Sexually Transmitted Infections Risk Research Articles

Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae in England, 2016-20.

Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea. We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae. We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016-20. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism. A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r = 0.97, P = 0.01) and antimicrobial treatment (r = 0.87, P = 0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings. Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.

Antibiotic overuse, poor antimicrobial stewardship, and low specificity of syndromic case management in a cross section of men with urethral discharge syndrome in Kampala, Uganda.

High prevalence of sexually transmitted infections (STIs) combined with poor antimicrobial stewardship are drivers of STI antimicrobial resistance (AMR) especially in resource-limited settings where syndromic case management (SCM) is the norm. We characterized patterns of antibiotic use prior to clinic attendance and study enrollment in Ugandan men with urethral discharge syndrome (UDS), evaluated in-clinic prescribing, and the performance characteristics of SCM. Participants were recruited from government clinics participating in an existing gonococcal surveillance program in Kampala, Uganda. Questionnaires including antimicrobial use prior to attendance, prior episodes of UDS, penile swabs, and blood samples were collected. Bivariable and multivariable logistic regression models were used to estimate odds ratios (OR) for preselected factors likely to be associated with antibiotic use. In-clinic antibiotic treatment data were extracted from clinical notes, and the performance of SCM against laboratory-based STI diagnoses was evaluated. Between October 2019 and November 2020, 100(40%) of 250 men with UDS reported taking antibiotics in the 14days prior to attending the clinic. Of these 210(84%) had at least one curable STI and 20% had a reactive point-of-care HIV test. Multivariable analysis demonstrated significant associations between recent antimicrobial use and duration of UDS symptoms <6 days (OR 2.98(95%CI 1.07,8.36), p = 0.038), and sex with women only (OR 0.08(95%CI 0.01,0.82),p = 0.038). The sensitivity of SCM ranged from 80.0% to 94.4%; specificity was low between 5.6% and 33.1%. The positive predictive value of SCM ranged from 2.4(95%CI 0.7,6.0) for trichomoniasis to 63.4(95%CI 56.5,69.9) for gonorrhea. Pre-enrollment antibiotic use was common in this population at high risk of STI and HIV. Combined with the poor specificity of SCM for male UDS, extensive antibiotic use is a likely driver of STI-AMR in Ugandan men. Interventions to improve antimicrobial stewardship and deliver affordable diagnostics to augment SCM and decrease overtreatment of STI syndromes are required.

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.

Exploring the need for sexually transmitted infection education among university student athletes in Saskatchewan.

Sexually transmitted infections (STIs) are common in young adults in Canada and their prevalence is rising. Assessing sexual health knowledge among young adults is essential for developing effective STI education strategies. However, there is limited research on the sexual health knowledge of Canadian university athletes, who have increased risks of STIs. To determine perceived and objective levels of knowledge on STIs among university athletes and their preferred methods of knowledge translation regarding sexual health information. U SPORTS athletes at the University of Saskatchewan and the University of Regina were invited to complete an electronic survey between January-March 2022. Participants completed the Sexual Transmitted Disease Knowledge Questionnaire (STD-KQ) and self-reported their confidence in their answers. Participants were asked about testing beliefs, where they receive their sexual health information and their preferred format for STI information delivery. One hundred participants completed the survey (14% response rate). Participants had a median composite self-reported STI knowledge score of 2.8 out of 5 (interquartile range [IQR]: 2.4-3.6). The median participant scored 12 out of 27 (44%) on the STD-KQ (IQR: 8-17). Sixty-seven percent of participants received sexual health information from a physician. Sixty-one percent of participants believed embarrassment may prevent them from getting tested or screened. The three most popular methods of health information sharing were online modules (34%), in-person lectures/conferences (24%) and self-paced videos (20%). This study highlighted that STI knowledge is limited in university athletes. Comprehensive online educational interventions may be effective at improving knowledge.

Approach to sexually transmitted infection testing for men who have sex with men.

