Sexually Transmitted Infections Clinic Research Articles

Translated article] What Proportion of the Spanish Dermatology Caseload Corresponds to Primarily Sexually Transmitted Infections and Other Anogenital Dermatoses? Results From the DIADERM National Random Survey

Background and objectivePredominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methodsObservational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. ResultsOnly 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. ConclusionsSTIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

A retrospective study of the pattern of sexually transmitted infections during a five-year period at tertiary care hospital in Central India.

Abstract Background: Knowledge about the current patterns and trend of sexually transmitted infections (STIs) in different geographical regions is necessary for proper implementation of control measures. Aim: To study the pattern and trend of STIs during a five-year period (2013-17) among patients attending Department of Dermatology, Venereology, and Leprology, Government Medical College and Hospital, Nagpur. Material and methods: Case records of 4552 patients with STIs who attended the Department of Dermatology, Venereology, and Leprology, Government Medical College, Nagpur for five years, from January 2013 to October 2017 were analysed in this retrospective study. Cases had been diagnosed based on the clinical presentation and relevant investigations. Results: Most common age group affected was 31-40 years (34.84%). Balanoposthitis was most common STI in (37.98%) followed by cervicovaginal discharge (30.07%), herpes genitalis (18.65%), molluscum contagiosum (8.26%), condylomata acuminata (1.43%), chancroid (1.43%), genital scabies (1.03%), syphilis (0.63%), urethral discharge (0.48%) and granuloma inguinale (0.11%). About 2.37% cases were human immunodeficiency virus (HIV) positive. Herpes genitalis (46.29%) was the most common STIs in HIV positive patients. Venereal disease research laboratory (VDRL) test was reactive in 0.63% patients. Conclusions: Study concluded that bacterial STIs like syphilis (0.63%), chancroid (1.43%) and granuloma inguinale (0.11%) were less common then viral STIs. The infection rate of syphilis and chancroid has increase dramatically in recent years. Viral STIs were more likely to be associated with HIV than bacterial infections. Balanoposthitis, cervicovaginal discharge and herpes genitalis constitute the major burden of STIs clinic. Key words: sexually transmitted infections, viral, bacterial, HIV

Sexual behavior and increasing vulnerability of elderly population to sexually transmitted infections: Need for active interventions

Objective: The objective of the study was to study the pattern of sexual behavior and sexually transmitted infections (STIs) among the patients attending the STIs clinic in a tertiary care hospital in Western Uttar Pradesh. Materials and Methods: A cross-sectional study was carried out among all confirmed STI cases attending the STI clinic during the period of 1 year. Data were collected by means of personal interview using pretested pro forma with questions related to their sexual behavior and STIs. Relevant investigations were carried out for all cases. Data were entered in Excel sheet and analyzed by means of Epi Info version 7. Results: A total of 373 patients were reported with anogenital lesions. Out of these, 310 were confirmed cases of STI. Surprisingly, in the clinic, the attendance of elderly was 41 (13% of total cases). The attendance of older adults (>40 years of age) was more (178, 57.41%) in comparison to the younger population (132, 42.58%). Among the older population, males outnumbered female patients. Out of the total lesions, the most common genital lesion was herpes genitalis followed by balanoposthitis. Conclusion: We generally assume that, with increasing age, the chances of acquiring STIs are less, but in our study, most of them admitted to having regular sexual activity and this clearly indicated the vulnerability of the elderly population to STIs. We definitely need to focus on their sexual needs and sex education to prevent the increased rate of infections among them.

