Sexually Transmitted Infections Rates Research Articles

The trend analysis of HIV and other sexually transmitted infections among the elderly aged 50 to 69 years from 1990 to 2030.

The HIV and other sexually transmitted infections (STI) excluding HIV among the elderly population urgently require more attention and in-depth study. We aimed to present and predict the worldwide of its burden from 1990 to 2030 using data from the Global Burden of Disease (GBD) study. Leveraging the 2019 GBD study, we investigated the average annual percentage change (AAPC) of HIV and other STI in incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates for individuals aged 50-69 across different age groups, genders, sociodemographic index (SDI) regions, and nations. The incidence of STI in the population from 2020 to 2030 was explored by Bayesian age-period-cohort (BAPC) prediction model. The HIV incidence rate experienced its fastest growth 1990-1992, peaked in 1996, and gradually declined thereafter, with the 2019 rate being lower than that of 1990. The prevalence rate didn't present a sharp turning point. After 2006, its growth rate accelerated. Both DALYs and mortality rates plateaued high between 2002 and 2005, followed by a decline. The decline was steepest from 2005-2012, yet the rate of decrease slowed noticeably from 2012-2019.When segmented by age, HIV was more prevalent among those aged 55-59 and 50-54, with the 50-54 age group witnessing the fastest decline in incidence rates. However, the fastest growth in prevalence rates was seen among the 60-64 and 65-69 age groups. The other STI incidence rate declined from 1990-1996, increased up to 2006, declined until 2015, and then saw a resurgence with accelerated growth thereafter. The prevalence rate showcased varied trends, with a notable increase in the past five years. The highest growth in incidence rate was among the 65-69 age group. We predict that the incidence rate of STI will increase in the future. Overall, despite the evident decline in incidence, mortality rates, and DALYs, the prevalence of HIV and other STI among the elderly is rising, and both demonstrated significant trend variations across different ages, genders, SDI regions, and nations. Comprehensive sexual health education, clinical care and adjustments in health service strategies based on the evolving trends of HIV and other STI among the elderly are paramount.

Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain.

In recent years, there has been an increasing use of sex-related substances (known as "Chemsex") to facilitate, intensify, and prolong the sexual experience of men who have sex with men. This phenomenon poses a public health problem, increasing the risk of sexually transmitted infections (STIs) and mental disorders. The primary aim of this study was to delve into the correlation between substance use and sexual health, specifically examining the association between different substances used and the risk of sexually transmitted infections (STIs) in the context of Chemsex in Spain. An observational, descriptive, cross-sectional study was conducted among 563 Spanish participants between January and April 2023. Non-probabilistic purposive sampling was used by the investigators. The researchers administered a questionnaire to men who have sex with men who use substances, especially in the sexual sphere, in all the autonomous communities of Spain. 14.7% reported having practiced slamsex in the last year, and 17.94% were diagnosed with a Sexually Transmitted Infection in the previous 6 months. Of these, 21% were on PREP treatment, with the main STIs being gonorrhea (p < 0.001), chlamydia (p < 0.001), genital herpes (p = 0.020), and syphilis (p < 0.001). The 63.7% used methamphetamines as the main drug in the practice of chemsex. Chemsex in Spain is linked to a high prevalence of STIs, especially gonorrhea and chlamydia, even among those on PrEP treatment. The use of various drugs during chemsex, such as amyl nitrite, GHB, ecstasy, and others, correlates with higher rates of STIs, highlighting the need for interventions to reduce risk and harm. The drugs most associated with slamsex include ketamine, mephedrone, and methamphetamine, underscoring the importance of addressing the risk behaviors associated with this activity. This study shows that chemsex appears to be associated with a high prevalence among men who have sex with men. Who use multiple substances in a sexual context, and are particularly exposed to sexually transmitted infections (STIs), indicating a particular need for STI prevention and care in this group.

Sexually transmitted infections: Prevalence and clinical outcomes among pregnant women in Western Sydney.

