Attending Sexually Transmitted Disease Clinics Research Articles

Mental Health and Substance Use Among Black Women Attending STD Clinics in Baltimore: The Role of Overt and Subtle Discrimination.

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013-2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

Attitudes toward an HPV vaccine for condyloma acuminata and willingness to undergo vaccination among STD clinic attendees in China: Focus on STI prevention with HPV vaccine

BackgroundCondyloma acuminata (CA) is a common, and recurrent sexually transmitted disease (STD) that greatly contributes to direct health care costs and has a substantial psychosocial impact. Human papillomavirus (HPV) vaccination (containing L1 protein for HPV types 6 and 11) effectively controls CA.ObjectivesWe investigated attitudes toward the HPV vaccine for CA and willingness to undergo vaccination among STD clinic attendees in China.MethodsAttendees at STD clinics at two selected hospitals in Guangdong and Jiangsu Provinces from May to September 2017 were requested to complete a self-administered questionnaire for this cross-sectional study.ResultsThe participants’ median age was 28 years (IQR: 24.0–34.0), and the sex ratio was balanced; 63.5% were from Guangdong, 36.5% were from Jiangsu, and 44.5% had a history of CA. The vaccine acceptance rate was high among the participants (85.8%,235/274) to whom the HPV vaccine for CA was available, especially among those who had heard of CA (89.0%, AOR = 3.14, 95% CI: 1.29–7.63, p = 0.0114). 95 (34.7%) of 274 participants had a positive attitude toward the HPV vaccine for CA. STD clinic attendees who had heard of the connection between HPV and CA (AOR = 2.56, 95% CI: 1.31-5.00, p = 0.0060), had heard of the HPV vaccines or cervical cancer vaccines (AOR = 1.90, 95% CI: 1.02–3.54, p = 0.0444) and had ever proactively discussed CA or the vaccine with others (AOR = 1.95, 95% CI:1.00-3.79, p = 0.0488) had better attitudes toward the HPV vaccine for CA. Over half of the participants (52.5%) expected the price of the HPV vaccine for CA to be under $90.ConclusionThe acceptance of the HPV vaccine for CA was high among STD clinic attendees in China, and the participants’ self-perceived knowledge of CA and HPV was associated with better attitudes toward the HPV vaccine for CA. Education to improve knowledge is vital for reducing vaccine hesitancy.

Prevalence and antimicrobial resistance profiles of Neisseria gonorrhea and Chlamydia trachomatis isolated from individuals attending STD clinics in Kampala, Uganda.

Sexually transmitted diseases (STDs) management in sub-Saharan Africa is syndromic but molecular diagnostics provide quicker, sensitive diagnosis and treatment. Effective STD control hinges on identification and treatment of infected persons and sexual partner contact tracing. This study assessed feasibility of using the Xpert CT/NG test to identify prevalent Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) infections among STD clinic attendees and their sexual partners and tested for antimicrobial resistance for N. gonorrhea. A cross-sectional study was conducted at 4 outpatient STD clinics in Kampala, Uganda from February 2019 to October 2019. Participants received a syndromic diagnosis, were tested for NG and CT, as well as their sexual partners. Urine (men) and high vaginal swabs (women) were collected, examined using Xpert CT/NG assay. A total of 79 participants were enrolled at baseline of whom 25 had CT/NG. 21 partners of infected baseline participants and 7 partners of the 21 primary partners were enrolled. The mean age of the reported sexual partners was 26 (18-43) years. The prevalence of NG was 25% at baseline and 18 % for CT. Nine (11.4%) people were dually infected. Men were more likely to have NG (p<0.001) at multivariable level. Two participants tested HIV-1 positive. On microbiological culture, 8 samples (2.5%) grew NG and all were resistant to penicillin, ciprofloxacin. For CT, we found a preponderance of the F-serovar in this population. The most prevalent organism was Neisseria gonorrhea. Generally, the prevalence of CT and NG was high. Infection proportions increased among primary partners, particularly women. Etiologic testing without partner tracing and treatment may underestimate burden of CT/NG in this population and contribute to re-infection.

High Prevalence of Rectal Chlamydia trachomatis Infection With the Same Genotype as Urogenital Infection in Female Outpatients in Sexually Transmitted Disease Clinics in China.