HIGH PREVALENCE OF DRUG RESISTANT NEISSERIA GONORRHOEAE IN MALES WITH URETHRAL DISCHARGE AT THE STD CLINIC MULAGO HOSPITAL UGANDA

Among the treatable sexually transmitted infections (STIs), Neisseria gonorrhoeae is considered to be most important because of its ever evolving antibiotic resistance. Currently third generation cephalosporins are recommended as first-line drugs in many countries. Unfortunately, resistance to these cephalosporins (cefixime and ceftriaxone) has been reported elsewhere. The objectives of the study were to determine the prevalence of Neisseria gonorrhoea in adult males presenting to Mulago hospital with urethral discharge and to determine the level of resistance of Neisseria gonorrhea to the commonly available antimicrobial agents at the clinic focusing on extended-spectrum cephalosporins. In a cross sectional study, we enrolled 112 adult males aged 18-65 yrs with urethral discharge at the STD clinic Mulago Hospital. Prevalence of gonorrhoea was determined based on Gram staining and/or N. gonorrhea isolation at culture. Antimicrobial susceptibility testing was determined with the Kirby-Bauer disk diffusion method and with the Nitrocefin tests for β-lactamase production. Among 112 adult male patients aged 18-65 years with urethral discharge,the prevalence of N. gonorrhea was at 81.3%. Resistance to drugs was identified at the following rates: tetracycline 100%, ciprofloxacin 94.8%, cotrimoxazole 91.4%, penicillin 82.8%, cefixime 20.7%, ceftriaxone 5.2%, spectinomycin 1.7%, and azithromycin 0%. According to this study drug resistance to commonly available antimicrobials for N. gonorrhea is very high among isolates from patients attending the STI clinic, Mulago Hospital Kampala, Uganda. Ceftriaxone, spectinomycin and azithromycin appeared to be the most useful drugs in the treatment of N. gonorrhea infection at the clinic. This work was completed in November 2017.

A retrospective study of the pattern of sexually transmitted infections of patients attending at Dermatology department of a tertiary care Hospital, Assam

Introduction: Sexually transmitted infections (STIs) are major global health problem. Pattern of STIs vary from place to place depending on various epidemiological factors. It is important to understand the pattern of STI prevailing in the region for proper planning and implementation of control strategies. This study was done with aims and objectives to find out the pattern of STIs, prevalence of STIs, any change in the trend of STIs and incidence of HIV/AIDS in STIs. Method: This is a retrospective study of patients attending to STI clinic attached to department of Dermatology and Venereology, FAAMCH, Assam from January 2013 to December 2017. The data were analysed epidemiologically for the pattern and prevalence of STIs. Result: Out of total 1360 new STI attendees 503 were diagnosed to have STI with male to female ratio of 1:1.3. Majority of patients were in the age group of 21-30 years, married and heterosexual. The STIs observed in our study was Cervico-vaginal discharge (26.83%), Genital herpes (24.85%), Genital wart(14.31%), Urethral Discharge (11.72%), Genital Molluscum Contagiosum (8.15%), Genital scabies (7.35%), GUD-NH (5.56%), and LAP (1.19%). Prevalence of HIV and PLHA presenting with STI and new sero positive cases detected was 6.95%. Conclusion: The persistent and recurrent nature of viral infections is responsible for their increasing trend in the current STI scenario. STs being higher in married individuals implies the importance of contact tracing, counselling and early management of the partners.

Uptake of voluntary medical male circumcision among men with sexually transmitted infections in Lilongwe, Malawi: a protocol for a pre-interventional and post-interventional study

IntroductionVoluntary medical male circumcision (VMMC) is one of the key interventions for HIV prevention. However, its uptake among men in Malawi is low. Implementation science strategies for demand creation of...

Alarming incidence of reinfections after treatment for Chlamydia trachomatis and gonorrhoea: Can we predict and prevent them?

BackgroundChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are a public health problem, worsened by frequent reinfections, whose incidence rate is not known in Spain. The objective of this study is to estimate in patients diagnosed with NG, CT or mixed infection (NG and CT): (1) the incidence of reinfections by the same microorganism, (2) the total incidence of Sexually Transmitted Infections (STI), both by the same microorganism and by infections other than the initial one, and (3) to identify predictors of reinfection. MethodsObservational prospective case series involving 986 patients with CT and/or NG at specialized STI clinics in Biscay (Spain) between 2016 and 2019. ResultsThe six month cumulative incidence of reinfection by the same microorganism was 17.24% (CI95%: 14.9–19.7) and 24.65% (CI95%: 21.9–27.4) for any STI (reinfection or other). Being an immigrant (OR=1.8; CI95%: 1.3–2.6), men who have sex with men (OR=1.8; CI95%: 1.3–2.6), number of sexual partners (OR=4.3; CI95%: 2.7–6.8 for more than 5 partners), having a new partner (OR=1.7; CI95%: 1.08–2.6), not always using a condom (OR=1.4; CI95%: 1.02–1.9) and consumption of alcohol prior to sex (OR=3.8; CI95%: 1.5–9.5) were associated with reinfection by any STI. ConclusionThese characteristics allow doctors to identify patients in whom to prioritize short-term rescreening for repeated infections with any STIs after initial treatment for NG or CT.

Prevalence and risk factors for gonococcal infection in Reunion Island

ObjectiveTo determine the prevalence and risk factors for gonococcal infection, and the resistance profile of Neisseria gonorrhoeae (NG) in Reunion Island. Patients and methodsAll patients who visited the four sexually transmitted infection (STI) clinics of Reunion Island between January 2017 and December 2018 were screened by multiplex polymerase chain reaction. Data on patient characteristics were collected using a self-administered questionnaire (reason for screening, marital status, risk-taking behaviors, place of birth, employment status, type of health care coverage, sexual orientation, number of sexual partners, occurrence of extra-marital relationships, history of STIs, and symptomatology. Precarity was defined as being unemployed and/or receiving universal health insurance). ResultsThe prevalence of NG (n=4289) in the screened population was 2.8% (95% CI [2.3–3.3]). Minors were especially at-risk (4.4% (95% CI [2.6–7])) and especially girls (5.6% (95% CI [3.2–8.9])). The prevalence observed in the homosexual population was 4.0% [2.6–5.9]. Gonococcal infection was asymptomatic in 56 (69%) patients. For all infection sites, the main risk factors were male minors (P=0.019), individuals living in conditions of precarity (P=0.023), individuals co-infected with chlamydia (P<0.001) or syphilis (P<0.001), and individuals of foreign origin (P=0.006). No NG strain was resistant to ceftriaxone. Strains were resistant to penicillin G, ciprofloxacin, and azithromycin in 22% (20/91), 38% (35/91), and 1% (1/91) of cases, respectively. ConclusionThe prevalence of NG in patients visiting STI clinics in Reunion Island is particularly high among minors. Prevention programs targeting this population should be reinforced and screening should be facilitated in school settings.

A time‐varying network model for sexually transmitted infections accounting for behavior and control actions

AbstractIn this article, we propose a stochastic network model for the spread of common sexually transmitted infections (STIs). The model expands the standard susceptible–infected–susceptible model by incorporating asymptomatic infected individuals—who are unaware that they are posing a health threat to themselves and the population—and individuals' behavioral preferences with regard to the use of protective measures during encounters. Behavioral preferences evolve according to a nontrivial mechanism accounting for the cost of using protection, the perceived risk, and persuasive effects due to sexual encounters with different‐minded individuals. The disease spreads on a time‐varying network of sexual contacts, generated using a mechanism inspired by continuous‐time activity‐driven networks. Such a network accounts for regular partners and casual encounters, which are regulated by a negotiation process that accounts for the individuals' behavioral preferences. Finally, three control measures are included in the model: (i) condom (social) marketing campaigns, (ii) routine screening at STI clinics, and (iii) partner notification. We use a mean‐field approach to analytically derive the epidemic threshold in the limit of large‐scale populations, in the absence of a partner network, for two distinct negotiation processes. Our results indicate that routine screening is key to the eradication of local outbreaks, while condom marketing campaigns become effective only when combined with screening. Monte Carlo simulations are then employed to extend our analytical findings, casting lights on the role of the partner network and on partner notification as a control measure in the spread of STIs.

Potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden, 2020.

