Risk Factors For Sexually Transmitted Infections Research Articles

Determinants of depressive and alcohol use disorders among female sex workers in Ethiopia: evidence from a national bio-behavioral survey, 2020

BackgroundFemale sex workers (FSWs) face an elevated risk of developing mental health disorders and alcohol use disorders (AUD), which in turn increase their vulnerability to HIV and other sexually transmitted infections (STIs) and other negative outcomes. To effectively address both of these health issues, it is crucial to understand the shared key determinants underlying these illnesses, which is a substantial knowledge gap in Ethiopia and elsewhere in the world. Therefore, this study aimed to identify the common key determinants of depression and AUD among FSWs in Ethiopia using a bivariate multivariable ordinal logistic model.MethodsWe analyzed cross-sectional biobehavioral data collected in 2020 from 16 cities and major towns in Ethiopia using the respondent-driven sampling (RDS) technique, which involved a total of 6,085 FSWs. FSWs who had lived at the study sites for at least a month before the study period were deemed eligible for recruitment. Major depressive disorder (DD) and AUD were screened using the Patient Health Questionnaire (PHQ9) and alcohol use disorder identification test (AUDIT), respectively. We used descriptive statistics to summarize study population characteristics and bivariate multivariable ordinal logistic regression (BMOLR) to identify common determinants of DD and AUD combined and their nonnormal correlation.ResultsAmong 6085 FSWs screened for DD and AUD, 13.5% and 4.0% have met the criteria for moderate and severe depressive disorder, respectively, and 20.3% and 34.7% have met the AUDIT criteria for harmful or hazardous behavior and alcohol dependence, respectively. FSW with experience of inconsistent condom use, condom failure, violence, mobility, use of any drugs, non-paying partners, abortion, and selling sex for more than five years were associated with an increase in the severity of both disorders. A high average income from selling sex and the number of paying partners reduced the severity of depression and increased the level of alcohol dependence. Being HIV positive and ever having anal sex were associated only with an increase in depression.ConclusionMajor DD and AUD are prevalent among FSWs in Ethiopia. The findings revealed that common key determinants, which exacerbated the severity of both disorders, were also risk factors for HIV and other STIs. Consequently, integrated STI strategies are essential in the screening, referral, and treatment of depression and AUD. Intervention packages should encompass determinants of depression and AUD, including condom utilization, drug use, mobility between towns, abortion, violence, and counseling services. Additionally, strategies to ensure economic security should be incorporated.

Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review.

Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.

Syphilis Diagnosis After a Chlamydia, Gonorrhea, or HIV Diagnosis Among Reproductive-Aged Women in Baltimore, MD.

Syphilis incidence is increasing among reproductive-aged women, and previous sexually transmitted infections (STIs) are a risk factor for subsequent STIs. This study aimed to determine syphilis incidence after a chlamydia, gonorrhea, or HIV diagnosis, and identify characteristics associated with higher syphilis incidence rates among reproductive-aged women in 1 mid-Atlantic city. A retrospective cohort of 85,113 chlamydia, gonorrhea, and HIV diagnoses occurring between 2009 and 2021 and among women aged 13 to 50 years was constructed using public health surveillance data. Cumulative incidence curves were estimated to examine time to early syphilis (i.e., primary, secondary, or early latent) diagnosis, and multivariable analyses determined incidence rate ratios by age (<25 vs. ≥25 years) and number of prior STI diagnoses (0 vs. ≥1) during the study period, stratified by STI. There were 85,113 reportable STI diagnoses and 646 syphilis diagnoses in the cohort. Approximately 1 of 150 chlamydia, 1 of 100 gonorrhea, and 1 of 50 HIV diagnoses were followed by a syphilis diagnosis within 5 years. Cumulative incidence of syphilis differed significantly by STI diagnosis ( P < 0.001). In multivariable analysis, syphilis incidence rates were higher among women diagnosed with ≥1 (vs. 0) prior STI regardless of STI type ( P < 0.05) and among women ≥25 (vs. <25) years old diagnosed with gonorrhea ( P < 0.05). There were significant differences in syphilis incidence by prior STI type, number of STIs, and age. Our data support targeted screening for syphilis among women with a history of STIs, parwomen with ≥1 prior STI diagnosis, and older women diagnosed with gonorrhea.

