Sexual Health Clinic Research Articles

Validation of a claims-based algorithm to identify pre-exposure prophylaxis indications for tenofovir disoproxil fumarate/emtricitabine prescriptions, United States, 2012-2014: algorithm validation by medical records review.

To monitor the use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) and related medicines for pre-exposure prophylaxis (PrEP) as HIV prevention using commercial pharmacy data, it is necessary to determine whether TDF/FTC prescriptions are used for PrEP, or for some other clinical indication. To validate an algorithm to distinguish the use of TDF/FTC for HIV prevention or infectious disease treatment. An algorithm was developed to identify whether TDF/FTC prescriptions were for PrEP or for other indications from large-scale administrative databases. The algorithm identifies TDF/FTC prescriptions, and then excludes patients with International Classification of Diseases (ICD)-9 diagnostic codes, medications or procedures that suggest indications other than for PrEP (e.g., documentation of HIV infection, chronic hepatitis B (CHB), or use of TDF/FTC for post-exposure prophylaxis (PEP)). For evaluation, we collected data by clinician assessment of medical records for patients with TDF/FTC, and compared the assessed indication identified by the clinician review with the assessed indication identified by the algorithm. The algorithm was then applied and evaluated in a large urban community-based sexual health clinic. The PrEP algorithm demonstrated high sensitivity and moderate specificity (99.6%, 49.6%) in the electronic medical record database, and high sensitivity and specificity (99%, 87%) in data from the urban community health clinic. The PrEP algorithm classified the indication for PrEP in most subjects treated with TDF/FTC with sufficient accuracy to be useful for surveillance purposes. The methods described can serve as a basis for developing a robust and evolving case definition for antiretroviral prescriptions for HIV prevention purposes. None required.

Australian Sexual Health Service Users’ Perspectives on Reducing the Oral Transmission of Bacterial STIs: A Qualitative Study

ABSTRACT Growing rates of bacterial sexually transmitted infections (STIs) demand new approaches to STI prevention. Sexual practices involving saliva or direct contact with the mouth increase the risk of STI transmission, but community awareness remains largely unexplored in the literature. The Community Awareness and Surveillance of STI Transmission study sought to explore sexual health clinic attendees’ awareness of oral STIs; experiences when seeking testing and treatment; and acceptable educational and clinical interventions. Twenty-one semi-structured interviews were conducted with a diverse group of Melbourne Sexual Health Center attendees’. Reflective thematic analysis was undertaken, revealing key themes across people of different genders, sexual identities, ages, and nationalities. All participants emphasized the importance of understanding how their sexual practices might put them at risk of an oral STI. They also sought care from specialist sexual health services with the expectation that health-care providers (HCPs) in these settings had more understanding of diverse sexual practices. Participants’ decisions to protect themselves against oral STIs were primarily driven by the effect the decision had on pleasure and intimacy. Comfort during the health-care encounter and trust in HCPs facilitated better understanding of individual STI risk. Differences in awareness and risk reduction strategies were noted based on past experience with oral testing and STIs. These findings highlight the importance of HCPs and public health interventions providing solutions that recognize the central role of pleasure and intimacy in our sexual lives.

Neisseria gonorrhoeae positivity in contacts presenting to a sexual health centre.

