Self-reported Sexually Transmitted Infections Research Articles

Self-reported sexually transmitted infections among men and women in Papua New Guinea: A cross-sectional study.

Sexually transmitted infections (STIs) pose a considerable concern for global healthcare systems. We examined the prevalence and correlates of self-reported STIs (SR-STIs) among men and women in Papua New Guinea. A total of 7,195 women and 4,069 men from Papua New Guinea who participated in the 2016-2018 Demographic and Health Survey were included in this study. Percentages were used to summarize the prevalence of SR-STIs among men and women. A multivariable multilevel binary logistic regression was used to examine the correlates of SR-STIs in men and women. An overall 5.9% and 4.6% prevalence of SR-STIs were recorded among women and men, respectively, in Papua New Guinea. The odds of SR-STIs were higher among women who ever tested for HIV (aOR = 2.47, CI: 1.80-3.39), those who had first sex below 20 years (aOR = 1.76, CI: 1.10-2.80), those who watched television less than once a week (aOR = 1.83, CI: 1.13-2.95) and those from the Highlands and Momase regions (aOR = 5.55, CI: 3.30-9.33) compared to their counterparts who never tested for HIV, who had their first sexual intercourse when they were 20 years and above, who did not watch television at all, and those from the Southern Region. For men, the odds of SR-STIs were high among those who ever tested for HIV (aOR = 1.65, CI: 1.11-2.45), those with one (aOR= 2.08, CI: 1.05-4.14) and two or more (aOR = 3.77, CI: 1.49, 9.52) sexual partners excluding spouse in the 12 months preceding the survey, those living in the Highlands region (aOR = 2.52, CI: 1.48-4.29), and those living in communities with medium literacy level (aOR = 2.33, CI: 1.38-3.94) compared to their counterparts who had never tested for HIV, those with zero sexual partners excluding their spouse in the 12 months preceding the survey, those living in the Southern region, and those living in communities with low literacy levels. We recommend that the National AIDS Council of Papua New Guinea through the National HIV and STI 2018-2022 Strategy program should be realigned to address these correlates and ensure that more sexual and reproductive health resources are provided to men and women in the Highlands and Momase regions.

The Prevalence of Sexually Transmitted Infections and Subsequent Association with Exposure to Childhood Violence and Mental Health Outcomes for Adolescents and Young Adults in Zimbabwe

Sexually transmitted infections (STIs) represent a major public health concern for young people in developing nations, impacting approximately two-thirds of individuals below the age of 25. This study examined the prevalence and the association between self-reported STIs, childhood violence exposure, and mental health outcomes among adolescents and young adults (13-24 years old) in Zimbabwe. Secondary data from the 2017 Zimbabwe Violence Against Children and Youth Survey (n=8,715) was utilized. Data analysis was performed using chisquare to determine the prevalence estimates for bivariate. Seven logistic regression models were used to examine the significant association between independent variables and outcomes for multivariate. About 45.5% of adolescents and young adults with self-reported STIs were exposed to multiple forms of childhood violence, 49.8% reported lifetime suicide risk, and 44.9% reported moderate-to-severe mental distress in the past 30 days. Furthermore, logistic regression results indicated that adolescents and young adults with self-reported STI diagnoses were more likely to be exposed to multiple forms of childhood violence, including physical, emotional, and sexual violence, as well as mental distress in the past 30 days and lifetime suicide risk compared to those without STIs. Therefore, this study underscores the importance of implementing comprehensive public health strategies to protect the wellbeing of adolescents and young adults with STIs. Interventions should also prioritize raising awareness, destigmatizing STIs, implementing and strengthening violence prevention policies, and addressing mental health problems through community mental health treatment programs in Zimbabwe. Keywords: Childhood violence, Emotional violence, Exposure, Mental distress, Physical violence, Sexual violence, Sexually transmitted infections (STIs), Suicide risk, Zimbabwe.

Prevalence and risk factors of sexually transmitted infections in the setting of a generalized HIV epidemic-a population-based study, western Kenya.