To provide a guide on appropriate sexually transmitted infection (STI) testing for primary care providers to use with patients who identify as men who have sex with men (MSM). Canadian guidelines for STI testing and enteric and protozoan infections; Ontario guidelines for HIV screening and mpox; and US guidelines for STI testing. Across Canada rates of sexually transmitted bacterial, enteric, protozoan, and systemic infections-including HIV and mpox-have been steadily increasing among cisgender and transgender MSM. Despite often having similar clinical presentations, these infections have different incubation periods and testing approaches and must be ruled out effectively to guide diagnosis and treatment for MSM-identifying patients who present with symptoms of various conditions. Clinical information and screening recommendations, however, are often found in multiple guidelines rather than in a single source, thus further complicating these clinical encounters. This document provides a consolidated set of evidence and recommendations for STI testing in MSM. Testing approaches for STIs should be comprehensive and based on the patient's reported risk factors and clinical presentation. Where ongoing STI risk is identified and negative laboratory test results are received, MSM should also be counselled on recommendations for repeat screening and HIV prevention services, such as preexposure prophylaxis.

Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids.

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.

Examining County-Level Associations between Federally Qualified Health Centers and Sexually Transmitted Infections: A Political Ecology of Health Framework.

Federally Qualified Health Centers (FQHCs) are the largest providers of healthcare for sexually transmitted infections (STIs) in medically underserved communities in the United States (US). Through the Affordable Care Act (ACA), FQHCs have grown in number, but the impact of this growth on STIs is poorly understood. This ecological study seeks to quantify the association between FQHCs and STI prevalence in all US counties. Variables were described utilizing medians and interquartile ranges, and distributions were compared using Kruskal-Wallis tests. Median rates of chlamydia in counties with high, low, and no FQHCs were 370.3, 422.6, and 242.1 cases per 100,000 population, respectively. Gonorrhea rates were 101.9, 119.7, and 49.9 cases per 100,000 population, respectively. Multivariable linear regression models, adjusted for structural and place-based characteristics (i.e., Medicaid expansion, social vulnerability, metropolitan status, and region), were used to examine county-level associations between FQHCs and STIs. Compared to counties with no FQHCs, counties with a high number of FQHCs had chlamydia rates that were an average of 68.6 per 100,000 population higher (β = 68.6, 95% CI: 45.0, 92.3) and gonorrhea rates that were an average of 25.2 per 100,000 population higher (β = 25.2, 95% CI: 13.2, 37.2). When controlled for salient factors associated with STI risks, greater FQHC availability was associated with greater diagnosis and treatment of STIs. These findings provide empirical support for the utility of a political ecology of health framework and the critical role of FQHCs in confronting the STI epidemic in the US.

Risk sexual behaviors for sexually transmitted infections among sexual minority women: A cross-sectional study in Beijing, China

Researchers in this study assesses risk behaviors for sexually transmitted infections (STIs) among sexual minority women (SMW) in Beijing, China. A total of 1,631 SMW participated in the study. Compared with women who have sex with women exclusively, women who have sex with both women and men reported more sex partners, more likely sharing sex toys, experiencing STI infections. Digital-genital sex, using sex toys, G-spot stimulation is associated with STI symptoms. SMW in Beijing engaged in high-risk sexual behaviors that may cause substantial risk for STIs. SMW and healthcare providers should be informed and STI testing should be promoted among SMW.

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.

