Bacterial Sexually Transmitted Infections Research Articles

High Incidence and Duration of Antibiotic Use Among a Cohort of Men Who Have Sex with Men in Seattle, WA

Abstract Background Doxycycline post-exposure prophylaxis (doxy-PEP) effectively prevents bacterial sexually transmitted infections (STIs) but may increase antibiotic pressure. Little is known about longitudinal antibiotic use among men who have sex with men (MSM), a key population for doxy-PEP. Methods We analyzed data from a prospective cohort of MSM in Seattle, WA, from 2016-2018, prior to the introduction of doxy-PEP. Antibiotic use and reason for prescription were self-reported in weekly surveys and extracted from medical records. We characterized antibiotic use across 49 weeks of follow-up, stratified by specific antibiotics of interest and reasons for prescription. Incidence rates (IR) were calculated for the number of incident events of antibiotic initiation per 100 person-years (PY) at risk. We assessed factors associated with antibiotic initiation using negative binomial regression to estimate adjusted incidence rate ratios (IRRs). Results Among 140 participants, 68.6% (n=96) received at least one antibiotic during follow-up, resulting in an overall IR=264.5 events of antibiotic initiation per 100 PY and 1,696 total days of antibiotic use. STI treatment was the most common reason for antibiotic initiation (IR=153.5 events per 100 PY; 462 days); however, treatment for other conditions contributed most to overall days of antibiotic use (IR=42.6 events per 100 PY; 947 days). An age of 25-39 years (IRR=1.54; 95%CI: 1.02,2.32) and a history of bacterial STIs <12 months prior to enrollment (IRR=1.81; 95%CI: 1.12,2.93) were significantly associated with higher incidence of antibiotic initiation. Conclusions Antibiotic consumption among this population was very high. Our analysis provides a necessary foundation for assessing the potential impacts of doxy-PEP.

P-504. Disparities in PrEP Coverage by Sex Among Individuals Diagnosed with Bacterial STIs in a Large Municipal Healthcare System

Abstract Background Nationally almost 20% of new HIV diagnosis are in females. Females carry 53% of sexually transmitted infection (STI) disease burden in the US, yet nationally represent only 10% of individuals on Pre-Exposure Prophylaxis (PrEP). The US Preventive Services Task Force and CDC include females diagnosed with bacterial STIs as one of the populations to be considered for PrEP. However, females are often not the focus of HIV PrEP campaigns, resulting in knowledge gaps, bias and stigma that further challenge PrEP access for women. As part of efforts to improve sexual health services and access within NYC's municipal healthcare system, we designed a sexual health dashboard (SHD) that included a “PrEP Eligible” metric focused on federal PrEP guidelines related to bacterial STIs. Methods All alive patients aged 13-75 years old with a primary care or women’s health clinic visit within a NYC Health and Hospitals facility during April 2023-March 2024 were included in the SHD. The SHD displays testing and positivity rates for Chlamydia, Gonorrhea, and Syphilis, in addition to PrEP eligibility and PrEP active status. PrEP eligibility is based on high frequency of HIV or STI tests (3+ in 1 year), an abnormal STI lab or STI diagnosis and ‘PrEP Active’ is defined as an active prescription for PrEP within the preceding 6-months. Results Females represented 82% of PrEP eligible patients but only 13.2% (162) of PrEP Active patients (1,223). Among all people with Chlamydia, 0.2% of females were PrEP Active compared to 16% of males. For Gonorrhea, 2.6% of females were PrEP Active compared to 44.3% of males. For Syphilis, 1.9% of females were PrEP Active compared to 18.6% of males (Figure 1). Conclusion According to the CDC, 6% of sexually acquired HIV can be attributed to bacterial STIs, however PrEP usage remains low among eligible females within a municipal healthcare system in NYC. Dedicated efforts are being made within NYC Health and Hospitals to expand PrEP to primary care and women’s health, with the hopes that diversifying care settings for PrEP will reach populations not currently accessing PrEP services. Lack of recognition of the connection between HIV risk and STIs may disproportionately impact females and contribute to underutilization of PrEP. Disclosures Emma Kaplan-Lewis, MD, Gilead Pharmaceuticals: Grant/Research Support

