Burden Of Sexually Transmitted Infections Research Articles

Partner notification services of the Sexually Transmitted Disease clinics in Sri Lanka

Introduction: Partner notification is a strategy used to control sexually transmitted infections (STI). It includes identifying a look-back interval and offering testing and treatment to the relevant sexual partners of an index patient. Objective: Study was carried out to assess partner notification (PN) services at selected Sexually Transmitted Disease (STD) clinics. Method: Study consisted of four components. Component 1 was a cross sectional descriptive study among the staff of five selected STD clinics who were directly involved in PN, to assess knowledge, attitudes and practices on PN. Component 2 was a retrospective descriptive study in the same setting to describe the burden of partner notifiable STIs during 2012. Component 3 was a case-control study among patients with partner notifiable STIs in the STD clinic, Colombo during 2012 to describe factors associated with patient compliance in PN. Component 4 was a cross sectional study at STD clinic, Colombo to evaluate PN indices. Results: All interviewed staff knew that gonorrhoea, early syphilis and chlamydia infection are partner notifiable but some misidentified bacterial vaginosis (20%) and vaginal candidiasis (14%) as partner notifiable. Knowledge on contact actions and look back period were unsatisfactory and 17% and 10% respectively were unaware that look back period is irrelevant to genital herpes and genital warts. A total of 1,157 partner notifiable STIs have been reported from all five clinics in 2012. Patient compliance in PN was significantly associated with regular partners, NGI and coitarche ≥ 19 years. Percentages of index cases interviewed for PN and index cases who had documented outcomes for all contacts were only 30.7% and 8.1% respectively. Conclusions: Knowledge, attitude and practices on PN among the clinic staff was unsatisfactory. Percentage of index cases interviewed was low (30%) probably leaving a considerable number of contacts unattended. Patient compliance on PN was significantly associated with regular partners, coitarche ≥ 19 years and NGI. Documentation relevant to PN was unsatisfactory.

The acceptability and feasibility of implementing a bio-behavioural enhanced surveillance tool in sexual health clinics: implications for STI prevention

BackgroundAlthough a world-class routine sexually transmitted infections (STI) surveillance system, England's Genitourinary Medicine Clinic Activity Dataset (GUMCAD) collects limited behavioural data, restricting insights into drivers of STI transmission. We developed a bio-behavioural enhanced surveillance tool (BBEST) comprising a short, self-administered online survey (focusing on STI-risk and health-care seeking behaviours) of sexual health clinic (SHC) attendees, informed by systematic review, qualitative research, and community engagement, and linked to GUMCAD's electronic patient records on clinical outcomes. Our aim, using mixed methods, was to assess the feasibility and acceptability of implementing BBEST among attendees and staff. Methods16 SHCs across England invited attendees to complete an online survey from May 1 to Sept 30, 2016, and recorded numbers invited and participants' clinic number to enable linkage. Survey participation rates, proportion of participants agreeing to linkage, and linkage success rate were assessed. Two of us (SW, DR) conducted face-to-face or telephone audio-recorded, semi-structured interviews with SHC staff (n=20) to explore barriers and facilitators to implementing BBEST. Data were transcribed and thematically analysed. Online consent was obtained for survey participation and linkage. National Research Ethics Service Committee South Central, Oxford C approved the study (ref 15/SC/0223). FindingsOf 7365 attendees invited, 6283 (85·3%) agreed to participate, of whom 4585 (73·0%) logged in and consented to survey participation. Recruitment success varied considerably among SHCs, which staff attributed to differences in clinics' culture of valuing research, and to structural changes in services, which negatively affected resources available for research and staff morale, and led to frequent staff turnover. 4048 (91·2%) of survey participants consented to linkage to electronic patient records, which did not vary by age or sex but was higher among men who have sex with men (MSM) than among heterosexual men (435 [95·5%] vs 3613 [88·4%], p=0·002), and higher in white than in black Caribbean participants (2181 [93·8%] vs 568 [87·1%], p=0·059). Linkage was achieved for 3596 (88·9%) of consenting participants. InterpretationImplementing BBEST in SHCs was feasible and acceptable to staff and attendees, including among MSM and black Caribbean populations, who bear a disproportionate STI burden. Linking routinely collected surveillance data with in-depth behavioural surveys provides intelligence on the drivers and context of STI risk, strengthening the evidence-base for designing and delivering effective public health interventions. FundingNational Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England and in collaboration with the London School of Hygiene & Tropical Medicine.