Enhancing Adolescent Sexual Health Education and Condom Use in Harare: Addressing Attitudes and Practices Amongst Adolescents on Antiretroviral Therapy

Background: This study is coming against the backdrop of the attitudes and practices portrayed by sexually active adolescents on antiretroviral therapy (ART) concerning preventing STIs through condoms as a practice for safe sexual relations. Aim: The study aims to explore the attitudes that adolescents on ART have towards the use of condoms as a preventive measure for the spread of sexually transmitted infections (STIs). Method: The research presents a comprehensive examination of adolescent knowledge and attitudes towards antiretroviral therapy (ART) and sexual health education in Harare, employing a mixed-method approach. Quantitative data were gathered through semi-structured questionnaires, capturing participants’ understanding of ART and their views on sexual health services. Qualitative data were obtained through structured interviews with purposely selected groups of adolescents, reflecting their lived experiences and perceptions. The sample was designed to reflect the diversity of the urban setting, with ten groups of participants representing various demographics. Data analysis encompassed univariate statistics, bivariate associations using Pearson’s Chi-square, and multivariate relationships between variables and consistent condom usage, all with a 95% confidence level. This integrated approach provides a nuanced understanding of the complex factors influencing adolescent behavior in relation to ART and sexual health services, contributing valuable insights for public health interventions in Harare. Results: This study investigated the attitudes and practices of condom use among 202 adolescents aged 10-19 years. The study found that several factors were significantly associated with a positive attitude towards condom use. Adolescents with older partners were more likely to have a positive attitude towards condom use (AOR=2.43, CI=1.16-5.10). This means that for every one year increase in the age of the sexual partner, the odds of having a positive attitude towards condom use increased. This could be attributed as adolescents perceive older partners as having more sexual experience and therefore consider condom use as a necessary precaution. Adolescents who reported a better understanding of STIs were more likely to have a positive attitude towards condom use (AOR=3.31, CI=1.07-1.79). This means that adolescents who understood STIs better were 3.31 times more likely to have a positive attitude towards condom use than those who did not understand STIs as well. Research showed that adolescents express concerns about contracting STIs and the negative impact it can have on their health and future relationships. This increased awareness of risk motivated them to adopt positive attitudes towards condom use as a preventive measure. Adolescents with more knowledge about condoms were more likely to have a positive attitude towards condom use (AOR=1.51, CI=0.10-3.45). This means that adolescents who had more knowledge about condoms were 150% more likely to have a positive attitude towards condom use than those who did not have as much knowledge about condoms. The conversations carried with the adolescents revealed that those with more knowledge about condoms have a better understanding of their efficacy, contributed to positive attitudes towards condom use. Others expressed a sense of self-assurance in their knowledge of how to properly wear and use condoms, which enhanced positive attitudes towards condom use. These findings suggest that interventions aimed at increasing condom use among adolescents should focus on educating them about the risks of STIs, the benefits of condom use, and safe sex practices. Conclusion: In light of the study’s findings, it is evident that adolescents’ attitudes towards condom use are influenced by various factors, including their own sexual maturation and the perceived experience of their sexual partners. The study underscores the importance of comprehensive sexual health education that addresses both the biological aspects of STIs and the social and psychological implications of sexual activity. As adolescents continue to navigate their sexual identities and relationships, interventions that enhance their knowledge and understanding of condom use as a tool for preventing STIs are crucial. Additionally, considering the broader context of adolescent sexual and reproductive health in developing countries, these findings contribute to a growing body of evidence that supports the need for tailored, culturally sensitive, and age-appropriate programs to support adolescents on antiretroviral therapy (ART) in making informed decisions about their sexual health.

Intersecting social-ecological vulnerabilities to and lived experiences of sexually transmitted infections among Syrian refugee women in Lebanon: A qualitative study.