Concerns regarding antimicrobial resistance and the appropriate use of antibiotics have resulted in many sexual health clinics moving away from the epidemiological treatment of contacts of gonorrhoea. The aim of this study was to inform decision-making regarding patients who are contacts who should be given epidemiological treatment. This is a retrospective study of positivity rates of symptomatic and asymptomatic contacts of gonorrhoea who attended the Adelaide Sexual Health Centre from 1 January 2018 to 31 December 2019. Relevant demographic and behavioural characteristics were examined. Non-parametric continuous data were examined as medians and interquartile ranges, and categorical variables were examined as proportions and percentages. Chi-squared tests were used to determine any statistically significant differences in the proportions of participants testing positive to gonorrhoea based on the categorical variables. A total of 402 clients were identified as contacts, of which 124 (30.8%) tested positive for gonorrhoea. Women were statistically more likely to test positive than men (27/56 (48.2%) of women vs 96/345 (27.8%) of men (P =0.002), 0/1 transgender female). From a total of 76 heterosexual men, 14 (18.4%) tested positive as contacts, compared to 82/269 (30.5%) of bisexual/MSM (P =0.038). Of the 214 asymptomatic bisexual/MSM, 55 (25.7%) were positive, 2/56 (3.6%) asymptomatic heterosexual men were positive and 10/29 (34.5%) asymptomatic females were positive for gonorrhoea. This study identifies some demographic and behavioural characteristics that may be associated with a higher rate of gonorrhoea positivity as a contact, particularly females and MSM. Careful consideration may be required as to who should be given epidemiological treatment to ensure appropriate and judicious use of antibiotics.

476. Increased Depression and Anxiety Associated with COVID-19 among Recipients of HIV Healthcare Services at Sexual Health Clinic in NYC

Abstract Background The COVID-19 epidemic disrupted routine healthcare services and affected mental health. Within Stick2PrEP, a suite of studies aimed at increasing pre-exposure prophylaxis (PrEP) uptake and healthcare engagement among men who have sex with men (MSM) and trans women (TW) in New York City, participants enrolled from November 2018 to February 2020 (Stick2PrEP2) and, after pandemic onset, from May 2021 onward (Stick2PrEP3). To understand the impact of the pandemic on the mental health of MSM/TW, we compared Stick2PrEP2 and Stick2PrEP3 participants' self-reports of depression and anxiety. Methods All participants in the two studies completed a baseline enrollment questionnaire that surveyed demographics, sexual behaviors, depression, anxiety, and intimate partner violence. We compared baseline characteristics of Stick2PrEP3 vs Stick2PrEP3 among participants enrolled between November 2018 and April 2022 using relevant statistics (e.g., Pearson's Chi-squared test or Wilcoxon rank sum test). Results We analyzed 345 participants, 141 in Stick2PrEP2 and 204 in Stick2PrEP3. Participants were similar in age, self-identified gender, race/ethnicity, income, rates of adverse childhood events, HIV and sexually transmitted infection (STI) risk scores, and PrEP adherence norms. More participants were on Medicaid or uninsured in Stick2PrEP3 (p< 0.001). Additionally, both PHQ9 (2 vs. 4, p< 0.001) and GAD7 (2 vs. 4, p=0.002) scores were significantly higher in Stick2PrEP3. More participants reported experience of intimate partner violence (24% vs. 45%, p=0.002) in Stick2PrEP3, but had higher PrEP engagement (INDEX score >45, 66% vs. 86%, p< 0.001). Demographic information of participants in Stick2PrEP2 and Stick2PrEP3. Results of different measurements from the enrollment survey that each participant completed. Conclusion The baseline results suggest that depression and anxiety levels were lower before COVID-19 among MSM and TW. The experiences during the COVID-19 pandemic may have contributed to increased depression and anxiety levels which may be multifactorial and modified by disruption in PrEP services. Further investigation is crucial to uncover the link between COVID-19, mental health, and health services delivery for people at risk of HIV acquisition. Disclosures All Authors: No reported disclosures

