Sexually Transmitted Infections Counseling Research Articles

Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men.

Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities. We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus. Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV. The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.

Sexually Transmitted Infections and Health Literacy: A Community-Based Preventive Program.

Sexually transmitted infections (STIs) are a public health problem with a high risk of morbidity and community transmissibility. Evidence points to their continuous increase. This study describes the design, development, and implementation of a community-based STI prevention program for community healthcare users. Based on the Health Planning Process design method, a structured, community-based intervention program on STI counseling and detection was conducted in a primary health care unit in Lisbon. Two data collection instruments were applied in the diagnosis of the situation, namely the Health Literacy Survey Portugal (ILS-PT) and the STD Attitude Scale, to 47 patients who attended the health consultation on STI counseling and detection in a primary care unit in Lisbon. Two interventions were implemented, the health education session and the provision of an educational poster. In the evaluation of the project, the acceptance and satisfaction of the patients with the implemented interventions were considered as outcome indicators. A descriptive statistical analysis of the data was performed. The participants shows considerably low levels of health literacy and high-risk behaviors for acquiring STIs. After an intervention, a high percentage of the participants point out the project as exciting and valuable and reveal having acquired knowledge that allowed them to improve their health. Furthermore, the patients were very satisfied with the implemented health education session and the educational poster. This project revealed the urgent and important need to implement community intervention projects to prevent STIs and promote health literacy among the most vulnerable groups.

2215. Pre-pregnancy STI Counseling and HIV Testing Among Married Women: PRAMS 2016-2019

Abstract Background Chlamydia, gonorrhea, and syphilis are one of the most reported and curable sexually transmitted infections (STIs) in the US, but rates continue to rise. STI during pregnancy can lead to perinatal infections. The best time to address this is at pre-conception. This study aims to examine health care visit practices among women before pregnancy and compare pre-pregnancy STI counseling and HIV testing rates among married women. Methods We utilized the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2019, a population-based survey of postpartum women. Mothers self-reported if any health care worker talked to them about STIs or tested for HIV during any health care visit in the 12 months before pregnancy. Marital status was obtained from birth certificate records. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth. Results Of the the162,558 surveyed women, only 66.1% had any health care visit within 12 months pre-pregnancy (Figure1). Among those with a health care visit and STI screening response (n=104,256), approximately 70% of women reported never receiving pre-pregnancy STI counseling or HIV testing. Puerto Rico and D.C. had the highest pre-pregnancy screening rates while Utah had the lowest (Figure 2). Married women were less likely to receive pre-pregnancy STI counseling (OR 0.6: 95% CI 0.56, 0.64) or HIV testing (OR 0.65: 95% CI 0.61, 0.69) compared to unmarried women (Figure 3). Other risk factors for missing pre-pregnancy STI screening were older age, having more education, private insurance, higher income, and previous live birth. Black and Hispanic women were 2-3 times more likely to receive STI screening compared to White women. Figure 1:Any health care visit and visit type within 12 months before pregnancy (n=162,558)Figure 2:Pre-pregnancy STI counseling and HIV testing across 43 states, DC, NYC, and PR (n=104,256)Figure 3:Adjusted odds of receiving pre-pregnancy STI counseling and HIV testing among recent mothers, PRAMS 2016-2019 (n=104,256) Conclusion Married women were less likely to receive pre-pregnancy STI counseling and HIV testing. Our study highlights the lack of preconception care among women who recently gave birth. Marital status, demographics, and socioeconomic factors continue to affect a woman’s likelihood of receiving STI screening. Risk-based, selective STI screening creates gaps and missed opportunities to address STIs before pregnancy. Universal screening should be adopted for all women regardless of their preconceived risk or assumptions. Disclosures All Authors: No reported disclosures.

Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men

ObjectivesWhile pre-exposure prophylaxis (PrEP) prevents HIV acquisition among gay, bisexual and other men who have sex with men (GBM), PrEP-using GBM may be more likely to engage in sexual behaviours...

Trends in Sexual Behavior and Sexually Transmitted Infections After Initiating Human Immunodeficiency Virus Pre-Exposure Prophylaxis in Men Who Have Sex with Men from Amsterdam, the Netherlands: A Longitudinal Exposure-Matched Study.