Prevalence of HIV, HBV, HCV, HPV and syphilis among female sex workers in Kurdistan, west of Iran.

Female sex workers (FSWs) in most societies run a high risk of health problems, including sexually transmitted infections (STIs) such as viral infections and syphilis. The present study examines the prevalence of viral infections and syphilis among FSWs. This cross-sectional study recruited 100 female sex workers (April 2019 to April 2020) who visited the Counseling Center for Behavioral Diseases or were selected via purposeful (snowball) sampling. A questionnaire (demographic information and STI risk factors) was completed in a face-to-face interview with the participants. Blood samples were then taken to test the markers for HBV, HCV Ab, HIV Ab, Rapid Plasma Reagin (RPR) for syphilis and a PCR was taken to test for HPV (in vaginal sex workers from the cervix and anal sex workers from the anal region). The data were analyzed in Stata 14. Among 100 FSWs, 6 (6%) were infected with HIV, 1 (1%) with hepatitis B, and 2 (2%) were anti-HCV positive. 1 (1%) participant was suspected of having syphilis. Based on the PCR tests, 16 (16%) participants were infected with HPV. Moreover, 68 (68%) FSWs reported having unprotected sex. Due to the prevalence of viral infections and syphilis and unprotected sex in FSWs, immediate preventive measures are critical for this vulnerable group to control the transmission of these viral infections in society.

Gonorrheal and chlamydia yield for genital and extragenital testing in children evaluated for sexual abuse

ObjectiveTexas Forensic Nurse Examiners (TXFNE) performs routine testing of genital and non-genital sites for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), and further testing for other sexually transmitted pathogens. The current Centers for Disease Control and Prevention (CDC) guidelines recommend that testing be based primarily on patient history of type of sexual contact, patient age, community prevalence of sexually transmitted infections (STIs), perpetrator risk factors for STIs, and patient symptoms (Centers for Disease Control and Prevention, 2021). In this study, we were interested in determining whether our practice of testing all sites in all prepubertal patients presenting for sexual abuse for CT and NG resulted in identification of infections that would have been missed if testing had been limited to disclosed sites of sexual contact. MethodsWe conducted a retrospective chart review of all children younger than 14 years who presented to a clinical or hospital site for evaluation by TXFNE in Harris County or surrounding counties during the period January 2020–December 2021. ResultsOf the 675 patients tested, 61 patients (9 %) had genital injuries and 45 patients (7 %) had either reported symptoms or examination findings consistent with possible STI infection. There were 11 patients who had positive gonorrhea and/or chlamydia results. Of the 11 patients with a positive result, 10 patients' reported history of type of contact did not fully match sites that tested positive. Diagnosis of STI infection would have been missed for 5 patients if testing had been limited to the disclosed sites of sexual contact. ConclusionPositive results for CT and NG at undisclosed body sites in children presenting with concern for sexual abuse most likely represent infection from sexual contact. Limiting STI testing based on disclosed contact may lead to missed NG and CT infections in prepubertal patients with concern for sexual abuse. This can lead to delayed treatment of the infection and a missed opportunity to ensure the safety of the child.

Racial Disparities Associated with Increased Burden of Sexually Transmitted Infections in North Carolina, Southeastern United States

Sexually transmitted infections (STIs) constitute a major public health issue in the United States. North Carolina (NC) in the southeastern U.S. ranks among the highest in STI incidence. We aimed to describe the incidence rates and identify potential risk factors of STIs in NC. The STI data reported by the NC Department of Health and Human Services for 2018 were compiled for chlamydia, gonorrhea, syphilis, and HIV infections for all 100 NC counties. Linear regression modeling was used to assess the association of STIs with predefined county-level variables. The mean STI incidence rates per 100,000 persons were highest for chlamydia (592.43 ± 30.02), followed by gonorrhea (212.06 ± 13.75), HIV (12.66 ± 0.947), and syphilis (3.33 ± 0.439). For chlamydia, higher risk was significantly associated with income (β = −0.008, SE = 0.003; p = 0.006), education (some college; β = 10.02, SE = 3.15, p = 0.002), race (Black; β = 12.17, SE = 1.57, p &lt; 0.0001), and number of truck stops (β = 20.20, SE = 6.75, p = 0.004). The same variables, except for education, were associated with higher gonorrhea risk. Only race (being Black) was significantly associated with higher syphilis risk. Racial disparities in STI burden were significant, with race (being Black) constituting a risk factor for all four STIs. Interventions targeted to identified risk factors may help to reduce the STI burden in NC.