2671. The Sexual Health Clinic Mpox Response in King County, Washington, May–October 2022

Abstract Background Sexual health clinics, vital to the 2022 mpox outbreak response, were challenged by high patient volumes and delayed access to vaccines and tecovirimat. We describe the Public Health - Seattle King County Sexual Health Clinic (SHC) response, including vaccine and tecovirimat distribution, from 5/23/22 (first case in King County) to 10/14/22. Methods SHC began vaccinations in clinic on 7/4/22 and implemented a mass vaccination clinic on 7/25/22. Tecovirimat prescriptions initially required positive test results; by 7/29/22 SHC offered same-day presumptive treatment based on clinical suspicion. We calculated vaccines administered per week, proportion of visits related to mpox evaluation, and collected and summarized demographic and clinical data for diagnosed mpox cases. We assessed temporal trends in treatment type (presumptive vs results-based) using Kruskal-Wallis testing and differences in treatment receipt by race/ethnicity using chi-square testing (p< 0.05). Results From 5/23/22 to 10/14/22, SHC provided ≥1 vaccine dose to 9,753 people; the highest number within a week (n=1,537) were provided the week of 8/1/22 (Figure 1). Of 4,845 clinic visits, 486 (10%) patients were evaluated and tested for mpox; 174 (36%) were positive, comprising 36% of cases in King County at the time. 94% were cisgender men; 57% were White. 74 (43%) had severe symptoms including proctitis, hematochezia, or need for adjunctive pain control. Of 172 patients with complete clinical data, 154 (90%) received tecovirimat, including 83 (54%) treated presumptively. Provision of presumptive treatment increased significantly over time (P< 0.001) (Figure 2). Treatment receipt did not differ significantly by race/ethnicity (P=0.4). Conclusion The SHC substantially expanded vaccine access, served over 1/3 of patients with mpox in King County, and expedited mpox treatment through presumptive therapy, while continuing general sexual health services for patients within the county. Disclosures Chase Cannon, MD MPH, Roche Diagnostics: Advisor/Consultant Julia C. Dombrowski, MD, MPH, Hologic: Grant/Research Support|Mayne Pharmaceuticals: Grant/Research Support

Implementation of an Mpox Vaccination Program at a Large Sexual Health Clinic in the Bronx-Lessons in Vaccine Equity.

Mpox caused a global outbreak in 2022. Among 249 people who received mpox vaccination at a sexual health clinic in the Bronx, New York, those with private vs public insurance were more likely to complete the series. No mpox cases were seen during follow-up at a median 121 days (IQR, 97-139).

Examining Patient Preferences for Express, Telemedicine, and Standard Visits in a Sexual Health Clinic in New York City.

This study, completed at an sexually transmitted infection (STI) clinic in 2019 to 2020, evaluated patient preferences for telemedicine, express, and standard visits. Active PrEP users preferred telemedicine and express visits, patients with prior STIs preferred express visits, and cisgender women preferred standard visits. Configuring STI clinic visit types requires shared decision making and individualization.

An Implementation Pilot of Web-Based Self-Training Programs on Sexual Dysfunctions in the Dutch Public Sexual Health Setting: Mixed Methods Study.

Web-based sexual health interventions may be more acceptable to people compared with face-to-face support, given the stigma and embarrassment often associated with sexual problems. The Dutch public sexual health clinics (SHCs) conducted an implementation pilot with 4 web-based self-training programs on sexual dysfunctions (WSTPs) for young people. In addition to a basic sexuality program, the WSTPs focused on the following complaints: pain during intercourse, premature ejaculation, and no sex drive. This study aims to gain insight into the potential reach of the freely offered WSTPs; use, acceptance, evaluation, and perceived impact of the WSTPs by young people; and evaluation and acceptance of the WSTPs by nurses of the SHCs. A quantitative baseline measurement (BM) and a follow-up measurement (FM) were conducted among the users. In addition, qualitative data were gathered through video interviews with a sample of respondents of the FM and nurses of the SHCs to gain more in-depth insights into their assessment of the WSTPs. Participants were recruited via social media, posters, and referrals by nurses of the SHCs. Quantitative data were analyzed using descriptive statistics. Independent 2-tailed t tests and one-way independent ANOVAs were used to compare the scores between subgroups based on background characteristics. Dependent 2-tailed t tests were used to assess the possible changes between BM and FM. The interviews were analyzed using a thematic analysis. A total of 1028 young people (aged 16-24 y) completed the BM, 666 started with 1 of the WSTPs, and 104 participants completed the FM. In addition, 8 users and 8 nurses were interviewed. Of the participants who completed the BM, 87.74% (902/1028) experienced moderate (411/1028, 39.98%) to high (491/1028, 47.76%) severity of complaints, of which 20.43% (210/1028) had had them for >1 year and 27.82% (286/1028) even for ≥2 years, and 38.91% (400/1028) were dissatisfied with their sex lives. Only 8.75% (90/1028) had sought professional help in the past 2 years. At FM, users rated satisfaction with their sex life more positively than they did at BM, and they experienced less discomfort from their complaints. The overall rating was positive, with a mean report grade of 7.3 (SD 1.45; on a 10-point scale). Anonymity, clear information and explanation, and practical exercises are indicated as strengths of the WSTPs, leading to more understanding and normalization. Nurses appreciate the high quality of information and accessibility of the WSTPs. They consider them as a valuable addition to the consultation hours. WSTPs can reach a large number of young people with sexual problems who are less likely to seek professional help. This can result in an improved understanding of their issues, a decrease in complaints, and reduced barriers to communicating with a partner or professional.