P-1398. Implementation of a Doxycycline for Post-Exposure Prophylaxis Protocol at a Large Academic HIV Clinic

Abstract Background The use of doxycycline post-exposure prophylaxis (DoxyPEP) lowers the incidence of gonorrhea, chlamydia, and syphilis in men who have sex with men and transgender women living with HIV or taking pre-exposure prophylaxis (PrEP) for HIV. We aimed to implement a standardized protocol to increase the number of appropriate DoxyPEP prescriptions and decrease bacterial sexually transmitted infections (STI) in our clinic population. Methods Based on existing evidence, a DoxyPEP clinic protocol and flowchart (Figure 1) were developed and implemented in November 2023 at an academic clinic providing HIV and PrEP services. Interventions included provider education and display of the flowchart in clinical workspaces. The number of new DoxyPEP prescriptions was collected by chart review for the 10 months prior to and 5 months after implementation and compared by t-test. Baseline patient characteristics and STI diagnoses for the clinic population living with HIV were described. Pre- and post-implementation surveys were used to assess provider practices and comfort with DoxyPEP prescribing. Results Of persons with HIV prescribed DoxyPEP in the pre-implementation period, 72.1% had at least 1 bacterial STI and 34.4% had >1 bacterial STI in the preceding 10 months (Table 1). There were significantly more DoxyPEP prescriptions (p< 0.001) in the 5-month post-implementation period [148 new prescriptions, 29.6/month] compared to the 10-month pre-implementation period [70 new prescriptions, 7/month] (Figure 2). Post-implementation, there was an increase in providers who felt comfortable or very comfortable counseling a patient on DoxyPEP (86% vs 60%) and assessing a patient’s eligibility for DoxyPEP (85% vs 60%). Most respondents (86%) reported use of the protocol, and of these providers, all reported it easy or very easy to use. Nine of the fourteen DoxyPEP prescribers (64.3%) in the post-implementation period had not prescribed DoxyPEP prior to the intervention. Conclusion Implementation of a standardized DoxyPEP protocol using education and updated policy increased providers’ comfort with and prescribing of DoxyPEP and can help inform future implementation efforts. Further assessment of post-implementation STI rates and patient characteristics are planned. Disclosures Sean Kelly, MD, ViiV: Advisor/Consultant

P-514. Enhancing the Pediatric Primary Care Provider’s Role in Adolescent HIV Prevention

Abstract Background Youth with a history of bacterial sexually transmitted infections (STIs) are at increased risk of HIV acquisition and should be counseled on HIV Pre-Exposure Prophylaxis (PrEP). PrEP counseling has been associated with high acceptability rates in primary care, but most pediatric providers do not discuss PrEP during clinic visits. We conducted a quality improvement project at primary care clinics affiliated with a tertiary not-for-profit children’s hospital serving the city of Milwaukee. The objective of this project is to increase rates of counseling on HIV testing and PrEP during primary care visits around an STI diagnosis, as part of a larger institutional initiative to increase PrEP utilization in at-risk youth. Methods Rates of HIV testing and PrEP counseling were monitored monthly during baseline (July 2022-June 2023) and post-intervention periods (July 2023-June 2024) using Plan-Do-Study-Act (PDSA) cycles tracked via a statistical process control chart. We included well child and sexual health-related office visits in youth aged 12 and older that occurred within 3 months of a bacterial STI diagnosis (gonorrhea, chlamydia, or syphilis). Interventions consisted of a clinician educational session, a prompt in the electronic health record (EHR) for missing HIV tests and a communication to the primary care provider containing internal PrEP resources following a patient’s STI diagnosis. Results From July 2022 to December 2023, we identified 255 primary care visits around an STI diagnosis (90.59% chlamydia, 25.49% gonorrhea, 0.39% syphilis and 16.47% co-infections). Patient characteristics are summarized in Table 1. Interim analysis showed counseling rates on HIV testing increased from 50% to 63% (Figure 1) and PrEP counseling from 5% to 15% (Figure 2) through December 2023. Data will continue to be measured through June 2024. Conclusion For the first 6 months of our project, clinician education combined with an EHR prompt and provider communications containing PrEP resources have resulted in a modest increase in counseling rates on HIV testing and PrEP for at-risk youth during primary care visits. These initial interventions demonstrate a promising start towards enhancing HIV prevention discussions in pediatric primary care. Disclosures All Authors: No reported disclosures

