Sexually Transmitted Infections Treatment Research Articles

Development of a scale for attitude toward sexually transmitted infections based on the Health Belief Model

ObjectivesDetermination of the attitudes of individuals toward sexually transmitted infections (STIs) can also help identify barriers to health service-seeking behavior. Hence, this study aimed to develop a scale for determining the attitudes of individuals toward sexually transmitted diseases. Study DesignThis was a methodological study. The Health Belief Model (HBM) framework was used to elucidate the perceptions and interpretations of illnesses among individuals. After reviewing the relevant literature, an item pool was created to include 4 dimensions (perceived susceptibility (A), perceived severity (B), perceived benefit (C), and perceived barriers and self-efficacy (D)) about sexually transmitted diseases from the perspective of HBM. Exploratory factor analysis was conducted to evaluate the construct validity of the scale. Moreover, confirmatory factor analysis was used to examine the suitability of the items in terms of factor structures. ResultsThe final version of the scale comprised 19 items and 4 subdimensions. The first subdimension of the scale accounted for 20.11% of the total variance, whereas the second, third, and fourth subdimensions accounted for 17.83%, 12.50%, and 8.75% of the total variance, respectively. Collectively, these four subdimensions accounted for 59.19% of the total variance. The Cronbach’s alpha reliability coefficient of the scale was found to be 0.74. Conclusions: Briefly, the present study led to the development of a novel assessment tool, Attitude Toward Sexually Transmitted Infections Scale. Higher scores on the scale indicated higher likelihood of taking action for a possible STI treatment according to the HBM approach.

Sexually transmitted infections in midlife women.

Rates of sexually transmitted infections (STIs) are increasing in all age groups. Although STI incidence decreases with age, midlife women have risk factors that may lead to STI acquisition and underdiagnosis. Clinicians may assume that older women are not sexually active. Although many STIs are asymptomatic, when midlife women do experience vaginal symptoms, they may be erroneously attributed to menopause changes. Clinicians should follow evidence-based screening recommendations provided by the US Preventive Services Task Force and consider STIs in the differential diagnosis of vaginal symptoms. Treatment of STIs in midlife women are guided by the Centers for Disease Control and Prevention's STI Treatment Guidelines.

Clinical Decision Support System for Guidelines-Based Treatment of Gonococcal Infections, Screening for HIV, and Prescription of Pre-Exposure Prophylaxis: Design and Implementation Study.

The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP. The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record-based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic. We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name "X-Clinic." We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods. Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%). We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use.

The generic structure potential (GSP) of STI doctor-patient interactions in southwest Nigeria

This study describes the generic structure potential (GSP) of sexually transmitted infection (STI) consultations in Nigeria. It is a further effort from previous studies not only in its consideration of the phase structure of consultations in a specific medical context, but also in its exploration of both the broad and narrow generic structure potential of the consultations. Fifty audio recordings of mixed-visit doctor-patient interactions in hospitals in three states in southwest Nigeria constitute the data. The data were analysed using Halliday and Hasan’s (1985) Generic Structure Potential theory (GSP). The analysis revealed four broad stages in the structural organisation of STI medical interactions, namely Opening (O), Diagnostic Interactions (DI), Treatment Recommendations (TR), and Closing (C). The obligatory elements in the broad catalogue are the diagnostic interactions and treatment recommendations, while the narrow GSP of the phases revealed the doctor’s problem elicitation as the obligatory element in the opening phase, the patient’s problem presentation activity was solely obligatory in DI, and the doctor’s treatment procedure, the only mandatory activity of the TP phase. The study concludes that the diagnostic interaction and treatment recommendation phases define medical consultations in STI (and HIV) encounters in Nigeria.

Minimum service package for the integration of female genital schistosomiasis in sexual and reproductive health services in Kenya

Female genital schistosomiasis (FGS) is caused by chronic Schistosoma hematobium infection. Over 56 million women and girls in sub-Saharan Africa are estimated to be infected with FGS. However, gaps in knowledge of the symptomatology of FGS often lead to misdiagnosis and undertreatment. FGS presents with nonspecific genital symptoms and is likely to be misdiagnosed as a sexually transmitted infection (STI). Recurrent treatment for STIs may result in marital discord, intimate partner violence, and social stigma. Other FGS complications include ectopic pregnancy, infertility, urine incontinence, 3-4-fold increased susceptibility to HIV infection, and persistence of human papillomavirus infection (HPV). A minimum service package (MSP) that is acceptable and feasible for the integration of FGS and sexual and reproductive health (SRH) services is needed. A foundational literature review was conducted to identify service points for FGS and sexual and reproductive health (SRH) service integration. The final MSP was developed through collaborative efforts with stakeholders in various fields associated with FGS and SRH services. The MSP identified four key areas for successful integration of FGS into SRH services including: health literacy, screening and diagnosis, treatment and care, and social inclusion and equity at the community and healthcare facility level. A context-specific integration MSP may be the most efficient, effective, and ethical way to comprehensively address the burden of FGS faced by women and girls in Africa.

