Incidence Of Sexually Transmitted Infections Research Articles

Sexually transmitted infections in Belgian general practices: a nationwide continuing surveillance study, data from 2015 to 2020.

The current study aims at describing sexually transmitted infections (STI) surveillance data collected from 2015 to 2020 as well as investigating patients' characteristics and risk factors in the sample population. Reported STI cases are continuously increasing in Europe. In Belgium, 94.1% of citizens have a regular general practitioner (GP) or are affiliated to a general practice. By using GPs for surveillance, STIs can be monitored in the general population. Between January 2015 and December 2020, the Sentinel General Practitioners (SGP) network retrospectively reported five STIs: chlamydia, gonorrhoea, genital warts, herpes, and syphilis. In the SGP network database on STIs, participating GPs report on case-by-case basis through paper or online registration forms. We performed descriptive statistics, X2 test and logistic regression using SAS® 9.4. Multivariate multiple logistic regression was performed to investigate the relationship between STIs and patients' characteristics. During the study period, 1009 cases were reported, corresponding to an episode-based incidence estimated at 121 per 100,000 inhabitants. The majority of patients (59.8%) were men, and 83.6% were under age 30. Among female patients 92.7% had heterosexual contacts whereas 64.4% of male patients did. Women were more likely to be diagnosed with chlamydia (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.12-2.17) and herpes (OR 1.72, 95% CI 1.04-2.86) than men.In this study, STI surveillance data were in agreement with literature. Continuous surveillance through the SGP network remains an important tool to obtain information about populations at risk and STI incidence in the general population.

STI Rates Among High-Risk Youth Undeterred During Early COVID-19 In A HIV Care Clinic

Abstract Background In recent years, the United States has observed increasing rates of sexually transmitted infections (STIs). Rates are highest amongst the teen and young adult age groups. In addition to the immense healthcare costs associated with STIs, long-term sequelae can be severe on the individual level. The risk of infertility is particularly high for those with repeated or prolonged infection. Upon entering the COVID-19 pandemic, it was unclear if the widespread behavioral changes and disruptions in routine care practices to minimize the further spread of COVID-19 would cause an increase or decrease in the United States’ STI rates. This study sought to determine if there was a change in the incidence of STIs during the first year of the COVID-19 pandemic compared to the year prior in a population at high risk for STIs. Methods A retrospective chart review was performed for 330 patients aged 12 to 41 years (mean 20.2 years, median 20 years, standard deviation 3.75 years) with human immunodeficiency virus (HIV) or on pre-exposure prophylaxis (PrEP) to prevent the acquisition of HIV, who presented for preventative and acute care appointments at a multidisciplinary pediatric and young adult HIV Clinic in the year prior to and during the first year of the COVID-19 pandemic (March 22, 2019-March 21, 2021). Utilizing telehealth, rapid COVID-19 screening, and multimodal patient communication, increased efforts were made in this clinic during the pandemic to maintain appropriate STI screening, testing, treatment, and rescheduling of routine visits when appropriate to minimize COVID-19 exposure and spread. Comparisons were made between the two time periods, which evaluated the incidences of individual and overall STIs diagnosed per person-years, STIs per total tests performed, and time to treatment initiation. Results Between one year prior to and the first year during the COVID-19 pandemic, this clinic experienced no statistically significant rate changes of sexually transmitted infections. A non-significant decreased incidence of chlamydia (22 cases per 100 person-years and 18 cases per 100 person-years, respectively) and unchanged rates of gonorrhea (22 cases per 100 person-years and 22 cases per 100 person-years, respectively) and syphilis (16 cases per 100 person-years and 15 cases per 100 person-years, respectively) were observed. The median times to treatment remained largely unchanged. Conclusion This HIV care clinic experienced a decreased chlamydia infection rate, a trend similar to the CDC United States STI data during this time period. In contrast to the nationally reported increased rates of gonorrhea and syphilis, this clinic experienced unchanged rates. The lack of change in our cohort could reflect that the benefits of a multidisciplinary HIV care model persist despite a pandemic that disrupted routine medical care and behavior practices.