Understanding sexual healthcare seeking behaviour: why a broader research perspective is needed

BackgroundDespite effective and accessible treatments, many sexually transmitted infections (STIs) in high-income countries go untreated, causing poor sexual health for individuals and their partners. Research into STI care has tended to focus on biomedical aspects of infections using patient samples and prioritised attendance at healthcare services. This approach overlooks the broader social context of STIs and healthcare-seeking behaviours, which are important to better understand the issue of untreated infections.Main bodyThis paper is structured around three main arguments to improve understanding of help-seeking behaviour for STIs in order to help reduce the burden of untreated STIs for both individuals and public health. Firstly, biomedical perspectives must be combined with sociological approaches to align individual priorities with clinical insights. More research attention on understanding the subjective experiences of STI symptoms and links to healthcare-seeking behaviour is also needed. Secondly, a focus on non-attendance at healthcare services is required to address the patient-centric focus of STI research and to understand the reasons why individuals do not seek care. Finally, research using non-patient samples recruited from outside medical contexts is vital to accurately reflect the range of behaviours, beliefs and health issues within the population to ensure appropriate and effective service provision. We suggest piggy-backing other research on to existing studies as an effective way to recruit participants not defined by their patient status, and use a study recruiting a purposive non-patient sample from an existing dataset – Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) as an illustrative example.ConclusionSTIs are common but treatable, however a range of social and cultural factors prevent access to healthcare services and contribute to the burden of untreated infection. Different conceptual and empirical approaches are needed to better understand care-seeking behaviour and reduce the gap between social and biomedical advancements in managing untreated infection.

Prevalence and risk factors associated with sexually transmitted infections (STIs) among women of reproductive age in Swaziland

BackgroundSexually transmitted infections (STIs) remain an important public health problem with approximately half a billion new cases annually among persons aged 15–49 years. Epidemiological data on STIs among women of reproductive age in Swaziland are limited. The availability of epidemiological data on STIs and associated risk factors in this population is essential for the development of successful prevention, diagnosis and management strategies in the country. The study aimed to determine the prevalence and risk factors associated with STIs.MethodsA total of 655 women aged 15–49 years were systematically enrolled from five health facilities using a cross-sectional study design. Cervical specimen were tested using GeneXpert CT/NG Assays for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), GeneXpertTV Assay for Trichomonas vaginalis (TV), and GeneXpert HPV Assays for hr-HPV. Blood samples were tested using Alere Determine HIV-1/2Ag/Ab Combo and Trinity Biotech Uni-Gold Recombigen HIV test for confirmation for HIV, and Rapid Plasma Reagin and TPHA test for confirmation for Treponema pallidum (syphilis). Genital warts were assessed prior to specimen collection. Survey weighted analyses were done to estimate the population burden of STIs.ResultsThe four most common curable STIs: CT, NG, TV, Treponema pallidum (syphilis), as well as genital warts were considered in this study. The overall weighted prevalence of any of these five STIs was 19.4% (95% CI: 14.9–24.8), corresponding to 72 990 women with STIs in Swaziland. The estimated prevalences were 7.0% (95% CI: 4.1–11.2) for CT, 6.0% (95% CI: 3.8–8.8) for NG, 8.4% (95% CI: 5.4–12.8) for TV, 1.4% (95% CI: 1.1–10.2) for syphilis and 2.0% (95% CI: 1.0–11.4) for genital warts. The overall weighted HIV prevalence was 42.7% (95%CI: 35.7–46.2). Among hr-HPV positive women, 18.8% (95% CI: 13.1–26.3) had one STI, while 6.3% (95% CI: 3.3–11.7) had multiple STIs. Risk factors associated with STIs were being employed (OR = 2.2, 95% CI: 1.0–4.7), self-employed (OR = 2.8, 95% CI: 1.5–5.5) and being hr-HPV positive (OR = 2.0, 95% CI: 1.3–3.1). Age (0.9, 95% CI: 0.8–0.9), being married (OR = 0.4, 95% CI: 0.3–0.7) and not using condoms with regular partners (OR = 0.5, 95% CI: 0.3–0.9) were inversely associated with STIs.ConclusionSTIs are highly prevalent among women of reproductive age in Swaziland. Thus, a comprehensive STIs screening, surveillance and treatment programme would be justified and could potentially lower the burden of STIs in the country.