Doxycycline Postexposure Prophylaxis and Bacterial Sexually Transmitted Infections Among Individuals Using HIV Preexposure Prophylaxis

Doxycycline postexposure prophylaxis (doxyPEP) has been shown to decrease the incidence of bacterial sexually transmitted infections (STIs) among people assigned male sex at birth in clinical trials, but data from clinical practice are limited. To describe early uptake of doxyPEP and evaluate changes in STI incidence following doxyPEP initiation. This retrospective cohort study of adults (aged ≥18 years) dispensed HIV preexposure prophylaxis (PrEP) at Kaiser Permanente Northern California during November 1, 2022, to December 31, 2023, examined electronic health record data to compare HIV PrEP users dispensed and not dispensed doxyPEP and rates of bacterial STIs before and after starting doxyPEP. Individuals were followed up from their first recorded STI test on or after November 1, 2020, until December 31, 2023, or discontinuation of health plan membership. Pharmacy dispensing data were used to define doxyPEP recipients. Demographic and clinical characteristics were compared between individuals dispensed and not dispensed doxyPEP. Primary outcomes were incident chlamydia, gonorrhea, or infectious syphilis measured as quarterly STI positivity (proportion of individuals testing positive at least once per quarter). Among doxyPEP recipients, rate ratios (RRs) compared mean quarterly STI positivity from 24 months before to 12 months after starting doxyPEP. In an exploratory analysis, STI trends were evaluated for the full cohort, stratified by receipt of doxyPEP. Among 11 551 HIV PrEP users (mean [SD] age, 39.9 [12.1] years; 95.1% male), 2253 (19.5%) were dispensed doxyPEP, of whom 2228 (98.9%) were male and 1096 (48.6%) had an STI in the year before starting doxyPEP. Compared with individuals not dispensed doxyPEP, doxyPEP recipients were older (mean [SD] age, 40.4 [10.8] vs 39.8 [12.4] years; P = .04) and had used HIV PrEP longer (mean [SD], 4.2 [2.8] vs 3.4 [2.6] years; P < .001), and a higher proportion were commercially insured (2091 [92.8%] vs 8270 [88.9%]; P < .001). Among doxyPEP recipients, quarterly chlamydia positivity decreased from 9.6% (95% CI, 9.0%-10.3%) before starting doxyPEP to 2.0% (95% CI, 1.5%-2.6%) after starting doxyPEP (RR, 0.21; 95% CI, 0.16-0.27; P < .001), with significant declines for each anatomic site of infection. Quarterly gonorrhea positivity decreased from 10.2% (95% CI, 9.6%-10.9%) before starting doxyPEP to 9.0% (95% CI, 8.0%-10.1%) after starting doxyPEP (RR, 0.88; 95% CI, 0.77-1.00; P = .048); site-specific declines were significant for rectal (RR, 0.81; 95% CI, 0.67-0.97; P = .02) and urethral (RR, 0.56; 95% CI, 0.40-0.79; P = .001) gonorrhea, but not pharyngeal gonorrhea. Quarterly syphilis positivity decreased from 1.7% (95% CI, 1.4%-1.9%) before starting doxyPEP to 0.3% (95% CI, 0.2%-0.6%) after starting doxyPEP (RR, 0.20; 95% CI, 0.11-0.37; P < .001). Positivity for STIs remained stable in individuals not dispensed doxyPEP. This study found that receipt of doxyPEP was associated with substantial declines in chlamydia and syphilis incidence and modest declines in urethral and rectal gonorrhea incidence among individuals using HIV PrEP. These findings suggest that doxyPEP may offer substantial benefits for reducing population-level STI transmission with broader implementation.

Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infection Trends

Increasing rates of sexually transmitted infections (STIs) have been associated with rises in serious morbidity. While doxycycline postexposure prophylaxis (doxyPEP), a strategy in which individuals take doxycycline, 200 mg, after condomless sex to prevent bacterial STIs, has been shown to be efficacious in randomized clinical trials, doxyPEP's potential effect on population-level STI incidence is unknown. To assess the association of citywide doxyPEP guideline release with reported chlamydia, gonorrhea, and early syphilis cases in men who have sex with men (MSM) and in transgender women in San Francisco, California. This population-level interrupted time series analysis of reported San Francisco STI cases measured monthly cases of chlamydia, gonorrhea, and early syphilis prior to (July 2021-October 2022) and after (November 2022-November 2023) release of citywide doxyPEP guidelines in October 2022. All reported chlamydia, gonorrhea, and early syphilis cases among MSM and transgender women in San Francisco during the period of analysis were included. Data were analyzed November 2023 to July 2024. Release of doxyPEP citywide guidelines. The primary outcome was the percentage change between projected and observed chlamydia, gonorrhea, and early syphilis cases in the 13-month postexposure period. Citywide, there were 6694 cases of chlamydia, 9603 cases of gonorrhea, and 2121 cases of early syphilis among MSM and transgender women during the analytic period. STI cases among MSM and transgender women decreased significantly compared with model projections for chlamydia (-6.58% per month; 95% CI, -7.99% to -5.16%) and early syphilis (-2.68% per month; 95% CI, -3.75% to -1.60%) after doxyPEP implementation. By the end of the 13-month postperiod in November 2023, chlamydia and early syphilis cases decreased -49.64% (95% CI, -59.05% to -38.06%) and -51.39% (95% CI, -58.21% to -43.46%), respectively, compared with projected cases. There was a significant increase in monthly gonorrhea cases compared with projections (1.77% per month; 95% CI, 0.87% to 2.67%). This study suggests that San Francisco's doxyPEP guideline release was associated with decreases in reported cases of chlamydia and early syphilis, but not gonorrhea, among MSM and transgender women in San Francisco. Further analyses are needed to assess whether declines are sustained and monitor for adverse consequences, including antimicrobial resistance. Supporting doxyPEP implementation for MSM and transgender women at risk for STIs could have a significant impact on the nationwide STI epidemic.

Doxycycline post-exposure prophylaxis for preventing bacterial sexually transmitted infections (STIs): Are clinical providers supportive?

Background Bacterial sexually transmitted infections (STIs) continue to increase in the United States. Despite evidence of the effectiveness of doxycycline post-exposure prophylaxis (Doxy-PEP) to prevent STIs, little is known about providers’ attitudes and willingness to implement Doxy-PEP. Methods An online questionnaire was sent to 575 clinical providers in New York State in September 2022. Results Ninety-one eligible individuals responded. Most providers served men who have sex with men (MSM) (84%); reported willingness to recommend Doxy-PEP (98%, 77%, and 67% for chlamydia, syphilis, and gonorrhea, respectively); preferred Doxy-PEP administration for MSM and transgender populations; believed recurring bacterial STIs (88%) and reported condomless sex (85%) were the most important characteristics to consider for recommending Doxy-PEP; and were concerned about antibiotic resistance (90%) (primarily for Neisseria gonorrhoeae). Insurance costs were the most perceived community-associated barriers (35%). There were no significant differences in providers’ recommendations towards Doxy-PEP use when comparing clinicians’ years of experience, regions, or professional titles. Conclusions Study results suggest high willingness and support for implementing Doxy-PEP. As this survey was administered prior to national guidelines on the use of Doxy-PEP, these data can be used as a baseline to compare to studies conducted after their release to formulate appropriate messages for providers to improve implementation.