Effectiveness of the Modified Vaccinia Ankara Vaccine Against Mpox in Men Who Have Sex With Men: A Retrospective Cohort Analysis, Seattle, Washington.

Data on modified Vaccinia Ankara (MVA) vaccine effectiveness against mpox in real-world settings are limited. We performed a retrospective cohort analysis using Cox proportional hazards regression to estimate the association between vaccination and laboratory-confirmed mpox incidence. Study subjects included all men who have sex with men seen in a sexual health clinic in Seattle, Washington, between 1 January 2020 and 31 December 2022. Subjects' receipt of vaccine and diagnosis with mpox were ascertained from public health vaccine registry and surveillance data. Analyses were adjusted for demographic factors, human immunodeficiency virus (HIV) status, and sexual risk behaviors. The incidence of mpox per 100 person-years was 8.83 among patients with 0 doses, 3.32 among patients with 1 dose, and 0.78 among patients with 2 doses of MVA vaccine. Mpox diagnosis was significantly associated with age category 30-39 and 40-51 years, HIV positivity, syphilis diagnosis in the prior year, >10 sex partners in the last year, and having a clinic visit in the last year. In the multivariate model adjusting for these factors, vaccine effectiveness was 81% for 1 dose and 83% for 2 doses. These data support the effectiveness of the MVA vaccine-including a single dose of the vaccine-in preventing mpox disease and highlight the appropriateness of risk factor-based prioritization of immunization early in the epidemic. The durability of MVA vaccine-induced immunity is unknown, and at-risk persons should receive 2 doses of MVA.

Social support and emotional wellbeing among women living with bacterial vaginosis in new york city

Abstract Background Bacterial Vaginosis (BV) is a common pathological vaginal condition in women and is disproportionately higher among Black (33%) and Hispanic women (31%) than among non-Hispanic White (23%) or Asian women (11%). BV can have highly distressing impacts on women, yet the role of social support has received limited attention. This paper aimed to explore women's experiences of social support for BV. Methods We conducted semi-structured interviews with women (n = 41) aged 18 years or older and who had a BV diagnosis in the past year. Interviews examined women's infection history and symptoms, BV management approaches, the impact of BV on women's lives, and BV clinical care experiences. Qualitative data were analyzed with an a priori coding framework based on key domains, followed by open-coding to uncover emergent themes. Results The majority of participants were Non-Hispanic Black/African American (63.4%). Nearly a quarter (22.0%) of participants identified as lesbian or bisexual or reported having sex with a woman in the past year. Most women with BV expressed feelings of shame. Many women noted a lack of social support, particularly from sexual partners, which might lead to relationship mistrust and blame for the infection. Sexual partners’ inadequate knowledge of BV resulted in women's reluctance to discuss their diagnosis and avoidance of sexual activities. Supportive partners or friends helped women recognize BV infection and seek treatment earlier, provided emotional support and reduced feelings of isolation. In addition, women reported receiving greater support and care from sexual health clinics than from other healthcare settings. Conclusions The study highlights the importance of social support in women's experiences of BV. Findings imply that enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women's emotional well-being and overall BV experiences. Key messages • The study highlights the importance of social support in women’s experiences of BV. • Enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women’s overall BV experiences.

