Bacterial Sexually Transmitted Diseases Research Articles

Global perspectives on the burden of sexually transmitted diseases: A narrative review.

Sexually transmitted diseases (STDs) pose a significant global health challenge with far-reaching social, economic, and public health implications. These infections have haunted humanity from ancient times to today, transcending geographical boundaries and cultural contexts. This article explores the multifaceted landscape of STDs, delving into their epidemiology, pathophysiology, clinical manifestations, and global response strategies. The global prevalence of STDs is staggering, with millions of new cases reported annually. Prominent among these infections is HIV/AIDS, which remains a major global health crisis, affecting over 38 million people worldwide. Additionally, bacterial STDs like chlamydia, gonorrhea, and syphilis continue to pose significant health risks, with millions of new cases reported yearly. Beyond the physical manifestations, STDs have profound social and economic implications. They can result in severe reproductive health issues, stigma, discrimination, and psychological distress, burdening healthcare systems and affecting individuals' quality of life. The global response to STDs has been multifaceted, with international organizations and governments implementing various prevention and control strategies, including sexual education programs and scaling up access to testing and treatment. However, challenges persist, including disparities in healthcare access, sociocultural factors influencing transmission, and evolving pathogens with increasing resistance to treatment. Through case studies and real-world examples, we illuminate the human stories behind the statistics, highlighting the lived experiences of individuals grappling with STDs and the complex interplay of factors shaping their journeys. Ultimately, this review calls for continued research, innovative strategies, and sustained global commitment to mitigating the burden of STDs and promoting sexual health and well-being for all.

Epidemiology and changing trends of sexually transmitted diseases over the past 17 years in a tertiary care center: A retrospective study.

Sexually transmitted diseases (STDs) continue to be a major public health problem with significant burden on the society. Some of this can be attributed to our lack of knowledge about the change of disease spectrum from time to time. The aim of the study was to understand the changing pattern of STDs over the past 17 years (2003-2019). It was a retrospective study where data of patients who attended our Suraksha Clinic from 2003 to 2019 were collected. All the cases were subjected to detailed history, examination, and investigations done to rule out STDs. A total of 2436 patients were included in the study. The majority of the patients were in the age group of 18-30 years. The most frequent diagnosis was vulvovaginal candidiasis, followed by herpes genitalis. 3.3% of patients had human immunodeficiency virus. 4.8% of patients were men sex men (MSM). Overall, viral STDs were most common, followed by fungal and bacterial. To understand the changing trends, data were divided into different phases according to the time period. During Phase 1 (2003-2007), viral STDs were most common, followed by bacterial and fungal. However, this trend changed in Phase 4 (2016-2019) and fungal STDs became most common. Despite numerous health initiatives, the number of STD cases is rising day by day. The increasing number of MSM over the study period necessitates dedicated efforts to address the health needs of this population. The National AIDS Control Organization should take necessary measures and steps to address the overall increase in STDs considering recent trends showing a drop in bacterial STDs and an increase in fungal and viral STDs.

Neisseria gonorrhoeae Cases at AMC Muhammadiyah Hospital Indonesia: The Importance of Screening and Health Service Improvement to Prevent its Transmission and Complications

BACKGROUND: Gonorrhoeae is a type of sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae (NG) bacteria. It is a commonly reported bacterial STD with rising cases in men and women in Indonesia. Gonorrhoeae is commonly asymptomatic. Therefore, the disease is often left undiagnosed, untreated, and causes further complications. AIM: This study aims to describe the incidence and distribution of gonorrhoeae in AMC Muhammadiyah Hospital, Yogyakarta, Indonesia. The importance of screening and health service improvement toward preventing transmission and complications are also discussed. METHODS: It is a descriptive observational study and aims to identify the percentage of NG in patients with clinical symptoms of STDs. The non-randomized sampling technique was used with 710 respondents. The inclusion criteria were women aged 15-44 years with STD symptoms who underwent vaginal smear examinations for NG, Bacterial Vaginosis (BV), yeast cells-pseudohyphae Candida sp, and were willing to be respondents. The exclusion criteria were women with STDs and HIV. Microscopic characteristics of NG were examined by Gram staining the vaginal swab samples from the respondents. RESULTS: It was found that 623 (87.7%) out of 710 respondents had NG with clinical symptoms of leukorrhea and itchiness. The vaginal smear results also found bacterial vaginosis and candidiasis. CONCLUSIONS: Screening and health facilities providing STI-related services are essential to prevent the transmission of gonorrhoeae and reduce the high incidence and severity of gonorrhoeae in reproductive health.