Men who have sex with men (MSM) initiating human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) may increase condomless anal sex (CAS) and number of partners, and, consequently, more often acquire sexually transmitted infections (STIs). Using data from the Amsterdam Cohort Studies, we compared sexual behavior and STI among MSM after PrEP-initiation with controls not initiating PrEP. The MSM reported on sexual behavior and were tested for HIV, chlamydia, gonorrhea, and syphilis semi-annually. We matched MSM who initiated PrEP between January 1, 2015 and December 31, 2019 1:1 to MSM who did not use time-dependent propensity scores based on age, sexual behavior, and STI. Primary end-points were number of casual partners, and proportion with CAS and receptive CAS (rCAS) with casual partners, sexualized drug use (SDU), any STI, and anal STI. We modeled end-points during the 4 years before and 2 years after PrEP-initiation or matched PrEP-initiation timepoint by using logistic regression (dichotomous end-points) or negative binomial regression (count end-point), adjusted for calendar year. Two hundred twenty-eight out of the 858 (26.6%) MSM initiated PrEP. We matched 198 out of 228 (86.8%) to a control. Before PrEP-initiation, end-points increased over time in both groups, with no statistically significant difference. The odds of CAS, rCAS, and anal STI were on average higher after than before PrEP-initiation in PrEP initiators, whereas after versus before differences were not observed in controls. After PrEP-initiation, PrEP initiators had statistically significantly more casual partners, and higher odds of CAS, rCAS, SDU, any STI, and anal STI than controls. These findings support frequent STI screening and counseling in MSM using PrEP.

A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial.

BackgroundFemale entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status.ObjectiveThis study evaluated the efficacy of the Mobile Link intervention in improving FEWs’ health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services.MethodsA randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression.ResultsA total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models.ConclusionsThe Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future.Trial RegistrationClinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842International Registered Report Identifier (IRRID)RR2-10.1186/s13063-018-2614-7

Knowledge about sexually transmitted infections among sexual and reproductive health clinic attendants in Ghana

Background: Prevention and treatment of sexually transmitted infections (STIs) are important to reduce associated morbidity and mortality. Awareness and knowledge about STIs promote healthy reproductive health behaviours. Objective: This study assessed the knowledge about STIs and their prevention among sexual and reproductive health clinic attendants. Methods: A survey was administered to attendants at two sexual and reproductive health clinics in Ghana. Questions included demographics, utilization of reproductive services, knowledge about STIs, and personal behaviours regarding STI prevention. AnSTI Knowledge Score was created by summing correct responses to thirty-three factual questions on STI transmission, prevention, and symptoms. Results: Of 155 participants, 85.8% reported any knowledge about STIs, and 56.8% had been educated about STIs by healthcare providers at the sexual and reproductive health clinic. Initial education about STIs was most encountered at school (56.3%). Most participants correctly identified gonorrhoea (87.1%), syphilis (65.8%), and human immunodeficiency virus(94.8%) as STIs, however, less than half correctly identified chlamydia (46.5%) and hepatitis B (45.2%). Regarding knowledge of transmission, 93.5% knew that STIs are transmitted through unprotected intercourse, however,36.1% incorrectly believed that STIs could be spread by sharing cups and spoons. The majority (90.2%) correctly identified condoms as a method of STI prevention. On a 33-point STI Knowledge Score, participants had a mean[±standard deviation (SD)]of 21(±-1.2). overall, 21.2%of participants had “poor” knowledge, 50.4% had “satisfactory” knowledge and 28.4% had “excellent” knowledge. Overall, 79% of participants felt that they were prepared to share information about STIs with others. A higher level of knowledge was associated with a greater preparedness to share. Conclusion: Attendants of sexual and reproductive health clinics have a high awareness about STIs, however important knowledge gaps exist. We highlight the importance of sexual and reproductive health clinics providing comprehensive STI counselling

1356. Association Between Marital Status and Pre-pregnancy STI Counseling Among Women Who Have Recently Given Birth: RI PRAMS 2016-2018