Sexually transmitted infections (STIs) cause adverse health outcomes, including increasing HIV acquisition/transmission risk. We analyzed data from an HIV biomarker and behavioral survey to estimate STI prevalence, and explore associated factors in the setting of a generalized HIV epidemic in Siaya County, western Kenya. Data were collected in March-September 2022 through face-to-face interviews using structured questionnaires; records from 9643 sexually active participants aged 13+ years were included in the analysis. We calculated weighted self-reported STI prevalence, by sex, age, and HIV status and explored associated factors using multivariable logistic regression. Median age was 37 years and 59.9% were female; HIV prevalence was 18.0%. Overall STI prevalence was 1.8%; 1.5-fold higher among males vs. females, and 2.6-fold higher among participants living with HIV vs. those without. HIV status and multiple sexual partners were independently associated with STI in both sexes. Mind-altering substance use and being circumcised were associated with STI among males. This study estimates STI prevalence in the setting of high HIV prevalence. Findings underscore the importance of: effective STI screening in HIV clinics and HIV testing and counseling in STI clinics; screening and counseling on substance use, and HIV pre-exposure prophylaxis; and intensive sexual health counseling in male circumcision programmes.

Understanding the Effects of Trauma Exposure, Life Stress, Intimate Partner Violence, and Depression on Sexually Transmitted Infection Risk in Post-Conflict Liberia.

In sub-Saharan Africa, sexually transmitted infections (STIs) are a public health concern. The impact of STIs are exacerbated in post-conflict low- and middle-income countries, such as Liberia, where exposure to traumatic events is prevalent and access to mental health services are limited. Following a syndemics framework, this study used regression analyses to explore the independent, additive, and multiplicative effects of four psychosocial conditions (exposure to war-related traumatic events, intimate partner violence [IPV], stressful life events, and depressive symptoms) on self-reported STIs. Data were collected from 379 youth aged 18-30 years (n = 170 women; n = 179 men) in Montserrado County, Liberia. Results revealed that psychosocial variables correlated with each other and STI risk. In multivariable analysis, stressful life events, depressive symptoms, and IPV were statistically significant predictors of STI risk. We found support for an additive effect between the number of psychosocial conditions reported and STI risk, as well as a multiplicative effect (interaction) between IPV and depressive symptoms on STI risk. Our results suggest a synergy between experiencing psychosocial conditions and STI risk and point to the potential benefit of multi-level sexual health approaches that simultaneously address mental health and IPV among youth in Liberia.

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.

Identifying risk factors for sexually transmitted infections and enhancing testing among sexual minority women in China: a national cross-sectional study

ABSTRACT Evidence showed a greater risk of sexually transmitted infections (STIs) among sexual minority women (SMW). Limited studies investigated characteristics and sexual health among Chinese SMW. To fill the current gaps, the research group launched the first national survey to explore sexual behavior and health outcomes among SMW in China. The study recruited participants online during Nov. 1–15, 2020, and disseminated online questionnaires to harvest participants’ sexual behaviors and self-reported STIs in the past year. All the participants read and signed an online informed consent form. Adjusted odds ratio (AOR) and 95 percent confidence intervals (CIs) were calculated in the analysis. Sex toy use (AOR = 1.5; 95 percent CI: 1.3, 1.7), G-spot exploration (AOR = 1.5; 95 percent CI: 1.2, 1.7), symptoms in the past year (AOR = 3.8; 95 percent CI: 3.1, 4.6), and self-reported STIs (AOR = 2.0; 95 percent CI: 1.6, 2.7) were associated with symptoms during sex. Factors associated with self-reported STIs were having first-time sex with a male (AOR = 2.0; 95 percent CI: 1.5, 2.5), digital-vaginal contact (AOR = 2.3; 95 percent CI: 1.1, 4.5), sexual intercourse with a male in the past year (AOR = 1.8; 95 percent CI: 1.2, 2.5), symptoms during sex (AOR = 2.0; 95 percent CI: 1.5, 2.6), and symptoms in the past year (AOR = 6.1; 95 percent CI: 4.8, 7.8). SMW reported risk behaviors for STIs, and women who have sex with women and men (WSW/M) were more susceptible to the infections. Tailored interventions should be developed to raise awareness of STIs and increase STI testing uptake.

Predictors of self-reported sexually transmitted infections among Turkish university students.