The trend of STD in COVID times- A retrospective hospital-based study from Northeast India

Sexually transmitted diseases (STD) are considered to be a burden for mankind since long. Different studies showed variation in epidemiology of STD. Our study is targeted towards unveiling the prevalence of STD during covid times. : To study the change of prevalence of sexually transmitted diseases during covid times.: A retrospective study of all patients, who attended the outpatient department (OPD) of Dermatology, Venerology and Leprosy (DVL) of Silchar Medical College and Hospital, Assam, India was done. All the follow-up cases and patients who showed no evidence of STD were excluded from the study.: In the study period (2020-21), out of the 10,954 patients who attended the DVL OPD, 90(0.8%) patients had STD, whereas, in the year (2019-20), total of 57,275 patients attended the clinic, among which 272(0.5%) patients had STD. STD was more among males than females, showing a male: female ratio of 1.9:1 in 2020-2021 as compared to 1.5:1 in 2019 to 2020. Some results were similar in both the study period; like the mean age group was 36 years, most females were housewives and males were shopkeepers and majority of the patients with STD were married. In our study from 2020-21, Herpes genitalis with 29 cases (32.2%) was the most common STD, followed by syphilis and urethral discharge with 17 (18.8%) cases each. Vaginal discharge with 11(12.2%) cases, genital warts with 7(7.7%) cases, GUD-non-herpetic with 5(5.5%) cases and balanoposthitis with 4(4.4%) cases were other STDs during the 2020-’21 period. When compared to 2019-20, herpes genitalis was most common with 72(26.4%) cases followed by vaginal discharge with 58(21.4%) cases, syphilis with 43(15.8%) cases, urethral discharge with 58(21.4%) cases, GUD-non herpetic with 26(9.6%) cases, balanoposthitis with 21(7.8%) cases and warts with16(5.8%) cases.Amidst the COVID-19 crisis and lockdown, a decline in the overall number of patients was seen and similar trend was observed among STD patients reporting to our hospital. Among these, the majority had genital ulcer disease of viral origin. Females were most commonly affected and a decline in bacterial STDs was also seen.

Emerging trends in sexually transmitted diseases in a tertiary care center in Davangere, Karnataka: A five year study.

Sexually transmitted diseases (STDs) are a public health challenge, and the epidemiological profile is variable by geographical region and distinct from that of other diseases. Accurate knowledge of emerging disease trends is crucial for formulating effective control strategies. The aim and objective of this study were to identify the changing scenario and emerging trends of STDs in Davangere, Karnataka, by evaluating patients attending a tertiary care center. A tertiary care-based retrospective study was conducted by analyzing the clinical records of the attendees presenting to the STD clinic at Chigateri General Hospital affiliated to JJM Medical College in Davangere, Karnataka, for a period of 5 years from January 2015 to December 2019. The collected data were analyzed and statistically compared with other studies. Out of the 614 patients studied, the male-to-female ratio was 2:1, with 30-39 age groups being most affected. Eighty-eight percent of patients were married, with 36.64% giving a history of extramarital contact. Homosexual and bisexual contacts were observed to be 5.21% and 0.65%, respectively. Viral STDs affected nearly half of the patients (49.51%), followed by fungal (28.88%), bacterial (22.63%), and others (3.1%). The most common STD observed was herpes genitalis as seen in 101 (24.48%) patients, followed by candidal balanoposthitis (17.1%). Thirty-three (5.7%) patients were diagnosed with more than one STD. Of these patients, 13 were seropositive for HIV, resulting in a prevalence of 2.12%. The epidemiological profile of STDs is ever changing, and this study found an increase in viral and fungal STDs and downward trend of bacterial STDs comparable to that of studies from other regions.