Delivering integrated strategies from a mobile unit to address the intertwining epidemics of HIV and addiction in people who inject drugs: the HPTN 094 randomized controlled trial protocol (the INTEGRA Study)

BackgroundPersons with opioid use disorders who inject drugs (PWID) in the United States (US) face multiple and intertwining health risks. These include interference with consistent access, linkage, and retention to health care including medication for opioid use disorder (MOUD), HIV prevention using pre-exposure prophylaxis (PrEP), and testing and treatment for sexually transmitted infections (STIs). Most services, when available, including those that address substance misuse, HIV prevention, and STIs, are often provided in multiple locations that may be difficult to access, which further challenges sustained health for PWID. HPTN 094 (INTEGRA) is a study designed to test the efficacy of an integrated, “whole-person” strategy that provides integrated HIV prevention including antiretroviral therapy (ART), PrEP, MOUD, and STI testing and treatment from a mobile health delivery unit (“mobile unit”) with peer navigation compared to peer navigation alone to access these services at brick and mortar locations.MethodsHPTN 094 (INTEGRA) is a two-arm, randomized controlled trial in 5 US cities where approximately 400 PWID without HIV are assigned either to an experimental condition that delivers 26 weeks of “one-stop” integrated health services combined with peer navigation and delivered in a mobile unit or to an active control condition using peer navigation only for 26 weeks to the same set of services delivered in community settings. The primary outcomes include being alive and retained in MOUD and PrEP at 26 weeks post-randomization. Secondary outcomes measure the durability of intervention effects at 52 weeks following randomization.DiscussionThis trial responds to a need for evidence on using a “whole-person” strategy for delivering integrated HIV prevention and substance use treatment, while testing the use of a mobile unit that meets out-of-treatment PWID wherever they might be and links them to care systems and/or harm reduction services. Findings will be important in guiding policy for engaging PWID in HIV prevention or care, substance use treatment, and STI testing and treatment by addressing the intertwined epidemics of addiction and HIV among those who have many physical and geographic barriers to access care.Trial registrationClinicalTrials.gov NCT04804072. Registered on 18 March 2021.

Receptivity of referral letters and partner notification practices for sexually transmitted infections among a population of men who have sex with men in South Africa: A qualitative study

Although an effective public health strategy to control transmission of sexually transmitted infection (STI) and promote linkage to care exists, little is known about the receptivity of patient referral letters and partner notification (PN) among men who have sex with men (MSM). A qualitative study was conducted involving MSM enrolled in a clinical trial. Individual exit interviews were done with purposefully sampled participants (n = 23) at month 12 from baseline. The study was conducted at a research institute located in a poorly resourced community in Gauteng Province, South Africa. The themes that emerged from the data during thematic content analysis were reaction to STI diagnosis on receiving a referral letter, receptivity of the referral letter and partner notification, STI treatment and usefulness of a referral letter, experiences of accessing healthcare services, nurses’ attitudes towards the MSM, and the MSM’s recommendations for improving health services. The findings suggest that the MSM were receptive to referral letters, which they believed allowed for earlier and easier access to treatment and provided the opportunity to embrace safer sexual practices. Nevertheless, many felt it was challenging to inform their sexual partners due to some being in casual or multiple sexual relationships. Some reported experiencing discrimination from nurses while seeking treatment. This study anticipated that it would be of importance to policymakers when designing and implementing policies on patient referral letters and partner notifications.

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

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

Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative.