The COVID‐19 pandemic has challenged the societies and health care systems globally, and resulted in many social and physical distancing restrictions to limit the spread of SARS‐CoV‐2. These restrictions have also likely affected the frequency of intimate contacts and the spread of sexually transmitted infections (STIs). Compared to most other countries, Sweden especially in Spring‐Autumn 2020 pursued mainly milder voluntary, that is, not mandatory enforced by laws, recommended restrictions and the impacts of these on society and spread of STIs remain largely unknown. We describe the potential impact of the COVID‐19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden in 2020. Compared to 2019, we found a significant decrease in incidence of chlamydia (−4.5%) and gonorrhoea (−17.5%), and in diagnostic testing (−10.5% for chlamydia, −9.4% for gonorrhoea) in 2020. However, the decrease in chlamydia incidence, which has mainly been decreasing in the last 10 years, was not significant when compared with the average incidence in 2017–2019. The largest decrease in national incidence of both infections was observed among young and heterosexual patients, however, some Swedish regions showed an increased incidence, particularly of chlamydia. Increased “internet‐based self‐sampling” testing approach partly compensated for a decreased attendance at STI clinics. Studies, including sexual behaviour, prevention, reasons for attending STI health care, STIs in different anatomical sites and management of STIs, are required to elucidate the impact of COVID‐19‐associated social and physical distancing restrictions on sexual activity and the incidence and epidemiology of chlamydia and gonorrhoea in Sweden.

Diagnostics of Gonococcal Infection in Ukraine: Current Challenges in Resource-Constrained Settings.

This study aimed to evaluate the compliance of laboratory diagnostics of gonorrhoea in Ukraine with the World Health Organization (WHO) laboratory manual. A quantitative non-randomised cross-sectional descriptive postal survey was conducted to evaluate the diagnostics of gonorrhoea in sexually transmitted infections (STI) clinics in Ukraine. The survey provided data about diagnostics of Neisseria gonorrhoeae in STI clinics from 14 regions of Ukraine from January 2013 to September 2014. The clinics performed microscopy, culture, and point-ofcare- testing in 100%, 85.7%, and 7.1% of the cases, respectively. None of the respondents had the option of performing nucleic acid amplification tests and antimicrobial susceptibility testing. Two regions reported their participation in the collaborative project by WHO on antimicrobial resistance investigation, as national antimicrobial susceptibility surveillance program had not been established in Ukraine. A "three-site testing" (urogenital, pharyngeal, and rectal specimens) in symptomatic heterosexuals was conducted by 25%, "twosite testing" (urogenital and pharyngeal specimens) was conducted by 41.7%, and "one-site testing" (urogenital specimen) was conducted by 33.3% of the respondents. External quality control of laboratory tests for the detection of N. gonorrhoeae was not performed in 50% of the regions in Ukraine. Non-selective culture media for isolation of N. gonorrhoeae and culture media in tubes instead of the recommended Petri dishes were used in 16.7% and 58.3% of the laboratories, respectively. Increased adherence to evidence-basedWHO and/or nationally adapted management guidelines is essential for monitoring gonorrhoea and preventing antimicrobial resistance of N. gonorrhoeae in Ukraine.

How the Disruption in Sexually Transmitted Infection Care Due to the COVID-19 Pandemic Could Lead to Increased Sexually Transmitted Infection Transmission Among Men Who Have Sex With Men in The Netherlands: A Mathematical Modeling Study.

During the COVID-19 pandemic, the disruption in care for sexually transmitted infections (STIs) and the social distancing measures have led to reductions in STI testing and sexual behavior. We assessed the impact of these COVID-19-related changes on transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among men who have sex with men (MSM) in The Netherlands. We developed a mathematical model for CT and NG transmission among MSM, accounting for COVID-19-related changes in sexual behavior and testing in 2020 to 2021. Changes in 2020 were estimated from data from the Dutch COVID-19, Sex, and Intimacy Survey among MSM and the National Database of STI Clinics. Because of the lack of data for 2021, we examined several scenarios covering a range of changes. A reduction of 10% and 40% in STI testing of symptomatic and asymptomatic, respectively, individuals with a 10% to 20% reduction in numbers of casual partners (according to partner status and activity level) during the second lockdown, resulted in a 2.4% increase in CT prevalence, but a 2.8% decline in NG prevalence in 2021. A 5% and 30% reduction in STI testing of symptomatic and asymptomatic, respectively, individuals with the same reduction in casual partners resulted in a 0.6% increase in CT prevalence and a 4.9% decrease in NG prevalence in 2021. The disruption in STI care due to COVID-19 might have resulted in a small increase in CT prevalence, but a decrease in NG prevalence. Scaling up STI care is imperative to prevent increases in STI transmission.