Measuring the Impact of the COVID-19 Pandemic on Sexually Transmitted Diseases Public Health Surveillance and Program Operations in the State of California.

As public health personnel and resources are redirected to COVID-19, sexually transmitted diseases (STD) programs have been unable to sustain pre-COVID-19 activities. We used California (CA) surveillance data to describe trends in case reporting for gonorrhea, chlamydia, and syphilis of any stage in the pre- versus post-COVID-19 eras (January-June 2019 and January-June 2020). We also analyzed data from an electronic survey administered by the CA STD Control Branch to local health jurisdictions in April, June, and September of 2020, assessing the impact of COVID-19 on STD programs. There were sharp declines in cases of all reportable bacterial STDs occurring in conjunction with the March 19, 2020 CA stay-at-home order, most of which did not return to baseline by July. Comparing January-June 2020 to January-June of 2019, there were decreases in reported cases of chlamydia (31%), late syphilis (19%), primary/secondary syphilis (15%), early nonprimary nonsecondary syphilis (14%), and gonorrhea (13%). The largest percentage declines in STD case reporting were among Hispanic, Asian/Pacific Islander, and Black persons. Seventy-eight percent of local health jurisdiction respondents indicated that half or more of their workforce had been redeployed to COVID-19 by September 2020. During the COVID-19 era, STD case reporting and programmatic functions have diminished throughout CA. Because this may contribute to decreases or delays in STD diagnosis and treatment-with resultant increases in STD transmission-providers and public health officials should prepare for potential increases in STD-related morbidity in the months and years to come.

Bacterial sexually transmitted infection testing and diagnoses among men who have sex with men and report prescription opioid misuse––American Men's Internet Survey, 2017–2018

PurposePrescription opioid misuse is associated with behaviors which increase bacterial sexually transmitted diseases (STD) risk among men who have sex with men (MSM). Annual syphilis, gonorrhea, and chlamydia screening is recommended for sexually active MSM at anatomical sites of contact, regardless of condom use. We describe the prevalence of self-reported bacterial STD testing and diagnoses in the past 12 months among sexually active MSM who report prescription opioid misuse. MethodsWe used data from the 2017 and 2018 American Men's Internet Survey to examine the prevalence of self-reported bacterial STD testing and diagnoses in the past 12 months. We calculated unadjusted prevalence ratios, adjusted prevalence ratios (APR), and 95% confidence intervals (CI) to compare bacterial STD testing prevalence across demographic, clinical, and behavioral factors. ResultsOf 932 sexually active MSM who reported prescription opioid misuse, 433 (46.5%) self-reported bacterial STD testing in the past 12 months. Of those who reported being tested, 131 (30.2%) self-reported ≥ 1 bacterial STD. Approximately 50% of respondents who reported condomless anal sex (CAS), casual sex, or exchange sex reported bacterial STD testing in past 12 months. Factors associated with bacterial STD testing among MSM who misused prescription opioids included visiting a healthcare provider in the past 12 months (APR = 1.70, 95% CI = 1.09–2.67), ever disclosing same-sex behavior to a healthcare provider (APR = 1.78, 95% CI = 1.27–2.50), and CAS in the past 12 months (APR = 1.51, 95% CI = 1.10–2.04). ConclusionsPrevalence of self-reported bacterial STD testing in this sample was low and one-third of tested MSM reported ≥ 1 bacterial STD in the past 12 months. Innovative approaches to identify MSM who misuse prescription opioids and expand bacterial STD testing in this population are needed.