Sexually Transmitted Infections in Pre-Exposure Prophylaxis Patients

Background and Objective: Pre-exposure prophylaxis (PrEP) effectively prevents the spread of the human immunodeficiency virus (HIV). HIV is a disease primarily contracted by men who have sex with men or the sharing of needles, syringes, and other drug injection equipment. However, there is some disparity over the thought that PrEP patients have a disproportionate incidence of sexually transmitted infections (STIs) compared with non-PrEP patients. This study aims to clarify the disparity and identify if PrEP patients have a higher incidence of STIs. Methods: A survey of 143 respondents was conducted on STI incidence, risk factors, and abstinence from May 13, 2022, to June 20, 2022. The results were analyzed in Statistical Package for the Social Sciences (SPSS V28.0.0.0). SPSS was used to analyze the descriptive statistics associated with STI data obtained from the Naval Medical Readiness and Training Command, Camp Lejeune, Community Health Clinic Patient and Laboratory Tracker. Results: This study found a higher incidence of STIs among PrEP patients than non-PrEP patients and a statistical significance (p = 0.010) between the number of partners a person had sex with over the past year and the lifetime incidence of STIs. Portions of the data in the linear regression were used to calculate the significance and can be used as a predictor of STIs based on the number of partners a person has. This can help patients within this community understand their actual risk of contracting an STI based on a potential risk factor. Conclusion and Implications for Translation: This study found a higher incidence of STIs among PrEP patients than non-PrEP patients. Additionally, the study can help public health professionals understand the risks associated with military patients who take PrEP and target specific risk factors that influence the disparity in the incidence of STIs. Future studies may use survey data from this study to understand the implications of other risk factors and their association with STIs. Public health professionals can also use these data to develop a predictive index for many risk factors. A predictive index on STI risk is an extremely valuable tool as it allows users to view their risk of obtaining an STI. Copyright © 2023 Sleeman and Hoban. Published by Global Health and Education Projects, Inc.This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Prevalence, incidence and recurrence of sexually transmitted infections in HIV-negative adult women in a rural South African setting.

Sexually transmitted infections (STIs), including syphilis, chlamydia, gonorrhoea and trichomoniasis, are of global public health concern. While STI incidence rates in sub-Saharan Africa are high, longitudinal data on incidence and recurrence of STIs are scarce, particularly in rural areas. We determined the incidence rates of curable STIs in HIV-negative women during 96 weeks in a rural South African setting. We prospectively followed participants enrolled in a randomised controlled trial to evaluate the safety and efficacy of a dapivirine-containing vaginal ring for HIV prevention in Limpopo province, South Africa. Participants were included if they were female, aged 18-45, sexually active, not pregnant and HIV-negative. Twelve-weekly laboratory STI testing was performed during 96 weeks of follow-up. Treatment was provided based on vaginal discharge by physical examination or after a laboratory-confirmed STI. A total of 119 women were included in the study. Prevalence of one or more STIs at baseline was 35.3%. Over 182 person-years at risk (PYAR), a total of 149 incident STIs were diagnosed in 75 (65.2%) women with incidence rates of 45.6 events/PYAR for chlamydia, 27.4 events/100 PYAR for gonorrhoea and 8.2 events/100 PYAR for trichomoniasis. Forty-four women developed ≥2 incident STIs. Risk factors for incident STI were in a relationship ≤3 years (adjusted hazard ratio [aHR]: 1.86; 95% confidece interval [CI]: 1.04-2.65) and having an STI at baseline (aHR: 1.66; 95% CI: 1.17-2.96). Sensitivity and specificity of vaginal discharge for laboratory-confirmed STI were 23.6% and 87.7%, respectively. This study demonstrates high STI incidence in HIV-negative women in rural South Africa. Sensitivity of vaginal discharge was poor and STI recurrence rates were high, highlighting the shortcomings of syndromic management in the face of asymptomatic STIs in this setting.