Utilization of an Off-Site Patient Navigator to Facilitate HIV Pre-Exposure Prophylaxis Referrals in Patients with Sexually Transmitted Infections in the Emergency Department.

The emergency department (ED) is an important setting to identify people at increased risk of HIV infection who may benefit from HIV pre-exposure prophylaxis (PrEP). However, prescribing or referral for PrEP in the ED is not widespread. The purpose of this study is to evaluate the use of an off-site HIV PrEP patient navigator to facilitate PrEP access for patients who seek care for sexually transmitted infections (STIs) in the ED. Between January 1, 2023 and June 30, 2023, patients who tested positive for a bacterial STI in the ED were eligible for outreach by an off-site PrEP patient navigator. Interested patients were scheduled for telehealth appointments for PrEP. Demographic, clinical information and outcomes were obtained. During the study period, there were 160 patients eligible for PrEP outreach. Outreach was completed in 75 (47%) of patients, with 46/75 (61%) agreeable to scheduling a PrEP appointment. Of these 46 patients, median age was 30 years old [IQR 23, 35], 25 (54%) were male, 40 (87%) were Black/African American and 6 (13%) identified as men who have sex with men (MSM). Forty three of 46 interested patients (93%) scheduled an appointment and 35/46 (76%) completed an appointment. Thirteen of 35 (37%) patients who completed an appointment were prescribed PrEP, with 6/13 (46%) and 2/13 (15%) remaining on PrEP at 3 and 6 months, respectively. Use of an off-site patient navigator can facilitate referrals for HIV PrEP for patients who are diagnosed with bacterial STIs in the ED.

Likelihood of HIV and recent bacterial sexually transmitted infections among transgender and non-binary individuals in 20 European countries, October 2023 to April 2024.

BackgroundGlobal data highlight the disproportionate burden of HIV and sexually transmitted infections (STIs) among transgender individuals. However, scant data exist for both transgender and non-binary individuals in European HIV/STI surveillance.AimTo assess self-reported prevalence of HIV and bacterial STIs (syphilis, gonorrhoea, chlamydia) in the past 6 months among transgender and non-binary individuals, comparing the likelihoods of recent STIs between groups.MethodsUsing data from the cross-sectional PROTECT survey conducted in 20 European countries from October 2023 to April 2024, we analysed a subset of 452 participants, 178 transgender and 274 non-binary individuals. Logistic regression was used to compare the risk of each recent bacterial STI, and Poisson regression to compare the risk of the number of recent STIs.ResultsAmong transgender individuals, 5 (2.8%) self-reported HIV infection, and recent STI prevalence was 6.7% for syphilis, 15.6% for gonorrhoea and 19.6% for chlamydia. For non-binary individuals, 15 (5.5%) self-reported HIV infection and recent STI prevalence was 15.0% for syphilis, 18.7% for gonorrhoea and 20.8% for chlamydia. Non-binary individuals had significantly higher risk for syphilis (aOR: 1.81; 95% CI: 1.01-4.05) and multiple recent STIs (aOR: 1.46; 95% CI: 1.11-1.91) compared with transgender individuals.ConclusionWhile both transgender and non-binary individuals showed high self-reported prevalence of HIV and bacterial STIs, non-binary individuals showed greater prevalence of STIs, particularly syphilis. Efforts aimed at HIV/STI prevention and surveillance should encourage inclusion of those who identify as non-binary and other gender-diverse individuals alongside transgender individuals to enhance the provision of tailored prevention and treatment services in Europe.