Sex Education Correlating with STI Rates Througout Counties in Florida

This study’s goal was to discover the impact that varying types of high school sex education curriculums had on the rate of which their alumni ages 19-27 in 2018 contracted bacterial sexually transmitted diseases (STDs) throughout counties in Florida. The study was able to establish results that communicated which programs were most effective in preventing the transmission of STDs in comparison to the ones that were least effective. A meta-analysis of the amount of bacterial STD cases in each of four different counties in Florida as well as their corresponding sex education curriculum was used to discover the paper’s outcome. The different curriculums analyzed in this paper include abstinence-only, abstinence-plus, and comprehensive. Abstinence-only based programs teach students that refraining from all sexual activity until marriage is the sole moral way of preventing STD transmission and generally does not go over other methods of contraceptives. Abstinence-Plus programs teach students about methods of contraception and how to prevent STDs, but still preach that remaining abstinent is the correct and moral route to go down. The results showed that Lafayette County and Martin County had the least amount of bacterial STD cases among their alumni ages 19-27 yet used the most strict program (abstinence-only), Orange County had the most amount of bacterial STD cases among their alumni and used the second most strict program(abstinence-plus), and Polk County’s amount of bacterial STD cases fell under Orange County but above Lafayette County and Martin County; however they used the least strict program (comprehensive).

Changing trends in sexually transmitted diseases during a seven year period- A retrospective study in STD clinic of a tertiary care hospital

Sexually Transmitted Diseases (STD) shows various trends in different parts of the country and constitute a major public health problem for both developing and developed countries. STD`s increases the risk of transmission of Human Immuno Deficiency virus (HIV) infection causing immense need to understand the patterns of STD`s prevailing in the regions of a country for proper planning and implementation of STD control strategies. To know the pattern of STDs and to analyze the changes during a 7 year period among patients attending the STD clinic at the tertiary care centre. A retrospective analysis of data collected from the clinical records of patients attending the STD clinic of a tertiary care hospital, Mysuru over a period of 7 years (from Jan 2010 to Dec 2016). During this 7 years period, a total of 1,98,991 patients attended Skin and STD Department on out-patient basis, among them 2,111(1.06%) were STD patients [1057 males and 1054 females]. Majority were married (89.86%). The most common STD in males was balanoposthitis (32.92%) and in females was vaginal /cervical discharge (28.42%). Among genital ulcer diseases herpes genitalis was most common and increased gradually while Syphillis and Chancroid declined during the study period. Gonococcal urethritis was seen among 4.69% and LGV only in 0.14% (3 cases). HIV seropositivity in the study population was 7.25%.Bacterial STD`s showed a gradual reduction in number while fungal and viral STD`s showed increasing trends.

Prevalence of Mycoplasma genitalium Infection, Antimicrobial Resistance Mutations, and Symptom Resolution Following Treatment of Urethritis.

Antimicrobial resistance in Mycoplasma genitalium (MG), a cause of urethritis, is a growing concern. Yet little is known about the geographic distribution of MG resistance in the United States or about its associated clinical outcomes. We evaluated the frequency of MG among men with urethritis, resistance mutations, and posttreatment symptom persistence. We enrolled men presenting with urethritis symptoms to 6 US sexually transmitted disease (STD) clinics during June 2017-July 2018; men with urethritis were eligible for follow-up contact and, if they had persistent symptoms or MG, a chart review. Urethral specimens were tested for MG and other bacterial STDs. Mutations in 23S ribosomal ribonucleic acid (rRNA) loci (macrolide resistance-associated mutations [MRMs]) and in parC and gyrA (quinolone-associated mutations) were detected by targeted amplification/Sanger sequencing. Among 914 evaluable participants, 28.7% (95% confidence interval [CI], 23.8-33.6) had MG. Men with MG were more often Black (79.8% vs 66%, respectively), <30 years (72.9% vs 56.1%, respectively), and reported only female partners (83.7% vs 74.2%, respectively) than men without MG. Among MG-positive participants, 64.4% (95% CI, 58.2-70.3%) had MRM, 11.5% (95% CI, 7.9-16.0%) had parC mutations, and 0% had gyrA mutations. Among participants treated with azithromycin-based therapy at enrollment and who completed the follow-up survey, persistent symptoms were reported by 25.8% of MG-positive/MRM-positive men, 13% of MG-positive/MRM-negative men, and 17.2% of MG-negative men. MG infection was common among men with urethritis; the MRM prevalence was high among men with MG. Persistent symptoms following treatment were frequent among men both with and without MG.

