STD Diagnosis Research Articles

Preconceptional brain structure and future conception: a prospective brain MRI study among 321 women

Brain structure may influence female fertility through its reciprocal relationship with the endocrine system, but this hypothesis is underexplored. This study investigated the association between preconceptional brain structure and the likelihood of conception in a prospective population-based neuroimaging cohort. Women intending to conceive within a year were recruited and structural brain MRI scans were collected from 321 participants between June 2019 and March 2021. During the 12-month follow-up, 185 women became pregnant, and 136 did not. Logistic regression was used to examine associations between global brain parameters and conception, adjusting for age, intracranial volume, BMI, prior STD diagnosis, ethnicity, education, household income, smoking, and alcohol use. Unadjusted analyses showed associations between conception and larger occipital lobe and nucleus accumbens volume, increased surface area across all lobes, and occipital cortical thickness, and conception. Adjusted analyses identified a positive association between nucleus accumbens volume and conception (OR = 1.50 (95% CI: 1.12, 1.99), p-value = 0.007). Sensitivity analyses linked caudate volume to conception, but no findings remained significant after correction for multiple comparisons. Further research is needed to understand the potential role of brain structure and function in conception, in relationship with general health and socioeconomic factors.

P-1317. Beyond Clinical Factors: Examining the Association between Socioeconomic Status and Severe Mpox Disease in NYC

Abstract Background The NYC 2022-23 mpox outbreak predominantly affected sexual minority men with notable racial/ethnic disparities. Clinical predictors of severe mpox disease (e.g., poorly controlled HIV) have been established, but little is known about the socioeconomic predictors of severe disease. Methods Patients age ≥ 18 with a confirmed mpox diagnosis from 5/1/2022-12/31/2023 (N=143) were identified through the electronic medical record at an academic medical center in NYC. Low socioeconomic status (SES) (N=41) was defined as being uninsured (N=4), on Medicaid (N=35), or in the AIDS Drug Assistance Program (ADAP) (N=2). We characterized patients by demographics and clinical characteristics and compared those who received tecovirimat for treatment and/or who were hospitalized with those who were not. We operationalized disease severity using the newly validated mpox severity score (mpox-SS). We then examined associations between SES and mpox-SS, controlling for age, race/ethnicity, mental health, substance use, high risk status (e.g., HIV with CD4 < 350cells/mm3), prior mpox vaccination, and STD diagnosis. Results Demographics (Table 1) and clinical characteristics (Table 2) were examined by tecovirimat and/or hospitalization. Over 67% of patients were privately insured. About 44% had HIV, 17% had prior mpox vaccination, and 22% were high risk. About 26% received tecovirimat, 15% were hospitalized inpatient, while 3% were admitted to ICU. There were 135 patients with clinical data to calculate the mpox-SS. The mean (SD) mpox-SS was 6.85 (3.36) (Figure 1). In univariate analysis, low SES was significantly associated with more severe mpox-SS (p=0.02) (Table 3) and remained significant in the model (p=0.03) controlling for race/ethnicity, high risk status, STD, or prior vaccination. High risk status was associated with higher mpox-SS and prior vaccination was associated with lower mpox-SS. Conclusion Using the mpox-SS, low SES was significantly associated with higher mpox severity in this diverse cohort of cisgender sexual minority men in NYC, likely reflecting delays in access to care or other inequities. Further studies are needed to assess the relationship between SES and severe mpox in order to understand factors beyond insurance that lead to disparate clinical mpox outcomes. Disclosures Ofole Mgbako, MD MS, Gilead: Advisor/Consultant Madeline DiLorenzo, MD, Abbvie: Stocks/Bonds (Public Company)|Agilent Technologies: Stocks/Bonds (Public Company)|Amgen: Stocks/Bonds (Public Company)|Becton Dickinson: Stocks/Bonds (Public Company)|Biogen: Stocks/Bonds (Public Company)|BioTechne Corp: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Cardinal Health: Stocks/Bonds (Public Company)|Centene Corp: Stocks/Bonds (Public Company)|CVS Health: Stocks/Bonds (Public Company)|Davita Inc: Stocks/Bonds (Public Company)|Ecolab: Stocks/Bonds (Public Company)|Elevance Health: Stocks/Bonds (Public Company)|Gilead Sciences Inc.: Stocks/Bonds (Public Company)|Glaxo Smith Kline: Stocks/Bonds (Public Company)|HCA Healthcare Inc: Stocks/Bonds (Public Company)|Healthpeak Properties: Stocks/Bonds (Public Company)|Henry Schein: Stocks/Bonds (Public Company)|Hologic Inc: Stocks/Bonds (Public Company)|Humana Inc: Stocks/Bonds (Public Company)|Idexx Laboratories: Stocks/Bonds (Public Company)|Jazz Pharmaceuticals: Stocks/Bonds (Public Company)|Labcorp: Stocks/Bonds (Public Company)|Merck and Company: Stocks/Bonds (Public Company)|Quest Diagnostics Inc: Stocks/Bonds (Public Company)|Resmed Inc: Stocks/Bonds (Public Company)|ThermoFisher Scientific: Stocks/Bonds (Public Company)|Vertex Pharmaceuticals: Stocks/Bonds (Public Company)|West Pharmaceuticals: Stocks/Bonds (Public Company)