Sexually transmitted infections (STIs) are among the most crucial health problems that sexually active university students may encounter. This study aims to identify the predictors of self-reported STIs among university students. Study participants were 2,241 individuals who reported having had sexual intercourse among a cohort of 9,693 students surveyed from 21 Turkish universities. The age of participants ranged from 17 years to 28 years. The Chi-Square Automatic Interaction Detection (CHAID) analysis indicated that gender was the main predictor of self-reported STI. Also, number of partners and substance use were found as predictor variables for males. Finally, the classification accuracy of the CHAID model was found to be 95.3% within the sample. The present findings shed light on risk factors for STI acquisition, suggesting possible directions for tailoring future preventive interventions.

Comparison of the burden of self-reported bacterial sexually transmitted infections among men having sex with men across 68 countries on four continents

BackgroundMen who have sex with men (MSM) are in general more vulnerable to sexually transmitted infections (STIs) than the heterosexual men population. However, surveillance data on STI diagnoses lack comparability across countries due to differential identification of MSM, diagnostic standards and methods, and screening guidelines for asymptomatic infections.MethodsWe compared self-reported overall diagnostic rates for syphilis, gonorrhea, and chlamydia infections, and diagnostic rates for infections that were classified to be symptomatic in the previous 12 months from two online surveys. They had a shared methodology, were conducted in 68 countries across four continents between October 2017 and May 2018 and had 202,013 participants.ResultsUsing multivariable multilevel regression analysis, we identified age, settlement size, number of sexual partners, condom use for anal intercourse, testing frequency, sampling rectal mucosa for extragenital testing, HIV diagnosis, and pre-exposure prophylaxis use as individual-level explanatory variables. The national proportions of respondents screened and diagnosed who notified some or all of their sexual partners were used as country-level explanatory variables. Combined, these factors helped to explain differences in self-reported diagnosis rates between countries. The following differences were not explained by the above factors: self-reported syphilis diagnoses were higher in Latin America compared with Europe, Canada, Israel, Lebanon, and the Philippines (aORs 2.30 – 3.71 for symptomatic syphilis compared to Central-West Europe); self-reported gonorrhea diagnoses were lower in Eastern Europe and in Latin America compared with all other regions (aORs 0.17-0.55 and 0.34 - 0.62 for symptomatic gonorrhea compared to Central-West Europe); and self-reported chlamydia diagnoses were lower in Central East and Southeast Europe, South and Central America, and the Philippines (aORs 0.25 - 0.39 for symptomatic chlamydia for Latin American subregions compared to Central West Europe).ConclusionsPossible reasons for differences in self-reported STI diagnosis prevalence likely include different background prevalence for syphilis and syndromic management without proper diagnosis, and different diagnostic approaches for gonorrhea and chlamydia.

Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda.

Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment seeking in low-resource settings is rare. This population-based study aimed to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a survey and STI testing among all consenting adults aged 18-49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both males and females, having multiple STI related symptoms was positively associated with clinic treatment seeking (males = PRR: 1.73, 95%CI: 1.36-2.21; females = PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of males and females who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment for recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.

Self-reported sexually transmitted infections among adolescent girls and young women in Mali: analysis of prevalence and predictors

ObjectiveTo examine the prevalence and predictors of self-reported sexually transmitted infections (SR-STIs) among adolescent girls and young women in Mali.DesignWe performed a cross-sectional analysis of data from the Demographic and...

Risk Prediction Score for Screening Asymptomatic Sexually Transmitted Infections in HIV-positive French Men Who Have Sex with Men (ANRS 9520 DRIVER).

Asymptomatic sexually transmitted infections (STI) are frequent among men who have sex with men (MSM). Identifying asymptomatic STIs is a crucial issue, not only for secondary but also for primary prevention, as early treatment can reduce transmission risk. We aimed to develop a self-reported predictive score for early identification of asymptomatic STIs. Participants provided clinical data and completed a self-administered questionnaire including sociodemographic variables and behaviors during the 6 previous months. We used multivariable logistic regression to identify factors associated with asymptomatic STIs. We calculated the accuracy of the model by the non-parametric area (AUC) under the receiver-operating-characteristic (ROC) curve to find the optimal discriminant threshold for screening. A total of 781 HIV-positive MSM were included with a mean age of 46.8 years. Asymptomatic STI prevalence was 13.2%. Detectable plasma HIV RNA (adjusted odds ratio (aOR [95% CI): 2.54 [1.23;5.25]), inconsistent condom use during anal sex (2.20 [1.36;3.56]), group sex (2.00 [1.15;3.45]), during or-genital practices (1.83 [1.12;3.01]), not being in stable relationship (1.70 [1.01;2.66] and an item from a sensation-seeking behavioral scale "I don't like watching porn videos" (1.61 [1.01;2.59] were associated with asymptomatic STI. AUC was 0.7 and with optimal threshold of 0.1082 for this model; sensitivity was 80.4%. Self-reported asymptomatic STI predictive score was built with this threshold according to the 6 factors in the final model. As this predictive score is not designed to be diagnostic, but to provide indications for diagnostic tests, its ease of administration and sensitivity remain the most important features. Its use in clinical practice for early detection of asymptomatic STIs potentially can reinforce STI primary and secondary prevention.