BackgroundLittle is known about rectal Chlamydia trachomatis (CT) infection in outpatients attending sexually transmitted disease (STD) clinics in China. In this study, we aimed to explore the clinical and epidemiologic features of rectal CT infection in this population.MethodsA cross-sectional study was conducted among patients attending STD clinics in Tianjin and Guangxi provinces of China from June 2018 to August 2020. Bivariate and multivariate logistic regression analysis were developed to explore the association of different risk factors for urogenital and rectal CT infection.ResultsThe prevalence of urogenital and rectal CT was 11.2% (154/1374) and 4.9% (68/1377), respectively. The rectal CT prevalence among female and male patients was 7.8% (60/767) and 1.3% (8/610), respectively. The most common genotype in urogenital CT–positive samples was genotype E (29.9%), while the most common genotype among rectal CT–positive samples was genotype J (23.4%). More than 85% (52/60) of women infected with rectal CT were co-infected with urogenital CT. About 90.0% (36/40) of women shared similar genotypes between rectal and urogenital samples. Females and patients infected with urogenital CT were deemed to be at an increased risk for rectal CT infection. A high proportion of rectal CT infection had concurrent urogenital CT infection, especially in women, and most of the co-infections were shared among the same genotypes.ConclusionsIt would be prudent to encourage awareness and introduce detection tests and treatment strategies for rectal CT infection particularly in female patients visiting STD clinics in China.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Rectal Mycoplasma genitalium in Patients Attending Sexually Transmitted Disease Clinics in China: An Infection That Cannot Be Ignored.

BackgroundPrevious studies have investigated rectal Mycoplasma genitalium (MG) in men who have sex with men (MSM), while little is known about the prevalence of rectal MG infection in individuals attending sexually transmitted disease (STD) clinics in China. We aimed to estimate the prevalence of rectal MG infection in this population and identified the potential risk factors for rectal MG infection.MethodsA cross-sectional study was conducted among individuals attending STD clinics located in China from June 2018 to August 2020. Univariate and multivariate logistic regression analyses were conducted to explore the association of different risk factors for rectal MG infection.ResultsA total of 1,382 patients were included in the final analyses. A total of 30 of 1377 rectal swabs (2.2%) and 77 of 1374 urogenital samples (5.6%) were positive for MG. In Guangxi, 18 of 47 patients (38.3%) infected with urogenital MG and 5 of 19 patients (26.3%) infected with rectal MG received the recommended treatment. Factors found to be significantly associated with rectal MG infection included: male (adjusted odds ratio (AOR) 0.232, [95% CI: 0.072–0.745]) compared to female, homosexual or bisexual (AOR 40.427, [95% CI: 3.880–421.196]) compared to heterosexual, and those infected with urogenital MG (AOR 7.215, [95% CI: 2.898–17.965]) compared to those who did not get infected with urogenital MG.ConclusionRectal MG infection should be thought of not only in MSM population but also in STD clinic patients, especially females who have urogenital MG infection. Appropriate strategy for rectal MG screening and treatment needs to be developed for these patients in China.

A need for trauma informed care in sexually transmitted disease clinics.

This review examines trauma from violence as a risk factor for sexually transmitted diseases (STDs) among women attending STD clinics. The review also aims to suggest trauma informed care (TIC) integrated into STD clinics might more effectively address traumatic effects of violence linked to sexual risk behaviors among this population. A systematic literature review was conducted to identify empirical studies examining the relationship between multiple forms of violence and sexual risk behaviors among women attending STD clinics. All studies found high rates of violence including childhood sexual abuse, intimate partner violence, and/or community violence associated with high rates of sexual risk behaviors among women attending these settings. Researchers recommend screening for multiple forms of violence, interdisciplinary STD clinic services, and more trauma informed sexual risk reduction interventions to address multiple forms of violence found prevalent among this population. Women attending STD clinics very often experience multiple forms of violence during their lifetime. TIC to address traumatic effects of violence might reduce sexual risk behaviors and sexually transmitted disease rates for improved health outcomes among this population.