Abstract Background As rates of sexually transmitted infections (STIs) continue to rise, all women of reproductive age can suffer from complications particularly during pregnancy which can lead to adverse neonatal outcomes. Currently, data on STI counseling among married women are limited. This study aims to assess differences in pre-pregnancy STI counseling based on marital status among women who have recently given birth. Methods We utilized the Rhode Island Pregnancy Risk Assessment Monitoring System (RI PRAMS) 2016-2018, a population-based survey of postpartum women. Mothers self-reported if they have received STI counseling for chlamydia, gonorrhea, and syphilis during any health care visit in the 12 months before becoming pregnant. Marital status was obtained from the birth certificate. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth. We accounted for weighting and complex survey design. Results Our analytic sample included 2,361 mothers. More than half of the women reported never having received pre-pregnancy STI counseling about the 3 most reported and curable STIs in the US. Among them, an estimated 78.9% (n=1,207) of married women did not receive pre-pregnancy STI counseling compared to 53.6% (n=429) of unmarried women (Table 1). Married women had 0.61 (95% CI: 0.46, 0.81) odds of receiving STI counseling before pregnancy compared to unmarried women (Figure 1). Other risk factors for not receiving STI counseling included having a college education or higher or having a previous live birth. Table 1. Characteristics of Women who have Recently Given Birth by Marital Status, RI PRAMS 2016-2018 (n=2,361) *Unknown/missing values for each category &amp;lt;10%.**Uninsured population &amp;lt;1% Figure 1: Adjusted Odds of Having Received Pre-pregnancy STI Counseling among Recent Mothers, RI PRAMS 2016-2018 (n=2,361) *P-value &amp;lt;0.05Reference Group; Marital Status: unmarried, Age: &amp;lt; 25 years old, Race: White, Hispanic: Non-Hispanic, Education: High school degree or less, Insurance: Public insurance, Income: &amp;lt; &amp;24,000, Previous live birth: No previous live birth Conclusion Selective STI counseling creates gaps and missed opportunities to address STIs early before pregnancy. All women regardless of their perceived risk for STI or assumptions based on their marital status should receive proper STI counseling as all women are vulnerable and at higher risk of developing complications. Health care providers should increase efforts to address this gap and counsel all women about STIs during every visit irrespective of their marital status. Disclosures All Authors: No reported disclosures

STI/HIV Testing and Prevalence of Gonorrhea and Chlamydia Among Persons with Their Specified-Type Sex Partner

BackgroundPrevious studies have shown that sexually transmitted infections (STI) and human immunodeficiency virus (HIV) testing has varied, but STI prevalence was not estimated among patients during their health care visits in which a high-risk sexual partnership was documented. This study estimated gonorrhea, chlamydia, syphilis, and HIV testing rates and chlamydia and gonorrhea prevalence. MethodsFrom the de-identified commercial claims data of OptumLabs Data Warehouse, we identified men and women aged 15-60 years classified as having high-risk sexual relationships as diagnosis codes: Z72.51 for opposite-sex, Z72.52 for same-sex, and Z72.53 for same-and-opposite-sex relationships, stratified by gender, age group, region, type of health plan, and HIV status. We estimated STI testing rate and prevalence for chlamydia and gonorrhea among patients with high-risk sexual relationships. HIV testing was assessed only in high-risk sexual relationship patients without HIV. ResultsAmong 8.2 million females and 7.3 million males aged 15-60 years in the database from 2016 to 2019, 115,884 patients (0.7% of female, 0.8% of male) including 3,535 patients with HIV were diagnosed with high-risk sexual relationships. The testing rates for gonorrhea, chlamydia, syphilis, and HIV were 69.4% (confidence interval [CI]: 69.1-69.7), 68.9% (CI: 68.6-69.2), 43.4% (CI: 43.1-43.7), and 41.7% (CI: 41.4-42.0), respectively. Among patients with valid chlamydia and gonorrhea tests, 7.2% (CI: 7.0-7.5) and 2.6% (CI: 2.4-2.8) had positive chlamydia and gonorrhea test results, respectively, and varied by type of high-risk sexual relationship. ConclusionsOur study findings of suboptimal STI screening among patient in high-risk sexual relationships are consistent with previous studies. Administrative records confirmed by lab results indicate a need for STI counseling, testing, and treatment among patients who are diagnosed with high-risk sexual relationships with same-sex, opposite-sex, or same-and-opposite sex partners.