Systematic review: characteristics of myocarditis followed by fixed drug eruption and dry eye syndrome in patients who have been vaccinated with monkeypox in children and adults

BackgroundThe Monkeypox Virus (MPOX) has caused a surge in viral infections, leading to the WHO recognizing it as a public health emergency of international concern. MPOX infection shares clinical similarities with smallpox but can cause complications like myocarditis, anorectal pain, ocular lesions, kidney damage, or soft tissue superinfection. The study aims to understand the characteristics of myocarditis, fixed drug eruption, and dry eye syndrome in Monkeypox patients.MethodsThis review was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and the Cochrane Handbook for Systematic Reviews of Interventions. The data was obtained from Scopus and international journal databases by conducting combined keyword searches restricted to English-language publications.ResultThe study examined 25 cases of Monkeypox, primarily involving males aged 32.9 years and experiencing chest pain. The prognosis was generally good, with no reported death. Risk factors for infection include sexual activity, STD diagnosis, sexual encounters, and workplace exposure to orthopoxviruses. Most cases were male and involved chest pain. Myocarditis, an inflammation in the myocardium, can cause dilated cardiomyopathy, acute arrhythmia, and heart failure. The pathophysiology of myocarditis in Monkeypox patients is not yet determined due to rarity of cases.ConclusionMPOX infection presents unique complications like myocarditis, necessitating research for vaccines, antiviral drugs, and infection prevention measures. Early screening for chest pain and investigating MPXV infection's pathogenesis and clinical features are crucial for differential diagnosis during outbreaks. This systematic review can determine MPOX infection outcomes and prepare appropriate treatment for patients with complications.

Costs Associated With Incorporation of Network Approaches Into Sexually Transmitted Disease Program Activities.

Network approaches can be used to study sociosexual partnerships and identify individuals at high risk of infection. Little is known about the cost structure of these services and their association with STD diagnoses. We collected costs associated with using a peer network strategy to recruit men who have sex with men and transwomen of color in 4 counties in North Carolina: Guilford, Forsyth, Durham, and Wake from February through October 2019. We used a comprehensive costing approach to gather detailed retrospective information on the intervention cost, broken down by category and programmatic activity. The sociosexual networks collected consisted of 31 initial seeds (index cases) and 49 peers of those seeds. In peers, 5 cases of human immunodeficiency virus (HIV) and 10 cases of syphilis were identified. The cost per case (HIV or syphilis) identified was $7325. Personnel costs accounted for 80% of total expenditures, followed by laboratory expenses (12%). Personnel cost was distributed between disease intervention specialist patient navigators (51%), nonclinical (37%), and management (12%) staff. General administration was the costliest programmatic activity (37%), followed by case management and field services (37%), and study activities (11%). The estimated average cost per patient tested was $2242. Finding positive peer cases in nonclinical settings is costly but may be crucial for limiting the spread of sexually transmitted diseases. The cost of staff was the major driver. This study demonstrates that using a network strategy can be a cost-effective way to identify, test, and refer patients at high risk of syphilis and HIV infections to care.