Analysis of Heavy Rainfall in Sub-Saharan Africa and HIV Transmission Risk, HIV Prevalence, and Sexually Transmitted Infections, 2005-2017

Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown. To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa. A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022. Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level. HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners. The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas. The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment.

Magnitude and Associated Factors for Sexually Transmitted Infections Among Hawassa Industrial Park Workers, Southern Ethiopia

Sexually Transmitted Infections (STI) are a group of infectious diseases spread through unprotected sexual intercourses, resulting in curable and incurable diseases. The syndrome is a variety of clinical signs and symptoms caused by pathogens that can be acquired and transmitted through sexual activity. Around the world estimated about 376 million people become infected each year with one of four common curable STIs where about 86 million new cases of curable STIs occurred in the African region. The objective of this study to assess the magnitude and associated factors for Sexually transmitted infections in 2020 among Hawassa industrial park workers, Southern Ethiopia. The multistage sampling technique was used to select a total of 663 study participants. The data were entered into the Epi-Data version 4.4 and analyzed by SPSS version 21. Both bivariate and multivariable logistic regression analyses were employ P-values of <0.05 and AOR with 95%CI was used to determine the presence of association between covariates and dependent variable.. The Self-reported STI magnitude in the last 12 months was 18.7% (18.54-18.91) among the Hawassa industry park workers. Hometown residence [AOR=2.29; 95%CI: 1.34-3.92], drinking alcohol (AOR=3.26; 95%CI: 1.74-6.09), view/read pornography (AOR=4.38; 95%CI: 2.67-7.18) and poor knowledge (AOR=2.69; 95%CI: 1.65-4.420 were significantly associated with the magnitude of STIs. The Self-reported magnitude of STIs among Hawassa Industrial Park was found to be high.

Sexually Transmitted Infections Diagnosed Among Sexual and Gender Minority Communities During the First 11 Months of the COVID-19 Pandemic in Midwest and Southern Cities in the United States.

The COVID-19 pandemic adversely affected sexual health services. Given the burden of sexually transmitted infections (STIs) on sexual and gender minorities (SGMs), we estimated incidence of self-reported STI diagnoses and factors associated with STI diagnoses among SGMs during the pandemic's first year. A cohort of 426 SGM persons, 25 years or older, recruited in Chicago, Milwaukee, Detroit, Minneapolis, and Houston completed 5 online surveys from April 2020 to February 2021. Persons self-reported on each survey all health care provider STI diagnoses. Kaplan-Meier was used to estimate the cumulative risk of STI diagnoses, stratified by human immunodeficiency virus (HIV) status. Factors associated with STI diagnoses were assessed with a longitudinal negative binomial regression. Median age was 37 years, and 27.0% were persons living with HIV (PLH). Participants reported 63 STIs for a cumulative incidence for PLH and HIV-negative persons of 0.19 (95% confidence interval [CI], 0.13-0.29) and 0.12 (95% CI, 0.09-0.17), respectively. Regardless of HIV, a younger age and changes in health care use were associated with STI diagnoses. Among HIV-negative persons, the rate of STI diagnoses was higher in Houston than the Midwest cities (adjusted relative risk, 2.37; 95% CI, 1.08-5.20). Among PLH, a decrease in health care use was also associated with STI diagnoses (adjusted relative risk, 3.53; 95% CI, 1.01-12.32 vs no change in health care services), as was Hispanic ethnicity and using a dating app to meet a sex partner. Factors associated with STI diagnoses during the COVID-19 pandemic generally reflected factors associated with STI incidence before the pandemic like geography, HIV, age, and ethnicity.

Differences in Sexual Behavior and Partner Notification for Sexually Transmitted Infections Between the Out of School Youth and University Students in a Peri-Urban District in South Africa-A Cross-Sectional Survey.