19. Knowledge of Human Papillomavirus, Human Papillomavirus Vaccination, and other Sexually Transmitted Infections among Individuals with Mayer-Rokitansky-Küster-Hauser Syndrome

<h3>Background</h3> Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital condition typified by underdevelopment of the female reproductive tract. Much of the MRKH literature addresses surgical options and psychosocial aspects, however little is known about the routine gynecologic care of individuals with MRKH. The purpose of this study was to assess the knowledge of and prior counseling on genital infection and prevention in a sample of people with MRKH. <h3>Methods</h3> The Beautiful You MRKH Foundation disseminated an IRB-approved, web-based survey through social media. Participants were eligible if they had previously been diagnosed with MRKH and were 18 years and older. Survey content included past gynecologic counseling, sexually transmitted genital infection knowledge, and sexual history. Questions assessing knowledge of human papillomavirus (HPV) and sexually transmitted infections (STI) were adapted from validated tools. For unanswered survey questions, an analysis was conducted according to the number of responses for each question. <h3>Results</h3> Eighty respondents consented to the study, mean age 30 ± 9 years. The majority (73%, 58/80) never received HPV vaccination counseling. Of the respondents, 38 out of 80 (48%) never received any HPV vaccine, 10 (13%) were unsure, 6 (8%) received at least one dose, and 26 (33%) completed the vaccination series. The most common reasons for not being vaccinated were lack of knowledge about the vaccine (22%, 8/37), did not think it was necessary (14%, 5/37), not sexually active (11%, 4/37), and did not want to receive the vaccine (11%, 4/37). The majority (61%, 49/80) also did not receive counseling on other STI. Sixty respondents completed the knowledge portion of the survey. HPV knowledge was low; 13 did not think they were a candidate for the HPV vaccine (22%) and 22 were unsure (37%). Less than half of respondents thought the HPV vaccine could help prevent anal cancer (15%), genital warts (30%), and vulvar/vaginal cancer (48%). Twenty-four respondents (40%) thought routine pap smear screening should be performed among MRKH patients, and 20 (33%) were unsure. The majority responded that sexually active persons with MRKH should be routinely tested for STI (87%) and use condoms (82%). Sixty-four percent of 56 respondents were undecided or unhappy with the gynecologic care they have received, and 75% strongly wished their providers knew more about MRKH. <h3>Conclusions</h3> The majority of individuals with MRKH did not receive adequate HPV, HPV vaccination, and STI counseling. As a result, the majority did not receive the vaccine. These data indicate that there is a lack of appropriate gynecological care for people with MRKH.

Evaluation of Chlamydia trachomatis and HR-HPV infection in women living with HIV: a cross-sectional study

Introduction: Infections caused by Chlamydia trachomatis (CT) and Human Papilloma Virus (HPV) are among the most prevalent sexually transmitted infections (STIs) worldwide. CT infection in women living with the human immunodeficiency virus (HIV) can facilitate HIV transmission by increasing HIV shedding in cervicovaginal secretions. The prevalence of Human papillomavirus (HPV) infection is higher in women living with HIV when compared to HIV-negative women, even when comparing those with the same sociodemographic characteristics. Generally, they have a high viral load and a higher persistence of viral infection, which increases the risk of developing premalignant and malignant lesions in the lower genital tract. Objective: To evaluate the frequency of CT and High-Risk HPV (HR-HPV) infection among women living with HIV and the association with sociodemographic, behavioral and clinical characteristics. Methods: Cross-sectional study carried out with a population of 66 non-pregnant women aged between 18 and 70 years living with HIV and/or acquired immunodeficiency syndrome (AIDS) at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói (RJ), Brazil, between the period of March 1, 2018 and October 31, 2018. A standardized questionnaire was applied including sociodemographic and behavioral characteristics, and clinical information (use of oral contraceptives, Antiretroviral Therapy (ART), cluster of differentiation 4 (CD4) cell count, and viral load). Endocervical samples were collected for CT (COBAS 4800® system, Roche) and HPV (COBAS® HPV test, Roche) detection. Fisher's Exact Test was used to assess the association between variables. Regression analyses were performed using the logistic model in order to identify the factors associated with the outcomes of interest. Results: A frequency of 1.5% for CT and 21.2% for HR-HPV was found. Age was the single factor that presented statistical significance associated with HR-HPV infection. Conclusion: Our study showed that some women living with HIV promote risky behavior which could facilitate the acquisition of other STIs, such as HPV and CT infection. Some of them, with detected viral load, were not using condoms even with HIV-negative partners. These results may suggest that in addition to treatment and follow-up of women living with HIV, STIs counseling and guidance may play an important role in the control of STIs in this population.