We report the prevalence, characteristics and clinical outcomes of women with sexually transmitted infections (STIs) in pregnancy in the Western Sydney Local Health District (WSLHD) serving a large culturally and socio-economically diverse community in New South Wales (NSW), Australia, over the last 10 years. A retrospective cohort study of all pregnant women booked for antenatal care at three hospitals in WSLHD between September 2012 and August 2022 inclusive. Characteristics and birth outcomes associated with STIs diagnosed in pregnancy (chlamydia, gonorrhea, and syphilis) are reported using multivariable logistic regression adjusting for relevant confounders. During 2012-2022, there were 102 905 births and 451 women (0.44%) with an STI diagnosis during pregnancy. The number of women with a history of chlamydia prior to their current pregnancy has increased over the last 10 years (P < 0.001). STIs in pregnancy were more common in younger women aged <20 years (adjusted odds ratio [aOR] 7.30, 95% confidence interval [CI] 5.04-10.57), 20-24 years (aOR 3.12, 95% CI 2.46-3.96), and >40 years (adj OR 1.67, 95% CI 1.07-2.59), in women with body mass index >30 (aOR 1.73, 95%CI 1.37-2.19), and those who smoked (aOR 2.24, 95% CI 1.71-2.94) and consumed alcohol (aOR 3.14, 95% CI 1.88-5.23) and illicit drugs (aOR 2.10, 95% CI 1.31-3.36). STIs in pregnancy were borderline associated with stillbirth (aOR 2.19 95% CI 0.90-5.36) but did not have a significant impact on preterm birth (aOR 1.21, 95% CI 0.87-1.68), admission to neonatal intensive care unit (NICU) (aOR 1.02, 95% CI 0.77-1.34), or having a small-for-gestational-age (SGA) baby (aOR 0.97, 95% CI 0.74-1.27). Sociodemographic factors such as age, weight, smoking, and alcohol and drug use, were associated with the STI incidence in pregnancy. While the latter did not have an impact on preterm birth, NICU admission, and SGA in our cohort, there was a borderline association with stillbirth. Future research should identify barriers and facilitators to testing in a multicultural population and understanding the drivers of higher rates of STIs in certain population groups.

Questioning risk compensation: pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022.

BackgroundPre-exposure prophylaxis (PrEP) effectively prevents HIV, but its association with sexually transmitted infections (STIs) has raised concerns about risk compensation, potentially impacting the expansion of PrEP programmes.AimWe examined the relationship between PrEP and the incidence of chlamydia, gonorrhoea and syphilis.MethodsIn this prospective cohort study, we compared STI rates before and after PrEP initiation among users in the capital region of Denmark (2019-2022), calculating incidence rate ratios adjusted for age and testing frequency (aIRR). To pinpoint when increases began, we plotted weekly STI rates, adjusting the timeline to correspond with PrEP initiation.ResultsThe study included 1,326 PrEP users with a median age of 35 years. The STI incidence rate per 100,000 person-years rose from 35.3 before to 81.2 after PrEP start, with an aIRR of 1.35 (95% CI: 1.18-1.56). Notably, this increase preceded PrEP initiation by 10-20 weeks. Specific aIRR for chlamydia, gonorrhoea and syphilis were 1.23 (95% CI: 1.03-1.48), 1.24 (95% CI: 1.04-1.47) and 1.15 (95% CI: 0.76-1.72), respectively. In subanalyses for anatomical sites aIRR was 1.26 (95% CI: 1.01-1.56) for rectal chlamydia and 0.66 (95% CI: 0.45-0.96) for genital gonorrhoea.ConclusionWe found a 35% increase in STI incidence associated with PrEP use. It started before PrEP initiation, challenging the assumption that PrEP leads to risk compensation. Instead, the data suggest that individuals seek PrEP during periods of heightened sexual risk-taking. Consequently, PrEP programmes should include sexual health consultations, STI testing, treatment and prevention strategies to prevent HIV and improve sexual health.

Sexually transmitted coinfections among at-risk HIV-positive MSM: implications for optimal preemptive treatment.