A national strategic plan for reducing the burden of sexually transmitted infections in Israel by the year 2025

BackgroundThere is on ongoing debate in the literature regarding the real burden of STIs (sexually transmitted infections) in Western countries and the proper strategies needed to estimate and to prevent them. Our purpose is to present an evidence-based national strategic plan for STI prevention in Israel through assessing the current burden of illness, leading international preventive strategies, and practical policymaking experience.MethodsEpidemiologic and health policy data on STIs were analyzed from various sources: a) systematic national surveillance data for the years 2002–2014; b) the international scientific literature (published between 2002–16; keywords: Sexually Transmitted Diseases (STD) (or STI) AND prevention AND intervention AND gonorrhea OR chlamydia OR syphilis; c) internal Ministry of Health (MOH) analyses and reports, and d) expert opinion.ResultsIncidence rates in Israel of Chlamydia trachomatis (chlamydia), Neisseria gonorrhea (gonorrhea) and Treponema pallidum (syphilis) are lower than in most Western countries. However, rates vary among population subgroups: chlamydia, gonorrhea and syphilis are higher in Jews than in non-Jews, and this gap has increased for chlamydia over the past decade. Primary and secondary syphilis rates have increased among men having sex with men (MSM). It is likely that STIs are under-reported and that incidence is even rising due to migration.A key recommendation is the establishment of an active surveillance system of STIs, utilizing active case finding in high risk populations, along with regular contact with STI clinics run by the four national health management organizations and by the MoH. As with most European countries, the low prevalence of chlamydia and gonorrhea does not justify population-wide screening. Conversely, the increasing incidence of syphilis among MSM should lead to regular screening among this group.ConclusionsA national STIs prevention strategy for the year 2025 was presented. Although the current burden of illness is low relatively to other Western countries, this is thought to reflect a certain degree of underreporting. These and other gaps suggest a need for focused epidemiologic and health services research to better characterize health risk behaviors as well as provider practice patterns. Innovative implementation strategies have been described, together with the capacity building components needed for developing specific and implementable policy recommendations for the year 2025.

Demographics, Behaviors, and Sexual Health Characteristics of High Risk Men Who Have Sex With Men and Transgender Women Who Use Social Media to Meet Sex Partners in Lima, Peru.

Men who have sex with men (MSM) and transgender women (TW) in Peru bear a disproportionate burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). In a context of quickly expanding communication technology, increasing numbers of MSM and TW are using social media applications to seek sex partners. Understanding social media users and their sex partnering practices is needed to update HIV and STI prevention programming. In Lima, Peru, 312 MSM and 89 TW from 2 STI clinics underwent HIV and STI testing and participated in a survey of demographics, behaviors, sexual health, and social media practices. χ, t tests, and Wilcoxon Mann-Whitney tests were used to compare those with and without recent social media sex partners. Men who have sex with men with social media sex partners were younger, more educated, and more likely to identify as gay. They were significantly more likely to report greater numbers of sex partners, including anonymous sex partners; sex in higher-risk venues, orgies, and have rectal Neisseria gonorrhoeae or Chlamydia trachomatis infection. Transgender women with social media sex partners were also younger, more likely to participate in sex work, and have a lower rate of rapid plasma reagin positivity or history of syphilis. Participants reported using several social media sites including sexual hook-up applications, websites for gay men, pornographic websites, and chat sites, but the most common was Facebook. Prevention strategies targeting Peruvian MSM and TW who use social media are needed to address higher-risk sexual behavior and the high burden of STIs.