The Implementation of Strengthening the US Response to Resistant Gonorrhea in the Emergency Department Setting: Successes and Lessons Learned in 2 Jurisdictions.

Neisseria gonorrhoeae (NG) continues to develop antimicrobial resistance (AR), and treatment options are limited. ARNG surveillance aids in identifying threats and guiding treatment recommendations but has traditionally been limited to sexually transmitted infection (STI) clinics. Large portions of STI care is delivered outside of STI clinics, such as emergency departments (EDs). These facilities might provide additional venues to expand surveillance and outbreak preparedness. Through the Strengthening the US Response to Resistant Gonorrhea program, Greensboro, NC, and Indianapolis, IN, identified 4 EDs in high-morbidity areas to expand culture collection. Patient demographics, culture recovery rates, and antimicrobial susceptibility results between EDs and local STI clinics were compared along with lessons learned from reviewing programmatic policies and discussions with key personnel. During the period 2018-2019, non-Hispanic Black patients were the most represented group at all 6 sites (73.6%). Age was also similar across sites (median range, 23-27 years). Greensboro isolated 1039 cultures (STI clinic [women, 141; men, 612; transwomen, 3]; EDs, 283 [women, 164; men, 119]). Indianapolis isolated 1278 cultures (STI clinic, 1265 [women, 125; men, 1139; transwomen, 1]; ED, 13 all male). Reduced azithromycin susceptibility was found at the Indianapolis (n = 86) and Greensboro (n = 25) STI clinics, and one Greensboro ED (n = 8).Implementation successes included identifying an on-site "champion," integrating with electronic medical records, and creating an online training hub. Barriers included cumbersome data collection tools, time constraints, and hesitancy from clinical staff. Partnering with EDs for ARNG surveillance poses both challenges and opportunities. Program success can be improved by engaging a local champion to help lead efforts.

High prevalence of syphilis in women, minors and precarious patients: a cross-sectional study in a Reunion Island sexually transmitted infection clinic, 2017-2020.

Syphilis is a sexually transmitted infection (STI) with a global prevalence estimated at 0.5% in 2012. Syphilis has been on the rise among men who have sex with men (MSM) in high-income countries and remains at endemic levels in low- and middle-income countries. This trend, however, has not been observed in Reunion Island. To determine the prevalence, clinical characteristics and risk factors of syphilis in at-risk patients visiting the South Reunion STI clinic in Reunion Island. This monocentric cross-sectional study included all patients who visited our STI clinic between 2017 and 2020. Syphilis serology was performed on all included patients, and data were collected using a standardized self-administered questionnaire. Over the 3-year study period, 2593 patients were enrolled. The prevalence of syphilis was 7.52% (n=195, 95% CI, 6.50-8.65%) in the overall study population, 11.76% (n=18, 95% CI, 6.97-18.59%) in minors (aged under 18years) and 36.36% (n=16, 95% CI, 21-59%) in pregnant women. The risk factors identified in multivariate analysis were being female [adjusted Prevalence Ratio (aPR) 1.85, 95% CI, 1.10-3.11], being MSM (aPR 2.87, 95% CI, 1.71-4.80), being aged under 18years (aPR 3.54, 95% CI, 1.90-6.57), living in precarious conditions [aPR 3.12, 95% CI, 2.11-4.62] and being born in Reunion Island (aPR 2.43, 95% CI, 1.42-4.13). The clinical presentation was heterogeneous (plaques and papules, chancre, atypical ulcerations, multiple ulcerations, condyloma lata, etc.). These findings suggest a high prevalence of syphilis in at-risk patients visiting our STI clinic. Unlike the situation in other high-income countries, the people most at risk of syphilis in Reunion Island are local-born residents, minors, women and precarious patients. This is a source of concern, especially given the risk of resurgence of congenital syphilis on the island.