Conflict-affected women and girls living in protracted forced displacement settings are vulnerable to sexually transmitted infections (STIs). Yet, little is known about the risk factors for and lived experiences of STIs in complex humanitarian settings, particularly in the Middle East and North Africa, where STIs have long been understudied. This qualitative study adapts the social ecological model to characterize the multi-level risks for and lived experiences of STIs among Syrian refugee women resettled in an urban refugee camp in Beirut, Lebanon. Adopting a community-based sampling strategy, community health workers, who were refugee women from the camp, recruited and conducted in-depth interviews (IDIs) with 30 adult Syrian refugee women. Data were analyzed using an interpretative phenomenological approach and thematically organized according to the levels of the social ecological model. We identified a confluence of individual, interpersonal, community-based, and societal vulnerabilities to STIs, including extreme poverty and insecurity, patriarchal gender norms, stigma, sexual exploitation and trafficking, poor healthcare accessibility, intimate partner violence, including marital rape, transactional sex, sexual harassment, social isolation, and internalized stigma. Participants described experiencing bothersome symptoms and sequelae of advanced and untreated STIs in the setting of limited access to health services and challenges with engaging their partners in STI treatment, largely due to STI stigma. These novel findings suggest dynamic, interrelated social and health disparities across all social ecological levels influencing refugee women's sexual health, including their risk of STIs. Comprehensive, multi-sectorial interventions, which transcend traditional public health methods and which adopt a sexual well-being approach, are urgently needed to address systemic and intrapersonal violence against refugee women, examine and mitigate the burden of STIs, and ensure sexual justice and health equity in this protracted forced displacement setting.

Posttraumatic Stress Disorder Symptoms and Incarceration: The Impact on Sexual Risk-Taking, Sexually Transmitted Infections, and Depression Among Black Sexual Minority Men in HIV Prevention Trials Network (HPTN) 061.

Black men and people belonging to sexual minority groups are disproportionately impacted by criminal legal involvement and sexually transmitted infections (STIs). Traumatic experiences are often associated with later criminal legal involvement, depression symptoms, sexual risk behavior, and STIs. Research on the joint influence of trauma and incarceration on STI risk among racial and/or sexual minority people is limited. This study tested the association between post-traumatic stress disorder (PTSD) symptoms and incarceration on sexual risk behavior and STI among Black sexual minority men, a population that may be at higher risk for contracting STIs. Using data from the HIV Prevention Trials Network 061 Study, a longitudinal study of adult Black sexual minority men in six U.S. cities (N = 855), we tested associations between past six-month incarceration and subsequent sexual risk behavior, STI, and depression symptoms, for those with and without pre-incarceration PTSD symptoms. PTSD symptoms were elevated among participants who reported Hispanic ethnicity, having sex with both men and women, and previous incarceration. Although there were not significant differences between recent incarceration and sexual risk for those with and without PTSD, incarceration was linked to some sexual risk behaviors regardless of PTSD symptoms. Among people with PTSD symptoms, there was a higher prevalence of sexual risk and depression symptoms, regardless of incarceration. These findings suggest a potentially compounding influence of PTSD symptoms and incarceration on sexual risk and infection among Black sexual minority men.

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.

Influence des facteurs liés au mode de vie sur la composition du microbiote vaginal

AbstractThe vaginal microbiota plays a crucial role in a women health, and serves as a defense barrier against vaginoses and sexually transmitted infections (STIs). However, data on this microbiota remain poorly documented, despite changes in the vaginal microbiote being a public vaginal modification constituting a public health concern. In this review, we investigated the impact of woman lifestyle or habits on the vaginal microbiota documented through metagenomic approaches. In this context, personal hygiene, sexual behaviors, hormonal contraception, smoking, alcohol consumption and psychosocial stress were analyzed. Lactobacillus played a key role, representing a first line of defense against pathogenic microorganisms. The imbalance of the microbiota with an increase in bacterial diversity and/or the rarefaction of Lactobacillus is a key factor in the progression towards vaginal infectious pathologies.We observed that hormonal contraception and personal hygiene increased the presence of Lactobacillus promoting stability in the vaginal microbiota while certain sexual behaviors, smoking, alcohol consumption, menstruation and psychosocial stress were associated with dysbiosis and an increased risk of bacterial vaginosis, STIs, and severe pelvic inflammatory diseases. Ethnicity represented a confounding factor in all studies, due to the unstable vaginal microbiota detected in some populations (african or afro-american). A better understanding of these factors influencing the vaginal microbiota is necessary for better women’s helath management.