The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial.

Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence. We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects. The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV. The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021.

Travel-associated sexually transmitted infections in Japan: An observational study using imported infectious disease registry data.

International travel is a risk factor for acquiring sexually transmitted infections (STIs) owing to factors such as increased sexual opportunities, a sense of freedom, and the allure of the sex industry. We investigated the incidence of travel-associated STIs in Japan using data from the Japan Registry for Infectious Diseases from Abroad (J-RIDA) reported by 17 participating medical institutions between October 2017 and December 2022. Data were collected on the patients' age, sex, nationality, chief complaint, whether they had visited a travel clinic before travel, travel history, and final diagnosis. Of 4545 cases of travel-associated illness reported, 52 (1.1%) were STIs. Most patients with STIs were male (81%) with a median age of 31 years. HIV (17%), genital herpes (13%), syphilis (13%), and gonorrhea (12%) were the most frequently reported STIs. Only one patient had visited a travel clinic before travel. Promoting awareness and vaccination is crucial for preventing travel-associated STIs.

Self-Reported PrEP Use and Risk of Bacterial STIs Among Ontarian Men Who Are Gay or Bisexual or Have Sex With Men.

HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence. We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification. Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06). We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population.Annals Early Access article.

MASLIHAT HIV Prevention Intervention Reduced Sexually Transmitted Infections Among Male Tajik Migrants Who Inject Drugs in Moscow.

Tajik male labour migrants who inject drugs while working in Moscow are at high risk of acquiring HIV and sexually transmitted infections (STIs) that compromise their health and potentially that of their sexual partners. In a cluster-randomized controlled trial, the "Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) reduced intervention participants' sexual risk behaviour including condomless sex, condomless sex with female sex workers (CS/FSW), and multiple sexual partners. This analysis investigates if the observed change in sexual risk behaviors due to the intervention translated into lower incidence of STIs among participants over 12-month follow-up. The MASLIHAT intervention was tested in a cluster-randomized controlled trial with sites assigned to either the MASLIHAT intervention or comparison health education training (TANSIHAT). Participants and network members (n=420) were interviewed at baseline and 3-month intervals for one year to assess HIV/STI sex and drug risk behaviour. Focusing solely on STIs in our current analysis, we conducted mixed effects robust Poisson regression analyses to test for differences between conditions in self-reported STIs during 12 months of follow-up, and to test the contribution of sexual risk behaviours to STI acquisition. Structural equation modelling investigated sexual behaviours as possibly mediating the observed differences in STI acquisition between the two conditions. Participants in the MASLIHAT condition were significantly less likely to report an STI during follow-up (IRR=0.27, 95% CI 0.13-0.58). Of the 3 sexual risk behaviours of interest, only CS/FSW was significantly associated with STI acquisition (IRR=3.30, 95% CI 1.57-3.93). Adjusting for CS/FSW, the effect of MASLIHAT intervention participation was reduced (IRR=0.37, 95% CI 0.17-0.84), signalling possible mediation. Structural equation modelling indicated that the intervention's effect on STI incidence was mediated by reductions among MASLIHAT participants in CS/FSW. The MASLIHAT peer-education intervention reduced the incidence of STIs among Tajik labour migrants through reduced CS/FSW.

Doxycycline prophylaxis for the prevention of sexually transmitted infections: A systematic review and meta-analysis of randomized controlled trials