998. Understanding Retention in PrEP Care in the South: Insights from an Academic HIV Prevention Clinic

BackgroundDaily emtricitabine-tenofovir disoproxil fumarate has emerged as one of the most effective tools to prevent HIV transmission. However, it remains poorly utilized in the South. We report on PrEP retention in care and sexually transmitted infections (STIs) in a large academic PrEP clinic in Durham, North Carolina.MethodsWe conducted a retrospective chart review of patients in the Duke University PrEP Clinic from Jan. 1, 2015 through Oct. 15, 2019. Short-term retention in care was completion of a 3 month (mo) follow up as per CDC guidelines. Long-term retention was defined as completion of a 3 mo visit and an additional visit between 8 and 12 mo. Baseline STI was defined as a diagnosis at or within 1 year prior to initial PrEP visit. STI diagnosis while on PrEP was any subsequent diagnosis while retained in care. Odds ratios (OR) were generated using multivariable logistic regression. Kaplan-Meier curves were generated for retention in care and compared using the log rank test.ResultsA total of 255 patients attended at least one PrEP clinic encounter; 89% were men, 37% were Black, and 73% identified as men who have sex with men (MSM); 153 (60%) returned for at least one follow-up visit. Short and long term retention in care were met by 130/237 (55%) and 80/217 (37%) patients respectively. OR for retention are reported in Table 1. MSM are more likely to be retained in the short-term (OR 5.22 [95% confidence interval (CI) 1.57-17.32]). Self-referred patients were more likely to be retained in the long-term (OR 2.18 [95% CI 1.12-4.23]). Patients without insurance were less likely to attain long-term retention in care outcomes (OR 0.32 [95% CI 0.11-0.91]). STI diagnoses include 30 (12%) patients for a total of 42 unique infections at baseline and 44 (17%) for a total of 69 unique infections at follow up. Two new HIV diagnoses were made at first PrEP clinic encounter with no new diagnoses made at follow-up. Baseline STI was not associated with retention in care over time with disengagement defined as 6 mo post last visit (Figure 1).Table 1) Odds Ratios of Retention in Care at 3 and 12 Months Figure 1) Retention in Care for Patients with Baseline STI Diagnosis. ConclusionOur PrEP clinic shows a decline in patient retention over time. STIs were also prevalent, reinforcing that frequent STI testing and counseling should be part of each PrEP encounter. Further investigations into how to increase and improve PrEP utilization for HIV prevention are needed.Disclosures All Authors: No reported disclosures

Sexual Behavior and Sexually Transmitted Infection Outcomes Among Men Who Have Sex With Men and Transgender Women Participating in a Study of the Timing of Antiretroviral Therapy in Lima, Peru.

We assessed sexual behavior and incidence of sexually transmitted infections (STIs) among men who have sex with men and transgender women participating in Sabes, a study of an expanded treatment as prevention strategy focused on early diagnosis and treatment of HIV infection in Lima, Peru (2013-2017). Sabes participants were tested monthly for HIV to identify acute or early infections, and HIV-positive participants were randomized to receive antiretroviral therapy immediately (immediate arm) or after 24 weeks (deferred arm) during a 48-week follow-up period. Sexual behavior was assessed at randomization (baseline) and every 12 weeks thereafter. Participants were tested for urethral and rectal chlamydia and gonorrhea and for syphilis at baseline, 12, 24, and 48 weeks. We describe patterns of sexual behavior during the 48-week follow-up period and compare sexual behavior and STI incidence between study arms. After randomization, 207 HIV-positive participants completed questionnaires and STI testing at 2 or more visits. After HIV diagnosis, participants in both arms reported increases in condom use with main and casual partners and decreased drug and alcohol use before or during anal sex. We observed no between-arm differences in sexual behavior. Deferred arm participants had higher incidence of chlamydia (incidence rate ratio, 2.33; 95% confidence interval, 1.14-4.77) but not gonorrhea or syphilis. Despite reported increases in condom use, the overall high incidence of STIs reflects some ongoing condomless sex among HIV-positive men who have sex with men and transgender women, highlighting the importance of regular STI screening and counseling to support consistent condom use among HIV-positive individuals at risk for STIs.