Adolescents and young adults (AYAs) face significant barriers to screening, testing, and treatment of sexually transmitted infections (STIs). Expedited partner therapy (EPT) streamlines partner treatment of STIs, but use among adolescents is low. We aimed to increase EPT offering and provision at 2 adolescent medicine clinics (AMCs) and the emergency department (ED) in an urban children's hospital. We addressed barriers at provider, pharmacy, and patient levels. We compared EPT offering and provision for chlamydia ( Chlamydia trachomatis [CT]) and trichomonas ( Trichomonas vaginalis [TV]) infection at baseline and across 2 intervention cycles. Baseline data were collected from July 2019 to March 2020 and our intervention time frame spanned from April 2020 to October 2021. Laboratory codes identified patients with CT or TV infections. Cycle 1 allowed providers to order EPT within a patient's chart. The second cycle targeted education and standardization for STI/EPT notification and counseling. During this cycle, notification of ED patients was centralized to the AMC nurses. A total of 747 CT and TV cases were identified. In the AMC, EPT offering increased from 77.3% to 87.7% ( P = 0.01). Expedited partner therapy provision increased from 32.3% to 69.9% ( P < 0.001). Expedited partner therapy offering for ED patients increased by 82.3%. Retesting rates remained consistent, with a significant drop in reinfection rates ( P = 0.003) within patients seen in the AMC. This quality improvement initiative successfully increased EPT offering and provision among the cases identified. Future cycles may include longer-term follow-up to confirm partner treatment and testing per guidelines.

Antimicrobial Resistance in Sexually Transmitted Infections: Current Trends

The review article discusses current trends in antibiotic resistance in bacterial and protozoal sexually transmitted infections (STIs). Antimicrobial resistance in STIs has increased significantly in recent decades due to the overuse and misuse of antibiotics, fueled by population migration and the high incidence of STIs worldwide. While emerging cephalosporin-resistant strains of Neisseria gonorrhoeae are one of the most pressing problems in the world, other pathogenic STIs that are resistant to antibiotics, such as Mycoplasma genitalium and Chlamydia trachomatis, are increasingly being reported. The emergence of multidrugresistant strains of bacterial STIs is of particular concern for researchers. The emerging global crisis in STI treatment is the result of neglect and inattention to repeated warnings from researchers about the emergence of STI strains resistant to the existing antibiotics, as well as shifting priorities in the pharmaceutical industry, which limited the development of new antibiotics. The current antimicrobial portfolio does not provide cause for optimism, as it contains few new antibiotics, and most developments are in the early stages of clinical trials. Experts have suggested that the failure of existing STI treatment regimens is largely inevitable and have called for the creation of entirely new classes of antimicrobial drugs that would take decades to develop. Currently, there are several promising alternative strategies for the treatment of antibiotic-resistant STIs. The use of phage therapy, antimicrobial peptides, and hydrolytic enzymes are particularly promising directions.

Comparison of two testing strategies for Mycoplasma genitalium in emergency department patients across a statewide health system

PurposeMycoplasma genitalium (Mgen) is a sexually transmitted infection (STI) that has an estimated prevalence in the general population of 2.3% in women and 1.1% in men aged 21–23 years. (Hilbert and Reno, 2018) A cross-sectional study conducted in a community emergency department (ED) determined that the prevalence of Mgen was 14.8% in asymptomatic female patients. (Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Treatment Guidelines, 2021) The Centers for Disease Control and Prevention (CDC) 2021 STI Treatment Guidelines recommend testing for Mgen in select circumstances. This study aims to determine what testing strategy in ED patients results in the most appropriate treatment of Mgen based on CDC recommendations. MethodsThis multicenter, retrospective, pre- and post-intervention cohort study assessed adherence to CDC recommendations for appropriate management of Mgen in ED patients. Inclusion criteria were patients at least 18 years of age discharged from one of the 15 ED sites within the health system studied who were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis (T. vaginalis), and Mgen. Subjects were excluded if they were pregnant, sexually assaulted, or had indeterminate STI results. For cohort 1, which included patients evaluated from May 2022 through July 2022, Mgen was incorporated into the standard STI testing panel. Cohort 2 consisted of patients evaluated from September 2022 through November 2022; testing for Mgen in cohort 2 was optional, and a testing algorithm based on CDC recommendations was disseminated to ED sites. The primary endpoint was the number of subjects treated appropriately for Mgen in accordance with CDC recommendations. Cohort 1 secondary endpoints included overall prevalence of Mgen in patients who presented to ED sites for STI testing and prevalence in ICD-10 code diagnosed PID. Secondary endpoints for both cohorts included baseline characteristics of patients who tested positive for Mgen. ResultsPercent appropriate treatment did not differ significantly between cohort 1 (21%) and cohort 2 (20%), (p > 0.9). However, greater than three times as many subjects were inappropriately treated for Mgen in cohort 1 when the health system studied did not adhere to current CDC Mgen testing recommendations. The overall prevalence of Mgen in ED patients who were tested for STIs was 13.1%. The prevalence of PID ICD-10 diagnosis code in patients positive for Mgen was 2.9%. Based on results of a risk factor analysis to determine if certain baseline characteristics are indicators for a positive infection with Mgen, a positive Mgen result was significantly associated with a positive result for T. vaginalis (p = 0.042). ConclusionsEvidence regarding the preferred testing strategy for Mgen is currently limited. This study demonstrates that testing all STI presenting patients for Mgen results in antibiotic overuse, so adhering to CDC testing recommendations is important. Prevalence of positive Mgen result in ED patients tested for STIs was similar to results of previously published literature. Risk factor analysis results could be used as a screening method to determine what patients should be considered for Mgen testing. Based on the results of this study, we recommend against including Mgen on the standard ED STI testing panel at this time.