The Knowledge, Attitudes and Practices (KAP) Regarding Human Papilloma Virus (HPV) Among Women in Karachi, Pakistan

<i>Background</i>: The burden of STIs in Pakistan is much larger than reported. Various research studies indicate that the knowledge of sexually transmitted infections (STIs) and Human Papilloma Virus (HPV) in the women is low. The objective of this study is to assess the knowledge, attitudes and practice regarding STIs, HPV and sexual behaviors of contraceptive practice among women in Karachi, Pakistan. <i>Methods</i>: The current study was conducted in a tertiary care hospital in Karachi from Aug 2014- Aug 2015, including 600 women (aged 19-50 years) by convenience sampling technique from waiting areas of out-patient clinics. <i>Results</i>: The mean age of participants was 39.5 ± 10.7 years. Eighty eight percent women (n = 529) were married, 8% (n = 50) female were unmarried and around 3% (n = 19) female were divorced, separated or widowed. Participants with no knowledge about STIs and viruses causing some cancers were 57% (n = 341) and 70% (n = 418) respectively. There was no knowledge about Pap smear in 80% (n = 479) of study population and the proportion of women not attending the annual gynecological examination were 88% (n = 525). Vaccine acceptability was found to be as low as 38% (n = 225). A similar trend 12% (n = 71) was seen in the response about willing to pay by themselves for the vaccination cost. <i>Conclusion</i>: The current study highlights inadequate knowledge about STDS, HPV, cervical cancer and its screening among women. Public health awareness programs should be raised at community level in order to increase the health seeking behavior of women.

Sexually Transmitted Infections and Associated Risk Factors Among Street-Based and Residence-Based Female Sex Workers in Dhaka, Bangladesh

Female sex workers (FSWs) in Bangladesh remain at elevated risk of sexually transmitted infections (STIs) although the human immunodeficiency virus (HIV) prevalence among them is low. Recent information on the burden and etiological diagnosis of STIs among them has been lacking. This study examines prevalence and risk behaviors of selected STIs among FSWs in Dhaka in 2014. Between August and October 2014, a cross-sectional study was conducted among street-based and residence-based FSWs receiving HIV prevention services at 24 drop in centers in Dhaka. Participants underwent behavioral interview, clinical examination, and laboratory testing for selected STIs using cervical swabs and blood. The sample consisted of 371 streets and 329 residence FSWs. Prevalence of gonorrhea, chlamydia, and active syphilis were 5.1%, 4.6%, 1.3% in street FSWs and were 5.8%, 8.2%, and 0.6% for residence FSWs which are lower compared with the previously reported rates. The following factors were associated with having any STI: being ≤5 years in sex trade (odds ratio, 2.2; 95% confidence interval, 1.2-3.9; P < 0.01), and having a cervical discharge (odds ratio, 2.6, 95% confidence interval, 1.5-4.6; P < 0.01). Resistance to cefixime and azithromycin was observed for 1 and 3 Neisseria gonorrhoeae strains, respectively. Despite receiving HIV/STI prevention services, bacterial STIs remain prevalent among FSWs suggesting the need for more effective management of STIs. The guidelines for management of STIs need revision in view of the emerging resistance.

Burden of Sexually Transmitted Infections in Iran from 1990 to 2010: Results from the Global Burden of Disease study 2010.

The present study describes the epidemiological status of sexually transmitted infections (STIs) in Iran based on the Global Burden of Disease study 2010 (the GBD 2010), and compares this with those of other neighboring countries. The burden of STIs from 1990 to 2010 in Iran was derived from a systematic study, namely the GBD 2010, which was conducted by the Institute for Health Metrics and Evaluation (IHME). Using a model-based estimation, Disability Adjusted Life Years (DALYs) were calculated on the basis of the prevalence of STIs. The GBD 2010 used disability weights, and a mortality rate that was obtained from the vital registration system of Iran. We review the results of the GBD 2010 estimations for STIs in Iran. The trend of DALYs attributable to STIs (107.3 and 26.47 per 100,000 people in 1990 and 2010, respectively) and deaths (1.13 and 0.12 per 100,000 people in 1990 and 2010, respectively) decreased dramatically in Iran during the last two decades. The majority of individuals affected by STI DALYs were aged 1 - 4 and 20 - 24 years. Since the majority of DALYs attributed to STIs were observed among those aged 1 - 4 years and young people, the economic burden of STIs will remain high in Iran. Therefore, effective evidence-based planning is critical to allocate the essential budget for utilizing treatment and prevention approaches.