Intragender Violence: An Approach from LGBTIQ+ University Students in Chile

Intimate partner violence has been extensively studied in the Latin context and in Chile, however, these do not distinguish between heteronormative relationships and those belonging to the LGBTIQ+ community, which is why the latter are invisible, which is why this study aims to understand the specific characteristics of how young LGBTIQ+ university students in Chile experience intragender violence, identifying its main manifestations and consequences. The research has a non-probabilistic sample of nine participants, who correspond to six women and three men between 18 and 31 years old, who participated in a semi-structured individual interview and/or in a discussion group conducted online, this being a qualitative study guided by the constructivist grounded theory. Among the main results found, it is reported that psychological violence is one of the most experienced by the participants, followed by cyber violence and sexual violence, in addition, other findings show that perception and social pressure are possible triggers of intragender violence, Thanks to this, it is possible to identify the low representativeness in terms of the LGBTIQ+ community and age ranges, so it is proposed to expand the sample for future research, in addition to this, other topics such as the experiences of having a diagnosis of STD in an intragender relationship should be investigated.

Effects of mental health and substance use disorder symptoms on the association between STDs and sexual identity: evidence from the 2017–2019 National Survey on Drug Use and Health

BackgroundSexually transmitted disease (STD) cases are rising in the USA, especially among sexual and gender minorities, despite the availability of numerous STD prevention programs. We examined the differences in STD prevalence among sexual and gender minority subgroups with major depressive episode symptoms and substance use dependence.MethodsWe combined 2017, 2018, and 2019 National Survey on Drug Use and Health (NSDUH) public-use data on adults (N = 127,584) to conduct weighted multivariable logistic regression and margins analyses.ResultsApproximately 2.05% of the population reported having STDs. The population that had major depressive episode symptoms (AOR = 1.70, 95% CI = 1.46, 1.99), alcohol use dependence (AOR = 1.79, 95% CI = 1.49, 2.16), illicit drug use other than marijuana use dependence (AOR = 2.25, 95% CI = 1.73, 2.92), or marijuana use dependence (AOR = 1.90, 95% CI = 1.57, 2.31) had higher odds of contracting STDs compared to their counterparts. Lesbian/gay (AOR = 2.81, 95% CI = 2.24, 3.54) and bisexual (AOR = 1.95, 95% CI = 1.60, 2.37) individuals had higher odds of contracting STDs. Lesbians/gays with major depressive episode symptoms, alcohol use dependence, or illicit drug use other than marijuana use dependence had the highest probability of having STDs, compared to bisexuals and heterosexuals with major depressive episode symptoms, alcohol use, or illicit drug use other than marijuana use dependence. Bisexuals with marijuana use dependence had the highest probability of STD contraction compared to their lesbian/gay and heterosexual counterparts. Within each sexual identity subgroup, the probability of having STDs was higher for individuals with major depressive episode symptoms, or dependence on alcohol use, illicit drug use other than marijuana use, or marijuana use compared to their counterparts.ConclusionMajor depressive episode symptoms, substance use dependence, and sexual and gender minority status had higher risks for STD diagnosis, particularly for sexual and gender minorities with major depressive episode symptoms or substance use dependence. Tailored interventions based on major depressive episode symptoms and substance use dependence may reduce the prevalence of STD, especially among sexual and gender minorities.

Barriers and facilitators to HPV vaccine uptake among US rural populations: a scoping review.

Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings. A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases. A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign. Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and communityresearch, as well as interventions and policy efforts.