Cabotegravir Maintains Protective Efficacy in the Setting of Bacterial STIs: A Secondary Analysis of HPTN 083.

Sexually transmitted infections (STIs) have been shown to facilitate HIV transmission and acquisition. HPTN 083, a global clinical trial, demonstrated superiority of long-acting cabotegravir (CAB-LA) versus daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV prevention among transgender women and cisgender men who have sex with men. This analysis assessed whether CAB-LA maintained protective efficacy when bacterial STIs (syphilis, rectal/urethral gonorrhea and chlamydia) were present. STI events per 100 person-years (PY) were calculated, including by subgroups (age, race/ethnicity, gender, education, treatment arm, drug use, alcohol use, region/country, condom usage, partner number, marital status, baseline STI). Association between baseline factors and STI incidence was modeled using Poisson regression. Cox proportional hazards modeling with STI status as a time-varying covariate was used to evaluate potential interactions between STI status and the relative efficacy of CAB-LA vs. TDF/FTC. Among 3,859 participants, overall STI incidence rate was 50.7 infections/100PY. STIs were diagnosed in 1,562 (40.5%) participants; 79% of STIs occurred in 25% of the participants. STI incidence was not different by PrEP arm. In the final multivariable model, age, region, race, education level, marital status, and baseline STI were associated with incident STI (p<0.05). HIV incidence was lower with CAB-LA vs. TDF/FTC with or without STIs (hazard ratios 0.37 and 0.31, respectively), with no significant interaction between STIs and the HR for HIV incidence (p = 0.75). In a large PrEP trial with high STI incidence, CAB-LA maintained robust protective efficacy relative to TDF/FTC in the setting of bacterial STIs.

Doxycycline Postexposure Prophylaxis (DoxyPEP) for Bacterial STI Prevention

This Viewpoint describes what dermatologists should know about doxycycline postexposure prophylaxis (doxyPEP) for bacterial sexually transmitted infection (STI) prevention, specifically syphilis, chlamydia, and gonorrhea.

Menstrual cups to reduce bacterial vaginosis and STIs through reduced harmful sexual and menstrual practices among economically vulnerable women: protocol of a single arm trial in western Kenya

BackgroundIn western Kenya, menstrual hygiene management (MHM) is a pervasive problem. Challenges are compounded for economically constrained women who continue to engage in sex during menses and resort to practices such as vaginal insertion of tissue and cotton to maintain dryness during sex. These practices can be harmful to the vaginal microbiome (VMB) and can lead to high rates of sexually transmitted infections (STIs) and HIV. This study will evaluate whether menstrual cups that can be worn during intercourse may be beneficial to the VMB and help prevent Bacterial vaginosis (BV) and STI acquisition among these economically vulnerable women.MethodsIn this single-arm trial among economically vulnerable women in semi-urban western Kenya, we will evaluate the preliminary efficacy of menstrual cups on non-optimal VMB, BV, and STIs, and investigate safety, acceptability, and implementation needs. Through peer referral we aim to recruit 402 menstruating women aged 15–35 who exchange sex for money or basic needs. Women who are pregnant, have delivered in the past six months, or use an intrauterine device (IUD) will not be eligible. Participants will be seen every six months for 24 months and be asked about their sexual and MHM practices, with samples collected to assess BV and VMB. At baseline, 12-, and 24-month visits, additional samples will be collected to measure HIV and STIs (C. trachomatis, N. gonorrhoeae, and T. vaginalis). HSV-2 status will be assessed at baseline. Intervention provision will consist of one reusable disc-shaped menstrual cup per participant and a group-based training within four weeks of the 12-month visit, followed by monthly telephone surveys for the first three months to assess cup use, adverse events, and provide any assistance. Primary analyses of preliminary efficacy will compare probabilities of optimal VMB, BV, and STIs in the pre-intervention period to the post-intervention period. Primary safety analyses will compare occurrence of menstrual toxic shock syndrome and cervicovaginal laceration.DiscussionIf demonstrated safe and effective, this multipurpose reproductive health intervention will offer a dignified solution for the menstrual hygiene needs of women who engage in sex for livelihood and reduce their occurrence of non-optimal VMB, BV, and STIs.Trial registrationClinicaltrials.gov NCT05666778 (28th December, 2022); Pan African Clinical Trials Registry 202,305,912,778,108 (25th May, 2023).