The increase in sexually transmitted infections (STIs) in young people is a public health concern. Among those in university and out of school, different contextual factors contribute to their risky sexual behavior and increased susceptibility to STIs and HIV. There are limited comparative studies examining risky sexual behavior and partner notification (PN) between these two groups, particularly in South Africa. We investigated sexual behaviors, self-reported STI diagnosis, health seeking behavior, and preferred PN methods of university students and out of school youth. A descriptive cross-sectional survey was used using convenient sampling to select 917 students across five health sciences universities and through periodic sampling 699 out of school youth were selected from two main local shopping centers in South Africa. Descriptive statistics, bivariate and multivariable logistic analysis were performed using Stata IC version 14. More university students (71.7%) than out of school youth were in casual relationships (28.3%), with half of out of school youth being in steady relations (50.2%). Moreover, university students (65.7%) used a condom in the past 6 months compared to their counterparts (34.3%). Of the 124 youth who were diagnosed with STI in the past 12 months, majority (n = 106, 85%) were out of school youth. The probability of notifying a partner about a STI infection was 82% among university students compared to their counterparts (p = >0.05). The odds of notifying a partner was 1.79 times more for those having multiple sexual partners than those who had only one partner. Both groups preferred a face-to-face STI disclosure with partner; however, more university students (67%) preferred SMS notification than PN referral slips as compared to out of school youth (42%). Both the university students and the out of school youth engaged in risky sexual behaviors. Both groups preferred face-to-face and clinic SMS partner notifications, even though university students were in the majority. There is a need for developing health promotion scripts on disclosing STIs to sexual partners to empower the majority of the youth who prefer face-to-face PN over the prescribed methods.

Prevalence and Correlates of Sexually Transmitted Infections in Transgender People: An Italian Multicentric Cross-Sectional Study.

The burden of sexually transmitted infections (STIs) in the transgender population remains an underestimated issue. The aims of the present study were to evaluate the prevalence of either self-reported and serological STIs and to describe socio-demographic and clinical characteristics of transgender individuals with STIs. A consecutive series of 705 transgender individuals (assigned-male at birth, AMAB n = 377; assigned-female at birth, AFAB n = 328) referring to six Italian gender clinics were included. Sociodemographic and clinical information was collected during the first visit. In a subsample of 126 individuals prevalence of STIs (human immunodeficiency virus, HIV; hepatitis C, HCV; hepatitis B, HBV; syphilis) were evaluated through serology tests. The self-reported prevalence of HIV, HBV, HCV and syphilis infection in the total sample were 3.4%, 1.6%, 2.6% and 2.0%, respectively. In the subsample who underwent serological tests, higher rates of serological prevalence were found (9.5%, 4.0%, 5.6% and 7.9% for HIV, HBV, HCV and syphilis, respectively). When comparing transgender people with or without self-reported STIs, unemployment, previous incarceration, justice problems and sex work resulted more frequent in the first group (p< 0.03 for all). Regarding health status, we observed higher rates of lifetime substance abuse and psychiatric morbidities in trans people with at least one reported STI (p < 0.05). The prevalence of STIs exceeded that reported in general population and STIs correlates underline the importance of stigma and discrimination as determinants of transgender health.

HIV, STI and renal function testing frequency and STI history among current users of self-funded HIV pre-exposure prophylaxis, a cross-sectional study, Germany, 2018 and 2019.

IntroductionUsers of pre-exposure prophylaxis (PrEP) require periodic testing for HIV, sexually transmitted infections (STI) and renal function. Before PrEP was made free of charge through statutory health insurance in late 2019, PrEP users in Germany had to pay for testing themselves.AimWe investigated self-reported HIV, STI and renal function testing frequencies among self-funded PrEP users in Germany, factors associated with infrequent testing, and STI diagnoses.MethodsA cross-sectional anonymous online survey in 2018 and 2019 recruited current PrEP users via dating apps for men who have sex with men (MSM), a PrEP community website, anonymous testing sites and friends. We used descriptive methods and logistic regression for analysis.ResultsWe recruited 4,848 current PrEP users. Median age was 37 years (interquartile range (IQR): 30–45), 88.7% identified as male, and respectively 26.3%, 20.9% and 29.2% were tested less frequently for HIV, STI and renal function than recommended. Participants with lower STI testing frequency were significantly less likely to report STI diagnoses during PrEP use, especially among those with many partners and inconsistent condom use. Factors most strongly associated with infrequent testing included not getting tested before starting PrEP, using PrEP from informal sources and on-demand/intermittent PrEP use.DiscussionIn a setting of self-funded PrEP, many users obtained medical tests less frequently than recommended, which can lead to missed diagnoses. Barriers to testing should be addressed to enable proper medical supervision. The suitability of testing frequencies to PrEP users with less frequent risk exposures needs to be evaluated.

