Acute Sexually Transmitted Infections Research Articles

HIV/Sexually Transmitted Infection Screening and Eligibility for HIV Preexposure Prophylaxis Among Women Incarcerated in an Urban County Jail.

Incarcerated women experience high rates of HIV and sexually transmitted infections (STIs); few are offered HIV preexposure prophylaxis (PrEP). We aimed to examine HIV/STI screening rates in this population and identify PrEP eligibility. Results of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) urine and HIV/syphilis screening in cisgender women in the Dallas County Jail were compiled from January to October 2020. An electronic health record review was conducted for a subgroup in March 2020 to identify PrEP eligibility. Overall, 4398 of 13,292 women were screened for CT and 4389 of 13,292 for GC, and among them, 479 (11%) screened for HIV and 562 (13%) for syphilis. Furthermore, 462 of 4398 (11%) were positive for CT, 323 of 4389 (7%) were positive for GC, 10 of 479 (2%) had positive HIV test results, of whom 6 (1.3%) were new diagnoses and 75 (13%) had a reactive rapid plasma reagin test. In March 2020, of 541 women screened, 90 tested positive for CT or GC. Of these 90, 70 (78%) did not receive HIV or syphilis screening, including women with these risk factors: 10 (14%) were homeless, 11 (16%) reported heroin use, and 10 (14%) reported methamphetamine use. Based on the presence of an acute bacterial STI, 17% (96 of 541) were PrEP eligible. Incarcerated women had high STI rates and other risk factors for HIV acquisition, although only 1 in 5 with acute STIs (11% overall) was also screened for HIV or syphilis. HIV prevention efforts should include comprehensive STI/HIV screening, linkage to treatment, and identification of PrEP candidates.

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections.

Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. Retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis. The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing. HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.

Reducing time to treatment of bacterial sexually transmitted infections in an HIV cohort

Sexually transmitted infections (STIs) are known to increase the risk of transmission of HIV and care of sexual health needs should form part of routine HIV care. Delayed treatment of...

181 Clinical Knowledge of Human Immunodeficiency Virus Among Emergency Providers at Two Level 1 Trauma Centers in Cleveland, Ohio

Emergency departments (ED) are targeted areas for prevention and diagnosis of early human immunodeficiency virus (HIV) and sexually transmitted infections (STI) given increased prevalence in this setting. Clinical knowledge and recognition of these diseases is required for identifying those at risk. Previous studies show that STI knowledge is sup-optimal among general practitioners, and acute HIV infection is frequently misdiagnosed in the ED. The purpose of this study was to assess the correlation between self-reported STI knowledge and HIV test ordering practices among emergency medicine providers in a survey study of simulated scenarios. We modified 2 surveys previously published in the literature that assess knowledge of acute HIV infection and STIs. The survey was divided into 2 sections: a 29-point score for STIs and a 10-point score for HIV. This modified survey was administered to all emergency physicians, residents, and advanced practice providers affiliated with 2 level 1 trauma centers in Cleveland, Ohio. The primary outcome of ordering an HIV test was analyzed using Spearman’s correlation coefficient (SC) to assess strength of correlation with STI knowledge. Subgroup analyses were conducted using SC and ANOVA. This study was powered to estimate the SC using an effect size of 0.3 at an alpha of 0.05 for 90% power requiring a sample size of 90 respondents. A total of 75 providers (31.3%) completed the survey. Respondents were primarily physicians (54.6%), male (56%), white (83.7%), with a median of 8 years in practice (IQR: 2,16). The majority of respondents (57%) report formal HIV training as part of their professional education. Spearman’s correlation of HIV and STIs showed a monotonic relationship with a weak positive correlation (r = 0.3513, p = 0.002). A similar analysis comparing length of time as an emergency medicine provider with HIV and STI scores was monotonic with a weak negative correlation that was not statistically significant. There was no association between HIV scores and provider type (p=0.67) or provider sex (p=0.89); however, those with formal HIV training scored higher than those without formal HIV training (p=0.003). There was no association between STI scores and provider type (p=0.10) or provider sex (p=0.79). The movement in emergency medicine to screen patients at risk of undiagnosed HIV focuses on universal or targeted screening. The results of our study reveal that when presented with a patient at high-risk for undiagnosed HIV or with undiagnosed symptomatic HIV infection, most providers either do not screen or do not have HIV in the differential diagnosis. Similarly, knowledge of STIs is only weakly correlated with knowledge of HIV risk factors and symptomatic HIV infection. Further research and screening efforts may benefit by focusing on HIV education among EM providers.

Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics.

The aim of the study was to analyse associations between chemsex and new HIV and sexually transmitted infection (STI) diagnoses among gay, bisexual and other men who have sex with men (GBMSM) accessing sexual health clinics. A retrospective case note review was carried out for all GBMSM attending two London sexual health clinics between 1 June 2014 and 31 July 2015. Chemsex status was documented for 1734 of 1840 patients. Overall, 27.1% (n = 463) disclosed current recreational drug use, of whom 286 (16.5%) disclosed chemsex participation and 74 of 409 (18.1%) injected drugs. GBMSM who were already HIV positive were more likely to disclose chemsex participation [adjusted odds ratio (AOR) 2.55; 95% confidence interval (CI) 1.89-3.44; P < 0.001]. Those disclosing chemsex participation had higher odds of being newly diagnosed with HIV infection (AOR 5.06; 95% CI 2.56-10.02; P < 0.001), acute bacterial STIs (AOR 3.94; 95% CI 3.00-5.17; P < 0.001), rectal STIs (AOR 4.45; 95% CI 3.37-6.06; P < 0.001) and hepatitis C (AOR 9.16; 95% CI 2.31-36.27; P = 0.002). HIV-negative chemsex participants were also more likely to have accessed post-exposure prophylaxis for HIV in the study period and to report sex with a discordant HIV- or hepatitis C virus-infected partner (P < 0.001). Chemsex disclosure in sexual health settings is associated with higher rates of STI diagnoses, including HIV infection and hepatitis C. GBMSM attending sexual health services should therefore be assessed for chemsex participation and disclosure should prompt health promotion, harm minimization and wellbeing interventions.

Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care

Hepatitis C virus (HCV) represents a significant cause of morbidity and mortality globally. While sex workers may face elevated HCV risks through both drug and sexual pathways, incidence data among sex workers are severely lacking. HCV incidence and predictors of HCV seroconversion among women sex workers in Vancouver, BC were characterized in this study. Questionnaire and serological data were drawn from a community-based cohort of women sex workers (2010-2014). Kaplan-Meier methods and Cox regression were used to model HCV incidence and predictors of time to HCV seroconversion. Among 759 sex workers, HCV prevalence was 42.7%. Among 292 baseline-seronegative sex workers, HCV incidence density was 3.84/100 person-years (PY), with higher rates among women using injection drugs (23.30/100 PY) and non-injection crack (6.27/100 PY), and those living with HIV (13.27/100 PY) or acute sexually transmitted infections (STIs) (5.10/100 PY). In Cox analyses adjusted for injection drug use, age (hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.86-1.01), acute STI (HR 2.49, 95% CI 1.02-6.06), and non-injection crack use (HR 2.71, 95% CI 1.18-6.25) predicted time to HCV seroconversion. While HCV incidence was highest among women who inject drugs, STIs and the use of non-injection stimulants appear to be pathways to HCV infection, suggesting potential dual sexual/drug transmission. Integrated HCV services within sexual health and HIV/STI programs are recommended.

The Men's Safer Sex Trial: A feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men.

ObjectivesWe aimed to determine the feasibility of an online randomised controlled trial (RCT) of the Men’s Safer Sex website, measuring condom use and sexually transmitted infection (STI).MethodsFor this study 159 men aged ≥16 with female sexual partners and recent condomless sex or suspected STI were recruited from three UK sexual health clinics. Participants were randomised to the intervention website plus usual clinic care (n = 84), or usual clinic care only (n = 75). Online outcome data were solicited at 3, 6, and 12 months.ResultsMen were enrolled via tablet computers in clinic waiting rooms. Software errors and clinic Wi-Fi access presented significant challenges, and online questionnaire response rates were poor (36% at 3 months with a £10 voucher; 50% at 12 months with £30). Clinical records (for STI diagnoses) were located for 94% of participants. Some 37% of the intervention group did not see the intervention website (n = 31/84), and (as expected) there was no detectable difference in condomless sex with female partners (IRR = 1.01, 95% CI 0.52 to 1.96). New acute STI diagnoses were recorded for 8.8% (7/80) of the intervention group, and 13.0% (9/69) of the control group over 12 months (IRR = 0.75, 95% CI 0.29 to 1.90).ConclusionIt is likely to be feasible to conduct a future large-scale RCT to assess the impact of an online intervention using clinic STI diagnoses as a primary outcome. However, practical and technical challenges need to be addressed before the potential of digital media interventions can be realised in sexual health settings.Trial registration number: ISRCTN18649610