425. Longitudinal Trends in Risk Behaviors and Sexually Transmitted Diseases among Adolescents and Young Adults at a Sexually Transmitted Diseases Clinic, 2013–2017

BackgroundSexually transmitted disease (STD) rates continue to rise in the United States (US). Over half of all new STDs occur in adolescents and young adults (AYA). Few studies have evaluated how sexual behaviors such as number of partners or condom use may contribute to this increase. We aimed to determine the association of sexual behaviors and condom use with STD incidence over time among AYA.MethodsWe reviewed all AYA ages 13–26 years attending a public STD clinic in Rhode Island from 2013–2017. We reviewed demographic and behavioral data including age, gender identity, risk group, race, ethnicity, insurance status, sexual behaviors, substance use, self-reported STD/HIV diagnosis (lifetime, past year), condom use, and HIV/STD testing results. We report proportions in 2013 and 2017, and performed trend analyses (Cocharn-Armitage test for categorical variables and Kruskal–Wallis trend test for continuous variables) to determine trends over time.ResultsA total of 3,822 AYA visited the clinic during the study time period. An increasing trend was observed for: multiple (≥5) partners (29% of AYA in 2013 vs. 38% in 2017, P < 0.001), self-reported past year and lifetime STD diagnosis (12 vs. 21%, P < 0.001 and 19 vs. 33%, P < 0.001, respectively), and lab-documented diagnosis of any STD (15 vs. 25%, P < 0.001), syphilis (2 vs. 5%, P = 0.006), any chlamydia (11 vs. 20%, P = 0.001), and any gonorrhea (3 vs. 8%, P = 0.008). A decreasing trend was observed for: white race (66% in 2013 vs. 43% in 2017, P < 0.001), uninsured (73 vs. 53%, P < 0.001), condomless sex during oral as well as vaginal/anal sex (22 vs. 10%, P = 0.001 and 16 vs. 8%, P = 0.001, respectively), and self-reported HIV diagnosis (2.5% to 0.9%, P = 0.016).ConclusionAmong AYA, risk behaviors such as condomless sex and multiple partners increased significantly from 2013–2017, which may be contributing to an increase in STDs. Increased public health efforts are needed to promote education and other interventions to address behaviors associated with STD transmission.Disclosures All authors: No reported disclosures.

Zapobieganie chorobom przenoszonym drogą płciową – aspekty seksuologii i medycyny rodzinnej

Sexually transmitted diseases are an important problem in family medicine and sexology. Women who already have an infection (particularly one that causes genital lesions) are more likely to get or transmit another STI, including HIV. Some aspects of the prevention of sexually transmitted infections in the context of sex education and promotion of healthy behaviors were discussed. Promoting mechanical contraceptives, consulting with sexual health specialists, and providing professional healthcare are effective tools in combating sexually transmitted diseases. It is impossible to overestimate the role of family doctors or primary care physicians in providing reliable information on prevention, diagnosis and treatment of sexually transmitted diseases. Sexually transmitted diseases belong to infectious diseases for which the incidence rate has grown steadily in recent years. They are a significant problem not only for family medicine or sexology, but they are a global social problem. The role of family doctors, i.e. general practitioners, in providing reliable information on prevention, diagnosis and treatment of STD should not be overestimated.

Sexual risk behaviors and STDs among persons who inject drugs: A national study

Opioid use and the rising case reports of STDs represent co-occurring epidemics; research indicates that persons who inject drugs (PWID) may be at increased risk for acquiring STDs. We use the National Survey of Family Growth (NSFG, 2011–2015) to examine the prevalence of risky sexual behaviors and STD diagnoses among PWID. We describe demographic characteristics, sexual behaviors, and self-reported STD diagnoses of sexually active women and men, separately, by whether they had ever engaged in injection-related behaviors (age 15–44; N = 9006 women, N = 7210 men). Results indicate that in 2011–15, 1.4% of women and 2.6% of men reported ever engaging in injection-related behaviors. Examining the full logistic regression models indicate that for women, sex with a PWID in the past 12 months (AOR = 5.8, 95% CI: 2.9, 11.7), exchanging money/drugs for sex in the past 12 months (AOR = 3.6, 95% CI: 1.2, 10.9), chlamydia and/or gonorrhea diagnosis in the past 12 months (AOR = 2.6, 95% CI: 1.2, 5.3), ever having a syphilis diagnosis (AOR = 8.5, 95% CI: 3.1, 23.4), and ever having a herpes diagnosis (AOR = 3.3, 95% CI: 1.0, 10.3) were associated with increased odds of engaging in injection-related behaviors. For men, sex with a PWID in the past 12 months (AOR = 10.9, 95% CI: 4.3, 27.7), ever being diagnosed with syphilis (AOR = 5.8, 95% CI: 1.8, 18.0), and ever being diagnosed with herpes (AOR = 2.7, 95% CI: 1.0, 7.1) were significantly associated with increased odds of engaging in injection-related behaviors. Future research may examine critical intervention points, including co-occurring factors in both STD acquisition and injection drug use.