420. Prevalence of Oropharyngeal Meningococcal Carriage in an Urban STD Clinic

Background Neisseria meningitidis (Nm) can cause invasive disease, but it also asymptomatically colonizes the pharynx in approximately 10% of the general population. Older studies have reported higher carriage rates (>30%) among individuals attending sexually transmitted disease (STD) clinics. This study examined the prevalence of oropharyngeal Nm carriage in STD clinic attendees in Columbus, Ohio.MethodsPer normal procedures, all patients presenting for care in the STD clinic who report oral sex in the last year are screened for oropharyngeal Neisseria gonorrhoeae (Ng) using nucleic acid amplification testing (NAAT). For the same patients, we also initiate cultures using media selective for Neisseria spp. Analytical Profile Index Neisseria-Haemophilus (API NH) and Nm-specific PCR screening is performed on colonies with oxidase-positive Gram-negative diplococci to distinguish between Ng and Nm. For this study, we then performed PCR-based genogrouping on confirmed Nm isolates.ResultsBetween July 2018 and March 2019, oropharyngeal screening occurred at 5,015 patient visits and oropharyngeal Nm was detected at 163 visits (3.3%). Nm-positive individuals were primarily male (69.9%), Caucasian (62.6%), with non-Hispanic ethnicity (98.8%). The median age was 27 years and 5.5% were HIV-positive. Among male cases, 49.1% reported sex with men; among women, 98.0% reported sex with men. Meningococcal vaccination status was unknown for 71.2%, but 26.4% had documentation of prior MenACWY vaccination and 2.3% had prior MenB vaccination. Among the 163 cases, genogroup distribution was 23.9% B, 10.4% E, 9.8% Z, 3.1% C, 0.0% W, 0.0% Y, and 39.3% capsule null locus. For 13.5%, the selected screening approach could not determine genogroup.ConclusionIn STD clinic patients reporting recent oral sex, we found a much lower prevalence of oropharyngeal Nm carriage compared with what has been reported historically for similar populations. While NmB was the most common capsular type identified by genogrouping, almost 40% of Nm isolates contained the capsule null locus, making them unable to express capsule. Additional studies should evaluate the effect of Nm vaccination programs on carriage among STD-clinic attendees.Disclosures All authors: No reported disclosures.

Prevalence and associated factors of genital chlamydia infection among Central Sexually Transmitted Diseases clinic attendees in Sri Lanka

Introduction: Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted disease (STD). The aims of the study were to determine the prevalence of chlamydia among STD clinic attendees in relation to socio-demographic characteristics, clinical presentation and sexual and STD-related risk behavior, to measure the significance of associated factors and identify the most significant risk factors for chlamydia infection. Methods: A cross-sectional, descriptive study was done on 216 females and 252 males attending the Central STD Clinic. Endocervical swabs from females and urine from males were tested using the COBAS® TaqMan® CT v2.0 rt-PCR. Socio-demographic data, clinical features and factors associated with infection were recorded. Significance of associated factors was determined using a Chi-square test and the most significant risk factors were identified using a binary logistic model. Results: Prevalence of chlamydia among females was 17.1%(37/216) and among males was 5.2%(13/252). Prevalence among female sex workers (FSWs) was 20.4%(20/98, p Conclusions: Prevalence of chlamydia among female attendees is high and a high proportion of infections are asymptomatic, rendering syndromic management inappropriate. Among males, however, symptomatic attendees were significantly more likely to be infected than asymptomatic. Female gender, age ≤25 years and providing or receiving commercial sex are significant risk factors.

New Human Immunodeficiency Virus Diagnoses Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics, STD Surveillance Network, January 2010 to June 2013.