Unnecessary antibiotic use in men who have sex with men (MSM) with anogenital symptoms attending a sexual health clinic: a retrospective analysis

ObjectivesTo quantify the amount of unnecessary antibiotics, in particular ceftriaxone, given to men who have sex with men (MSM) with anogenital symptoms as part of presumptive management in an urban...

The association between lifestyle factors and the composition of the vaginal microbiota: a review.

The vaginal microbiota offers valuable insights into women's sexual health and the risk of developing sexually transmitted infections (STIs) and bacterial vaginosis. Despite the public health implications of changes in the vaginal environment, existing data on this topic remain sparse. Following the PRISMA statement guidelines, we consulted five bibliographic databases, focusing on five main daily habits and behaviors. We included only studies published up to October 2023, investigating the influence of personal hygiene, sexual behaviors, hormonal contraception, smoking, alcohol consumption, and psychosocial stress on the vaginal microbiota using next-generation sequencing. Based on our inclusion criteria, we incorporated 37 studies into this review. Hormonal contraception and personal hygiene were found to promote eubiosis of the vaginal microbiota. In contrast, sexual behaviors, smoking, alcohol consumption, and psychosocial stress were associated with an increased susceptibility to bacterial vaginosis, STIs, and severe pelvic inflammatory diseases due to a modified vaginal microbiota. Black ethnicity emerged as a confounding factor, with this population showing unstable vaginal microbiota. Oral contraception and a stable male sexual partner were found to favor Lactobacillus colonization, acting as a protective factor. Conversely, non-hormonal contraception and unprotected or non-penile/vaginal sexual activity increased the incidence of vaginal inflammation and bacterial vaginosis by disturbing the vaginal microbiota and reducing Lactobacillus abundance. Daily habits and lifestyle can influence the composition of the vaginal microbiota, thereby affecting vaginal health. Disturbances in the vaginal microbiota could be associated factors for STIs and vaginosis. Therefore, prioritizing more appropriate management of the vaginal microbiota is crucial.

An STI rarely comes alone-An overview of sexually transmitted infections

Sexually transmitted infections (STI) or sexually transmitted diseases (STD) can be caused by bacteria, viruses, fungi, protozoa and arthropods. The most frequent bacterial STIs include Chlamydia infections, syphilis and gonorrhea; viral STIs include herpes genitalis (herpes simplex virus 1 and 2), human papillomavirus (HPV) and human immunodeficiency virus (HIV). An empathetic medical history taking in cases of a clinical suspicion can provide important information for adequate diagnostics. When an STI is detected, a complete screening for other STIs should be carried out. The STIs result in awide variety of symptoms and it is often difficult to make a clear diagnosis to a certain pathogen based on the clinical symptoms. To avoid reinfections, it is recommended to also test recent sexual partners. For certain pathogens highly effective postexposure prophylaxis or preventive vaccinations are available.

Prevalence of bacterial vaginosis, sexually transmitted infections and their association with HPV infections in asymptomatic women attending antenatal care in Ethiopia.