Equine Therapy (ET): Integrating medicine, surgery and psychiatry using a centuries old tool

With more than 374 million new cases of curable sexually transmitted infections (STI) globally each year, STI present a significant disease burden. This article examines the epidemiology of STI, a diverse category of pathogens that are primarily transmitted through sexual contact, and highlights key factors affecting public health and the global burden of STI. The article presents a broad overview of some of the most prevalent persistent viral infections and treatable bacterial infections, with a focus on: human immunodeficiency virus, herpes simplex virus, human papillomavirus, and hepatitis B virus, syphilis, gonorrhea, and chlamydia. The article also offers some general care and management strategies. The article concludes with a discussion about opportunities for sexual health gain and the control of STI and suggests that, ultimately, there remains a pressing need for greater investment in effective STD treatment, diagnosis, prevention, and surveillance.

The relationship of anxiety and depression symptoms with AIDS knowledge, cognition of risk and sex behavior in young men who have sex with men

Objective To understand the relationship of anxiety and depression with AIDS knowledge, cognition of risk and sex behavior among young men who have sex with men(YMSM). Methods The study was conducted by the snowballs sampling method for the recruitment and serological examination of YMSM aged 15-24 in Mianyang city, Sichuan province.The anxiety and depressive symptoms were assessed by the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS). Chi-square test was used to implement single-factor analysis and non-conditional logistic regression for multiple-factor analysis. Results Totally 356 cases completed the SAS and 355 cases completed the SDS.And the total scores of SAS and SDS were (42.96±10.81) and (45.63±12.40). The detection rates of anxiety and depressive symptoms were 23.60% and 33.24% respectively.There was no statistical difference in the incidence of HIV infection with or without anxiety and depression (χ2=2.235, 1.718, both P>0.05), and there was a statistical difference in the incidence of syphilis infection (χ2=6.840, P <0.05). Multi-factor analysis results showed that HIV infection risk awareness(β=1.101, P=0.015), number of anal sex in nearly 1 week(β=1.111, P=0.005), and the diagnosis of STD in nearly 1 year(β=1.996, P=0.010) were independent factors influencing anxiety symptoms, meanwhile occasional sex in nearly six months(β=0.692, P=0.037), and the number of anal sex in nearly one week(β=0.969, P=0.012) were independent factors in depressive symptoms (P <0.05). Conclusion The detection rate of anxiety and depressive symptoms among YMSM is high.Anxiety and depressive symptoms are related to AIDS related factors, which has certain characteristics to the YMSM sex behavior and is of great health risk.AIDS prevention should combine behavior with psychological intervention. Key words: Men who have sex with men; Anxiety; Depression; AIDS; Related factor

High Prevalence of Inconsistent Condom Use With Regular Female Sex Partners Among Heterosexual Male Sexually Transmitted Disease Patients in Southern China

This study was to investigate the prevalence of and factors associated with inconsistent condom use with regular female sex partners (RPs) among heterosexual male STD patients (MSTDPs) in China. We interviewed 413 MSTDPs who had had sex with at least one RP and had received a diagnosis within the past week to six months. The prevalence of inconsistent condom use with RPs was 42.9% since STD diagnosis. Associated factors included perceptions related to condom use, regret about the decision of having unprotected sex with RP, and perceived personal partners’ responsibility of using condoms.