ObjectivesTo investigate the effects of doxycycline pre- and post-exposure prophylaxis (doxy-PrEP/PEP) on bacterial sexually transmitted infections (STIs) by conducting a systematic review and meta-analysis. MethodsPubMed, Embase, and CENTRAL were searched for randomized controlled trials (RCTs), including ongoing studies published until November 7, 2023. Our primary endpoint was the incidence of bacterial STIs measured as the number of visits with an STI per total number of visits. Random-effects model was used to estimate pooled effect sizes. The study was registered with PROSPERO, CRD42023478486. ResultsWe identified six eligible studies containing data from seven articles and four conference abstracts, enrolling men who have sex with men (MSM), transgender women (TGW), and cisgender women (CGW). The pooled analysis of 1,766 participants with 602 newly diagnosed STIs showed a 56% decrease in the overall STI incidence using doxy-PrEP/PEP (RR = 0.44; 95% CI: 0.30-0.65; I2 = 73%). For doxy-PEP, including MSM and TGW only, the RR observed for overall STI incidence was 0.40 (95% CI: 0.28-0.57; I² = 37%), 0.19 (95% CI: 0.08-0.44; I² = 39%) for chlamydia, 0.23 (0.14-0.36; I² = 0%) for syphilis and 0.55 (95% CI: 0.34-0.87; I² = 41%) for gonorrhea. No serious adverse events were reported in the studies. The certainty of evidence regarding the efficacy of doxy-PEP among MSM and TGW was graded as high. ConclusionDoxy-PEP significantly reduces the number of new cases of chlamydia and syphilis and is potentially effective against gonorrhea, influenced by local resistance patterns. Thus, it is a promising tool in the prevention of bacterial STIs among MSM and TGW.

Routine Data Analysis of HIV Pre-Exposure Prophylaxis Use and Rates of Sexually Transmitted Infections Since Coverage of HIV Pre-Exposure Prophylaxis by the Statutory Health Insurance in Germany

Human immunodeficiency virus pre-exposure prophylaxis (PrEP) is considered as an effective protection against a human immunodeficiency virus (HIV) infection. However, it is still unclear, how PrEP use is associated with the incidence of sexually transmitted infections (STI) other than HIV. PrEP became reimbursable in Germany from September 1, 2019 for persons with statutory health insurance (SHI). With the EvE-PrEP study, the Federal Ministry of Health commissioned the evaluation of the effects of the new reimbursement situation in Germany. In the presented module of the EvE-PrEP study, routine data from three large German SHI funds were analyzed in anonymized form for the period January 1, 2019 to March 31, 2020. Data were analyzed regarding: Characteristics and adherence of PrEP users, treatment success of PrEP, and changes in STI incidence rates before and since PrEP use. The cooperating SHI funds collectively covered about 52% of the overall population in Germany in 2019. A total of 7102 persons with PrEP use were included into the analysis. These were predominantly male (99%), on average 37.4 years old and a high proportion of persons lived in large cities. The average quotient of PrEP daily defined doses and assumed days on PrEP was 87%. The average STI rates normalized per 100 person-years at individual level pre PrEP did not statistically significant differ compared to since PrEP (chlamydia: 17.5 vs. 17.6, gonococcal infection: 29.1 vs. 30.7, and syphilis: 14.6 vs.13.6). A large data set was used to evaluate the introduction of PrEP as a SHI benefit in Germany. A potentially suspected increase in bacterial STI incidence rates was not found. A rather high average adherence rate was observed. The very high proportion of men and people from the largest German cities among PrEP users is striking. These results could indicate barriers to PrEP access for people at risk of HIV, especially if they are women or people living in less urban areas.

Prevalence of sexually transmitted infections and human papillomavirus in cervical samples from incarcerated women in São Paulo, Brazil: a retrospective single-center study.