STD Partner Services to Monitor and Promote HIV Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men.

Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk of HIV. We evaluated the integration of pre-exposure prophylaxis (PrEP) referrals into STD partner services (PS) for MSM. King County, Washington. Disease Intervention Specialists (DIS) in King County attempt to provide PS to all MSM with early syphilis and, as resources allow, MSM with gonorrhea or chlamydia. Our health department defines MSM with any of the following as at high HIV risk: early syphilis, rectal gonorrhea, methamphetamine/poppers use, sex work, or an HIV-unsuppressed partner. DIS offer high-risk MSM referral to our STD Clinic for PrEP and other MSM referral to community providers. In 2017, we interviewed a random sample of MSM offered referrals in 2016 to assess PrEP initiation after PS. From August 2014 to August 2017, 7546 cases of bacterial STDs were reported among HIV-negative MSM. DIS provided PS to 3739 MSM, of whom 2055 (55%) were at high risk. DIS assessed PrEP use in 1840 (90%) of these men, 895 (49%) of whom reported already using PrEP. DIS offered referrals to 693 (73%) of 945 MSM not on PrEP; 372 (54%) accepted. Among 132 interviewed for the random sample, men who accepted referrals at initial interview were more likely to report using PrEP at follow-up (32/68 = 47%) than those who did not (12/64 = 19%) (P = 0.0006). An estimated 10.4% of all interviewed MSM initiated PrEP following PS-based referral. Integrating PrEP referrals into STD PS is an effective population-based strategy to link MSM at high HIV risk to PrEP.

Optimizing the Impact of Expedited Partner Therapy.

Optimizing the Impact of Expedited Partner Therapy.

Surface enhanced Raman spectroscopy of Chlamydia trachomatis and Neisseria gonorrhoeae for diagnostics, and extra-cellular metabolomics and biochemical monitoring

SERS spectra excited at 785 nm of the bacteria Chlamydia trahomatis (elementary bodies, EB) and Neisseria gonorrheoae, the causative pathogens for the two most common sexually transmitted diseases (STD), chlamydia and gonorrhea, respectively, are reported. Although both are Gram-negative bacteria, the SERS signatures of C. trachomatis and N. gonorrheoae are completely different. N. gonorrheoae SERS spectra are due to the starvation induced nucleotide metabolites adenine and guanine, and the surface associated co-enzyme nicotinamide adenine dinucleotide and are very similar on Au and Ag although the spectrum appears more rapidly on Ag. The C. trachomatis SERS spectrum is dominated by the vibrational features of cell surface proteins. While features attributable to specific residues and the amide backbone characterize the C. trachomatis spectrum on Ag, the corresponding SERS spectrum on Au substrates displays vibrational characteristics of aggregated proteins. The prospects for the development of a SERS based platform for rapid (<one hour), low-cost bacterial STD diagnostics are promising based on these initial studies. Furthermore, this biomedical application demonstrates the potential for SERS to be a sensitive real time probe of the dynamics of biochemical activity in the cell wall and extracellular regions of microorganisms.