HIV- related knowledge, attitude, practices, and stigma among healthcare providers caring for HIV in Jordan: Identification of several organizational challenges

BackgroundThere is a paucity of data on Healthcare Providers (HCPs) caring for people living with HIV in Jordan. ObjectiveWe aimed to understand HCPs’ knowledge, attitude, stigma, and practices, to assess the gaps in HIV care in Jordan. MethodsWe conducted recorded in-depth interviews with all five HCPs working at the only HIV Service Center in Jordan, using semi-structured questions in 2021. Content analysis was performed. ResultsSeveral organizational challenges were identified. Only one had received HIV training. All were uncertain of updated recommendations with little knowledge of international guidelines, vertical transmission, contraception, sexually transmitted infections (STIs), non-communicable diseases (NCDs), and prophylaxis. Four HCPs perform counseling, focusing on easing anxieties, risk modification, and the importance of treatment adherence. However, their counseling on contraception, risk of transmission, STIs, and NCDs is inadequate, and they have little-to-no experience with prophylaxis. Most had a positive attitude towards people living with HIV, especially HCPs working at the center the longest, encouraging marriage and reproduction. Most do not approve of mandatory testing, or of breaching patient confidentiality. They repetitively described risky behavior as ‘immoral behavior’, empathizing more with patients who caught HIV through blood transfusion or birth, and demonstrating embedded stigmatized beliefs. They reported people living with HIV experience anticipated stigma and stigma by their general community including by other HCPs. ConclusionThis is the first study on HCPs caring for people living with HIV in Jordan. It highlights the suboptimal knowledge, practices, and stigma which improve with greater participatory exposure to HIV care. HCPs had an overall positive attitude, more evident in HCPs working at the clinic the longest.

User experiences of an AI application for predicting risk of sexually transmitted infections.

Awareness of one's individual risk of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is a necessary precursor to engagement with prevention strategies and sexual health care. Web-based sexual health applications may improve engagement in sexual health prevention and care by providing individualised and evidence-based sexual health information. The STARTOnline (Supporting Timely and Appropriate Review and Treatment Online) study sought the views of sexual health service users on three web-based sexual health applications to better understand their usefulness, acceptability and accessibility. This paper reports the views and experiences of users of one of the applications called MySTIRisk. MySTIRisk estimates the risk of three common STIs and HIV using data from attendees of a metropolitan sexual health service. This study used a bespoke qualitative design, informed by a developmental evaluation approach. Melbourne Sexual Health Centre clinic attendees' views were sought using semi-structured interviews conducted between October 2023 and January 2024 via videoconferencing, telephone and on site at the clinic. Data was analysed using qualitative data analysis methods. A diverse group of 14 participants described an ideal pathway to better sexual health outcomes that might be facilitated by use of the MySTIRisk application, particularly for individuals with limited sexual health knowledge, or affected by stigma and geographical barriers. This pathway was described as: 1) being concerned about my sexual health; 2) checking my STI risk easily and privately; 3) understanding and trusting the result; and 4) deciding how to look after my health. Factors that might influence this pathway were also described, including areas for improvement in accessibility and acceptability. These findings support the role of web-based sexual health applications in facilitating access to sexual health education and behavioural change and underscore the importance of codesign approaches in improving their uptake and impact.

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.

HIV Testing and Preexposure Prophylaxis Prescriptions Among U.S. Commercially Insured Transgender Men and Women, 2014 to 2021.