Sexually transmitted infections (STIs) cause considerable morbidity worldwide and, depending on the specific pathogen, may lead to serious complications in the female reproductive tract. Incarcerated women are particularly vulnerable to health problems with a disproportionate high rate of STIs, including infections with human papillomavirus (HPV). Here, cervical swab samples collected from 299 women (18 to 64 years) living in one of the women's prisons of São Paulo, Brazil were submitted for liquid-based cytology to determine the prevalence of precancerous lesions. Furthermore, direct detection of 30 genital HPV genotypes (18 high-risk and 12 low-risk types) and 11 additional STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium and hominis, Treponema pallidum, Trichomonas vaginalis, Ureaplasma parvum and urealyticum) were performed by molecular typing using two PCR-based DNA microarray systems, i.e., EUROArray HPV and EUROArray STI (EUROIMMUN), respectively. The overall prevalence of cytological abnormalities was 5.8%, including five women with low-grade and five women with high-grade squamous intraepithelial lesions. The overall prevalence of HPV was 62.2, and 87.1% of the HPV-positive women were infected with oncogenic high-risk (HR) HPV types. HPV types 16 (24.1%), 33 and 52 (both 10.4%) were the most frequently detected. The prevalence of the other STIs was 72.8%. Up to four different pathogens were found in the infected women, the most frequent being Ureaplasma parvum (45.3%), Mycoplasma hominis (36.2%) and Trichomonas vaginalis (24.8%). The high number of HR-HPV infections and other STIs described here highlights the fact that the Brazilian female prison population requires more attention in the country's health policies. The implementation of screening programs and treatment measures might contribute to a decrease in the incidence of STIs and cervical cancer in this vulnerable population. However, for such measures to be effective, further studies are needed to investigate the best practice to get more women to engage in in-prison prevention programs, e.g., through offering further sexual health education and self-sampling.

The trend analysis of HIV and other sexually transmitted infections among the elderly aged 50 to 69 years from 1990 to 2030.

The HIV and other sexually transmitted infections (STI) excluding HIV among the elderly population urgently require more attention and in-depth study. We aimed to present and predict the worldwide of its burden from 1990 to 2030 using data from the Global Burden of Disease (GBD) study. Leveraging the 2019 GBD study, we investigated the average annual percentage change (AAPC) of HIV and other STI in incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates for individuals aged 50-69 across different age groups, genders, sociodemographic index (SDI) regions, and nations. The incidence of STI in the population from 2020 to 2030 was explored by Bayesian age-period-cohort (BAPC) prediction model. The HIV incidence rate experienced its fastest growth 1990-1992, peaked in 1996, and gradually declined thereafter, with the 2019 rate being lower than that of 1990. The prevalence rate didn't present a sharp turning point. After 2006, its growth rate accelerated. Both DALYs and mortality rates plateaued high between 2002 and 2005, followed by a decline. The decline was steepest from 2005-2012, yet the rate of decrease slowed noticeably from 2012-2019.When segmented by age, HIV was more prevalent among those aged 55-59 and 50-54, with the 50-54 age group witnessing the fastest decline in incidence rates. However, the fastest growth in prevalence rates was seen among the 60-64 and 65-69 age groups. The other STI incidence rate declined from 1990-1996, increased up to 2006, declined until 2015, and then saw a resurgence with accelerated growth thereafter. The prevalence rate showcased varied trends, with a notable increase in the past five years. The highest growth in incidence rate was among the 65-69 age group. We predict that the incidence rate of STI will increase in the future. Overall, despite the evident decline in incidence, mortality rates, and DALYs, the prevalence of HIV and other STI among the elderly is rising, and both demonstrated significant trend variations across different ages, genders, SDI regions, and nations. Comprehensive sexual health education, clinical care and adjustments in health service strategies based on the evolving trends of HIV and other STI among the elderly are paramount.

Gynecologic infection rates after ablation treatment for cervical intraepithelial neoplasia grade 2 and higher (CIN2+): Secondary analysis of a non-inferiority randomized trial.