Sexually transmitted infections other than HIV/AIDS among women of low socio-economic class attending antenatal clinics in Khartoum, Sudan.

Sexually transmitted infections (STIs) are major health threats affecting people globally; however, the burden of STIs is greatest in low-income countries. Since they are physiologically more vulnerable, women are mostly affected. The risk is increased dramatically during pregnancy leading to serious health complications that may affect the newborn. Underprivileged pregnant women attending antenatal clinics for routine checkups in displaced camps, a women's prison and several peripheral health centres were clinically and laboratory screened for trichomoniasis, chlamydial infections, gonorrhea and syphilis. A total of 426 women with an age range of 14-45 years were included. Clinical data, blood, cervical and vaginal swabs were collected. Conventional bacteriological and serological methods were applied. All attendees were HIV1/2-negative. The prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae and Treponema pallidum infections was found to be 7.8%, 4.9%, 0% and 5%, respectively. Although vaginal discharge, among other symptoms, is known to be the most significant indicator for STIs, our identified positive predictive value was only 14.1%. We conclude that use of syndromic approach for diagnosing and treating attendees of antenatal settings is of low clinical value and many easily curable STIs will be overlooked. Consequently, trichomoniasis, chlamydial infection and syphilis prevailed widely among this population.

A systematic review of randomised control trials of sexual health interventions delivered by mobile technologies.

BackgroundSexually transmitted infections (STIs) pose a serious public health problem globally. The rapid spread of mobile technology creates an opportunity to use innovative methods to reduce the burden of STIs. This systematic review identified recent randomised controlled trials that employed mobile technology to improve sexual health outcomes.MethodsThe following databases were searched for randomised controlled trials of mobile technology based sexual health interventions with any outcome measures and all patient populations: MEDLINE, EMBASE, PsycINFO, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, NHS Health Technology Assessment Database, and Web of Science (science and social science citation index) (Jan 1999–July 2014). Interventions designed to increase adherence to HIV medication were not included. Two authors independently extracted data on the following elements: interventions, allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. Trials were assessed for methodological quality using the Cochrane risk of bias tool. We calculated effect estimates using intention to treat analysis.ResultsA total of ten randomised trials were identified with nine separate study groups. No trials had a low risk of bias. The trials targeted: 1) promotion of uptake of sexual health services, 2) reduction of risky sexual behaviours and 3) reduction of recall bias in reporting sexual activity. Interventions employed up to five behaviour change techniques. Meta-analysis was not possible due to heterogeneity in trial assessment and reporting. Two trials reported statistically significant improvements in the uptake of sexual health services using SMS reminders compared to controls. One trial increased knowledge. One trial reported promising results in increasing condom use but no trial reported statistically significant increases in condom use. Finally, one trial showed that collection of sexual health information using mobile technology was acceptable.ConclusionsThe findings suggest interventions delivered by SMS interventions can increase uptake of sexual health services and STI testing. High quality trials of interventions using standardised objective measures and employing a wider range of behavioural change techniques are needed to assess if interventions delivered by mobile phone can alter safer sex behaviours carried out between couples and reduce STIs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3408-z) contains supplementary material, which is available to authorized users.

P068 Inequalities in sexually transmitted infection risk among black and minority ethnic men who have sex with men in England

Background/introduction Sexually transmitted infection (STI) diagnoses are increasing in men who have sex with men (MSM) in England. While black and minority ethnic (BME) populations bear a disproportionate burden of STIs overall, it is unclear whether this inequality persists among MSM. Aim(s)/objectives To assess the likelihood of an STI diagnosis among BME MSM relative to other MSM attending genitourinary medicine (GUM) clinics in England. Methods We included data from the GUM clinic activity dataset (GUMCADv2), the national STI surveillance system in England. All attendances by MSM in 2014 were analysed using univariate and multivariable generalised estimating equations logistic regression. Separate models, adjusted for age, sexual orientation (homosexual/bisexual), residence (London/non-London), area-level deprivation, HIV positivity and history of HIV testing in the past year, were run for each STI. Results BME men accounted for 5.6% of the 326,820 attendances by MSM in 2014. An STI was diagnosed at 12.5% of attendances by MSM, ranging from 11.1% in Asian non-Indian/Pakistani/Bangladeshi to 17.7% in mixed white and black African MSM. Compared to white British MSM, black Caribbean MSM were most likely to be diagnosed with chlamydia (aOR [95% CI]:1.34 [1.18–1.52]) and rectal gonorrhoea (1.31 [1.08–1.60]), while those of mixed white and black African ethnicity were most likely to be newly diagnosed with HIV (1.90 [1.14–3.17]). Discussion/conclusion Among MSM attending GUM services, BME MSM are most likely to be diagnosed with bacterial STIs and HIV. Culturally appropriate prevention messages must be developed to address this inequality and reduce the higher burden of STIs among BME MSM.