Concurrent sexually transmitted infections (STIs) are common in sexually active populations. We aimed to estimate the prevalence and coinfection rates of bacterial STIs among sexually active, HIV-positive men who have sex with men (MSM), and to assess the potential benefits of different combination treatment regimens in managing concurrent bacterial STIs. From September 2021 to September 2023, HIV-positive MSM underwent STI testing when they had symptoms suggestive of STIs or recently acquired hepatitis C virus (HCV) infection or early syphilis. The oral rinse, rectal swab, and urethral swab specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma spp., Ureaplasma spp., and Trichomonas vaginalis with the use of multiplex real-time polymerase-chain-reaction assays. The estimated coinfection rates were used to evaluate the benefits of different combination treatment regimens for managing coinfections. During the study period, 535 participants (median age, 37 years; and CD4 count, 615 cells/mm3) were enrolled. On their first visits, at least one bacterial pathogen was detected in 57.9% and concomitant bacterial infections were found in 32.9% of the participants. The most commonly identified pathogen was U. urealyticum (36.3%), followed by C. trachomatis (22.8%), and N. gonorrhoeae (19.8%). The factors associated with any bacterial STIs included older age (per 1-year increase, adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.95-1.00), early syphilis (AOR, 1.87; 95% CI, 1.22-2.84), and having more than 5 sex partners in the preceding 3 months (AOR, 2.08, 95% CI, 1.07-4.06). A combination therapy of benzathine penicillin G with a 7-day course of doxycycline could simultaneously treat 27.1% of C. trachomatis coinfections in participants with early syphilis, while a combination therapy of ceftriaxone with doxycycline could simultaneously treat 40.6% of chlamydial coinfections in participants with gonorrhea. Bacterial STIs were prevalent and concomitant infections were not uncommon among sexually active, HIV-positive MSM, supporting regular screening for bacterial STIs. The effectiveness of preemptive use of doxycycline as combination therapy for concurrent STIs warrants more investigations.

Mycoplasmoides genitalium Macrolide Resistance Detection is Needed in University Settings.

Background: Mycoplasmoides genitalium remains a difficult sexually-transmitted infection (STI) to manage due to its potential for antimicrobial resistance and post-infection sequelae. University students are especially vulnerable, as this demographic has the highest rate of STI in the United States. As a result, investigating prevalence rates and therapeutic outcomes in this population is essential to minimize future impact of M. genitalium The purpose of this study was to investigate a university student population for M. genitalium distribution and treatment outcome.Design: Retrospective chart-review of university health clinic attendees, augmented by laboratory detection of M. genitalium following therapeutic intervention.Methods: A total of 1617 student encounters at a midwestern United States university health clinic over a 28-month interval from November 2017 through February 2020 were analyzed for M. genitalium and Chlamydia trachomatis positivity rates and prevalence. Detection of these sexually-transmitted pathogens occurred by commercial RNA amplification testing. Chart review was focused on participant outcomes following initial M. genitalium detection and therapeutic intervention.Results: C. trachomatis positivity and prevalence rates were 7.05% and 9.00%, respectively, while analogous rates for M. genitalium were 7.05% and 6.51%, respectively. An average of 1.83 positive results was generated from participants infected with M. genitalium at any time, with an average of 1.17 positive results for C. trachomatis (P < 0.0002). For students treated with azithromycin, 30.3% generated a negative M. genitalium result upon follow-up, with 1g daily and 2-day 500mg dosing regimens demonstrating less efficacy than a 4-day 250mg regimen or moxifloxacin.Conclusion: Data indicate a need for molecular M. genitalium macrolide resistance determination from primary specimens in the university setting.

What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis.

While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults.

Improving partner notification for sexually transmitted infections: Interviews with key informants in Aotearoa New Zealand.

Partner notification is a vital part of sexually transmitted infection (STI) control but evidence suggests that its practice in Aotearoa New Zealand (NZ) is inconsistent. This study sought to explore barriers to partner notification for STIs, identify areas for improvement and draw on lessons learnt from Covid-19. Semi-structured interviews with key informants working in primary care, sexual health, public health, management, and research were undertaken between December 2021 and March 2022. Interviews were audiorecorded, transcribed, coded, and analysed using thematic analysis. The overarching theme was that partner notification for STIs needs to be improved, and must be a more acceptable experience for providers, cases and their contacts. Four themes described how this could be achieved: (i) destigmatise and increase understanding of STIs, (ii) ensure engagement with services is easy and affirming, (iii) prioritise and resource evidence-based services and (iv) develop tools to optimise partner notification. Sexually transmitted infection partner notification in NZ needs prioritisation, resourcing and innovation. The inadequate resourcing of STI management in NZ contrasts with the well-funded response to Covid-19. Without a well-resourced action plan, NZ's high rates of STIs will persist and continue to inequitably impact Māori, Pacific, gay and bisexual men and young people.