Although concerns have been raised regarding potential infection and morbidity in women undergoing ablation treatment for cervical precancer in low- and middle-income countries (LMIC), there is extremely limited data to substantiate this claim. This is a secondary analysis of a randomized non-inferiority trial (id: NCT03084081) that compares the efficacy and safety of three ablation treatments for biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher (CIN2+): CO2 gas-based cryotherapy, non-gas cryotherapy, and thermal ablation (TA). Here, we present findings regarding the incidence of sexually transmitted infections (STI) and vaginitis post-treatment. Samples were collected at enrollment and again at 6 weeks post-treatment and assessed for STIs (Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV)) and vaginitis (Bacterial vaginosis (BV) and/or Candida albicans (Candida)). This analysis reflects 864 women with baseline and 6-week follow-up data. None of the ablative treatments put women at increased risk for STIs (CT, NG, TV) or vaginitis (BV, Candida). While most women adhered to post-treatment recommendations (97%) and no difference by treatment arm was observed, the incidence of STIs at follow-up in women that did not adhere with a given recommendation was higher compared to their adherent counterparts. The incidence of gynecologic infection did not increase with any of the ablation treatments from baseline to the six-week follow-up. Non-gas cryotherapy and TA emerge as safe alternatives to gas-based cryotherapy with respect to gynecologic infection rates.

Improvement and exacerbation of multiple disparities in sexually transmitted infections among children and adolescents aged 6-22 years: An analysis of national surveillance data from 2013 to 2021.

To investigate the progress of disparities in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), gonorrhea, and syphilis among children and adolescents aged 6-22 years in China during 2013-2021. A total of 614 325 cases data were extracted from the Chinese Information System for Infectious Diseases Control and Prevention during 2013-2021. Puberty health education data were drew from the Student Health Surveillance in 2021. Disparity patterns and average annual percentage changes (AAPCs) in sexually transmitted infections (STIs) incidence or new cases in China were examined using descriptive statistics and joinpoint regression. The incidence across 345 cities was stratified by gross domestic product (GDP). Between 2013 and 2021, there were 614 325 reported cases of HIV/AIDS, gonorrhea, and syphilis among children and adolescents aged 6-22, with an annual average incidence of 24.0967 per 100 000. The expansion of HIV/AIDS has halted, yet the surge in gonorrhea and syphilis remains notably pronounced. The ratio of male to female AIDS incidence increased from 2.75 (2.60, 2.90) to 7.13 (6.68, 7.62), but that of syphilis changed from 0.33 (0.32, 0.34) to 0.56 (0.55, 0.57). Students and out-of-school individuals aged 13-15 experienced a notably high increase in STI cases, surpassing other age groups, with an average annual percentage increase of 29.2% and 26.3%, respectively. Nonstudents consistently had a higher incidence rate than students, with an IRR reaching 31.80 (31.24, 32.37) in 2021. A noticeable clustering pattern of new cases emerged in the southeastern region of the Heihe-Tengchong line, extending inland from the coastal areas. Districts and counties with lower rates of puberty sexual health education tended to have higher average STI incidence rates. At the prefecture and city levels, there was a noticeable upward trend on average STI incidence rates in cities with per capita GDPs. Strategies to address those disparities include promoting equitable health education, and widespread sexual health education, particularly in areas with limited access to education and experiencing rapid economic development. The effectiveness of sexual health education intervention needs to be further evaluated in well-designed studies.

Concept Mapping STI/HIV Prevention and Condom Use among Young African American Adults.

Theory-based HIV prevention programs have resulted in increased condom use, which remains the best method for the prevention of sexually transmitted infections (STIs) among sexually active heterosexual individuals. Particularly, the integrative model of behavior prediction theorizes that attitudes, norms, self-efficacy, and socioenvironmental factors influence intention and behavior and has been useful in understanding STI risk among adolescents. However, more research is needed regarding young African American adults. Given the increased freedom and decision-making independence afforded to young adults compared to adolescents, it is important to consider the STI/human immunodeficiency virus (HIV) prevention messages that would resonate with them, particularly regarding condom use. The present study sought to explore how attitudes, subjective norms, self-efficacies, and socioenvironmental factors may influence condom use and STI/HIV prevention, as conceptualized by the participants. We conducted a group-based concept map, a systems-thinking mixed methodology that resulted in a geospatial map reflecting the conceptualizations of the participants. Self-identified young heterosexual African American adults (N = 43) aged 20-26 engaged in an interactive concept mapping procedure in order to "map out" their overarching concepts about STI/HIV risk and condom use. Seven overall conceptual domains emerged: self-efficacy for partner communication, condom use self-efficacy, social media/sociocultural influences, condom use/STI knowledge, condom use cons, condom use pros, and subjective and social norms about condom use. We presented the concept map and discussed the conceptual interpretations and the relationships among the overarching concepts. We also discussed how the social environment, including the social media environment, was conceptualized regarding STI/HIV risk and prevention among young African American adults. Concept mapping can be viewed as a way to determine worthwhile messages for intervention development. The findings may provide information for prevention programs aimed at reducing the incidence of STIs among young adult heterosexual persons within African American communities.