Transgender persons are disproportionately affected by HIV, but preexposure prophylaxis (PrEP) use has been low in this population. Clinical encounters for gender-affirming hormone therapy (GAHT) provide opportunities for HIV prevention. To estimate the number of commercially insured transgender women (TGW) and transgender men (TGM) in the United States and their use of HIV prevention services. Retrospective analysis of secondary data. Merative MarketScan commercial databases from 2014 to 2021. TGW and TGM, defined as those with transgender-related diagnoses and prescriptions for feminizing or masculinizing GAHT. HIV testing and PrEP use. A substantially increasing trend was observed in the prevalence of transgender-related diagnosis codes from 2014 to 2021 and in the proportion of persons who used GAHT. The increases were driven by persons aged 18 to 34 years. In 2021, among 10 613 TGW with a test for or a diagnosis of a sexually transmitted infection (STI) in the previous 12 months, 61.1% had an HIV test; among those, 20.2% were prescribed PrEP. Among 4184 TGM with STI risk, 48.3% had an HIV test; among those, 10.2% were prescribed PrEP. The prevalence of TGW and TGM who had a test for or a diagnosis of an STI, had an HIV test, and were prescribed PrEP increased substantially from 2014 to 2021. The findings represent only persons with commercial health insurance who sought health care services for GAHT. It is important to identify transgender persons to monitor their receipt of HIV prevention services. Encounters for GAHT provide opportunities to offer HIV prevention and other prevention services. Many HIV prevention opportunities were likely missed at clinical encounters for GAHT. None.

Sexually transmitted infections and associated risk factors among sexual minority women in China

There is a potential for transmission of sexually transmitted infections (STIs) within sexual minority women (SMW) in China. However, research specifically focused on STIs among SMW in China is severely limited. This study aims to evaluate the prevalence of STIs and identify associated risk factors among SMW in Beijing, China. This study comprised a baseline assessment followed by a follow-up evaluation. Consistent questionnaire interviews and STI tests were administered during both stages. Participants were recruited online in Beijing between 2020 and 2021 and factors associated with STIs were analyzed using logistic and Cox regression models. The baseline included 219 SMW, and 58.9% (129/219) of these individuals participated in the follow-up. During the baseline assessment, 4.1% (9/219) tested positive for chlamydia infection, while 5.0% (11/219) were HSV-2 seropositive. At the follow-up, the incidence of HSV-2 was 3.7 cases per 100 person-years. Notably, engaging in sexual activity with men and having an increased number of sexual partners were both identified as factors associated with a higher risk of STIs. The findings suggest that SMW in Beijing may face a significant risk of contracting STIs. As a preventive measure, there should be a concerted effort to promote STI testing within the SMW community.

Embedding a Novel Screening Programme for Sexually Transmitted Infections Within an Ambulatory Emergency Surgical Admissions Unit: An Observational Cohort Study

Abstract Aims To establish a sexually transmitted infection (STI) screening programme for females presenting to an Emergency Ambulatory Surgical Clinic (ASC), and to analyse incidence and prevalence of STIs as an underlying cause for their abdominal pain. Methods Observational cohort study in ASC of a tertiary hospital. Between December 2021 to December 2022, females aged 18-44 years presenting with abdominal pain were offered self-collected vulvovaginal swabs for chlamydia and gonorrhoea as part of a new standardised diagnostic pathway. Positive results were referred to local sexual health services for treatment and contact tracing. Main outcome measures included number of patients consenting to the screening programme and number of positive swab results. Results The cohort comprised 297 eligible patients; 259 with 20 patients declining testing and 18 samples rejected. A total of 5.4% of swabs were positive (2 gonorrhoea, 12 chlamydia) with mean age of 24.5. All positive patients presented with lower abdominal pain and of these, only 25% had a documented sexual history during assessment. 7 had further imaging with 4 results diagnosing pelvic inflammatory disease (PID). 4 patients were treated for PID empirically. Remaining patients were treated for non-specific pain or unrelated pathology. Conclusions Undiagnosed STIs are prevalent, and have known fertility and public health risks. Young females with lower abdominal pain provide an opportunistic and arguably necessary screening cohort in ASC with good uptake of self-testing. Results demonstrate high incidence of positive tests, suggesting that inclusion of sexual history during assessment is vital to identify those with highest STI risk.