Retrospective analysis using 2010 to 2013 data from the STD Surveillance Network (SSuN), a sentinel surveillance system comprised of health departments in 12 cities conducting sentinel surveillance in 40 STD clinics. We analyzed data from all MSM repeatedly (≥2 times) tested for HIV, with an initial negative HIV test required for staggered cohort entry. Follow-up time was accrued from the date of the first negative HIV test to the most recent negative test or the first positive HIV test. The STD diagnoses during the follow-up period were reviewed. We estimated HIV diagnoses rates (number of HIV diagnoses/total number of person-years [PY] at risk) by demographic and clinical characteristics with 95% confidence intervals (CI) using an inverse variance weighted random effects model, adjusting for heterogeneity between SSuN jurisdictions. Overall, 640 HIV diagnoses occurred among 14,824 individuals and 20,951.6 PY of observation, for an adjusted incidence of HIV diagnosis of 3.0 per 100 PY (95% CI, 2.6-3.4). Rates varied across race/ethnicity groups with the highest rate among Blacks (4.7/100 PY; 95% CI, 4.1-5.3) followed by Hispanics, whites, and persons of other races/ethnicities. Men who have sex with men having a diagnosis of primary or secondary (P&S) syphilis on or after the first negative HIV test had a higher new HIV diagnosis rate (7.2/100 PY; 95% CI, 5.8-9.0) compared with MSM who did not have a P&S syphilis diagnosis (2.8/100 PY; 95% CI, 2.6-3.1). Men who have sex with men who tested positive for rectal gonorrhea (6.3/100 PY; 95% CI, 5.7-6.9) or rectal chlamydia (5.6/100 PY; 95% CI, 4.6-6.6) had higher rates of new HIV diagnosis when compared to those with negative test results. Men who have sex with men attending SSuN STD clinics have high rates of new HIV diagnoses, particularly those with a previous diagnosis of P&S syphilis, rectal chlamydia, and/or gonorrhea. Sexually transmitted disease clinics continue to be important clinical setting for diagnosing HIV among MSM populations.

Prevalence and Genotype Distribution of Chlamydia trachomatis in Urine among Men Attending Sexually Transmitted Disease Clinics in Guangdong Province, China, in 2016.

Studies have rarely assessed the genotype distribution of Chlamydia trachomatis (CT) in urine among men attending sexually transmitted disease clinics (MSCs) in China. This study was aimed at investigating the prevalence and molecular epidemiology of CT infection by examining urine samples among MSCs from different geographic areas of Guangdong Province, China. A cross-sectional study was conducted among MSCs from 10 human immunodeficiency virus sentinel surveillance sites in Guangdong Province. CT DNA was extracted from male urine samples and analyzed using a Roche cobas 4800 CT/NG. The ompA genes were amplified by nested PCR and sequenced. The leukocyte esterase test was performed by routine urine analysis at local clinics. Of the 1,903 samples, 163 (8.6%, 95% confidence interval [CI] 3.8-16.3%) tested positive for CT. The highest prevalence (10.5%) of CT infection was observed among participants aged between 21 and 30 years. A total of 130 CT-positive samples (79.8%, 130/163) were successfully genotyped by nested PCR, resulting in 8 genotypes. The most prevalent genotypes were D, E, F, and J, with proportions of 20.8%, 20.0%, 17.7%, and 16.9%, respectively. There were no significant correlations between the geographical areas, leukocyte esterase test results and genotype distribution. Promotion of detection and molecular epidemiology research is needed for effective and comprehensive prevention and control programs.

Genital Chlamydia trachomatis infection and associated risk factors in male clients attending sexually transmitted disease clinics in 9 cities in Guangdong province

Objective: To investigate the prevalence of genital Chlamydia trachomatis (GCT) infection and associated risk factors in male clients attending sexually transmitted disease (STD) clinics in Guangdong and provide integrated intervention strategy for this group. Methods: Convenient sampling was used to recruit participants from April to June in 2015 in Guangdong province. The information about their socio-demographic characteristics and sexual behaviors were collected by using a questionnaire, and blood samples were taken from them to test the antibodies against HIV, syphilis and HCV. First pass urine was taken to test GCT and gonorrhea. Results: A total of 1 749 participants with the average age of 39.53 years were recruited. The majority of them were married (73.87%, 1 292/1 749), residents of Guangdong (92.28%, 1 614/1 749) and in Han ethnic group (99.49%, 1 740/1 749). The positive rates for GCT, HIV, syphilis, HCV, Neisseria gonorrhea, and WBC in urinalysis were 6.06% (106/1 749), 0.46% (8/1 749), 3.43% (60/1 749), 0.45% (7/1 550), 2.74% (48/1 749), 7.89% (138/1 749) respectively. Multivariate analysis showed that risk factors for GCT infection include IDUs (OR=13.98, 95%CI: 3.35-58.38), anal sex with men (OR=3.11, 95%CI: 1.45-6.71), Neisseria gonorrhea positive (OR=9.64, 95% CI: 5.09-18.24), and WBC positive (OR=1.96, 95%CI: 1.08-3.55). Conclusions: This study demonstrated the high prevalence of GCT infection in male clients attending STD clinics in Guangdong. Therefore precision intervention should target this population at high-risk.