Understanding the Impact of Mpox on Sexual Health Clinical Services: A National Knowledge, Attitudes, and Practices Survey-United States, 2022.

During the 2022 mpox outbreak, most cases were associated with sexual contact, and many people with mpox sought care from sexual health clinics and programs. The National Network of STD Clinical Prevention Training Centers, in partnership with the Centers for Disease Control and Prevention, conducted a survey of US sexual health clinics and programs to assess knowledge, practices, and experiences around mpox to inform a future public health response. Between August 31 and September 13, 2022, the National Network of STD Clinical Prevention Training Centers facilitated a web-based survey. Descriptive statistics were generated in R. Among 168 responses by clinicians (n = 131, 78%) and program staff (n = 37, 22%), more than half (51%) reported at least somewhat significant mpox-related clinical disruptions including burdensome paperwork requirements for mpox testing (40%) and tecovirimat use (88%). Long clinic visits (51%) added additional burden, and the median mpox-related visit lasted 1 hour. Few clinicians felt comfortable with advanced pain management, and clinicians felt most uninformed about preexposure (19%) and postexposure (24%) prophylaxis. Of 89 respondents involved in vaccination, 61% reported using equity strategies; however, accounts of these strategies revealed a focus on guideline or risk factor-based screenings instead of equity activities. These findings highlight the substantial impact of the 2022 mpox outbreak on sexual health care in the United States. Critical gaps and barriers were identified that may inform additional mpox training and technical assistance, including challenges with testing, diagnosis, and management as well as a disconnect between programs' stated goal of equity and operationalization of strategies to achieve equity.

Evaluation of the Impact and Outcomes of a Rapid Transition to Telehealth PrEP Delivery at a Sexual Health Clinic During the COVID-19 Pandemic.

Increasing human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) use is a critical part of ending the HIV epidemic. In response to the COVID-19 pandemic, many PrEP services transitioned to a telehealth model (telePrEP). This report evaluates the effect of COVID-19 and the addition of telePrEP on delivery of PrEP services at the Denver Sexual Health Clinic (DSHC), a regional sexual health clinic in Denver, CO. Before COVID-19, DSHC PrEP services were offered exclusively in-clinic. In response to the pandemic, after March 15, 2020, most PrEP initiation and follow-up visits were converted to telePrEP. A retrospective analysis of DSHC PrEP visits compared pre-COVID-19 (September 1, 2019 to March 15, 2020) to post-COVID-19 (March 16, 2020 to September 30, 2020) visit volume, demographics, and outcomes. The DSHC completed 689 PrEP visits pre-COVID-19 and maintained 96.8% (n = 667) of this volume post-COVID-19. There were no differences in client demographics between pre-COVID-19 (n = 341) and post-COVID-19 PrEP start visits (n = 283) or between post-COVID-19 in-clinic (n = 140) vs telePrEP start visits (n = 143). There were no differences in 3- to 4-month retention rates pre-COVID-19 (n = 17/43) and post-COVID-19 (n = 21/43) ( P = 0.52) or between in-clinic (n = 12/21) and telePrEP clients (n = 9/22) in the post-COVID-19 window ( P = 0.37). Also, there were no significant differences in lab completion rates between in-clinic (n = 140/140) and telePrEP clients (n = 138/143) ( P = 0.06) and prescription fill rates between in-clinic (n = 115/136) and telePrEP clients (n = 116/135) in the post-COVID-19 window ( P = 0.86). Implementation of TelePrEP enabled the DSHC to sustain PrEP services during the COVID-19 pandemic without significant differences in demographics, engagement, or retention in PrEP services.