Sero-prevalence and associated factors of sexually transmitted infections among youth-friendly services Attendees.

Worldwide, more than one million peoples acquire sexually transmitted infections (STIs). The burden of STIs and the youth awareness level on the transmission of STIs is under investigated in Sidama Regional State. To determine the seroprevalence of STIs such as hepatitis B surface antigen (HBsAg), Anti-hepatitis C virus (HCV) antibodies, Human Immunodeficiency virus (HIV) seroprevalence, and syphilis and to determine associated factors among youth-friendly services Attendees at selected health facilities in Hawassa city, Ethiopia. A multicenter cross-sectional study was conducted among 416 randomly selected youth attending youth-friendly services at selected health facilities from May to August 2021. To collect the background characteristics of participants an interviewer-administered questionnaire was used. Blood samples were collected, processed, and tested using Advanced Quality One Step rapid colloidal gold immunochromatographic assay for detection of antibodies for syphilis and hepatitis C virus infection, and hepatitis B virus surface antigen. For the diagnosis of syphilis Rapid Plasma Reagin was also used. HIV1/2 STAT PAK, HIV1/2/O ABON and HIV1/2 SD Bioline were used for testing antibodies for HIV infection. Data entry and analysis were performed using Statistical Package for the Social Sciences (SPSS) version 20.0 software. A crude and adjusted odds ratio with a 95% confidence interval (CI) was computed to identify associated factors. The overall seroprevalence of STIs was 11.5% (48/422), with a 95% CI: (8.7-14.9). Out of the 48 positive results, the proportions of HBsAg, Anti-HCV, HIV, and syphilis were 56.3% (27/48), 27.1% (13/48), 10.4% (5/48), and 6.3% (3/48) respectively. Out of 416 participants, 17.1% responded that it is safe to have sex without using a condom. The Odds of developing STI among female participants, participants who did not identify alcohol intake as a risk factor for STIs, and those who engaged in transactional sex were (AOR = 2.989: 95% CI: 1.27, 7.02), and (AOR = 2.393, 95% CI: 1.18, 4.81) and practice of transactional sex (AOR = 5.527, 95% CI: 1.62, 18.75). STIs are common among youth-friendly services Attendee in Hawassa city The overall STI was significantly associated with sex (females), not able to identify alcohol intake as a risk factor, and practice of transactional sex. High number of (n = 289, 69.5%) participants think that the use of condoms is not effective in preventing STIs and they engage in sexual activity without using condoms.

The profile of sexually transmitted infections of men who have sex with men: A tertiary care center-based comparative cross-sectional study.

Very few studies have compared the prevalence of sexually transmitted infections (STIs) and risk factors particularly among men who have sex with men (MSM) with the non-MSM group. (1) To compare the profile of STIs among MSM and non-MSM attending our STI clinic, (2) To identify the risk factors for STIs among MSM. In this comparative cross-sectional study, we analyzed the records of all male attendees of our STI clinic from March 2015 to March 2020 for demographic details, sexual history, clinical examination and laboratory findings. Chi-square test and logistic regression were utilized in analysis. The number of both MSM and non-MSM attending the clinic increased over 5 years with a more sharp increase in the number of MSM, after 2017. 68.9% of MSM had their first sexual contact before attaining 20 years of age. The most common STIs were syphilis (53.75%), genital warts (30%) and herpes genitalis (20.62%). Syphilis was the most frequent STI among MSM (48/74, 64.90%) as well as non-MSM (38/86, 44.20%); though its frequency was significantly more among MSM (P < 0.01). Being unmarried (odds ratio [OR] = 3.58, 95% confidence interval [CI] = 1.85-6.93, P < 0.01), having more than two sexual partners (OR = 4.49, 95% CI = 2.12-9.50, P < 0.01), practising peno-oral sex (OR = 4.74, 95% CI = 2.33-9.62, P < 0.01) and peno-anal sex (OR = 19, CI = 8.55-42.38, P < 0.01) were significantly associated with MSM behavior. There was an increasing trend of MSM attending the STI clinic from the year 2017. MSM persons are likely to be younger, unmarried, and have more than two sex partners. The commonest STI among MSM was syphilis.