Anticipated Notification of Sexual Partners following STD Diagnosis among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Mixed Methods Analysis.

BackgroundNew strategies to support partner notification (PN) are critical for STD control and require detailed understanding of how specific individual and partnership characteristics guide notification decisions.MethodsFrom 2011 to 2012, 397 MSM and TW recently diagnosed with HIV, syphilis, or another STD completed a survey on anticipated notification of recent sexual partners and associated factors. Qualitative interviews were conducted with a subset of participants to provide further depth to quantitative findings. Prevalence ratios and generalized estimating equation (GEE) models were used to analyze participant- and partner-level factors associated with anticipated PN.ResultsAmong all partners reported, 52.5% were described as “Very Likely” or “Somewhat Likely” to be notified. Anticipated notification was more likely for main partners than casual (adjusted Prevalence Ratio [aPR], 95% CI: 0.63, 0.54–0.75) or commercial (aPR, 95% CI: 0.44, 0.31–0.62) partners. Other factors associated with likely notification included perception of the partner as an STD source (aPR, 95% CI: 1.27, 1.10–1.48) and anticipated future sexual contact with the partner (aPR, 95% CI: 1.30, 1.11–1.52). An HIV diagnosis was associated with a lower likelihood of notification than non-HIV STDs (aPR: 0.68, 0.55–0.86). Qualitative discussion of the barriers and incentives to PN reflected a similar differentiation of anticipated notification according to partnership type and type of HIV/STD diagnosis.DiscussionDetailed attention to how partnership characteristics guide notification outcomes is essential to the development of new PN strategies. By accurately and thoroughly assessing the diversity of partnership interactions among individuals with HIV/STD, new notification techniques can be tailored to partner-specific circumstances.

Incidence and Predictors of HIV Infection Among Men Who Have Sex with Men Attending Public Sexually Transmitted Disease Clinics, New York City, 2007–2012

We examined five annual cohorts (2007-2011) of men who have sex with men (MSM) attending New York City STD clinics who had negative HIV-1 nucleic acid amplification tests (NAATs) on the day of clinic visit. Annual HIV incidence was calculated using HIV diagnoses within 1year of negative NAAT, determined by matching with the citywide HIV registry. Predictors (demographic; behavioral; bacterial STD from citywide STD registry match) of all new HIV diagnoses through 2012 were calculated from Cox proportional hazards models. Among 10,487 HIV NAAT-negative MSM, 371 had an HIV diagnosis within 1year. Annual incidence was 2.4/100 person-years, and highest among non-Hispanic black MSM (4.1/100 person-years) and MSM aged<20years (5.7/100 person-years). Characteristics associated with all 648 new HIV diagnoses included: black race (aHR 2.2; 95% CI 1.6-3.1), condomless receptive anal sex (aHR 2.1; 95% CI 1.5-2.8), condomless insertive anal sex (aHR 1.3; 95% CI 1.1-1.8), and incident STD diagnosis (aHR 1.6; 95% CI 1.3-1.9). MSM attending STD clinics have substantial HIV incidence and report risk behaviors that are highly associated with HIV acquisition. Increased uptake of effective interventions, e.g., pre- and post-exposure prophylaxis, is needed.

Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study

Syphilis is an infectious disease caused by the bacterium Treponema pallidum. Syphilis has three clinical stages and may present various oral manifestations, mainly at the secondary stage. The disease mimics other more common oral mucosa lesions, going undiagnosed and with no proper treatment. Despite the advancements in medicine toward prevention, diagnosis, and treatment syphilis remains a public health problem worldwide. In this sense, dental surgeons should be able to identify the most common manifestations of the disease in the oral cavity, pointing to the role of this professional in prevention and diagnosis. This study describes a case series of seven patients with secondary syphilis presenting different oral manifestations.

Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator?

Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations. A sample of 841 female adolescents (aged 16-19) and 1,387 young adult women (aged 20-24) recruited from 24 family planning clinics in western Pennsylvania in 2011-2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy. At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, -0.27 to -0.13) and increased odds of STD diagnosis (odds ratios, 1.03-1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect). Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.