Lasting Impact of the COVID-19 Pandemic on Care and Prevention of Sexually Transmitted Infections in the Midwest.

The COVID-19 pandemic reduced the general accessibility of health services. Many sexually transmitted infection (STI) testing and treatment sites modified services (e.g., reduced hours, limited walk-in availability, decreased testing capacity), changes that may result in permanent change in STI service availability. At the same time, systems were driven to innovate in ways that could benefit patients. This study aimed to describe how the COVID-19 pandemic changed STI clinical services, with a focus on long-term impacts. In July 2022, a phone survey was designed to assess services for STIs at the 105 STI testing and treatment providers in the St. Louis metropolitan statistical area. Sexually transmitted infection testing providers included STI clinics, primary care clinics that cater to a broad population, and community-based organizations, and excluded emergency departments and urgent care centers. In most cases, the survey was completed by a clinic manager, medical director, or nursing staff member. Of the 75 locations that were interviewed, 12 (16%) had not returned to prepandemic capacity and operations as of July 2022. Five sites had closed completely since the pandemic began, 3 of which are in the northwestern region of the metropolitan statistical area. Most (58.6%) of the open clinics had added telehealth appointments. Sexually transmitted infection testing sites decreased during the pandemic with lasting impact in one area of the Midwest. Resources to support STI infrastructure should be expanded. Maintaining updated information on STI care providers in the region can aid future assessments.

Sexually transmitted infection (STI) knowledge and perceptions among people in HIV-sero-different partnerships in rural southwestern Uganda.

Globally, over one million people acquire curable sexually transmitted infections (STI) each day. Understanding how people think about STIs is key to building culturally appropriate STI prevention and treatment programs. We explored STI knowledge and perceptions in rural, southwestern Uganda to inform future interventions. From August 2020 to December 2020, we conducted individual in-depth interviews among adult men and women (≥18 years) with recent or current personal or partner pregnancy, a history of an STI diagnosis and treatment, and membership in an HIV-sero-different relationship. Interviews explored STI knowledge, perceptions, and barriers and facilitators to engaging in STI care. We used inductive and deductive approaches to generate a codebook guided by the healthcare literacy skills framework in a thematic analysis. Ten men with STI, five of their female partners, eighteen women with STI, and four of their male partners participated in individual in-depth interviews. The median age was 41 (range 27-50) for men and 29 (range 22-40) for women. Sixteen (43%) participants were with HIV. Significant themes include: 1) Participants obtained STI knowledge and information from the community (friends, family members, acquaintances) and medical professionals; 2) While participants knew STIs were transmitted sexually, they also believed transmission occurred via non-sexual mechanisms. 3) Participants associated different connotations and amounts of stigma with each STI, for example, participants reported that syphilis was passed down "genetically" from parent to child. 4) Participants reported uncertainty about whether STIs affected pregnancy outcomes and whether antenatal STI treatment was safe. The complicated nature of STIs has led to understandable confusion in settings without formal sexual healthcare education. Robust counseling and education prior to sexual debut will help allow men and women to understand the signs, symptoms, and treatments necessary for STI cure and to navigate often complicated and overburdened healthcare systems.

Teledermatology in the diagnosis and treatment of sexually transmitted infections: a narrative review.