Need for revisiting the role of sexually transmitted disease clinics in government hospitals in India.

Introduction:The Government of India provides treatment for sexually transmitted infections (STIs) through government's sexually transmitted disease (STD) clinics with the mandate of providing curative and preventive services for clients in the context of STIs. However, besides the patients suffering from STDs, other clients with problems related to reproductive and sexual health also attend these clinics. This study aimed to assess the profile and treatment-seeking behavior of clients attending STD clinics in government hospitals in India.Materials and Methods:This multicentric, cross-sectional study with 5098 participants was conducted over 2 months in identified 19 Indian states. Chi–square test was used for statistical analysis.Results:The percentage with STDs (62.98%) was nearly double than those with non-STDs (37.1%). Around 8.2% of patients had an STD and were also HIV positive. Compared to the total STD cases, only 9% of the partners had turned up for screening. Of significance were the non-STD cases who presented with both physical and psychological symptoms including infertility. Among males, it was mainly sexual dysfunction and balanoposthitis, and in females, lower abdominal pain and bacterial vaginosis. Only 27.3% reported that they had come directly to the government facility/clinic. Nearly 38% of males and 30% of females had tried home remedies before coming to the government clinic. Majority (77.9%) of the clients reported that they had never been counseled on any aspect of STD or HIV.Conclusion:The profile of clients in the various clinics across the country indicates that the name “STD Clinic” is a misnomer since the presenting complaints of clients are varied, and related not only to STDs but also to other reproductive tract problems. Furthermore, the average new patient load observed in our study is low and this was attributed to the name “STDs” given to these clinics. Renaming them as “Reproductive Health Clinics” would attract more patients and lead to better utilization.

Study of Prevalence of GUDs in STD Clinic Attendees of A Tertiary Care Hospital

Introduction: Sexually Transmitted Diseases (STDs) are a burden to the individual, his family and the community as the patients are mostly from the working age group. Genital Ulcer Diseases (GUDs) are a type of manifestation of STDs. GUDs are commonly caused by Syphilis, Chancroid, Donovanosis, LymphoGranulomaVenereum (LGV) and Genital Herpes. It is now clearly understood that GUDs facilitate Human Immunodeficiency Virus (HIV) transmission and vice versa. Objectives: In this context a study was conducted by the department of DermatoVenereoLeprology (DVL) to study the prevalence of STDs in patients attending STD clinic over a period of one year. Methodology: All the patients attending the STD Clinic from 01-04-2015 to 31-03-2016 were enrolled in the study and examined for GUDs. After necessary investigations appropriate diagnosis of the GUD was made. The results were analysed. Results: The prevalence of GUDs in total STD clinic attendees is 2.57%. Among the total STD clinic male attendees , the prevalence of GUDs is 6.92% while it is only 1.12% in the total female attendees. Genital herpes was the leading cause of GUDs in both male and female patients in our study. Conclusion: The prevalence of GUDs in the STD clinic attendees is decreasing which is a welcome sign but at the same time, genital herpes is emerging as the leading cause of GUDs. This should be a matter of concern because, unlike other GUDs, genital herpes cannot be totally cured and asymptomatic shedding of herpes virus will not only increase it’s (herpes) transmission but also increases HIV transmission.

The Role of Behavioral Counseling in Sexually Transmitted Disease Prevention Program Settings.