The Influence of Housing Status and Food Insecurity on a Behavioral HIV/STI Prevention Intervention for Black Women under Community Supervision in New York City: A Moderation Analysis.

Black women in community supervision programs (CSPs) are disproportionately affected by HIV and other sexually transmitted infections (STIs). A randomized controlled trial of a group intervention titled Empowering African-American Women on the Road to Health (E-WORTH) demonstrated effectiveness in reducing sexual risk behaviors and STI incidence among Black women in CSPs. This secondary analysis aimed to assess the moderating effects of housing status and food security on E-WORTH effectiveness in reducing sexual risk behaviors and cumulative incidence of STIs over a 12-month period which were found significant in the original trial among a sample of 351 Black women in CSPs in New York City who use drugs and/or engage in binge drinking who reported engaging in HIV risk behaviors or testing positive for HIV. We examined the moderating effects of housing stability, housing independence, and food insecurity on reducing cumulative STI incidence and number of unprotected sex acts using mixed-effects negative binomial regression and logistic regression models that controlled for age, high school education, employment status, and marital status. Findings indicate that the intervention effect was moderated by housing stability, but not housing independence or food security. Compared to the control group, E-WORTH participants who were housing insecure had 63% fewer acts of condomless sex. Our findings highlight the importance of interventions designed for women in CSPs that account for upstream determinants of health and include service linkages to basic needs provisions. Further research is needed to unpack the cumulative impacts of multiple experiences of poverty faced by this population.

Frequent chlamydia and gonorrhoea but very infrequent syphilis among men who have sex with men using HIV pre-exposure prophylaxis in West Africa

ObjectivesAlthough oral pre-exposure prophylaxis (PrEP) for HIV is being rolled out in West Africa, data on sexually transmitted infections (STIs) in PrEP users are scarce. We assessed the prevalence, incidence...

Sexual behaviour and incidence of sexually transmitted infections among men who have sex with men (MSM) using daily and event-driven pre-exposure prophylaxis (PrEP): Four-year follow-up of the Amsterdam PrEP (AMPrEP) demonstration project cohort.

An increasing number of countries are currently implementing or scaling-up HIV pre-exposure prophylaxis (PrEP) care. With the introduction of PrEP, there was apprehension that condom use would decline and sexually transmitted infections (STIs) would increase. To inform sexual health counselling and STI screening programmes, we aimed to study sexual behaviour and STI incidence among men who have sex with men (MSM) and transgender women who use long-term daily or event-driven PrEP. The Amsterdam PrEP demonstration project (AMPrEP) was a prospective, closed cohort study, providing oral daily PrEP and event-driven PrEP to MSM and transgender women from 2015 to 2020. Participants could choose their PrEP regimen and could switch at each three-monthly visit. STI testing occurred at and, upon request, in-between 3-monthly study visits. We assessed changes in numbers of sex partners and condomless anal sex (CAS) acts with casual partners over time using negative binomial regression, adjusted for age. We assessed HIV incidence and changes in incidence rates (IRs) of any STI (i.e., chlamydia, gonorrhoea, or infectious syphilis) and individual STIs over time using Poisson regression, adjusted for age and testing frequency. A total of 367 participants (365 MSM) commenced PrEP and were followed for a median 3.9 years (interquartile range [IQR] = 3.4-4.0). Median age was 40 years (IQR = 32-48), 315 participants (85.8%) self-declared ethnicity as white and 280 (76.3%) had a university or university of applied sciences degree. Overall median number of sex partners (past 3 months) was 13 (IQR = 6-26) and decreased per additional year on PrEP (adjusted rate ratio [aRR] = 0.86/year, 95% confidence interval [CI] = 0.83-0.88). Overall median number of CAS acts with casual partners (past 3 months) was 10 (IQR = 3-20.5) and also decreased (aRR = 0.92/year, 95% CI = 0.88-0.97). We diagnosed any STI in 1,092 consultations during 1,258 person years, resulting in an IR of 87/100 person years (95% CI = 82-92). IRs of any STI did not increase over time for daily PrEP or event-driven PrEP users. Two daily PrEP users, and no event-driven PrEP users, were diagnosed with HIV during their first year on PrEP. Study limitations include censoring follow-up due to COVID-19 measures and an underrepresentation of younger, non-white, practically educated, and transgender individuals. In this prospective cohort with a comparatively long follow-up period of 4 years, we observed very low HIV incidence and decreases in the numbers of casual sex partners and CAS acts over time. Although the STI incidence was high, it did not increase over time. The study was registered at the Netherlands Trial Register (NL5413) https://www.onderzoekmetmensen.nl/en/trial/22706.