Recent Trends of Syndromic Sexually Transmitted Infections at a Tertiary Care Center in Maharashtra, India: A Retrospective Analysis

Background: Sexually transmitted infections (STIs) constitute a major public health problem in both developed and developing countries. Human immunodeficiency virus (HIV) and STIs are linked in their similar mode of transmission, with STIs facilitating the acquisition and transmission of HIV. The prevalence pattern of individual STIs may evolve over time necessitating a corresponding change in management strategies. Objectives: The study was conducted to determine the burden and any change in the etiological trend among attendees of an STIs clinic at a tertiary care hospital. Methods: This retrospective study analyzed data retrieved from consecutive patients attending an STIs clinic over two years (July 2018 to July 2020). Results: Overall, 1916 patients were diagnosed with STIs. The predominant age group was 25 - 44 years (59.23%). Genital ulcer disease was the foremost syndrome (1213, 63.3%). Overall, herpetic genital ulcer was the most common (682, 35.6%), followed by non-herpetic ulcers (531, 27.7%). Vaginal discharge, lower abdominal pain, and urethritis were found in 461 (24%), 219 (11.43%), and 23 (1.27%) of the patients, respectively. Amongst 237 (12.36%) In HIV seropositive attendees, genital ulcer disease (herpetic) was the most common syndrome (179, 75.53%), followed by vaginal discharge (42, 17.72%), lower abdominal pain (9, 3.8%), and urethritis (7, 2.9%). Conclusions: A definite change in the profile of STIs was observed with ulcerative STIs (particularly herpes genitalis) constituting the major burden against a discernible back drop of decreasing non-herpetic STIs. A systematic, regional, periodic synopsis would not only help to follow and document the dynamic trends, but also can help to assess the effectiveness of control programs.

Changing Patterns of Sexual Behavior and HIV/STI Among Men Who Have Sex With Men in Seattle, 2002 to 2018.

The extent to which uptake of biomedical HIV prevention strategies have affected population-level sexual behavior and sexually transmitted infections (STIs) among men who have sex with men (MSM) is not well understood. We collected data as part of routine care from MSM attending the municipal STI clinic in Seattle, Washington, 2002-2018. MSM were asked about condom use in the previous 12 months. We classified behaviors into 4 mutually exclusive categories: no anal sex; consistent condom use for anal sex; serosorting [condomless anal sex (CAS) only with HIV-concordant partners]; and CAS with serodiscordant/unknown-status partners. STI/HIV testing was performed per routine clinic protocol. There were 45,656 and 6987 visits by MSM without HIV and MSM with HIV, respectively. The use of antiretroviral therapy and preexposure prophylaxis increased substantially during the study period to 94% and 50%, respectively, by 2018. CAS with serodiscordant/unknown-status partners decreased through 2013 but increased thereafter (to 40% among MSM without HIV; 68% among MSM with HIV). Serosorting increased among MSM without HIV but declined after 2013 among MSM with HIV. Consistent condom use declined for all MSM (from 35% to 11% among MSM without HIV; from 20% to 5% among MSM with HIV). HIV test positivity declined substantially (3.5%-0.5%), whereas STI test positivity increased over time. Since 2013, CAS with HIV-discordant/unknown-status partners increased substantially concurrent with declining HIV test positivity and increasing STI test positivity. This highlights the success of biomedical HIV prevention strategies to reduce HIV incidence while affirming the need for new approaches to STI prevention.

Artificial intelligence and sexual health in the USA

Artificial intelligence and sexual health in the USA

Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services

IntroductionVoluntary medical male circumcision (VMMC), an effective HIV prevention programme for men, is implemented in East and Southern Africa. Approximately 50% of VMMC clients are aged below 15 years. More...