P056 Influence of country of birth on risk of STI diagnosis among black Caribbeans in England in 2014

Background/introduction In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this is associated with their country of birth. Aim(s)/objectives To examine differences in STI diagnoses among UK- and Caribbean-born BC people. Methods Data on STI diagnoses in BC people attending genitourinary medicine (GUM) clinics and living in England were obtained from the GUM Clinic Activity Dataset (GUMCADv2). Associations between being UK- or Caribbean-born and diagnosis with an STI were derived using univariate and multivariable multilevel logistic regression models adjusted for age, gender/sexual-orientation, residence, and HIV status. Results BC people made 231,719 attendances in 2014; 81.9% were UK-born. The median age (years) was 25 for UK-born and 34 for Caribbean-born people (p ≤ 0.001). Chlamydia, non-specific genital infection and gonorrhoea were the most commonly diagnosed STIs among UK- (37.4%, 19.5% and 13.7%) and Caribbean-born attendees (32.1%, 25.2% and 13.1%). From the multilevel analysis, UK-born attendees were less likely to be diagnosed with chlamydia (aOR 0.87 [95%C.I. 0.81–0.94]) and trichomoniasis (0.83 [0.71–0.97]), and more likely to be diagnosed with genital warts (1.24 [1.07–1.45]) than Caribbean-born attendees. The adjusted odds of a gonorrhoea diagnosis did not vary by country of birth. Discussion/conclusion STI rates among black Caribbeans attending GUM clinics in England are high and might be influenced by STI epidemiology in their country of birth. Studies on the effectiveness of interventions aimed at reducing the burden of STIs in all black Caribbeans are urgently needed.

Barriers and opportunities for sexual health services for key populations in the Dominican Republic: provider, government, and community-leader perspectives

36 www.thelancet.com/lancetgh Published Online April 8, 2016 Columbia University Medical Center, New York, NY, USA (A Gomes BA, C Nicholas BA, S Amesty MD, R Perez-Figueroa MD, S Nicholas MD, B Taylor MD); Instituto Dermatologico y Cirugia de Piel “Dr. Humberto Bogaert Diaz”, Santo Domingo, Dominican Republic (Y Donastorg MD, M Perez MS); University of Texas Health Science Center San Antonio, San Antonio, TX, USA (B Taylor MD) Correspondence to Angelina Gomes amg2272@cumc.columbia.edu Barriers and opportunities for sexual health services for key populations in the Dominican Republic: provider, government, and community-leader perspectives Angelina Gomes, Catherine Nicholas, Yeycy Donastorg, Martha Perez, Silvia Amesty, Rafael Perez-Figueroa, Stephen W Nicholas, Barbara S Taylor Abstract Background Sexually transmitted infections (STIs) are an important health issue in developing countries. Key populations, including people living with HIV, men who have sex with men, trans women, transactional sex workers, pregnant adolescents, and migrants, are at high risk of STIs and have barriers to sexual health services. In this study, we aim to understand capacities and barriers to access for key populations in the Dominican Republic, and to identify opportunities to improve services.Background Sexually transmitted infections (STIs) are an important health issue in developing countries. Key populations, including people living with HIV, men who have sex with men, trans women, transactional sex workers, pregnant adolescents, and migrants, are at high risk of STIs and have barriers to sexual health services. In this study, we aim to understand capacities and barriers to access for key populations in the Dominican Republic, and to identify opportunities to improve services. Methods We used purposive sampling to solicit views from stakeholders in Santo Domingo, Dominican Republic, including health-care agencies, community-based organisations, and government entities that guide STI screening policy. We conducted 19 semi-structured interviews between February, 2015, and May, 2015, with: nine health providers, seven community leaders, and three government authorities, asking questions about STI services for key populations, gaps in services, and barriers to access. Comprehensive notes and audio recordings were iteratively reviewed by two investigators to defi ne barriers and opportunities for STI screening. Findings Respondents identifi ed barriers to access at individual, community, organisational, and policy levels. Individual barriers include poor risk perception and health knowledge, drug use in transactional sex workers and trans women, inability to negotiate condom use in sex worker and adolescent groups, and poverty. Community barriers include: discrimination against sex workers, trans women, people living with HIV, men who have sex with men, and migrants; and a culture of self-medicating in all populations. Organisational barriers include a lack of centres off ering STI testing, unavailability of medications in centres accessed by key population, and poor knowledge of available resources in the community. Policy barriers include poor access to insurance in populations; low resource allocation to STIs, other than HIV; and inconsistent supply of materials and funds. Despite these barriers, local organisations that work with key populations expressed interest in increasing capacity to screen and treat STIs. Interpretation There are many barriers to STI services for key populations in the Dominican Republic. Communitybased organisations working with such populations could leverage their expertise to increase STI awareness, screening, and treatment. Our fi ndings can help generate sustainable interventions to reduce the burden of STIs in these key populations. Funding NIAID (K23AI081538 to B Taylor); Columbia University IFAP Global Health. Copyright © Gomes et al. Open Access article distributed under the terms of CC BY. Declaration of interests We declare no competing interests.