Decreasing occurrence of bacterial STD after introduction of voluntary counseling and testing HIV-program in Eldoret and Naivasha in Kenya in 1999-2013

Introduction: HIV with Tuberculosis represent “deadly” synergy and HIV with STD “suffering”: Synergy in areas of SS Asia with higher AIDS/HIV prevalence. Patients and Methods: The aim of this research was to assess the impact of the community based integrated health program focused on HIV/ AIDS and tuberculosis (TB) on the occurrence of bacterial STD in the rural community of North Eldoret as well as in the area of Lake Naivasha in Kenya. Results: Both areas home HIV prevalence of around 6%. A dramatic decrease of HIV was correlated with sustained decrease of bacterial STD’s (mainly syphilis and gonorrhea). Conclusion: An integrated program of HIV/TB (STD) should be supported in the community with higher HIV prevalence. Original Articles 46 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Introduction Incidence of bacterial sexually transmitted diseases (STD) correlates with HIV as well with Hepatitis B and C and introduction of an integrated community program usually impacts multiple diseases. The aim of this research was to assess the impact of a community based integrated health program focused on HIV/AIDS and tuberculosis (TB) on the occurrence of bacterial STD in a rural community in North Eldoret as well as in the area of Lake Naivasha in Kenya, both areas with HIV prevalence of around 6%.

Integrating HIV Testing as an Outcome of STD Partner Services for Men Who Have Sex with Men.

Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk for HIV infection, but often do not test for HIV at time of STD diagnosis. We instituted and evaluated a program promoting HIV testing through STD partner services (PS). In May 2012, health departments in Washington State modified STD PS programs with the objective of providing PS to all MSM with early syphilis, gonorrhea, or chlamydial infection and ensuring that those without a prior HIV diagnosis tested for HIV infection. We used chi-square tests and logistic and log-binomial regression to compare the percentage of MSM who received PS, HIV tested, and were newly HIV diagnosed before (January 1, 2010 to April 30, 2012) and during the revised program (May 1, 2012 to August 31, 2014). Among MSM without a prior HIV diagnosis, 2008 (62%) of 3253 preintervention and 3712 (76%) of 4880 during the intervention received PS (p < 0.001). HIV testing among PS recipients increased from 63% to 91% (p < 0.001). PS recipients were more likely to be newly HIV diagnosed than nonrecipients during the preintervention (2.5% vs. 0.93%, p = 0.002) and intervention periods (2.4% vs. 1.4%, p = 0.050). The percentage of MSM with newly diagnosed HIV infection who had a concurrent STD diagnosis increased from 6.6% to 13% statewide (p < 0.0001). Among all MSM with bacterial STDs, 61 (1.9%) preintervention and 104 (2.1%) during the intervention were newly diagnosed with HIV infection (adjusted relative risk = 1.34, p = 0.07). In conclusion, promoting HIV testing through STD PS is feasible and increases HIV testing among MSM. Our findings suggest that integrating HIV testing promotion into STD PS may increase HIV case finding.

Differing Identities but Comparably High HIV and Bacterial Sexually Transmitted Disease Burdens Among Married and Unmarried Men Who Have Sex With Men in Mumbai, India.

Although HIV incidence has declined in India, men and transgender women who have sex with men (MSM) continue to have high rates of HIV and sexually transmitted disease (STD). Indian MSM face substantial pressures to marry and have families, but the HIV/STD burden among married Indian MSM is not well characterized. A diverse sample of Indian MSM were recruited through respondent-driven sampling. Independent variables that produced a P value of 0.10 or less were then added to a multivariable logistic regression model. Most of the 307 MSM (95 married and 212 unmarried) recruited into the study were younger than 30 years, and less than one-third had more than a high school education. Almost two-thirds of the married men had children, compared with 1.4% of the unmarried men (P < 0.001). The numbers of condomless anal sex acts did not differ by marriage status. Although unmarried MSM more often identified themselves as "kothi" (receptive role), their rates of HIV or bacterial STD were similar to married MSM, with 14.3% being HIV infected. The respondent-driven sampling-adjusted prevalence of any bacterial STD was 18.3% for married MSM and 20% for unmarried MSM (not significant). Participants reported high levels of psychological distress, with 27.4% of married and 20.1% of unmarried MSM reporting depressive symptoms (not significant). Men who have sex with men in Mumbai had high rates of HIV, STD, and behavioral health concerns. Clinicians need to become more comfortable in eliciting sexual histories so that they can identify MSM who need HIV/STD treatment and/or prevention services.