Behavioral counseling for sexually transmitted disease (STD) prevention is recommended for persons at risk, and the body of evidence yields numerous interventions that have STD preventive efficacy. What is needed is a review of the subset of these interventions that could be feasible in clinical settings, especially settings in STD prevention programs. We reviewed existing systematic reviews of the literature and abstracted from them studies that fit the following criteria in that the interventions: (1) used no more than 60 minutes of contact time in 1 to 2 sessions, (2) were individual level and face to face, (3) took place in a clinical setting, (4) had STD outcomes available, (5) were based in the United States, (6) were peer reviewed, and (7) had a control group. From 6 reviews (published 2006-2014) covering 91 studies, we found 13 analyses representing 11 intervention studies that fit the selection criteria. Of these 13, 5 returned lower STD rates in the intervention group at follow-up; one study reported a higher rate of STD in one subset of the intervention group (men who have sex with men). Studies with effects on STD at follow-up were quite similar to studies across populations, settings, and follow-up periods, although successful interventions were more likely to demonstrate behavioral effects as well (5/5 vs. 2/5 among 10 interventions measuring behavior change). Counseling is likely to benefit some STD clinic attendees, although unlikely to benefit men who have sex with men. The balance of costs and benefits of implementing behavioral counseling in STD programs is unclear, but feasibility would be improved if behavioral counseling were implemented in the context of other prevention efforts. Because populations outside typical STD clinic settings could also benefit, programs may exercise a valuable role through partnerships.

Prevalence of Pap smear abnormalities among women who attend Sexually Transmitted Diseases (STD) clinic, Colombo

Introduction: Cervical cancer ranks as the second most frequent cancer among women in Sri Lanka. It has been now well established that oncogenic subtypes of human papillomavirus (HPV) is a necessary cause of cervical cancer. An abnormal Pap smear may indicate an infection, inflammation or cervical cytological abnormality. Objectives: The objective of this study was to ascertain the prevalence of Pap smear abnormalities among women who attend Sexually Transmitted Disease (STD) clinic, Colombo Method: A total of 1300 females who underwent routine Pap smear screening at STD clinic, Colombo in the year 2010 and 2011 were analysed for the prevalence of all forms of Pap smear abnormalities including cervical cytological abnormalities. Cytology was interpreted according to the national guideline which is based on Bethesda system 2001. Results: Prevalence of all forms of abnormal Pap smears was 24.2% while the prevalence of cervical cytological abnormalities was only 2.2% in the sample, out of which 1 .4% were low grade squamous intraepithelial lesions (LGSIL), 0.5% were high grade squamous intraepithelial lesions (HGSIL) and 0.3% were glandular cell atypia. The cervical cancer prevalence in the sample was 0.077%. Conclusions: All forms of Pap smear abnormalities among STD clinic attendees were relatively high (24.2%) due to concurrent infections and inflammation. The rate of cervical cytological abnormalities was 2.2% while the cervical cancer rate was 0.077% in the sample. There was no significant difference between groups with and without cervical cytological changes. Sri Lanka Journal of Venereology Vol.5(1) 2014: 20-30

The incidence of Trichomonas vaginalis infection in women attending nine sexually transmitted diseases clinics in the USA

ObjectivesTrichomoniasis (TV) is associated with an increased risk of acquisition of sexually transmitted diseases (STDs) and HIV. The purpose of this study is to evaluate factors associated with incidence TV...

The changing trends of HIV-1 prevalence and incidence from sentinel surveillance of five sub-populations in Yunnan, China, 2001-2010.

BackgroundYunnan is one of the provinces hardest-hit by HIV in China. To understand HIV epidemic dynamics and evaluate prevention effectiveness, we studied the changing trends in HIV-1 prevalence and incidence among five sub-populations in Yunnan.MethodsConsecutive sentinel surveillances were conducted among people who inject drugs (PWID), male sexually transmitted diseases (STD) clinic attendees, and pregnant women for 2001–2010,female sex workers (FSWs) for 2007–2010, men who have sex with men (MSM) for 2008–2010. For the newly diagnosed HIV-seropositive samples, the recent infections were determined with BED-capture enzyme immunoassay (BED-CEIA), based on which HIV incidence was calculated for each sub-population using McDougal algorithm.ResultsFrom 231,117 individuals, 6,107 HIV-positive samples were tested with BED-CEIA, among which 964 samples were identified as recent infections. In PWID, HIV prevalence for 2001–2010 was between 27.16% and 18.35%, while the estimated incidence rate significantly decreased from 11.68% in 2001 to 1.70% in 2010. Among male STD clinic attendees, both the HIV prevalence (from 3.62% in 2001 to 1.73% in 2010) and incidence (from 1.10% in 2001 to 0.40% in 2010) showed a significant decreasing trend. In FSWs, the HIV prevalence for 2007–2010 kept stable (between 2.46% and 1.95%), while the HIV incidence significantly decreased (from 0.71% in 2007 to 0.31% in 2010). In MSM, the HIV prevalence (between 11.78% and 9.42%) and incidence (between 6.01% and 8.38%) remained stable at a relatively high level for 2008–2010. In pregnant women, the HIV prevalence (between 0.44% and 0.30%) and incidence (between 0.15% and 0.08%) remained stable for 2001–2010.ConclusionThe HIV incidences in PWID, male STD clinic attendees and FSWs showed the decreasing trend, supporting a positive effect of prevention strategies for these sub-populations. MSM with the highest HIV incidence have become the sub-population most at risk. In most sub-populations, the HIV prevalence did not decline, suggesting the disease burden is still heavy. These findings are valuable for developing HIV prevention strategies in Yunnan.