ANALISIS TINGKAT PENGETAHUAN DAN KEJADIAN INFEKSI MENULAR SEKSUAL PADA WANITA USIA

Sexually transmitted infections (STIs) are one type of infectious disease that is widespread and has serious risks. East Java ranks ninth as the province with the highest number of HIV/AIDS sufferers, with the highest cases concentrated in Kediri Regency and City. One of the health service centers that is active in handling STIs is the Campurejo Health Center Working Area. In the Campurejo Puskesmas Working Area, as many as 410 cases of STIs were detected in the Campurejo Puskesmas Working Area through a laboratory approach. This study aims to identify the relationship between the level of knowledge and the incidence of STIs in women of childbearing age who visit the STI clinic in the Campurejo Health Center Work Area. Analytical survey method with cross sectional design was used in this study. A total of 56 samples of women of childbearing age were taken using accidental sampling techniques. The results showed that most respondents had a good level of knowledge, which is around 50%. The majority of respondents, 54.6%, did not experience an STI. Bivariate analysis showed that there was a relationship between the level of knowledge and incidence of STIs in women of childbearing age in the Campurejo Health Center Work Area, with a p-value of 0.001 and a correlation coefficient r of 0.450, indicating moderate closeness. Thus, it can be concluded that there is a significant relationship between the level of knowledge and the incidence of STIs in women of childbearing age in the Campurejo Health Center Work Area

Performance of an Electronic Medical Record-Based "Syphilis Flag" in Identifying At-Risk Patients in an Emergency Department.

The United States has seen a > 40% increase in syphilis cases since 2017. Early disease identification and treatment are crucial. This review sought to identify emergency department (ED) patients at risk for syphilis. A 30-day retrospective review was conducted of visits to a single ED. Patient visits were assessed for predetermined syphilis "flags" to include a history of sexually transmitted infection (STI), current chief complaint or reason for visit (RFV) keyword(s) suggestive of potential STI or a positive pregnancy test result. Flagged charts were assessed for STI testing results within 6 months of ED visit. Data were analyzed using χ2 . There were 5537 total patient encounters, resulting in 455 flagged visits from 408 (8.4%) unique individuals, majority of whom were female (282, 69.1%; P < 0.001), Black (251, 61.5%; P < 0.001), aged 15 to 44 years (308, 75.5%; P < 0.001). Chief complaint was the most frequent flag (65.3%), followed by RFV (37.4%), prior STI (31.0%), and pregnancy (12.3%). Syphilis testing data were available for 120 flagged patients; 29 (24.2%) screened positive, including 11 (2.7% of total flagged cohort) with evidence for active infection. Among those, most were Black (90.9%), male (72.7%), aged 25 to 34 years (63.6%), and 9 (81.8%) had concomitant HIV. In active infection, prior STI flag was most common (72.7%), followed by chief complaint (54.5%) and RFV (45.5%). This review demonstrates the performance of an electronic medical record-based "syphilis risk flag" screener applied to ED patients. Sex- and race-based discrepancies exist in flag rates, which may be reflective of sex- and race-based epidemiologic discrepancies in STI incidence.