Prevalence of Chlamydia trachomatis, Mycoplasma genitalium, and Neisseria gonorrhoeae infections in a screening program for under‐30‐year‐old pregnant women with a high participation rate in northern Spain (2016–2020)

AbstractObjectiveTo assess a screening program for sexually transmitted infections (STIs) in under‐30‐year‐old pregnant women, focusing on Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections, which though often asymptomatic, may significantly affect women's health and can be vertically transmitted.DesignProspective, descriptive, observational study.SettingGipuzkoa (Basque Country, Spain).PopulationUnder‐30‐year‐old pregnant women.MethodsBetween 2016 and 2020, cervical samples were taken at first prenatal appointments from 3051 women. STIs were detected by multiplex nucleic acid amplification.Main Outcome MeasuresPrevalence of infections by age and geographical origin groups, and screening coverage.ResultsThe coverage rate was 86% between 2017 and 2020. At least one STI was detected in 5.2% of the under‐30‐year‐olds screened (95% confidence interval [CI]: 4.5%, 6.1%): C. trachomatis in 4%, M. genitalium in 1.3% and N. gonorrhoeae in 0.1%. C. trachomatis and M. genitalium prevalence rates were higher among younger women (7.2% and 2.8%, respectively in under‐25‐year‐olds), while C. trachomatis prevalence in 25‐ to 30‐year‐olds was 2.5%. C. trachomatis was more common among Latin American women (9.7% [95% CI: 7.4%, 12.3%] vs. 2.5% [95% CI: 2.0%, 3.2%] in other women). Additionally, analysing samples from 708 pregnant over‐30‐year‐old women with STI risk factors, 1.6% had at least one of the STIs studied. Notably, 20% of all cases had STI‐related symptoms or complications during pregnancy.ConclusionsThe high coverage achieved, and prevalence, clinical and epidemiological results support the view that the implementation of a screening program across Spain for C. trachomatis in under‐30‐year‐old pregnant women would be both feasible and appropriate.Tweetable abstractHigh Chlamydia trachomatis infection prevalence (4%) and coverage (&gt;80%) in local program support pregnancy screening across Spain.

Differences in HIV, STI and Other Risk Factors Among Younger and Older Male Sex Workers Who Have Sex With Men in Nairobi, Kenya.

IntroductionPrevious surveys of male sex workers (MSW) in sub-Saharan Africa have not fully documented the HIV and sexually transmitted infections (STIs) rates and vulnerabilities by age category.MethodsThe bio-behavioral survey of MSW in Nairobi, Kenya, utilized respondent-driven sampling to recruit MSW. Structured interviews captured MSW's behavioral aspects, and biological tests for HIV and other STIs.ResultsAnalysis of the two age categories, 18–24 years (younger MSW) and 25 years and above (older MSW), shows that of all participants, a significantly higher proportion of younger MSW (59.6% crude, 69.6% RDS-adjusted) were recruited compared to older MSW (40.4% crude, 30.4% RDS-adjusted, P < 0.001). Young male sex workers were more likely to report multiple sexual partnerships in the last 12 months and had multiple receptive anal intercourses (RAI) acts in the last 30 days than older MSW: 0–2 RAI acts (20.6 vs. 8.6%, P = 0.0300), 3–5 RAI acts (26.3 vs. 11.5, P < 0.001), and >5 RAI acts (26.3 vs. 11.5%, P < 0.01). Furthermore, younger MSW were significantly more likely to have 3–5 insertive anal intercourse (IAI) with a regular male sex partner in the last 30 days than older MSW (24.3 vs. 8.0%, P < 0.01). Younger MSW were also more likely to report other STIs [28.5% (95% CI: 19.1–40.4%)] than older MSW [19.0% (95% CI: 7.7–29.2%)]. However, older MSWs were more likely to be infected with HIV than younger MSW (32.3 vs. 9.9 %, P < 0.01).ConclusionsOwing to the high risk sexual behaviors, HIV and STIs risks among younger and older MSW, intensified and targeted efforts are needed on risk reduction campaigns and expanded access to services.

Trends in risk behaviors and sexually transmitted infections among youth presenting to a sexually transmitted infection clinic in the United States, 2013-2017.