Sexually transmitted infections (STIs) and human papillomavirus (HPV) infections are common among women of reproductive age and can lead to infertility, adverse pregnancy outcomes, neonatal infections and cervical cancer. In countries with limited medical coverage, untreated infections contribute to high morbidity. This study aimed to expand the current knowledge on the prevalence of bacterial vaginosis (BV) and STIs in pregnant Ethiopian women and assess the association of these conditions with HPV infections. Socio-demographic data and vaginal lavage samples were collected from 779 asymptomatic women aged 18 to 45 years (median age, 25.9 years) attending antenatal care in seven centres across Ethiopia. Multiplex polymerase chain reaction was used to test for BV, Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, herpes simplex virus types 1 and 2 (HSV-1/2), Mycoplasma, Ureaplasma, Candida species and HPV. Overall, 26.8% (95% confidence interval (CI): 23.7-29.9) of women tested positive for BV or one of the following STIs: C. trachomatis, T. vaginalis, N. gonorrhoeae, Mycoplasma genitalium, HSV-1/2 or Ureaplasma urealyticum. Additionally, 22.1% tested positive for at least one high-risk HPV type. Chlamydia trachomatis and HSV-2 were significantly more common among women who were positive for HPV and high-risk HPV. This study reveals a high prevalence of asymptomatic pregnant women who are positive for BV, STIs or HPV, putting them at risk of adverse pregnancy outcomes, secondary infertility or cervical cancer in a country with limited medical coverage. Screening and treating these women could be crucial in reducing morbidity.

Outcomes of a policy to prioritize populations with expected healthcare barriers for subsidized preexposure prophylaxis care in Amsterdam, the Netherlands.

The Dutch HIV preexposure prophylaxis (PrEP) pilot provided subsidized PrEP care to maximum 2900 individuals at a time in Amsterdam. Populations with expected barriers to accessing PrEP elsewhere were prioritized for program inclusion. We evaluated their prior sexual health service engagement and PrEP need. Cross-sectional analysis using enrolment data. We included individuals ever enrolled in the PrEP program at the Center for Sexual Health (CSH) Amsterdam between 2019 and 2023. We calculated the proportion belonging to higher-priority groups (i.e., <25 years old, transgender, sex worker, uninsured or migrant). We defined classes of sexual health service engagement in the 12 months preceding enrolment using latent class analysis (LCA). We compared engagement classes, sexual behavior and positivity of HIV and sexually transmitted infections (STI) between higher- and lower-priority groups. 2004/4075 (49%) individuals enrolled belonged to higher-priority groups. LCA showed three classes of prior engagement: "newly engaged" (14%, n = 551) were new to the CSH-Amsterdam; "PrEP initiators" (40%, n = 1642) previously visited the CSH-Amsterdam but had not used PrEP; "PrEP experienced" individuals (46%, n = 1882) previously accessed PrEP. Higher-priority groups were more often "newly engaged" or "PrEP-initiators" than "PrEP-experienced". Higher-priority groups less often had condomless anal sex with casual partners or chemsex in the prior 6 months. Positivity of bacterial STI was similar between higher-priority ( n = 300/2004, 15.0%) and lower-priority ( n = 315/2071, 15.2%) groups. 13/14 HIV diagnoses at enrolment were in higher-priority groups. Higher-priority populations had less often previously used sexual health services and accounted for most new HIV diagnoses at enrolment. Engaging these populations in sexual healthcare, including PrEP, should be stressed.

Effectiveness of modified vaccinia Ankara-Bavarian Nordic vaccine against mpox infection: emulation of a target trial

ObjectiveTo estimate the real world effectiveness of modified vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine against mpox infection.DesignEmulation of a target trial.SettingLinked databases in Ontario, Canada.Participants9803 men aged ≥18 years with a...

Self-Reported PrEP Use and Risk of Bacterial STIs Among Ontarian Men Who Are Gay or Bisexual or Have Sex With Men.

HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence. We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification. Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06). We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population.Annals Early Access article.

Early adopters of doxycycline as post-exposure prophylaxis to prevent bacterial sexually transmitted infections in a real-world clinical setting

ObjectivesDoxycycline as post-exposure prophylaxis (DoxyPEP) is a novel prevention approach which has demonstrated efficacy in preventing bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) and...