Global, regional, and national burden of HIV and other sexually transmitted infections in older adults aged 60–89 years from 1990 to 2019: results from the Global Burden of Disease Study 2019

Sexually active older adults are often more susceptible to HIV and other sexually transmitted infections (STIs) due to various health conditions (especially a weakened immune system) and low use of condoms. We aimed to assess the global, regional, and national burdens and trends of HIV and other STIs in older adults from 1990 to 2019. We retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 on the incidence and disability-adjusted life-years (DALYs) of HIV and other STIs (syphilis, chlamydia, gonorrhoea, trichomoniasis, and genital herpes) for older adults aged 60-89 years in 204 countries and territories from 1990 to 2019. Estimated annual percentage changes in the age-standardised incidence and DALY rates of HIV and other STIs, by age, sex, and Socio-demographic Index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the relationship between age-standardised rates and SDI. In 2019, among older adults globally, there were an estimated 77 327 (95% uncertainty interval 59 443 to 97 648) new cases of HIV (age-standardised incidence rate 7·6 [5·9 to 9·6] per 100 000 population) and 26 414 267 (19 777 666 to 34 860 678) new cases of other STIs (2607·1 [1952·1 to 3440·8] per 100 000). The age-standardised incidence rate decreased by an average of 2·02% per year (95% CI -2·38 to -1·66) for HIV and remained stable for other STIs (-0·02% [-0·06 to 0·01]) from 1990 to 2019. The number of DALYs globally in 2019 was 1 905 099 (95% UI 1 670 056 to 2 242 807) for HIV and 132 033 (95% UI 83 512 to 225 630) for the other STIs. The age-standardised DALY rate remained stable from 1990 to 2019, with an average change of 0·97% (95% CI -0·54 to 2·50) per year globally for HIV but decreased by an annual average of 1·55% (95% CI -1·66 to -1·43) for other STIs. Despite the global decrease in the age-standardised incidence rate of HIV in older people from 1990 to 2019, many regions showed increases, with the largest increases seen in eastern Europe (average annual change 17·84% [14·16 to 21·63], central Asia (14·26% [11·35 to 17·25]), and high-income Asia Pacific (7·52% [6·54 to 8·51]). Regionally, the age-standardised incidence and DALY rates of HIV and other STIs decreased with increases in the SDI. Although the incidence and DALY rates of HIV and STIs either declined or remained stable from 1990 to 2019, there were regional and demographic disparities. Health-care providers should be aware of the effects of ageing societies and other societal factors on the risk of HIV and other STIs in older adults, and develop age-appropriate interventions. The disparities in the allocation of health-care resources for older adults among regions of different SDIs should be addressed. Natural Science Foundation of China, Fujian Province's Third Batch of Flexible Introduction of High-Level Medical Talent Teams, Science and Technology Innovation Team (Tianshan Innovation Team) Project of Xinjiang Uighur Autonomous Region, Cure Alzheimer's Fund, Helse Sør-Øst, the Research Council of Norway, Molecule/VitaDAO, NordForsk Foundation, Akershus University Hospital, the Civitan Norges Forskningsfond for Alzheimers Sykdom, the Czech Republic-Norway KAPPA programme, and the Rosa Sløyfe/Norwegian Cancer Society & Norwegian Breast Cancer Society.

The impact of Chatbot-Assisted Self Assessment (CASA) on intentions for sexual health screening in people from minoritised ethnic groups at risk of sexually transmitted infections.