Impact of a Brief Intervention for Substance Use on Acquisition of Sexually Transmitted Diseases Including HIV: Findings From an Urban Sexually Transmitted Disease Clinic Population.

Unhealthy substance use is associated with increased rates of sexually transmitted diseases (STDs), including HIV. The screening, brief intervention, and referral to treatment strategy is effective at reducing substance use over time. We investigated whether STD clinic patients who received a brief intervention (BI) had lower rates of STD/HIV acquisition over time than those who did not. A retrospective sample of 7665 patients who screened positive for substance abuse or dependence between May 1, 2008, and December 31, 2010, was matched with STD and HIV surveillance registries for a 1-year follow-up period to determine incidence of STD and HIV infection. Overall, 44.6% (n = 3420) received BI; 7.0% of this population acquired a bacterial STD compared with 8.8% of persons who did not receive BI (P < 0.005). In multivariate analysis, BI had a protective effect against STD infection for men (odds ratio, 0.774; 95% confidence interval [CI], 0.63-0.96), after controlling for age, race/ethnicity, and sex of partner. There were 61 new HIV infections over the follow-up period; however, we found no significant association between BI and subsequent HIV diagnosis. Brief intervention is associated with a reduction in STD incidence among men who screen positive for substance abuse and should be considered as an STD prevention strategy. Further study is needed to identify mechanisms through which BI may impact STD outcomes.

The high risk of an HIV diagnosis following a diagnosis of syphilis: a population-level analysis of New York City men.

Epidemiologic studies have shown that syphilis is associated with risk for human immunodeficiency virus (HIV) infection. We used population-level syphilis and HIV data to quantify HIV incidence among men following primary or secondary (P&S) syphilis diagnoses and identify the highest-risk subgroups for intensified prevention, such as pre-exposure prophylaxis with antiretroviral medications. Male cases reported to the New York City HIV/AIDS and Sexually Transmitted Disease (STD) surveillance registries were matched using a deterministic algorithm. We measured HIV incidence following P&S syphilis diagnosed between 2000 and June 2010 and identified risk factors for HIV infection using Cox proportional hazards models. Of 2805 men with syphilis contributing 11 714 person-years of follow-up, 423 (15.1%) acquired HIV; annual incidence was 3.61% (95% confidence interval [CI], 3.27%, 3.97%). HIV incidence was high among: men who have sex with men (MSM) (5.56%, 95% CI, 5.02%-6.13%); males with secondary compared with primary syphilis (4.10% vs 2.64%, P < .0001); and males diagnosed with another bacterial STD after syphilis (7.89%, 95% CI, 6.62%-9.24%). HIV incidence among men diagnosed with syphilis is high; one in 20 MSM were diagnosed with HIV within a year. Our data have implications for syphilis and HIV screening and may be useful for further targeting HIV-negative populations for pre-exposure prophylaxis.