Teledermatology is a dynamically developing field of medicine with the potential to significantly impact the future functioning of the healthcare system, including the prevention, diagnostics, and treatment of sexually transmitted infections (STIs). While its implementation has resolved numerous issues associated with the traditional patient management model for STIs, the risk associated with handling sensitive patient data in a virtual space must not be overlooked. This article presents a literature review regarding the application of teledermatology in the diagnostics and treatment of STIs, with a particular focus on addressing relevant problems, potential obstacles, and examining the impact of the COVID-19 global epidemic on the development of this field.

Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique.

In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018-January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%-82.5% and a specificity of 14%-15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.

Sexual and reproductive health issues of women attending psychiatric clinic in India-A qualitative study.

Women with mental illness (WMI) experience considerable disparities in sexual and reproductive health (SRH) when compared to the general population. Due to their restricted access to SRH services, they have unmet contraceptive needs, a greater prevalence of sexually transmitted infections (STIs), and sexual dysfunction. The study aimed to explore the SRH issues of WMI in a tertiary care psychiatric outpatient clinic in Bengaluru, India. A qualitative hermeneutic phenomenological approach was used. A reproductive age group (18-49 years) WMI (n = 32) was selected by purposive sampling technique. The period of data collection was from January 2021 to September 2021. An in-depth face-to-face interview was conducted using a validated interview schedule. Hycner's explicitation process was used to investigate the constituents of a phenomenon. The codes revealed potential themes and subthemes. SRH issues faced by WMI were organized under three main themes, namely, (1) factors responsible for sexual dysfunction, (2) symptoms of STI and treatment adherence, and (3) use of contraception and its barrier. Sexual dysfunction among WMI is contributed by numerous factors. Women were exhibited limited knowledge of STI symptoms and treatment compliance. Such women experience issues with current method of contraception and are unaware of the alternatives. The findings of this study may be helpful for clinical nurses in drawing attention to and increasing knowledge of the reproductive health issues that women with psychiatric disorders face, taking the required precautions, and devising strategies for minimizing harm.

Adverse Childhood Experiences and Self-Reported Sexually Transmitted Infections among Adolescents and Young Adults in Zimbabwe

Sexually transmitted infections (STIs) are a public health crisis that can be devastating to individuals with adverse childhood experiences (ACEs). This study examined the prevalence and association between ACEs and self-reported STIs among adolescents and young adults in Zimbabwe. Data for this study was derived from the 2017 Zimbabwe Violence Against Children Survey (ZVACS) from the participants aged 13 to 24 (n=504). The self-reported prevalence estimates of STIs were calculated using weighted frequencies and percentages. Two logistic regression models were employed to assess an association between eight ACE types and self-reported STIs. The findings revealed that STIs were higher among orphans (52.2%), followed by participants with a history of lifetime suicide ideation or attempts (49.8%), were exposed to any ACE (42.5%), and had moderate/severe mental distress in the past 30 days (44.8%). Additionally, self-reported STI rates were higher for participants who experienced any form of physical violence (30.8%), witnessed physical violence (22.4%), experienced sexual violence (16.1%) and emotional violence (11.7%). In unadjusted regression models, all ACEs, except participants who experienced emotional violence, were significantly associated with self-reported STIs. However, after adjusting for covariates in the model, none of the ACEs maintained a significant association with self-reported STIs. Despite this, it is evident that interventions remain crucial for effectively preventing STIs for individuals with ACEs. There is a pressing need to implement and expand STI prevention programs nationally, including identifying and addressing ACEs and early screening, diagnosis, and treatment of STIs among adolescents and young adults in Zimbabwe. Keywords: Adverse childhood experiences (ACEs), Adolescents, sexually transmitted infections (STIs), Violence, Young adults, Zimbabwe.

Awareness And Attitudes Of Pregnant Women Towards STI Prevention And Treatment In New Sociomedical Conditions Of COVID-19 Pandemic