Background Sexually transmitted infections (STIs) present a significant global public health issue, with disparities in STI rates often observed across ethnic groups. The study investigates the impact of Chatbot-Assisted Self Assessment (CASA) on the intentions for sexual health screening within minoritised ethnic groups (MEGs) at risk of STIs as well as the subsequent use of a chatbot for booking STI screening. Methods A simulation within-subject design was utilised to evaluate the effect of CASA on intentions for STI/HIV screening, concern about STIs, and attitudes towards STI screening. Screening intentions served as the dependent variable, while demographic and behavioural factors related to STI/HIV risk were the independent variables. ANCOVA tests were conducted to measure the impact of CASA on these perceptions. Results Involving 548 participants (54% women, 66% black, average age=30years), the study found that CASA positively influenced screening intentions t (547)=-10.3, P t (544)=-4.96, P t (543)=-4.36, P Conclusion CASA increased motivations for STI screening intentions among ethnically diverse communities. The intervention's non-judgemental nature and the chatbot's ability to emulate sexual history-taking were critical in fostering an environment conducive to behavioural intention change. The study's high acceptability indicates the potential for broader application in digital health interventions. However, the limitation of not tracking actual post-intervention behaviour warrants further investigation into CASA's real-world efficacy.

Profile of sexually transmitted infections among attendees of special clinics (Suraksha) at an apex regional sexually transmitted disease centre in North India – a five-year study

Introduction: Sexually transmitted infections (STIs) present significant global and national health challenges, particularly in India. Objective: To estimate the prevalence and characteristics of STIs among attendees at the Suraksha Clinic in the Apex Regional STD Centre, Safdarjung Hospital. Methods:Retrospective data from January 2018 to December 2022 were statistically analyzed using Excel and SPSS. The study included the examination for diagnosis of various STIs, such as syphilis, human immunodeficiency virus (HIV), gonorrhoea, chlamydiasis, trichomoniasis, candidiasis, bacterial vaginosis, chancroid, and genital herpes. Gender distribution and syndromic diagnoses, including vaginal/cervical discharge and genital ulcers, were also considered. Referrals to Integrated Counseling and Testing Centres for HIV testing were analyzed. Results: The outcomes reveal a substantial burden of STIs, with 3.06% showing reactivity to syphilis, 1.74% testing positive for HIV, 3.36% for gonorrhoea, 11.78% for chlamydiasis, 1.05% for trichomoniasis, 26.24% for candidiasis, 9.97% for bacterial vaginosis, 7.80% for chancroid, 11.64% for herpes genitalis, and 4.01% for other non-STIs. Attendees’ interactions included 34.36% of referrals to Integrated Counseling and Testing Centres for HIV testing. The gender distribution showed 58.92% male and 40.94% female attendees. Conclusion: Syndromic diagnoses, including vaginal/cervical discharge (21.22%) and genital warts (8.00%), highlight prevalent conditions, necessitating routine screening, early detection, and targeted interventions for effective disease control and prevention. These findings underscore the significance of integrated screening, patient education, and proactive strategies to safeguard public health in the face of rising STI rates.

Sexually Transmitted Infection Rates and Patterns of Condom Use Among Young Adult Females at an Urban Emergency Department as Compared to College Students

Introduction Despite months of shelter-in-place orders and two years of heavily cautious person-to-person contact, the rates of sexually transmitted infections (STIs) continue to rise (Conference on Decision and Control and Prevention (CDC), 2022). A recent survey of females presenting to an urban emergency department (ED) had a higher rate of STI and unplanned pregnancy than those in a nearby college. This study further investigated patterns of male condom use by these populations. Methods Females aged 18-22 who reported vaginal intercourse at least once were surveyed in 2022 by an urban women’s hospital emergency department and a large urban-based public university. The survey addressed STI rates, number of partners, demographics of self and partners, and the use of condoms. Results Seventeen point one percent (17.1%) of university students and 43.8% of the ED patients reported a lifetime STI (p=0.034). The ED population was more non-white and poorer. University students reported a similar likelihood of condom use, 3.63, and ED patients 3.38 (p=0.557). Within the ED, African American-identifying individuals reported similar condom use, 3.54 versus 3.23, p=0.572. College students who reported STI had more partners, 16 versus 6.4 in the college population (p=0.0475); a trend not seen in the ED population. Conclusion STI rate remained higher in the ED population. Individuals identifying as African American represented 30.7% of the ED cases and trended towards more condom use. High-risk behavior does not directly correlate with income or non-white race. Risk per partner is higher in the ED population, suggesting more frequent exposure.