Digital health promotion in sexual health clinics: results of a feasibility trial of the Men’s Safer Sex website

Digital health promotion in sexual health clinics: results of a feasibility trial of the Men’s Safer Sex website

‘It's all in the message’: the utility of personalised short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing—a repeat before and after study

BackgroundPatients at increased risk of sexually transmitted infections (STIs)/HIV acquisition are advised to reattend for retesting. A previous study showed that ‘generic’ text reminders did not improve reattendance.AimTo assess if...

P12.16 Older patients attending sexually transmitted infections clinics

Background Many older patients remain sexually active well into their eighth decade of life. Surveillance data suggest that rates of sexually transmitted infections (STIs) in this age group may be increasing. We sought to compare demographics, risk behaviours and predictors of acute infections in patients 50 years and older versus younger patients attending STI clinics in Baltimore, Maryland. Methods Retrospective study from a large electronic database of all visits to two urban STI clinics between 2005 and 2010. Proportions were compared using the c2 test. Logistic regression was used to assess predictors of acute STIs in older versus younger groups. Results 4461 first visits for patients over 50 and 4893 visits for patients under 50 were included in the analysis. Patients over 50 frequently reported high-risk behaviours [35.4% (CI 0.34–0.37) vs. 52.7% (CI 0.51–0.54) in those Conclusion Older patients who seek care at STI clinics engage in significant risk behaviours. Race, a factor strongly predictive of acute STIs in young men and women is not a significant predictor of STIs in older persons. Disclosure of interest statement No sources of funding or conflicts of interest to disclose.

P08.21 Sex and pelvic inflammatory disease: what’s the relationship? case-control study

Background Pelvic inflammatory disease (PID) results from infection ascending to the upper female genital tract. The timing of progression of untreated infections is poorly understood and difficult to study prospectively. We investigated temporal relationships between recent sexual partnerships and PID caused by the sexually transmitted infections (STI) Chlamydia trachomatis or Neisseria gonorrhoeae . Methods We did a case-control study, using case records. Cases were women with clinically diagnosed PID and a positive C. trachomatis or N. gonorrhoeae test result. Control groups were women who presented on the same day with: control1) clinical PID and negative test results; control 2 ) no clinical PID and negative test results; control3) uncomplicated C. trachomatis or control4) uncomplicated N. gonorrhoeae infection. We used survival methods for statistical analysis. Results We analysed data from 356 women: 72 cases, 83 control1, 75 control 2 , 68 control3 and 58 control4. Cases and women in control3 and control4 were younger than women in control1 or control 2 (p Conclusion Differences in the course of STI- and non-STI associated PID were mainly due to age. Further studies to elucidate the course of acute STI and ascending infection will help to understand the impact of screening and treatment interventions on PID prevention. Disclosure of interest No funding was received for this study.

S03.3 Sti estimates within the institute for health metrics and evaluation global burden of disease process