Attitudes and Preferences Regarding Non-Clinic-Based Self-Collection for Sexually Transmitted Infection Testing Among Clinic Attendees in British Columbia, Canada.

Sexually transmitted infections (STIs) are a global epidemic; although screening programs reduce transmission, barriers, including access and stigma, hinder success. The World Health Organization highlights the ability to maintain health without the direct support of a health care provider as one form of self-care, which can be applied to STI testing. Self-care through non-clinic-based self-collection for STI testing can address barriers while providing comprehensive care. Before implementation of innovative changes to screening approaches, it is important to understand if communities who rely on in-person care will self-collect outside of the clinic setting. This study investigated willingness to use non-clinic-based self-collection for STI testing among STI clinic attendees in British Columbia, Canada. Participants (n = 446) were recruited from STI clinics offering clinic-based self-collection for STI testing and completed a survey assessing self-care attitudes, including willingness to self-collect urine samples, throat swabs, and anogenital swabs outside of the clinic setting. Descriptive statistics, bivariable analyses, and multivariable models were conducted to investigate willingness to use non-clinic-based STI self-collection methods and associated correlates. This population reported high willingness to use non-clinic-based self-collection methods for STI testing (urine samples, 73%; throat swabs, 67%; anogenital swabs, 65%). Those aged 35 to 54 years compared with 15 to 34 years were more likely to be willing (adjusted odds ratio, 1.87; 95% confidence interval, 1.03-3.50); those identifying as straight/mostly straight compared with gay/lesbian were less likely to be willing (adjusted odds ratio, 0.39; 95% confidence interval, 0.23-0.65). Non-clinic-based self-collection for STI testing can address barriers to testing while maintaining quality care. Those currently receiving in-person care find these methods highly acceptable. These findings reinforce that self-collection for STI testing used in British Columbia clinics is acceptable to clients and may be extended to collection performed outside of the clinical setting.

Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000–20

SummaryBackgroundThe WHO Global Health Sector Strategy aims to reduce worldwide syphilis incidence by 90% between 2018 and 2030. If this goal is to be achieved, interventions that target high-burden groups, including men who have sex with men (MSM), will be required. However, there are no global prevalence estimates of syphilis among MSM to serve as a baseline for monitoring or modelling disease burden. We aimed to assess the global prevalence of syphilis among MSM using the available literature.MethodsIn this global systematic review and meta-analysis, we searched MEDLINE, Embase, LILACS, and AIM databases, and Integrated Bio-Behavioral Surveillance (IBBS) reports between April 23, 2019, and Feb 1, 2020, to identify studies done between Jan 1, 2000, and Feb 1, 2020, with syphilis point prevalence data measured by biological assay among MSM (defined as people who were assigned as male at birth and had oral or anal sex with at least one other man in their lifetime). Studies were excluded if participants were exclusively HIV-infected MSM, injection-drug users, only seeking care for sexually transmitted infections (STIs) or genital symptoms, or routine STI clinic attendees. Data were extracted onto standardised forms and cross-checked for accuracy and validity. We used random-effects models to generate pooled prevalence estimates across the eight regions of the Sustainable Development Goals. We calculated risk of study bias based on the Appraisal tool for Cross-Sectional Studies, and stratified results based on low versus high risk of bias. This systematic review and meta-analysis was registered with PROSPERO, CRD42019144594.FindingsWe reviewed 4339 records, 228 IBBS reports, and ten articles from other sources. Of these, 1301 duplicate records were excluded, 2467 records were excluded after title and abstract screening, and 534 articles were excluded after full-text analysis. We identified 345 prevalence data points from 275 studies across 77 countries, with a total of 606 232 participants. Global pooled prevalence from 2000–20 was 7·5% (95% CI 7·0–8·0%), ranging from 1·9% (1·0–3·1%) in Australia and New Zealand to 10·6% (8·5–12·9%) in Latin America and the Caribbean.InterpretationUnacceptably high syphilis prevalence among MSM warrants urgent action.FundingWellcome Trust.