Sexually Transmitted Diseases Among Persons With HIV With Low Viral Load

To the Editors HIV transmission is rare at viral loads (VL) up to several thousand copies.1 However, persons with low VL are at risk for sexually transmitted disease (STD) if they engage in unprotected sex, which may be related to beliefs about lower HIV infectiousness.2 Among persons with HIV, coinfection with another STD is common3 but has not been studied in a population-based group that is generally assumed unlikely to transmit HIV.4 We investigated STD prevalence among persons with different HIV VL levels, focusing on the subpopulation with low VL, by matching HIV and STD registry data. The New York City (NYC) HIV/AIDS surveillance registry contains data on New Yorkers diagnosed as having AIDS since 1981 and HIV infection or disease since 2000. Since 2005, it has received HIV-related laboratory results on persons living with HIV/AIDS (PLWHA) in NYC. The NYC STD surveillance registry contains data on New Yorkers diagnosed and reported to have any of 7 notifiable STD. A cross-registry match included 138,235 PLWHA as of March 30, 2011, excluding persons who died before January 1, 2000, and STD cases diagnosed January 1, 2000 to June 30, 2010. Viral load test dates and results were obtained from the HIV registry as of June 30, 2011. Among 69,418 PLWHA in 2009 who had 1 or more VL tests in 2009 and survived 31 days or longer after VL measurement (62.8% of all 2009 PLWHA), we calculated the proportion of those with a diagnosis of early syphilis, gonorrhea, chlamydia, or lymphogranuloma venereum within 31 days before or after the last VL in 2009 and characterized demographic and clinical characteristics and coinfection rates of PLWHA whose last VL was low (defined as 0–3499 copies/mL).1 Last VL was 0 to 3499 for 55,558 persons, 80.0% of PLWHA in the analysis, among whom last VL was less than 1000 copies/mL for 92.9% and less than 400 copies/mL for 87.3%. Of the 55,558, 478 (0.9%) had an STD diagnosis within 31 days of their low VL, with the highest prevalence among persons aged 20 to 29 years (3.1%) and 30 to 39 years (1.9%) and men who have sex with men (MSM; 1.8%) (Table 1). Early syphilis (43.1%) and chlamydia (36.3%) were the most frequent STD among PLWHA with low VL, followed by gonorrhea (19.7%) and lymphogranuloma venereum (0.8%). Most persons with STD and low VL were male (91.4%) and, specifically, MSM (73.8%). Sexually transmitted disease prevalence was higher among PLWHA with higher last VL (1.9% among 3500–9999; 2.0% among 10,000–99,999; and 2.2% among ≥100,000 [P trend <0.0001]).TABLE 1: STD Diagnosis Within 31 Days Among PLWHA With a Low (<3500) VL, by Demographics, Transmission Risk, and Clinical Characteristics, for All Persons and MSM, NYC 2009Overall, bacterial STD was rare (<1%) among PLWHA who, on the basis of their low VL, are assumed unlikely to transmit HIV. Still, these STD prevalence data suggest ongoing risk behavior (unprotected sex) among some persons with low VL and reinforce the value of STD screening and risk reduction services, even for persons with low HIV VL. Subgroups such as young adults and MSM had a higher STD prevalence that would be even higher if the highly prevalent genital herpes simplex virus were reportable also. Previous studies have found disproportionate STD rates among MSM PLWHA locally5,6 and nationally,7 and a recent mathematical model suggested that increased unprotected sex among MSM has diminished the population-level benefits of antiretroviral treatment for HIV prevention.8 Our findings reinforce the value of STD screening and risk reduction counseling among persons with low HIV VL. Ellen W. Wiewel, MHS Sarah L. Braunstein, PhD, MPH Preeti Pathela, DrPH, MPH Qiang Xia, MD, MPH Lucia V. Torian, PhD New York City Department of Health and Mental Hygiene New York, NY

Sexually transmitted diseases among men who have sex with men: A retrospective analysis from Suraksha clinic in a tertiary care hospital

Background:Men who have sex with men (MSMs) are a vulnerable population for spread of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Apart from being important for HIV transmission, they tend to have a different distribution patterns of STDs. Few Indian studies have looked into this aspect.Objective:We retrospectively analyzed the available data on MSM from Suraksha clinic of a tertiary care hospital in a metropolitan city from 2004 to 2010.Materials and Methods:A total of 75 MSM constituting 11.4% of the total 660 patients visited our Suraksha clinic in these 6 years. The clinical and behavioral profile of each patient along with the pattern of STDs was evaluated.Observations and Results:75% of the MSMs were promiscuous; one-third of them indulging in only homosexual activities. Syphilis was the most common STD, followed by condyloma acuminata, herpes genitalis, and gonorrhea. On comparing the data on the STD profiles of the heterosexual males, predisposition toward bacterial STDs among MSMs was observed.Conclusion:Identification of MSMs is important as most of them are bisexual and promiscuous, thereby playing a role in spread of STDs in vast number of partners. The profile of STDs also differs in MSM, which makes it all the more important to identify them.