Do Swiss community pharmacists address the risk of sexually transmitted infections during a consultation on emergency contraception? A simulated patient study

Objectives: Since 2002, Swiss community pharmacists have dispensed emergency contraception (EC) as pharmacist-only medicine ideally using the official Swiss protocol. Our study aimed to determine pharmacists’ resolution of an imaginary EC case, compliance with the protocol, and provision of information on the risk of sexually transmitted infections (STIs).Methods: We conducted a simulated patient study with 69 students who each visited a community pharmacy. The scenario started with the student requesting the ‘morning after pill’. Current practice was assessed using an online evaluation form adapted from the Medication-Related Consultation Framework. Descriptive and statistical analyses were carried out.Results: All pharmacists correctly identified that the person needed EC. All pharmacists used an EC protocol and asked on average 10.9 (standard deviation 0.68) of 11 compulsory EC assessment questions. In total, 93% of pharmacists addressed EC counselling items and 56% addressed the risk of STIs, mainly by mentioning that condoms offered the best protection (76%).Conclusions: Community pharmacists correctly issued the EC, complied with the dispensing protocol and used their professional judgement to ensure optimal EC use. There is nevertheless room for improvement regarding pharmacists’ STI counselling. Finally, the protocol’s STI section could be enriched with specific information to guide counselling.

Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016.

Background:The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016.Methods:The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate.Results:Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%).Discussion:Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.

Prevalence and risk factors of sexually transmitted infections among French service members.

IntroductionSexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs.MethodsData are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18–57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports.ResultsThe prevalence of diagnosed STIs was 4.7% [3.8–5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6–2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports.ConclusionThis study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women’s health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.

Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia: analysis of longitudinal continuous quality improvement data

BackgroundChlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in continuous quality improvement (CQI).MethodsPreventive health audits (n = 16,086) were conducted at 137 Aboriginal PHC centres participating in the Audit and Best Practice for Chronic Disease Program, 2005–2014. STI testing and counselling data were analysed to determine levels of variation in chlamydia, syphilis and gonorrhoea testing and sexual health discussions. Multilevel logistic regression was used to determine factors associated with higher levels of STI-related service delivery and to quantify variation attributable to health centre and client characteristics.ResultsSignificant variation in STI testing and counselling exists among Aboriginal PHC centres with health centre factors accounting for 43% of variation between health centres and jurisdictions. Health centre factors independently associated with higher levels of STI testing and counselling included provision of an adult health check (odds ratio (OR) 3.40; 95% Confidence Interval (CI) 3.07-3.77) and having conducted 1–2 cycles of CQI (OR 1.34; 95% CI 1.16-1.55). Client factors associated with higher levels of STI testing and counselling were being female (OR 1.45; 95% CI 1.33-1.57), Aboriginal (OR 1.46; 95% CI 1.15-1.84) and aged 20–24 years (OR 3.84; 95% CI 3.07-4.80). For females, having a Pap smear test was also associated with STI testing and counselling (OR 4.39; 95% CI 3.84-5.03). There was no clear association between CQI experience beyond two CQI cycles and higher levels of documented delivery of STI testing and counselling services.ConclusionsA number of Aboriginal PHC centres are achieving high rates of STI testing and counselling, while a significant number are not. STI-related service delivery could be substantially improved through focussed efforts to support health centres with relatively lower documented evidence of adherence to best practice guidelines.

High-risk Behavior Among U.S. Military HIV-Infected Active-Duty and Retired Personnel