An Exploratory Study Investigating the Correlates of Sexual Health Anxiety and Preferences for Digital Services Amongst Internet Users

Background: Sexual health clinics are under increasing pressure because of the demand for sexually transmitted infection (STI) screening services. Sexual health anxiety has been associated with increased clinic attendance and repeat screening. Aims: This study aimed to investigate the level of sexual health anxiety and its correlates in adults in England and their opinions on digital sexual health services. Setting and Design: An online cross-sectional study was conducted between May 2019 and January 2020 among internet users living in England aged 18 years and older. Methods: Participants were recruited from advertisements on social media (eg, Facebook, Twitter, Tumblr, and Reddit), and data were collected via an online Qualtrics survey. Statistical Analysis: Multiple regression analyses were used to identify correlates of sexual health anxiety. Results: One-hundred and thirty-eight participants completed the survey (mean age = 29.25, SD = 11.29; 51% male, 81% White, and 56% educated to the degree level). Average sexual health anxiety was mild ( M = 2.19, SD = .79), and the average subscale values ranged from 1.88 (SD = .92) to 2.67 (SD = 1.25). Higher sexual health anxiety was predicted by a higher frequency of obsessive-compulsive behavior and a greater risk perception of STIs. There were some overlaps between the predictors of subtypes, but further research is needed. Conclusion: Despite the levels of sexual health anxiety in the sample, the acceptability of digital sexual health services was high, but preferences leaned heavily toward face-to-face and in-person interaction.

The Update of HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV Recent Infection Among Four Sub-Groups in Sichuan, China During Surveillance Period Between 2016 and 2022.

Sichuan Province has gradually become a hot-spot for HIV/AIDS. Little is known about the HIV-1 incidence and prevalence among four sub-groups since 2015. Meanwhile, the distributions of hot-spot areas related to recent infection cases that indicate current transmission among the four subgroups are also rare. The main purpose of this study was to assess the HIV-1 prevalence and incidence and to visualize the distributions of hot-spot areas of current transmission among four subgroups (people who inject drugs, male STD clinic attendees, female sex workers and men who had sex with men) during the surveillance period in Sichuan province between 2016 and 2022. Of the 267,617 individuals, 2158 HIV-positive samples were tested with Lag-Avidity EIA, among which 493 samples were identified as recent infections. Among people who inject drugs (PWID), both HIV-1 prevalence (from 1.41% to 0.34%) and incidence (from 0.03% to 0.140%) showed a significant decreasing trend. Among men who had sex with men (MSM), female sex workers (FSWs), and male STD clinic attendees, HIV-1 prevalence indicated significant decreasing trends, whereas HIV-1 incidence showed no significant changes. Spatial analysis demonstrated the formation of hot-spots and clusters of current transmissions sharing regional differences, mainly concentrated in the southeast, and most of these were consecutive hot-spots. The prevention and control were efficacious and persistent. However, among the other three subgroups, there is a need for a regional cooperative in prevention and control approaches and collaborative research in many aspects.

Exploration of Barriers and Possible Solutions for Nonutilization of Facility-based Integrated Counseling and Testing Center Using the Delphi Technique.

A major group of the population, especially antenatal checkup (ANC) mothers and their spouses, people admitted for surgery, and people attending STI clinics, are reluctant to pretest counseling. This study has been taken up to explore the barriers and possible solutions to improve the utilization of Facility based integrated counseling and testing center (F-ICTC) counseling services. Phase 1: In-depth interview and ranking with stakeholders from the F-ICTC center (n = 13) were conducted to identify the barriers to utilization of F-ICTC and solution for the same. Phase 2. Delphi panel with experts (n = 17) was invited through mail to find out the potential solution to improve the utilization of F-ICTC counseling services. Possible barriers from the stakeholders' perspectives were fear of the disease, violate the privacy, unacceptance, gender bias, fear of social stigma and discrimination, and neglect attached to the disease. At third round of Delphi experts had arrived at a consensus regarding of following possible potential solutions: 1. Those who refuse pretest counseling they should be asked to answer a set of questions(which are usually told during counseling), only those questions not answered correctly by them can be corrected, 2.conducive hospital environment, 3.zero discrimination policy, 4. group counseling for ANC mothers and patients in waiting area of the hospital,5. phone counseling for unwilling patients and relocation of testing center and health education camping. Context-specific proactive evidence-based intervention will help in improving the proper utilization of the F-ICTC center.