Chlamydia trachomatis, Neisseria gonorrhoeae and syphilis among men who have sex with men in Brazil.

BackgroundSexually transmitted diseases (STD) are frequently asymptomatic and increase the likelihood of transmitting and acquiring HIV. In Brazil, the guidelines for STDs diagnosis and treatment are based on the syndromic approach. Nucleic acid amplification tests (NAAT) has been recommended as routine STDs screening in some countries, especially for men who have sex with men (MSM). Limited data are available about how to best define target groups for routine screening by NAATs within this population. We aimed to assess the prevalence of rectal and urethral Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections and syphilis, and the factors associated with having at least one STD among HIV-infected and uninfected MSM in Rio de Janeiro, Brazil.MethodsFrom August 2010 to June 2012, 391 MSM were enrolled into the Evandro Chagas National Institute of Infectious Diseases-INI-Fiocruz cohort, and 292 MSM (HIV-infected:211 and HIV-uninfected:81) were included in this study. NAATs were performed on the rectal swabs and urine for CT and NG. The rapid plasma reagin test and microhemagglutination assay for Treponema pallidum were performed for syphilis diagnosis.ResultsThe overall prevalence of STD was 20.0 % (95%CI:15.7-25.1): 10 % anorectal chlamydia; syphilis 9.9 %; anorectal gonorrheae 2.5 %; and urethral chlamydia 2.2 %; no case of urethral gonorrheae was detected. The proportion of HIV-positive MSM who had at least one STD was nearly two times that of HIV-negative MSM (22.6 % vs 13.2 %; P = 0.09). The frequency of each STD, except for anorectal NG (1.5 % vs.5.2 %), was higher among HIV-positive than HIV-negative individuals. Among the 211 asymptomatic participants, 17.5 % (n = 37) were identified as having at least one STD; 10.4 % (n = 22/211) tested positive for anorectal chlamydia. Sixty five percent of HIV-positive MSM were asymptomatic at the time of the STD diagnosis, while 100.0 % of the HIV-negative MSM. Age (APR = 0.78; 95%CI:0.60-1.00 for each additional ten years) and a positive-HIV serostatus (APR = 2.05; 95%CI:1.03-4.08) were significantly associated with STD diagnosis.ConclusionAn overall high STD-prevalence rate was observed, especially among HIV-infected and in younger individuals, and the majority of STDs were asymptomatic. STD screening using NAATs among asymptomatic MSM is a potentially cost-effective intervention for the prevention of HIV infection among MSM.

143. The State of Sexual Health Services at U.S. Colleges & Universities

143. The State of Sexual Health Services at U.S. Colleges & Universities

Evidence for risk reduction among amphetamine-injecting men who have sex with men; results from national HIV behavioral surveillance surveys in the Seattle area 2008-2012.

In the Seattle area men who have sex with men and also inject amphetamines (amphetamine-injecting MSM/IDU) are disproportionately likely to be infected with HIV. To characterize their distinctive characteristics, we combined data from two Seattle-area surveys of men who have sex with men (MSM) and two surveys of injection drug users (IDU). Amphetamine-injecting MSM/IDU were compared with: male IDU, MSM and other MSM/IDU. Amphetamine-injecting MSM/IDU were older than MSM but younger than IDU, more likely to be white than either group, and had an educational level higher than IDU but below MSM. They had the highest HIV prevalence (56 vs. 4-19 %). However, reported HIV cases among them fell from 92 in 1990 to 25 in 2012. They were most likely to report ten or more sex partners (49 vs. 4-26 %), an STD diagnosis (22 vs. 1-7 %) and be tested for HIV (odds ratio 1.00 vs. 0.34-0.52), and least likely to share needles (odds ratio 1.00 vs. 6.80-10.50). While sexual risk remains high, these data suggest measurable and effective risk reduction with respect to sharing injection equipment and HIV testing among Seattle-area amphetamine-injecting MSM/IDU.