Introduction Sexually-transmitted infections (STIs) are an important cause of acute illness, disability and death throughout the world. In this study, we used GBD 2013 systematic approach to analyze levels and trends in health loss due to STI for the years 1990 to 2013, for 188 countries, both sexes, and 20 separate age groups. We separately estimated deaths, years of life lost (YLLs), prevalence, incidence and years of life lived with disability (YLDs) for five different infections: gonorrhea ( Neisseria gonorrhea ), chlamydia ( Chlamydia trachomatis ), trichomoniasis ( Trichomonas vaginalis ), syphilis ( Treponema pallidum ), genital herpes due to herpes simplex virus 2 (HSV-2), and the residual category of “other” STI. Methods Age- and sex-specific mortality due to all STI in ages 10 and over was estimated using cause-of-death ensemble modeling (CODEm). Syphilis deaths in ages 0 to 9 used a natural history model combining data on syphilis prevalence in pregnancy, live births, antenatal care coverage, routine antenatal syphilis testing, and excess neonatal mortality rates in those infected with syphilis. Years of life lost (YLL) were calculated by multiplying age-specific deaths with life expectancy at time of death. We estimated non-fatal STI burden consequent to acute, recurrent, and chronic infection as well as pelvic inflammatory disease (PID) and infertility. Our dataset was developed via systematic literature review, supplemented with national reports and hospital datasets. We modeled the epidemiology of each condition using DisMod-MR 2.0, a Bayesian meta-regression tool developed for GBD 201313, thereby generating age- and sex-specific prevalence and incidence estimates for each condition. Years of life lived with disability (YLD) were calculated by pairing symptomatic case numbers with corresponding disability weights (DW). Results Global STI deaths decreased from 257,648 (95% UI: 154,732 to 396,443) in 1990 to 142,017 (87,589 to 213,920) in 2013. Most deaths were due to congenital syphilis which was the dominant driver of YLLs. Over 99% of all STI deaths occurred in developing countries, including 32.9% in eastern sub-Saharan Africa alone. Annualised rate of change (ARC) of age-standardized death rates globally was -3.0%, with 38 countries exceeding -5.0%. New cases of chlamydia, gonorrhea, trichomoniasis and genital herpes all increased between 1990 and 2013 and were amongst the top 25 most common acute conditions. North Africa and the Middle East saw the biggest percentage increase, driven mostly by population growth. Peak ages for incident infection in each STI were between 20 and 25 years and largely unchanged from 1990 to 2013. The most common acute STI in females was trichomoniasis whereas it was chlamydia in males. Genital herpes was by far the most common chronic infection in both sexes. In females, chlamydia and gonorrhea were the dominant driver of YLDs, mostly due to PID and infertility, whereas genital herpes was the biggest cause of disability due to STI in males. Discussion Despite significant improvement in congenital syphilis mortality from 1990 to 2013, STI remain a significant cause of acute infection and disability throughout much of the world, even increasing in many locations. Surveillance and treatment programs for STI should remain a priority.

Contribution of transmission in HIV-positive men who have sex with men to evolving epidemics of sexually transmitted infections in England: an analysis using multiple data sources, 2009-2013.

HIV seroadaptive behaviours may have contributed to greater sexually transmitted infection (STI) transmission in HIV-positive men who have sex with men(MSM) and to the global increase in STIs. Using multiple national surveillance data sources and population survey data, we estimated the risk of STIs in HIV-positive MSM and assessed whether transmission in HIV-positive MSM has contributed to recent STI epidemics in England. Since 2009, an increasing proportion of STIs has been diagnosed in HIV-positive MSM, and currently, the population rate of acute bacterial STIs is up to four times that of HIV-negative or undiagnosed MSM. Almost one in five of all diagnosed HIV-positive MSM in England had an acute STI diagnosed in 2013. From 2009 to 2013, the odds of being diagnosed with syphilis increased from 2.71 (95% confidence interval (CI) 2.41–3.05, p<0.001) to 4.05 (95%CI 3.70-4.45, p<0.001) in HIV-positive relative to HIV negative/undiagnosed MSM. Similar trends were seen for gonorrhoea and chlamydia. Bacterial STI re-infection rates were considerably higher in HIV-positive MSM over a five-year follow-up period, indicative of rapid transmission in more dense sexual networks.These findings strongly suggest that the sexual health of HIV-positive MSM in England is worsening, which merits augmented public health interventions and continued monitoring.