Background — Restriction on in-person events during the pandemic constitutes a dangerous factor causing the reduced awareness of youth of the risks and measures to prevent sexually transmitted infections (STIs). Consequently, pregnancies ending in childbirth in 2022 occurred against the backdrop of the COVID-19 situation, characterized by a decrease in preventive activity. Information deficit in 2020-2021 and the emphasis on issues of maintaining health in connection with the psychological factors of the pandemic accounted for peculiarities of awareness of young women regarding the prevention of STIs. The objective of our study was to analyze the knowledge and attitude of women towards prevention, diagnosis and treatment of STIs during pregnancy and to highlight the differences that arose depending on their education profile/profession. Materials and Methods — In 2022, against the background of the cancelation of most anti-epidemic restrictions, we conducted a sociological survey of 518 pregnant women. The respondents were divided into two comparable subgroups (178 respondents with education in medicine/biology and 340 females with other education profiles). This sample size corresponded to a significance level of 95%. Data processing was based on the calculation of relevant indicators (the proportion of parents – women and their husbands – screened for STIs prior to the conception, readiness for systematic screening examinations, and intentions to seek medical help for STIs). The significance of the difference in values between the subgroups of respondents with education in medicine/biology and education in humanities or technology was assessed using the Student’s t-test. Results — We revealed that 66.8% of respondents were focused on productive contact with the health care system, 74.2% of women with education in medicine/biology were examined for STIs, which statistically significantly (p&lt;0.05) exceeded the proportion of women with other education profiles (62.9%). At the same time, the level of trust in the public venereological services vs. private clinics was significantly higher among all categories of pregnant women (p&lt;0.01). Conclusion — Our study exhibited a high level of awareness among pregnant women about the STIs and the beneficial importance of preparation for conception by STI prevention. Women with education in medicine/biology had a more conscious attitude towards screening examinations for STIs, but at the same time demonstrated a higher desire for self-medication. We established that during the pandemic, young people in general have shown a stronger intention to receive medical care in private clinics, but in case of pregnancy exhibited higher confidence in public medical facilities.

Expanding expedited partner therapy and HIV prophylaxis in the emergency department.

Sexually transmitted infections (STIs) continue to have a disproportionate impact on individuals belonging to sexual, gender, and racial minorities. Across the nation, many emergency medicine pharmacists (EMPs) possess the skills and knowledge to expand the provision of expedited partner therapy (EPT) for STIs and provide HIV prophylaxis within existing practice frameworks. This report serves as a call to action for expanded provision of EPT and HIV prophylaxis by EMPs and highlights current barriers and solutions to increase pharmacist involvement in these practice areas. Emergency medicine pharmacy practice continues to expand to allow for limited prescribing authority through collaborative practice agreements (CPAs). In recent years, CPA restrictions have been changed to facilitate treatment of more patients with less bureaucracy. This report addresses the unique challenges and opportunities for expanding EPT and HIV pre- and postexposure prophylaxis provision by pharmacists in emergency departments (EDs). Furthermore, current strategies and treatments for EPT, such as patient-delivered partner therapy and HIV prophylaxis, are discussed. Pharmacist involvement in STI treatment and HIV prevention is a key strategy to increase access to high-risk populations with high ED utilization and help close current gaps in care. Expanding EMP provision of EPT and HIV prophylaxis may be beneficial to reducing the incidence of STIs and HIV infection in the community. CPAs offer a feasible solution to increase pharmacist involvement in the provision of these treatments. Legislative efforts to expand pharmacist scope of practice can also contribute to increasing access to EPT and HIV prophylaxis. With these efforts, EMPs can play an essential role in the fight against STIs and HIV.

Systematic review and meta-analysis of the global prevalence of sexually transmitted infections in people living with HIV and associated risk factors.

People living with HIV (PLWH) constitute a vulnerable population for acquiring additional sexually transmitted infections (STIs). This study was conducted to provide a summary of the evidence on the global prevalence of STIs in PLWH with an emphasis on infectious agents, diagnostic methods, and related risk factors. PubMed, Scopus, and Web of Science were systematically searched to include records published from January 01, 1990, to January 31, 2022, and the Google Scholar search engine was used to check the search strategy. In total, 132 eligible studies reporting STIs in PLWH were included, enrolling subjects from 35 countries across five continents. The pooled proportion of STIs was estimated to be 30.23% (95% CI, 26.1-34.45%) in PLWH and 20.01% (95% CI, 17.17-23.01%) in HIV-negative patients. Our meta-analysis indicated that in PLWH, the pooled OR of STIs compared to HIV-negatives was 1.77 (95% CI: 1.58-1.98) (p < 0.0001). The pooled OR of STIs by viral infectious agents was highest in PLWH (52.19% [95% CI: 43.88-60.43]) compared with fungal (22.19% [95% CI: 15.64-29.53]), bacterial (19.07% [95% CI: 13.59-26.63]), and parasitic (14.05% [95% CI: 11.88-16.38]) infections. Our findings show that there is a rather significant frequency of STIs among PLWH. This study highlights the need for new programs for the detection, treatment, and prevention of STIs in this at-risk population.