Likelihood of Condom Use When Sexually Transmitted Diseases Are Suspected: Results From a Clinic Sample.

To determine the event-level associations between perceived risk of sexually transmitted disease (STD) acquisition/transmission and condom use during penile-vaginal intercourse (PVI) among STD clinic attendees. A convenience sample (N = 622) completed daily electronic assessments. Two questions were proxies of perceived risk: suspicion that the partner might currently have an STD and that "you" might currently have an STD. Participants reported whether condoms were used with PVI events in the past 24 hours. Generalized estimating equations determined the association between each of the perceived risk variables and event-level condom use. For the model pertaining to suspicion of sex partner infection, there were 16,674 events of PVI, with condom use during 10,552 of these events. The effect of current suspicion was significant after adjusting for gender and whether participants identified as African American/Black (estimated odds ratio = 2.17, 95% confidence interval = 1.57-3.00, P = .0001). The model pertaining to suspicion of self-infection included 16,679 events of penile-vaginal sex, with condom use during 10,557 of these events. Again, the effect of current suspicion was significant after adjusting for gender and African American/Black race (estimated odds ratio = 2.05, 95% confidence interval = 1.43-2.40, P = .0001). Tests for interactions with gender and with race were nonsignificant (all Ps > .25). Using an event-level research design, strong associations were found between perceptions of STD risk and condom use in a clinical population. Health care providers and other professionals may indirectly promote condom use by helping clinic patients realistically evaluate their risk of having sex with infected partners or of being a source of STD transmission to others.

Utilization of information and communication technology (ICT) among sexually transmitted disease clinics attendees with coexisting drinking problems.

BackgroundAlcohol misuse remains a major risk factor for contracting sexually transmitted diseases (STDs) not typically addressed in STD clinic settings. Information and communication technology (ICT) can offer new avenues to deliver evidence-based screening and treatment for problematic drinking, however, few data exists regarding the utilization of ICT among STD clinic attendees with coexisting drinking problems. The objectives of this study are to identify STD clinics attendees with hazardous drinking, to examine socio-demographic factors associated with ICT use, and to explore individuals’ interests in engaging in ICT-based health interventions.MethodsCross-sectional questionnaires examining alcohol consumption and ICT use were administered to 396 persons attending two non-urban STD clinics. Descriptive statistics for ICT use were calculated for both hazardous drinkers and the entire sample. Multivariable logistic regression models among hazardous drinkers identified factors significantly associated with use of each kind of ICT.ResultsThe mean age of the 396 participants was 25 years, 66% were females and 60% were African-Americans. One third of the sample met the criteria of hazardous drinking. ICT use in hazardous drinkers included 94% reporting having internet access at least monthly, 82% reporting having an email account, 85% reporting currently owning a cell phone, and 91% reporting use of any cell phone application. More than two thirds (73%) of hazardous drinkers were willing to play health-related video games during clinic waiting time, slightly higher than the entire sample (69%). Multivariable analyses indicated that younger age were significantly related to monthly internet use, and multifunction cell phone use, while being males and younger age were significantly associated with monthly video game playing.ConclusionsOur study demonstrates commonality of ICT use among STD clinic attendees with hazardous drinking, indicating the viability of using ICT to assist screening and behavioural intervention for alcohol misuse in STD clinic settings. Future research is needed to demonstrate the effectiveness of ICT-based health behavioural interventions in the STD clinic settings or other venues that serve populations at high risk for substance abuse, HIV or other STDs.