90, 1.13).The authors conclude that maternal infection with chlamydia, gonorrhea, or syphilis is associated with an increased risk of premature birth.Dr Von Kohorn has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The holy grail of neonatal-perinatal medicine is the prevention of adverse newborn outcomes, and, ultimately, the prevention of preterm birth. Intrauterine infection is thought to be a leading cause of preterm birth, although the precise contribution of specific STIs to preterm birth is unclear.1 The current study, a high-quality observational analysis of more than 14 million women with singleton pregnancies in the US, provides some of the best evidence to date that STIs—specifically chlamydia, gonorrhea, and syphilis—are associated with preterm birth. Still, the nature of the study leaves key questions unanswered.The authors of the accompanying editorial comments that some epidemiologists caution against considering interpreting near-even odds, such as those in the current study, as valid when the sample size is extremely large.2 Furthermore, observational studies, no matter how large, are subject to bias and cannot determine causation.3 Thus, it remains possible that pregnant women with STIs in this study, or in general, are systematically prone to preterm birth for reasons other than the STIs themselves. Perhaps most importantly, the current researchers did not seek to elucidate whether prevention or treatment of STIs is effective in preventing preterm birth. Recent observational data suggest that treatment of STIs in pregnancy is not effective in preventing preterm birth.4 The editorial authors state that they know of no randomized controlled trials that answer this question.2 A randomized trial of STI prevention to decrease preterm birth is intriguing. It is unclear how a randomized trial could be designed for treatment of STIs, since treatment is the standard of care in pregnancy.The best evidence to date indicates that STIs are associated with preterm birth. It remains unclear whether treatment of STIs is an effective intervention to prevent preterm birth.