Background: Sexually transmitted infections (STIs) are increasing among adolescents and young adults (AYA) across the United States. However, data are scarce on trends in condom use, number of partners, and other STI risk factors among AYA. The present study evaluated associations between sexual behaviors and STI diagnoses over time among AYA. Methods: We evaluated linked encounters of AYA aged 13-26 attending an urban Northeast public STI clinic from 2013-2017. Demographics, risk behaviors, self-reported past year and lifetime STI, and STI diagnosis during clinic encounter (positive test for urine, oral, or anal chlamydia; urine, oral, or anal gonorrhea; urine trichomonas; HIV; and syphilis) were extracted from electronic health records. We estimated prevalence and performed trend analyses of the repeated cross-sectional data. Cochran-Armitage and Kruskal-Wallis trend test were conducted for categorical and continuous variables, respectively. Results: Among 3822encounters, clinical STIs demonstrated statistically significant increases including chlamydia (+9%, p = 0.001), gonorrhea (+5%, p = 0.008), and syphilis (+3%, p = 0.006) all of which significantly increased over time, as did any STI (+10%, p < 0.001). HIV and trichomonas rates remained low and unchanged. Self-reported STI increased as well, both past year (+9%) and lifetime (+14%). Greater proportions of AYA reported multiple partners (+9%, p < 0.001), and condomless oral (+12%, p = 0.001) and vaginal/anal (+7%, p = 0.001) sex. Conclusion: Among AYA presenting to a STI clinic, the proportion who engaged in condomless sex and had multiple partners increased over a 5year period, which corresponded to increased STI prevalence during this period. Preventions efforts for AYA should continue to emphasize the importance of condoms and partner selection.

Prevalence of sexually transmitted infections in patients with schizophrenia in Morocco

People with schizophrenia are likely to be overrepresented in high-risk categories for sexually transmitted infections (STIs). We aimed to determine the seroprevalence of HIV, HBV, HBC, and syphilis in these patients. Sociodemographic and clinical characteristics of 444 patients were collected, as well as risk factors for STIs. Serological tests were performed. Lifetime seroprevalence rates were 0.0% for HIV, 1.6% for HBV, 0.9% for HBC, and 3.6% for syphilis. These figures are lower than those reported in the general population except for syphilis. Only 0.45% of patients were seropositive for both HBV and syphilis. No higher rates of HBV, HBC, and HIV seroprevalence were observed compared with the general population, except for syphilis.

Bacterial sexually transmitted infections and syndromic approach: a study conducted on women at Moroccan University Hospital.

In Morocco, a syndromic approach has been implemented for sexually transmitted infections (STIs) management. However, those infections can be asymptomatic and the use of the syndromic approach to their management can be inappropriate and lead to dissemination of infection. Therefore, it would be important to determine the epidemiology and risk factors of bacterial STIs (Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG)) in a Moroccan population and their association with symptoms to assess the appropriacy of the use of the syndromic approach. Cervical samples were collected from symptomatic and asymptomatic consenting women attending the University Hospital of Fez and were tested by PCR for NG, CT and MG using specific primers. We assessed the infection status and its association with different risk factors and genital STIs-related symptoms. Of 809 tested for CT, NG and MG, 16.6% tested positive for at least one STI. Of the 134 participants who tested positive for at least one bacterial STI, 74.2% had no genital STIs-related symptoms. Moreover, the results showed a significantly high rate of NG and MG infections in asymptomatic women. However, the determined risk factors for NG, MG and CT infections were menopause (p=0.002), oral contraception (p=0.036) and a high number of parities (p=0.048), respectively. This investigation shows a predominance of NG infection and a high prevalence of STIs in asymptomatic patients. These results highlight that the adopted syndromic approach will not be adapted in the management of these STIs. Thus, the implementation of a systematic diagnostic program in order to enhance their management is needed.

Value of Packaged Testing for Sexually Transmitted Infections for Persons who Inject Drugs Hospitalized With Serious Injection-Related Infections.