BackgroundDespite a high incidence of sexually transmitted infections (STIs), sexual behavior among U.S. military personnel remains understudied. Since 2014, the U.S. Military HIV Natural History Study has administered a behavioral questionnaire to a cohort of HIV-infected active-duty (AD) and retired personnel (RP). We compared patterns of risk behavior between AD and RP.MethodsMale participants who completed a behavioral questionnaire (n = 1,465) were included in this study. Chi-square and stepwise logistic regression were used to compare AD with RP. Our model included all behavioral variables listed below with adjustment for age and race. We assumed a priori that duty status would be correlated with age and selected the former as our variable of interest, hypothesizing that AD would engage in a higher number of risk behaviors.ResultsSelected demographics and behavioral data are summarized below.AD (n = 731) %RP (n = 734) %Univariate Odds (95% CI)Multivariate Odds (95% CI)DemographicsMedian Age (IQR)30 (26,37)51 (46,57)Race--White32.745.0--Black46.143.6--Hispanic/Other21.211.4Behavioral DataConsumed > 6 drinks on a single occasion (past year)50.932.12.2 (1.7,2.8)Ever experienced injury from drinking84.572.92.0 (1.6,2.6)Ever used hard drugs7.317.60.4 (0.3,0.5)0.5 (0.3,0.9)High self-perceived risk for STI22.119.11.3 (1.0,1.6)> 2 new sexual partners in past three months22.614.51.7 (1.3,2.3)Ever had sex with woman65.982.80.4 (0.3,0.5)Ever had sex with man82.179.81.2 (0.9,1.5)Condomless anal intercourse in last 3 mos (casual partner)29.527.21.1 (0.8,1.5)Condomless anal intercourse in last 3 mos (anonymous partner)22.318.21.3 (0.9,1.8)AD had significantly (P < 0.01) higher rates of gonorrhea (6.4) and chlamydia (6.0) per 100 person-years (py) than RP (2.2 and 1.6, respectively); syphilis rates did not differ between the groups (AD 1.2/100 py; RP 1.3/100 py).Conclusion In contrast with our hypothesis, we found a high prevalence of sexual risk behavior among both AD and RP, and only lifetime use of hard drugs was independently associated with duty status. Despite high STI rates, ~20% in either group reported high self-perceived risk for STIs and/or recent condomless sex with an anonymous partner. Our findings demonstrate a need for intensive STI screening and counseling among HIV-infected military personnel in multiple career stages.Disclosures All authors: No reported disclosures.

Chlamydia screening and prophylactic treatment in termination of pregnancy clinics in the Netherlands and Great Britain: a qualitative study

Background: Women having a termination of pregnancy (TOP) have higher rates of Chlamydia trachomatis (CT) than the general population. In this study, we explored CT treatment and prevention in Dutch TOP clinics in comparison to that provided in Great Britain (GB).Methods: A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (the Netherlands: 9, GB: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis.Results: Prophylactic treatment with azithromycin is routinely prescribed after surgical TOP, but not after medical TOP (‘abortion pill’). Sexually transmitted infections (STI) tests are offered to clients who are considered at high risk of having STI. Uptake varies according to health insurance coverage of STI testing. Some Dutch clinics are able to provide free testing for women under 25 years of age. Sexual health counselling is often limited to discussing birth control. The major difference between the Netherlands and GB is that GB TOP clinics more often offer free STI testing and prophylaxis to their clients.Conclusion: HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent testing on location. Dutch TOP clinics should offer STI tests to all women, and collaboration with public health services could improve STI testing and counselling for young people. Furthermore, clinics should treat all TOP clients with prophylactic azithromycin. This could prevent CT and other upper genital tract post-abortion infections.

Motives of Dutch men who have sex with men for daily and intermittent HIV pre-exposure prophylaxis usage and preferences for implementation: A qualitative study.

Although PrEP is not yet registered in Europe, including the Netherlands, its approval and implementation are expected in the near future. To inform future pre-exposure prophylaxis (PrEP) implementation, this study aimed to gain insight into motives and preferences for daily or intermittent PrEP use among Dutch HIV-negative men having sex with men (MSM).Between February and December 2013, semistructured interviews were conducted until data saturation was reached (N = 20). Interviews were analyzed using the Grounded Theory approach.Motives for (not) using daily PrEP were based on beliefs about PrEP efficacy and side effects, preferences for other prevention strategies, self-perceived HIV risk, self-perceived efficacy of PrEP adherence, beliefs about possible benefits (e.g., anxiety reduction, sex life improvement), and barriers of PrEP use (e.g., costs, monitoring procedures). The perceived benefits of intermittent versus daily PrEP use were the lower costs and side effects and the lower threshold to decision to start using intermittent PrEP. Barriers of intermittent PrEP versus daily PrEP use were the perceived need to plan their sex life and adhere to multiple prevention strategies. Although some perceived PrEP as a condom substitute, others were likely to combine PrEP and condoms for sexually transmitted infections (STI) prevention and increased HIV protection. Participants preferred PrEP service locations to have specialized knowledge of HIV, antiretroviral therapy, sexual behavior, STIs, patients’ medical background, be easily approachable, be able to perform PrEP follow-up monitoring, and provide support.To maximize the public health impact of PrEP, ensuring high uptake among MSM at highest risk is important. Therefore, targeted information about PrEP efficacy and side effects need to be developed, barriers for accessing PrEP services should be minimized, and perceived self-efficacy to use PrEP should be addressed and improved. To prevent increases in STIs, condom use should be monitored and PrEP should be integrated into routine STI screening and counseling.