Adverse Childhood Experiences and Self-Reported Sexually Transmitted Infections among Adolescents and Young Adults in Zimbabwe

Sexually transmitted infections (STIs) are a public health crisis that can be devastating to individuals with adverse childhood experiences (ACEs). This study examined the prevalence and association between ACEs and self-reported STIs among adolescents and young adults in Zimbabwe. Data for this study was derived from the 2017 Zimbabwe Violence Against Children Survey (ZVACS) from the participants aged 13 to 24 (n=504). The self-reported prevalence estimates of STIs were calculated using weighted frequencies and percentages. Two logistic regression models were employed to assess an association between eight ACE types and self-reported STIs. The findings revealed that STIs were higher among orphans (52.2%), followed by participants with a history of lifetime suicide ideation or attempts (49.8%), were exposed to any ACE (42.5%), and had moderate/severe mental distress in the past 30 days (44.8%). Additionally, self-reported STI rates were higher for participants who experienced any form of physical violence (30.8%), witnessed physical violence (22.4%), experienced sexual violence (16.1%) and emotional violence (11.7%). In unadjusted regression models, all ACEs, except participants who experienced emotional violence, were significantly associated with self-reported STIs. However, after adjusting for covariates in the model, none of the ACEs maintained a significant association with self-reported STIs. Despite this, it is evident that interventions remain crucial for effectively preventing STIs for individuals with ACEs. There is a pressing need to implement and expand STI prevention programs nationally, including identifying and addressing ACEs and early screening, diagnosis, and treatment of STIs among adolescents and young adults in Zimbabwe. Keywords: Adverse childhood experiences (ACEs), Adolescents, sexually transmitted infections (STIs), Violence, Young adults, Zimbabwe.

Examination of Incidence of Sexually Transmitted Infections in the Ending the HIV Epidemic Priority Counties of the United States, 2005-2019.

The incidence of sexually transmitted infections (STIs) has been increasing in the United States, and this trend has continued alongside expanding/changing human immunodeficiency virus (HIV) prevention strategies, moving from reliance solely on behavioral interventions like condoms to biomedical methods like oral and injectable antiretroviral preexposure prophylaxis (PrEP). In 2019, the Ending the HIV Epidemic (EHE) initiative was released to prioritize resource allocation to the 50 jurisdictions in the United States with the highest HIV incidence, providing an opportunity to monitor STI incidence in a national group of discrete, geographic units and identify trends and differences across jurisdictions. Using existing data from the US CDC and Census Bureau, a retrospective analysis was conducted to examine the incidence of STIs in 49 of the 50 EHE priority counties between 2005 and 2019. This timeframe was divided into 2 periods representing a before and after entry into the biomedical era of HIV prevention: P1 (2005-2011) and P2 (2012-2019). A total of 49 EHE counties were included in this analysis, representing 27.4% of the total US population. Entry into the biomedical HIV prevention era was associated with an increase in STI incidence in 28 EHE counties and a decrease in 14 EHE counties. The greatest percent increase in total STI incidence was in the District of Columbia (+12.1%; incidence rate ratio = 1.121 [1.115, 1.127]; P < 0.001) and the greatest percent decrease was identified in Orleans Parish, LA (-8.7%; incidence rate ratio = 0.913 [0.908, 0.919]; P < 0.001). Rising STI rates in the biomedical era of HIV prevention represent missed opportunities for comprehensive sexual and preventive healthcare. County-level data provide actionable insight for reducing STI incidence. The EHE counties that have experienced decreases in STI incidence while being in the biomedical era may provide models of best practice, which may be scaled in other jurisdictions.