Hepatitis E Virus Seroprevalence among Men Who Have Sex with Men, United Kingdom

Hepatitis E Virus Seroprevalence among Men Who Have Sex with Men, United Kingdom

The need for innovative sexually transmitted infection screening initiatives for young men: evidence from genitourinary medicine clinics across England

The study objectives were to ascertain behavioural, access-related, health-seeking factors and sexually transmitted infection (STI) prevalence in young men (<25 years) attending genitourinary (GU) medicine clinics and compare them with older men (≥ 25 years) and young women (<25 years). Between October 2004 and March 2005, 4600 new attendees at seven sociodemographically and geographically contrasting GU medicine clinics across England completed questionnaires, which were linked to routine clinical data. Young men waited significantly less time to be seen in clinic compared with older men and young women. They were less likely to report symptoms than older men (P = 0.021) yet more likely to be diagnosed with chlamydia (P = 0.001) and gonorrhoea (P = 0.007). They were also more likely to be diagnosed with an acute STI relative to young women (P = 0.007). Our data confirm the need to make comprehensive STI screening readily available for young men and to develop effective and innovative screening strategies in different settings.

P1-S5.11 High prevalence of STIs and risk behaviours among persons living with HIV in Nicaragua: missed opportunities for prevention

BackgroundThe UNAIDS Report on the Global AIDS Epidemic estimated that in 2009 Nicaragua had 6900 cases of HIV, almost double the 2001 estimate. Among people living with HIV in Nicaragua,...

P1-S5.46 Assessing the relationship between sexually transmitted infection rates, ethnic group and socio-economic deprivation in England

BackgroundDisparities in the distribution of sexually transmitted infections (STIs), especially gonorrhoea, across ethnic groups in England are well recognised. Socio-economic deprivation (SED) is also a known determinant of poor health...

Factors associated with sexually transmitted infection underreporting among female sex workers in China.

To examine the underreporting of sexually transmitted infections (STI) (i.e., no STI by self-report but have at least one STI through biological testing or clinical examination) and factors associated with underreporting among female sex workers (FSWs) in China. A total of 454 FSWs were recruited from entertainment establishments in a rural county of Guangxi, China. Participants completed a self-administered survey about their demographic and working characteristics, history of STI (past or current infections), sexual history and practices, and HIV/STI-related knowledge and perceptions; 411 of the sample were also tested for syphilis, Neisseria gonorrheae, Chlamydia, Trichomonas, and genital warts. About 18% (79 of 411) of the sample reported a history of STI (past or current infections). Biological testing or clinical examination revealed at least one STI (acute STI) for 42% (171 of 411) of the sample. Only 9% (37 of 411) of FSWs with acute STI reported an STI through self-report, which resulted in 33% (134 of 411) of FSWs who were considered underreporting their STI. STI underreporting was independently associated with younger age (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.76-0.99), a shorter duration of commercial sex (aOR 0.97, 95% CI 0.94-0.99), poorer knowledge of STI (aOR 0.81, 95% CI 0.70-0.94), and less sexual risks (aOR 0.52, 95% CI 0.41-0.66). Underreporting of STI was prevalent in FSWs, especially among women with perceived lower STI risks. The underreporting might be largely due to their perception of low risks for STI and unawareness of STI symptoms (including asymptomatic STIs). Future studies of FSWs should identify those new in commercial sex with lower STI awareness and perceived risks and encourage them to seek timely and appropriate testing and treatment.

The Interplay between Sexually Transmitted Infections and HIV: An Evolving Story.

The Interplay between Sexually Transmitted Infections and HIV: An Evolving Story.

Emergency Care of Urban Women With Sexually Transmitted Infections: Time to Address Deficiencies

Patient education upon diagnosis of a sexually transmitted infection (STI) may effect changes in high-risk sexual behavior. Describe emergency department (ED) communication with urban female patients treated for STIs. : This secondary analysis of data collected during a study of ED communication used mixed quantitative and qualitative methods. The medical records of female patients ages 18 to 35 presenting to an urban ED for low abdominal/pelvic pain, gynecological complaints, and urinary symptoms (n = 134) were reviewed for STI testing and treatment proportions. A subsample of 30 audiotaped interactions with women treated for STIs were coded for provider assessment of sexual risks and delivery of STI prevention messages. Audiotape analysis found sexual histories were very limited and only 17% of women received prevention messages. Provider STI treatment had an estimated overall sensitivity of 46% (95% CI, 24.4%-69.0%) and specificity of 66% (95% CI, 61.8%-70.7%). Urban female patients treated for an STI in the ED rarely received recommended STI prevention messages. The study raises policy issues regarding the need for quality indicators in acute STI care. Access to STI treatment in other practice settings or by alternative methods need to be strongly considered.