Improving Patient Compliance with Vaginal Dilator Therapy by Implementation of Sexual Health Consult in Gynecologic Malignancies after Radiation Therapy

Typical vaginal dilator therapy (VDT) compliance falls short at approximately 30% of patients in reported studies, which could lead to vaginal stenosis (VS) in as high as 88% of patients who undergo radiation therapy (RT) for gynecologic malignancies. In an ongoing effort to improve adherence to VDT aimed to prevent vaginal stenosis post pelvic and vaginal RT, a prospective study was implemented to assess the feasibility and the impact on vaginal dilator therapy adherence when implementing a consult with the oncology women's sexual health clinic following the completion of radiation therapy. This was a single institution, prospective analysis and feasibility study that included patients diagnosed with a gynecologic cancer who were treated with RT to the pelvic and or vaginal tissues. Using purposive sampling, the treating radiation oncologists identified eligible patients and referred them to the oncology women's sexual health clinic for consult four to six weeks status post completion of RT in a six-month period. A post treatment survey was conducted via a telephone interview 12 weeks after the sexual health clinic initial consult to assess vaginal dilator therapy compliance. Descriptive statistics were calculated. Pre-intervention retrospective data analysis revealed poor compliance to VDT with only 3 of 40 (7.5%) patients judged as compliant. Post-intervention, 30 of 37 (81.1%) patients in the sample were judged compliant. The adherence rate in the post-intervention group was significantly higher (Fisher's Exact Test two-tailed p-value < 0.0001). With confidence of 95%, the proportion of the potential population that would adhere post intervention was between 68.5% and 93.7%. Sociodemographic and clinical characteristics did not have a statistically significant correlation with VDT compliance. Implementing a referral to an oncology women's sexual health clinic at the completion of RT for the sample population is feasible. Our project demonstrates that instituting this new sexual health clinic may have a large, positive impact on patient compliance to vaginal dilator therapy. More importantly, this may lead to decrease incidences of vaginal stenosis and improvement in patient health outcomes and quality of life (QoL).

Genomic Epidemiology of Treponema pallidum and Circulation of Strains With Diminished tprK Antigen Variation Capability in Seattle, 2021-2022.

The incidence of syphilis continues to increase in the United States, yet little is known about Treponema pallidum genomic epidemiology within American metropolitan areas. We performed whole-genome sequencing and tprK deep sequencing of 28 T. pallidum-containing specimens, collected mostly from remnant Aptima swab specimens from 24 individuals from Seattle Sexual Health Clinic during 2021-2022. All 12 individuals infected with Nichols-lineage strains were men who have sex with men, while a specific SS14 cluster (mean, 0.33 single-nucleotide variant) included 1 man who has sex with women and 5 women. All T. pallidum strains sequenced were azithromycin resistant via 23S ribosomal RNA A2058G mutation. Identical T. pallidum genomic sequences were found in pharyngeal and rectal swab specimens taken concurrently from the same individuals. The tprK sequences were less variable between patient-matched specimens and between epidemiologically linked clusters. We detected a 528-base pair deletion in the tprK donor site locus, eliminating 9 donor sites, in T. pallidum genomes of 3 individuals with secondary syphilis, associated with diminution of TprK diversity. We developed an end-to-end workflow for public health genomic surveillance of T. pallidum from remnant Aptima swab specimens. tprK sequencing may assist in linking cases beyond routine T. pallidum genome sequencing. T. pallidum strains with deletions in tprK donor sites currently circulate and are associated with diminished TprK antigenic diversity.

Increasing Rates of Human Papillomavirus Catch-Up Vaccination at a Sexual and Reproductive Health Clinic: A Quality Improvement Project.