BackgroundPersons who inject drugs (PWID) are frequently admitted for serious injection-related infections (SIRIs). PWID are also at risk for sexually transmitted infections (STIs).MethodsWe conducted a multicenter quality improvement project at 3 hospitals in Missouri. PWID with SIRI who received an infectious diseases consultation were prospectively identified and placed into an electronic database as part of a Centers for Disease Control and Prevention–funded quality improvement project. Baseline data were collected from 8/1/2019 to 1/30/2020. During the intervention period (2/1/2020–2/28/2021), infectious diseases physicians caring for patients received 2 interventions: (1) email reminders of best practice screening for HIV, viral hepatitis, and STIs; (2) access to a customized EPIC SmartPhrase that included checkboxes of orders to include in assessment and plan of consultation notes. STI screening rates were compared before and after the intervention. We then calculated odds ratios to evaluate for risk factors for STIs in the cohort.ResultsThree hundred ninety-four unique patients were included in the cohort. Initial screening rates were highest for hepatitis C (88%), followed by HIV (86%). The bundled intervention improved screening rates for all conditions and substantially improved screening rates for gonorrhea, chlamydia, and syphilis (30% vs 51%, 30% vs 51%, and 39 vs 60%, respectively; P < .001). Of patients who underwent screening, 16.9% were positive for at least 1 STI. In general, demographics were not strongly associated with STIs.ConclusionsPWID admitted for SIRI frequently have unrecognized STIs. Our bundled intervention improved STI screening rates, but additional interventions are needed to optimize screening.

High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing.

To our knowledge, there are no studies estimating the prevalence of extragenital sexually transmitted infections (STIs) among pregnant adolescents in the Caribbean. This study sought to fill this gap by assessing the prevalence and correlates of oral, genital, and rectal chlamydia (CT) among a sample of pregnant adolescents in La Romana, Dominican Republic. Two hundred pregnant youths, aged 15-24years, were recruited by systematic sampling during their first prenatal visit to a maternal care unit. A sociodemographic and behavioral questionnaire was administered and urine and oral/anal swabs were collected and tested for CT. Descriptive analyses and Fisher's exact tests were performed. The prevalence of oral, genital, and rectal CT was 6%, 15%, and 23%, respectively, although less than 5% of participants reported ever engaging in receptive anal intercourse. This discrepancy could be explained by autoinoculation, concurrent transmission during sex, undertreatment of rectal CT, or underreporting of anal sex. Almost half of CT infections would have been missed if only genital samples were collected, as current protocol dictates. More research is needed to understand sexual behaviors and rectal STI risk factors among heterosexual adolescent women. STI screening procedures for pregnant and sexually active adolescents should include routine testing of extragenital sites.

Association of Marital Status in the Testing and Treatment of Sexually Transmitted Infections in the Emergency Department.

IntroductionSexually transmitted infections (STIs) are frequently tested for and treated in the emergency department (ED). Age, race, and number of sexual partners are known risk factors for STIs. The objective of the current study was to examine marital status as it relates to testing and treating for STIs in the ED.MethodsA database of 75,000 ED patient encounters from a single healthcare system in northeast Ohio between April 18, 2014, and March 7, 2017, was examined. All patients in the dataset underwent a urinalysis and urine culture or received STI testing in the ED. We performed Chi-square and multivariable regression analysis to examine the relationships between the patient's marital status and testing and treatment for STIs performed in the ED.ResultsThere were 20,965 patient encounters where STI testing was performed and was analyzed. Patients were 9.1% (N=1,912) married, 86.6% (N=18,149) single, 4.0% (N=837) were neither married nor single, and 0.3% (N=67) with an unknown marital status. There were 7.1% (19/267) and 4.9% (12/267) of tested married men who were infected with gonorrhea and chlamydia, respectively, whereas only 0.4% (6/1,583) and 2.2% (35/1,588) of tested married women were infected with gonorrhea and chlamydia, respectively. Single men and women were both significantly more likely to have a positive test for gonorrhea and chlamydia compared to married men and women, respectively (P<0.001). Married men and women, compared to single men and women, respectively, were more likely to be given antibiotics for gonorrhea and chlamydia in the ED when the infection was present and not be given antibiotics for the infections when testing was negative (P<0.001). Single women (9.1%; 1,291/14,258) were more likely than married women (4.9%; 75/1,534) to have a positive test for trichomonas, but there were no significant differences between married (1.0%; 1/100) and single men (0.7%; 6/893).ConclusionEven when accounting for age and race, marital status can help predict infection with gonorrhea and chlamydia in the ED. The marital status could be considered by clinicians when risk stratifying patients regarding testing and treating for the diseases in the ED. Gonorrhea and chlamydia are much more common in single men and women and much less common in married persons. However, married men tested for gonorrhea and chlamydia were more than twice as likely to test positive for infection than married women. Married men and women were both more likely to be appropriately treated with antibiotics for gonorrhea and chlamydia in the ED (i.e., testing negative for infection and not receiving antibiotics or testing positive and receiving antibiotics) compared to non-married men and women. While trichomonas was more common in single women than married women, the infection was less common in men, and both married men and single men had similar rates of testing positive for the infection.