Surveillance systems for sexually transmitted infections

Sexually transmitted infections (STIs) continue to exert a substantial public health burden globally but surveillance remains a challenge, especially in the developing world. We reviewed STI surveillance systems in various regions globally and used available data to provide an overview of recent trends in STI epidemiology. STI surveillance systems in the developing world are often limited and restricted to ad hoc cross-sectional surveys; however, available data suggest that these areas are disproportionately affected by STIs, with a higher burden in marginalized groups such as sex workers. Developed countries typically have established surveillance systems. Recent reports suggest many of these countries are experiencing rising diagnoses of STIs in men who have sex with men (MSM) and an increasing contribution of HIV-positive MSM to STI epidemics. There is considerable variability in the surveillance for STIs globally, ranging from active or passive, to sentinel, laboratory or clinic-based systems. Given different levels of resources and patterns of healthcare provision, it is difficult to compare surveillance data across regions; however, available data suggest that considerable inequality in STI burden exists. In resource-limited settings, syndromic surveillance with periodic laboratory assessments is recommended to monitor trends in STIs.

Prevalence and Risk Factors for Self-reported Sexually Transmitted Infections among Adults in the Diepsloot Informal Settlement, Johannesburg, South Africa

Background: Sexually transmitted infections (STIs) are a significant cause of morbidity among sexually active adults with multiple consequences including enhancing HIV transmission. Objective: To determine the prevalence of self-reported sexually transmitted infections and associated risk factors among adults in Diepsloot informal settlement, Johannesburg, South Africa. Design: This is a cross sectional study involving secondary analysis of data collected in a survey among adults living in Diepsloot in 2013. Data from 3953 respondents was analysed. Univariable and multivariable logistic regression modelling was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between selfreported STI status and socio-demographic and clinical characteristics. Results: Of the 3953 participants, 2481 (62.8%) were female. Self-reported prevalence of STIs was 20.4% (n=808). Among the study participants, 815 (25.9%) people were HIV positive and of these 19.9% reported an STI. Being single [Odds Ratio (OR) 1.82, (95% CI 1.08, 3.05)], prior exposure to gender based violence or sexual assault (OR 2.25, 95% CI 1.39, 3.63), alcohol use (OR 1.50, 95% CI 1.04, 2.16), and having not utilised healthcare services in the past 2 years (OR 2.30, 95% CI 1.44, 3.68) were associated with increased odds of self-reporting an STI. HIV negative status was associated with reduced odds of self-reporting an STI (OR = 0.26, 95% CI 0.14, 0.50) Conclusion: The estimated prevalence of self-reported STIs among adults aged 20 to 82 years in Diepsloot, indicates a substantial burden of STIs in this population. The close connection between HIV status, history of gender based violence/sexual assault and utilisation of healthcare services underscore the need to scale up behavioural interventions coupled with targeted screening of at risk populations to simultaneously reduce the occurrence of genderbased violence and prevent the transmission of STIs including HIV.

Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis.

BackgroundThe 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.MethodFour electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection.ResultThree hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.ConclusionPrevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1322-0) contains supplementary material, which is available to authorized users.

P03.19 Screening for sexually transmitted infections in adolescent girls and young women in mombasa, kenya

Introduction As adolescents and young women become sexually active, they are at risk of adverse reproductive health outcomes including sexually transmitted infections (STIs). We assessed feasibility and acceptability of STI screening among 15–24 year-old women in Mombasa County, Kenya. Methods Participants were recruited from three high schools and one university. Study staff conducted informational sessions. Students interested in participating were given informed assent/consent forms to take home, and asked to visit our clinic for STI screening. During clinic visits, participants completed a self-administered questionnaire and provided a urine specimen to test for Neisseria gonorrhoeae , Chlamydia trachomatis , and Trichomonas vaginalis using the Hologic Aptima Detection System. Results Between August 2014 and March 2015, 463 high school and 165 university students collected assent/consent forms. Of these, 293 (63%) from high schools versus 158 (95%) from university attended clinic for STI screening (p N. gonorrhoeae , 16 [3.6%] with C. trachomatis and 3 [0.7%] with T. vaginalis ). Older age (OR 1.28; 95% CI 1.07–1.53), reporting vaginal sex (OR 5.89; 95% CI 2.42–14.36), non-penetrative sex (OR 3.47; 95% CI 1.56–7.75), alcohol use (OR 3.34; 95% CI 1.26–8.87), smoking (OR 5.82; 95% CI 1.12–30.37), chewing khat (OR 3.19; 95% CI 1.27–8.01), and being at university rather than high school (OR 4.58; 95% CI 1.94–10.79) were associated with increased likelihood of STI (p ≤ 0.05). Condom use was protective (OR 0.32; 95% CI 0.11–0.94). Conclusion There was considerable demand for STI screening, and a substantial burden of STIs was observed. These findings support the need for reproductive health interventions to reduce adolescent risk for STIs, pregnancy, and their complications. Disclosure of interest statement This research was funded by a 2011 developmental grant from the University of Washington Global Centre for Integrated Health of Women, Adolescents, and Children (Global WACh).

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

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

High burden of STI and HIV in male sex workers working as internet escorts for men in an observational study: a hidden key population compared with female sex workers and other men who have sex with men.

BackgroundMale sex work in the western countries has changed, including now a subculture of male sex workers who have paid sex with men arranged for via the internet. The men involved in this subculture do not easily identify themselves as sex workers nor as homosexual, and are therefore missed by regular health care and public health interventions. These male sex workers may form a hidden key population for sexually transmitted infections (STIs) and HIV, bridging towards other persons outside this context.MethodsThis clinic-based observational study included consultations by male sex workers (n = 212), female sex workers (n = 801) and in men having sex with men who did not report being paid for sexual contacts (MSM, n = 2703) who received STI and HIV testing and counselling at our clinic during the study period. In this study we compare the consultations in male sex workers to those in in female sex workers and MSM.Demographic characteristics and sexual behaviour of the male sex workers, female sex workers and MSM were compared using chi-square tests and non-parametric tests. Using univariate and multivariate regression analyses, determinants for STI positivity in male sex workers were evaluated.ResultsMale sex workers tested positive for STI (including HIV) in 40 % of the consultations; female sex workers and MSM respectively in 9 and 14 % of the consultations. A new HIV infection was found in 8 % of the consultations of male sex workers. Male sex workers were a young population of migrant sex workers from Eastern Europe. They reported more often to also have sex contacts with women and other sex workers. Male sex workers are at a higher risk for one or more new STI than female sex workers and other MSM, even after correction for age, ethnicity, known HIV positivity and behavioural variables.ConclusionsMale sex workers form a hidden key population that impacts the transmission of STI and HIV within the MSM population and, possibly, to the heterosexual population. They require specific targeted interventions. Although targeting male sex workers is labour intensive it is feasible and important to reduce STI transmission.