2675. Concurrent HIV and Sexually Transmitted Infections in People with Mpox in Guatemala City

Abstract Background High rates of HIV and sexually transmitted infections (STIs) among people with mpox have been reported. Guatemala has the highest number of mpox cases reported in Central America. Data on this topic in the region is lacking. We report the prevalence of STIs and HIV in people evaluated for mpox at Hospital Roosevelt in Guatemala City. Methods We conducted a cross-sectional analysis of confirmed mpox cases with outpatient care at our institution between July 2022 and January 2023. Sociodemographic and clinical data was retrospectively collected. This analysis includes new diagnoses of HIV, syphilis, chlamydia, gonorrhea, mycoplasma genitalium infection and herpes virus simplex (HSV) infection. Diagnoses were confirmed by serology or nucleic acid amplification tests. Rates of HIV/STIs were assessed and association with sociodemographic, behavioral and clinical characteristics was analyzed through non-parametric statistical tests. Results Sixty participants with mpox were included. All cis-gender male, 34 (56.6%) younger than 30 years old, 52 (86.6%) were residents of Guatemala City, 57 (95%) men who have sex with men (MSM), 51 (85%) had above secondary education, 36 (60%) with known HIV-positive status. Recent participation in group sex was reported in 9 (15%) participants and inconsistent or no condom use in 49 (81.6%). Among participants with known HIV-positive status 34 (94.4%) had CD4 count &amp;gt; 200/µL and 32 (88.9%) had a HIV viral load &amp;lt; 200 copies/ml. Two previously undiagnosed HIV infections were detected. Overall, 27 new STIs were found in 20 (33.3%) participants (5 had more than one STI). Comparisons between participants with concurrent STIs and those without are shown in Table 1. Nine cases of syphilis were detected. Eighteen STIs involved mucous membranes (oropharyngeal, genital or anorectal). Rates by site are shown in Table 2. Conclusion At least one STI was detected in a third of the mpox cases with syphilis being the most frequent. Almost half of STIs cases involved the anorectal site. People with previously known HIV-positive status had a significantly higher rate of STIs. HIV/STI care is key to an appropriate mpox management. Disclosures All Authors: No reported disclosures

2677. Evaluation of Expedited Partner Therapy Prescribing in an Urban Emergency Department

Abstract Background Expedited Partner Therapy (EPT) is a useful tool that facilitates prompt treatment of sex partners in patients diagnosed with sexually transmitted infections (STIs). This study describes EPT utilization and documentation practices in an urban Emergency Department (ED) after implementing electronic EPT orders into a medical record system. Methods This retrospective, cross-sectional study evaluated EPT prescribing and documentation practices in an urban ED from 1/1/22 – 9/30/22. The study included patients older than 18 years of age with suspected chlamydia, gonorrhea, and/or trichomoniasis who received either a physical EPT prescription or an EPT kit. Collected data included patient characteristics, diagnostic and treatment data, and documentation measures. Descriptive statistics were used to assess the number of STI cases and those who received EPT. Results Data was collected on 37 patients who received EPT during their ED visit. The majority were uninsured (43%), and each patient had an average of 1.27 sex partners. HIV and syphilis screening were performed only in 8 (22%) and 7 (19%) of patients seen for a suspected STI. The number of cases for chlamydia (n=228), gonorrhea (n=149), and trichomoniasis (n=282) were disproportional to the total number of EPT orders throughout the 9-month study period. The number of EPT prescriptions was highest after the implementation of electronic sentences (n=27). At discharge, 76% of patients received a medication kit to provide direct treatment access for sex partners of index patients. Electronic dot phrases were used by 81% of providers to meet state documentation requirements. The results of this study demonstrate a significant STI burden with low EPT utilization from providers. Conclusion There was an increase of EPT utilization after the implementation of electronic order sentences in the electronic medical record. Screenings for HIV and syphilis are an area for improvement among patients at risk for an STI who are seen in the ED. The integration of electronic EPT methods can help address the growing rates of STIs in the U.S. Disclosures All Authors: No reported disclosures