A Collaborative Intervention Between Emergency Medicine and Infectious Diseases to Increase Syphilis and HIV Screening in the Emergency Department.

Sexually transmitted infections (STIs) are a common reason for evaluation in the emergency department (ED). Given the overlapping risk factors for STIs, patients screened for gonorrhea and chlamydia should be tested for syphilis and HIV. Syphilis and HIV testing rates in the ED have been reported to be low. The study objective was to examine whether collaboration between emergency medicine (EM) and infectious disease (ID) providers improved syphilis and HIV testing in the ED. A multidisciplinary team of EM and ID providers was formed to identify and address barriers to syphilis and HIV testing in the ED. Syphilis, HIV, chlamydia, and gonorrhea testing and infection rates were calculated and compared during 2 time periods: preintervention (January 1, 2012-December 30, 2017) and postintervention (November 1, 2018-November 30, 2019). We also extracted clinical and laboratory data from patients with positive syphilis and HIV results during the study period. The most commonly cited barrier to syphilis and HIV testing was concern about follow-up of positive results. Compared with the preintervention period, syphilis and HIV testing rates increased significantly in the postintervention period (incidence rate ratios, 30.70 [P < 0.0001] and 28.99 [P < 0.0001] for syphilis and HIV, respectively). The postintervention period was also associated with a significant increase in the identification of patients with positive syphilis and HIV results (incidence rate ratios, 7.02 [P < 0.0001] and 2.34 [P = 0.03], respectively). Collaboration between EM and ID providers resulted in a significant increase in syphilis and HIV testing and diagnosis in the ED.

Profiles of young women’s alcohol and cannabis use linked to risk for sexually transmitted infection highlight the importance of multi-level targeted interventions: Findings from the Pittsburgh girls study

Background: Social ecological models designed to understand disparities in sexually transmitted infection (STI) prevalence highlight understudied structural and community risk factors. Guided by a social ecological model, this study identified profiles based on substance use-related STI risk, and examined associations of the profiles with selected indicators of structural-, community-, and individual-level STI risk factors. Methods: Repeated measures latent class analysis was applied to Pittsburgh Girls Study data (n = 2,138; 58% Black, 42% White) at ages 18–20. Profile indicators included: women’s and partner’s alcohol and cannabis use, women’s sexual risk behavior, and self-reported STI. Profile predictors included racial background, structural-, community-, and individual-level risk factors. Results: Two of the five identified profiles had low STI likelihood: “Low Use” of alcohol and cannabis (25.5%; overrepresented by Black women), and “Alcohol Only” (19.1%; overrepresented by White women). Three profiles, all representing co-use of alcohol and cannabis, had higher STI likelihood: “Co-Use: Increasing Alcohol and Occasional Cannabis use” (16.5%; overrepresented by White women), “Co-Use: Occasional Alcohol and Cannabis use” (26.1%; overrepresented by Black women), and “Co-Use: Frequent Cannabis and Occasional Alcohol use” (12.8%; overrepresented by Black women). Structural STI risk (household use of public assistance at wave 1) was associated with “Low Use” and “Co-Use: Frequent Cannabis and Occasional Alcohol use” profiles. STI risk at multiple levels (structural, neighborhood, individual) was associated with the “Co-Use: Frequent Cannabis and Occasional Alcohol use” profile. Conclusions: Co-use of alcohol and cannabis is an important target for STI prevention efforts. Results also highlight structural- and community-level STI risk factors that disproportionately impact Black women, and the importance of multi-level interventions that are targeted to profile of risk to optimize the effectiveness of interventions.