Sexually transmitted infections: Prevalence and clinical outcomes among pregnant women in Western Sydney.

We report the prevalence, characteristics and clinical outcomes of women with sexually transmitted infections (STIs) in pregnancy in the Western Sydney Local Health District (WSLHD) serving a large culturally and socio-economically diverse community in New South Wales (NSW), Australia, over the last 10 years. A retrospective cohort study of all pregnant women booked for antenatal care at three hospitals in WSLHD between September 2012 and August 2022 inclusive. Characteristics and birth outcomes associated with STIs diagnosed in pregnancy (chlamydia, gonorrhea, and syphilis) are reported using multivariable logistic regression adjusting for relevant confounders. During 2012-2022, there were 102 905 births and 451 women (0.44%) with an STI diagnosis during pregnancy. The number of women with a history of chlamydia prior to their current pregnancy has increased over the last 10 years (P < 0.001). STIs in pregnancy were more common in younger women aged <20 years (adjusted odds ratio [aOR] 7.30, 95% confidence interval [CI] 5.04-10.57), 20-24 years (aOR 3.12, 95% CI 2.46-3.96), and >40 years (adj OR 1.67, 95% CI 1.07-2.59), in women with body mass index >30 (aOR 1.73, 95%CI 1.37-2.19), and those who smoked (aOR 2.24, 95% CI 1.71-2.94) and consumed alcohol (aOR 3.14, 95% CI 1.88-5.23) and illicit drugs (aOR 2.10, 95% CI 1.31-3.36). STIs in pregnancy were borderline associated with stillbirth (aOR 2.19 95% CI 0.90-5.36) but did not have a significant impact on preterm birth (aOR 1.21, 95% CI 0.87-1.68), admission to neonatal intensive care unit (NICU) (aOR 1.02, 95% CI 0.77-1.34), or having a small-for-gestational-age (SGA) baby (aOR 0.97, 95% CI 0.74-1.27). Sociodemographic factors such as age, weight, smoking, and alcohol and drug use, were associated with the STI incidence in pregnancy. While the latter did not have an impact on preterm birth, NICU admission, and SGA in our cohort, there was a borderline association with stillbirth. Future research should identify barriers and facilitators to testing in a multicultural population and understanding the drivers of higher rates of STIs in certain population groups.

Seroprevalence of sexually transmitted infections over 44 years - A cross-sectional study in Sweden.

Sexually transmitted infections (STIs) may cause substantial individual suffering and a large economic burden for society. This study examined the seroprevalence of Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus (HSV) types 1 and 2, and several human papillomaviruses (HPV) in the Swedish population over time. The study population consisted of 30-year-old women attending maternity care, and 50year-old men and women attending health check-ups, from 1975 to 2018. Antibody status was determined by multiplex serology and quantified using median reporter fluorescence intensity (MFI). A total of 891 samples were analysed (519 from 30-year-old women, 186 from 50year-old women and 186 from 50year-old men). Of these, 41.5% showed seropositivity for Chlamydia trachomatis, 16.7% for Mycoplasma genitalium, 70.5% for HSV-1, 14.9% for HSV-2, 13.2% for high-risk HPV, and 8.3% for low-risk HPV. Seropositivity for Mycoplasma genitalium, HSV-1 and especially Chlamydia trachomatis decreased over time. There was a decrease over time in Chlamydia trachomatis seroprevalence, probably due to contact tracing, testing and early treatment; this might also have affected Mycoplasma genitalium seroprevalence. Despite the reduction, seroprevalences are still high, so continued and new efforts to reduce STI incidence are essential.