2666. Rates of STI Testing and Diagnoses among Patients with Mpox in New York City, 2022

Abstract Background The 2022 global mpox outbreak occurred in the context of rising rates of sexually transmitted infections (STIs). We hypothesize that concurrent STI rates were underestimated due to inadequate testing during virtual visits and non-sexual health clinical settings. Methods We included data from all patients with confirmed mpox (through non-variola orthopoxviral PCR testing) from June 25 to October 17, 2022 at an urban tertiary academic center in New York. Manual chart review supplemented data extracted from the electronic medical record. We calculated descriptive statistics for HIV, syphilis, genitourinary, rectal, and pharyngeal gonorrhea/chlamydia (GC/CT) screening and diagnosis rates. We evaluated relationships between site-specific symptoms and extragenital testing. Results Of 228 individuals in the database, 98% were male at birth, the median age was 34 years. 40% were Hispanic and 27% Black. 50% were living with HIV. Only 41% were tested for other STIs in the two weeks prior to their mpox diagnosis. At the time of their mpox visit, 62.7% of patients were tested for syphilis, with 45.5% showing evidence of active or previously treated syphilis. 67 persons without known HIV were tested for HIV, resulting in 3 new diagnoses within 2 weeks of mpox diagnosis. 57.5% of patients were screened with a genitourinary GC/CT nucleic acid amplification testing (NAAT), with 2.3% and 3.8% positive for gonorrhea and chlamydia, respectively. 46.5% were screened with a rectal GC/CT NAAT, with 16.0% and 6.6% positive for gonorrhea and chlamydia, respectively. 47.4% of individuals were screened with a pharyngeal GC/CT NAAT, with 7.4% and 0.9% positive for gonorrhea and chlamydia, respectively. Site specific GC/CT NAATs were obtained from 52.2%, 55%, and 54% of patients with urinary, rectal and pharyngeal signs or symptoms, respectively. Without extragenital testing, 10 of 28 total gonorrhea cases (35.7%) and 3 of 13 total chlamydia cases (23.1%) would have been missed. Conclusion STI testing was insufficient in people with confirmed mpox, likely leading to under diagnosis of STIs. HIV testing was inadequate in at-risk individuals, and patients presenting with site-specific symptoms were too frequently not offered targeted testing. Disclosures All Authors: No reported disclosures

Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study.

We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May-December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/μL; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/μL. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/μL. PWH with CD4+T-cell < 200 cells/μL were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.

Effectiveness of interventions to reduce sexually transmitted infections and blood-borne viruses in incarcerated adult populations: a systematic review protocol.

This review will identify, synthesize, and make recommendations regarding the effectiveness of interventions to reduce sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in incarcerated adult settings. High-risk sexual behaviors, intravenous drug use, piercing, and tattooing are well documented within incarceration environments. Despite the World Health Organization's Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 and the Global Health Sector Strategies on, Respectively, HIV, Viral Hepatitis, and Sexually Transmitted Infections for the Period 2022-2030, STI rates within adult incarceration environments continue to rise. Identifying and implementing best-practice interventions to prevent and manage STIs and BBVs will aid infection reduction in correctional settings. The review results will inform the development of educational programs, health promotion, and policies and procedures to improve health outcomes for incarcerated populations. This review will consider studies in any language from any adult incarceration facility. Studies set in juvenile facilities or detention centers will be excluded. Any intervention for preventing or reducing STI and/or BBV transmission will be included. This review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched will include PubMed, CINAHL (EBSCO), Ovid Library, PsycINFO (EBSCO), Cochrane CENTRAL, and Scopus. Two independent reviewers will screen titles and abstracts and assess full-text citations against inclusion criteria. Methodological quality will be appraised using JBI's standardized critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, findings will be presented in narrative format. Certainty of evidence will be ascertained using the GRADE approach. PROSPERO CRD42022325077.

Sexually Transmitted Infections and the Risk of Reinfection Within 12 Months: A Population-Based Cohort.

Chlamydia, gonorrhea, and syphilis are common sexually transmitted infections that disproportionately affect specific groups in New Zealand (NZ). Predictors of reinfection are not well studied in NZ but could inform public health strategies to decrease sexually transmitted infection (STI) incidence. New Zealand-wide chlamydia, gonorrhea, and syphilis cases during 2019 were identified using nationally collected data. Cases were followed-up to identify reinfection with the same STI within 12 months of initial infections. Logistic regression models were used to identify predictors for each STI reinfection. Determinants identified for increased odds of chlamydia reinfection were age groups 16-19 and 20-24 years, females, Māori and Pacific peoples, cases in the Northern region, and cases with at least one test before the initial infection. Age 40 years and older was associated with lower odds of gonorrhea reinfection, as was being of Asian ethnicity, living in Midland or Southern regions, and reporting heterosexual behavior. Region was the only statistically significant predictor for syphilis reinfection, with higher odds of reinfection for people living in the Central region. Our findings reflect disproportionate STI rates for some groups in NZ, with younger age groups, Māori and Pacific peoples, men who have sex with men, and people living in the Northern region experiencing higher odds of reinfection. Groups identified with higher odds for reinfection require increased access to culturally responsive health services to treat, understand, and prevent possible reinfection. Changes to current public health strategies could include culturally specific behavioral counseling, and improvements to and adherence to effective contract tracing.