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.

Sexual violence and self-reported sexually transmitted infections among women in sub-Saharan Africa.

Sexual violence has proven to be associated with sexually transmitted infections (STIs) in sub-Saharan Africa (SSA). We examined the association between sexual violence and self-reported STIs (SR-STIs) among women in sexual unions in 15 sub-Saharan African countries. This was a cross-sectional study involving the analysis of data from the Demographic and Health Surveys (DHS) from 15 countries in SSA. A total sample of 65,392 women in sexual unions were included in the final analysis. A multilevel binary logistic regression analysis was carried out and the results were presented using adjusted odds ratios (aOR) at 95% Confidence Interval (CI). Women who experienced sexual violence in the last 12 months were more likely to self-report STIs compared to those who did not experience sexual violence [aOR = 1.76, 95% CI = 1.59-1.94]. Compared to women in Angola, those who were in Mali, Nigeria, Sierra Leone, Uganda, and Liberia were more likely to self-report STIs while those in Burundi, Cameroon, Chad, Ethiopia, Malawi, Rwanda, South Africa, Zambia, and Zimbabwe were less likely to self-report STIs. The study has revealed variations in the country level regarding the prevalence of sexual violence and SR-STI in the last 12 months among women in sexual unions in the selected countries. This study has demostrated that sexual violence in the last 12 months is associated with SR-STIs among women in sexual unions. Moreover, factors that predict SR-STIs were observed in this study. Policymakers and agencies that matter could consider the factors identified in this study when designing policies or strengthening existing ones to tackle STIs among women in SSA. To accelerate the progress towards the achievement of Sustainable Development Goal 3, its imperative efforts and interventions must be intensified in SSA to reduce sexual violence which will go a long way to reduce SR-STIs among women.

Self-reported sexually transmitted infections among adolescent girls and young women in sub-Saharan Africa.

Sexually transmitted infections (STIs) affect individuals of all ages, but adolescent girls and young women are disproportionately affected. We examined the prevalence and factors associated with self-reported STIs (SR-STIs) among adolescent girls and young women in sub-Saharan Africa (SSA). Demographic and Health Survey data of 27 sub-Saharan African countries were used for the study. The sample size comprised 68944 adolescent girls and young women (15-24 y of age). The outcome variable was SR-STIs. Multilevel binary logistic regression analysis was performed to identify factors associated with SR-STIs. On average, the prevalence of SR-STIs among adolescent girls and young women in SSA was 6.92%. The likelihood of SR-STIs was higher among young women aged 20-24y (adjusted odds ratio [aOR] 1.36 [confidence interval {CI} 1.27 to 1.46]), those not married (aOR 1.64 [CI 1.51 to 1.79]), those working (aOR 1.20 [CI 1.12 to 1.27]), those whose age at first sex was ≤19y (aOR 1.99 [CI 1.80 to 2.20]), those with two or more sex partners (aOR 1.56 [CI 1.35 to 1.80]), those who listened to radio (aOR 1.26 [CI 1.17 to 1.35]), those in urban areas (aOR 1.42 [CI 1.30 to 1.51]) and those with a wealth index of rich (aOR 1.28 [CI 1.17 to 1.40]) compared with their counterparts. In contrast, those with a primary (aOR 0.86 [CI 0.78 to 0.94]) or secondary/higher level of education (aOR 0.83 [CI 0.75 to 0.92]) compared with those with no formal education and those who were exposed to television (aOR 0.90 [CI 0.84 to 0.98]) compared with those who were not exposed were less likely to report STIs. Our findings demonstrate the need for countries in SSA to commit towards reducing the incidence of STIs. Community-based health educational programs are required to intensify the awareness of STIs and their prevention in various sub-Saharan African countries considering the factors that expose adolescent girls and young women to STIs.