Catch-up human papillomavirus (HPV) vaccination of adults aged 19 to 26 who were not vaccinated as children or adolescents may decrease rates of HPV-associated cancer. The purpose of this project was to increase uptake of catch-up HPV vaccination at a sexual and reproductive health clinic through the implementation of a multicomponent, systems-based intervention. Catch-up vaccination rates were recorded at an intervention health clinic and a comparison health clinic. A comparative, interrupted time series design was used to compare rates of catch-up vaccination pre- and postintervention. Electronic health record prompts, in-clinic education, and scheduling of a next visit at the current visit were implemented. Data were analyzed using descriptive statistics, t tests, and regression analysis. The proportion of all patients aged 19 to 26 who received an HPV vaccination rose at the intervention health clinic from 0.76% preintervention to 4.42% postintervention. At the intervention clinic there was a nonsignificant increase (4.47 minutes) in average daily patient cycle times between the pre- and postintervention periods (t(13) = 1.895, P = .075). Rates of catch-up HPV vaccination increased significantly following the multicomponent, systems-based intervention. Further iteration of the quality improvement process should examine the sustainability of the interventions and the effects of the intervention on vaccine series completion.

Demographic and Clinical Characteristics of Mpox Patients Attending an STD Clinic in Lisbon.

Mpox is a viral disease caused by the monkeypox virus, which marked the year of 2022 with a global outbreak. While previously considered to be a zoonosis of almost exclusive animal-to-human transmission, the current outbreak has been attributed to human-to-human transmission, particularly sexual transmission. As a new sexually transmissible disease, we studied the epidemiological and clinical features, as well as the concomitant occurrence of other sexually transmissible diseases, treatment approach, and outcome of our 291 patients, in the current outbreak. We found a total of 169 concomitant sexually transmissible infections of bacterial and viral origins, corresponding to 107 patients. Neisseria gonorrhoeae was the most common agent, particularly in the anal location. With this work, we emphasize the need for a thorough epidemiological and medical history, as well as a concomitant complete laboratorial screening for other STIs in patients with confirmed or suspected mpox.

Evidence of emerging sexually transmitted Mycoplasma genitalium infection among women detected using multiplex and uniplex PCR

Background The Centre for Disease Control has recognised Mycoplasma genitalium as an emerging sexually transmitted infection. Sparse literature is available in India regarding Mycoplasma genitalium infection. Aims To evaluate the prevalence of Mycoplasma genitalium, its detection from samples obtained from various sites, evaluate co-infections and follow up after treatment. Methods A prospective study was conducted among 341 sexually active women presenting with the complaints of lower genital tract infection to the Municipal STD clinic and ART Centre. Endocervical swabs, vaginal swabs and urine samples were tested for Mycoplasma genitalium using uniplex and multiplex real-time PCR kits. Gram stain was used for diagnosing bacterial vaginosis and candidiasis. Data on HIV, RPR, TPHA, Hepatitis C and HBsAg were also collected. Results The mean age of the participants was 33.4 ± 5.7 years. Mycoplasma genitalium was found in 23 (6.7%) patients, while Neisseria gonorrhoeae and Chlamydia trachomatis were detected in 8 (2.3%) of the participants. The highest Mycoplasma genitalium positivity was in the endocervical swab sample at 6 (26%), followed by the urine sample at 4 (17.3%). The most common coinfection was HCV (33.3%), followed by syphilis (14.3%). The uniplex and multiplex kits showed 47.8% concordance for Mycoplasma genitalium in endocervical swab samples. Tobacco addiction was a significant risk factor for the Mycoplasma genitalium infection. Out of the 6 women who attended the follow up visit at the end of three months, a positive test for cure was seen in 4 (66.6%). Limitations Significant numbers of patients were lost to follow up. Also, the presence of anti-microbial resistance was not evaluated. Conclusion Mycoplasma genitalium is prevalent among women with high-risk behaviours, highlighting the need for further studies are needed among other high-risk populations.