STI Screening Research Articles

Increasing Screening for Sexually Transmitted Infections Among Adolescents and Young Adults Diagnosed With Sickle Cell Disease: A Quality Improvement Project

BackgroundSexually transmitted infections affect 20 million adolescents and young adults in the United States annually. Local ProblemIn a pediatric outpatient sickle cell disease clinic, in southeastern, US, 16% (43/272) of patients aged 16-24 had a documented sexual health history and 12% (4/77) completed STI screenings. The clinic's aim was to increase sexual health assessment, STI screenings, diagnosis, and treatment. Methods/InterventionUsing process redesign, a standardized sexual health and STI screening process at routine visits was implemented to increase completion of sexual health histories and STI screening. ResultsSexual health history collection rates increased from 16% (43/272) pre- to 92% (107/116) post-intervention. The rate of STI testing offered increased from 12% (5/43) pre- to 100% (116/116) post-intervention. The STI testing rates increased 22.5 % from 40% (2/5) pre- to 49% (20/41) post-intervention. ConclusionsEvidence-based standardized interventions can successfully be used to assist in sexual health documentation and STI screening.

Оценка эффективности и безопасности применения медицинского изделия «МАВИТ» у пациентов с хроническим простатитом и синдромом хронической тазовой боли

Abstract. Recent studies have shown that chronic prostatitis is one of the most common clinically and socially significant diseases. With chronic prostatitis, mental health suffers no less than with other severe somatic diseases, which sharply reduces the quality of life of men. This was a serious incentive for this study. In outpatient conditions, 50 patients with a confirmed diagnosis of N41 were examined. 1 Chronic prostatitis; R10.2 Pelvic and perineal pain. At the stage of inclusion in the study and treatment, the patient is examined: 1) Study of anamnesis. (NIH-CPS; IPSS; IIEF-5; PHQ-9; GAD-7; EQ–5D–3L) 2) Physical examination (determination of the somatic status of the study subjects) 3) Laboratory examinations were carried out in the laboratories of the clinical bases of the Consultative and Diagnostic Center No2 of the Moscow Health Department, Moscow, 8 Igralnaya Street; Clinical base Central Medical Clinic CMD, Moscow, Perovo metro station, Novogireevskaya st., 3A; Clinical base Clinic «New Medicine», Moscow region, Orekhovo-Zuevo, Lenin st., 44. (urine culture for microflora or urine assessment with a test strip once - before the start of therapy, four-cup test, PSA, CRP, STI screening) 4). Specialized diagnostic tests (ultrasound of the bladder with determination of the volume of residual urine, uroflowmetry, TRUS of the prostate with Doppler mapping). GE LOGIQ V2 ultrasound machine with convex and rectal probe. The obtained research data and interpretation of statistical data allow us to conclude that it is possible to use the MAVIT device according to GIKS.941549.102 TU, manufactured by Yelatma Instrument Plant JSC, according to the selected methods, 7 procedures every 2 months in urological patients with chronic prostatitis and the presence of chronic pelvic pain syndrome in order to relieve pain symptoms, lower urinary tract symptoms. The study also found positive effects on men’s sexual function and a reduction in anxiety disorders. All these positive outcomes in relation to the treatment of the main group of patients allow us to conclude that the MAVIT device may be widely used in the work of a practitioner both on an outpatient basis and in a day hospital.

Impact of STIs on cervical cancer screening: Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in visual inspection with acetic acid (VIA) positive women in Mozambique.

Cervical cancer, primarily from HPV, is prevalent in countries like Mozambique, with HIV individuals at higher risk. The Visual Inspection with Acetic Acid (VIA) screening method can be influenced by STIs like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). This study examines CT and NG prevalence in HIV-positive and negative women using VIA in Mozambique's DREAM program. In this cross-sectional research conducted at a DREAM program facility in Maputo from 01/07/2021 to 31/05/2022, cervical specimens were taken from VIA-positive patients. CT/NG testing was performed using the Cobas® 4800 DNA CT/NG test. Statistical analyses focused on associations and prevalence rates, considering demographic, clinical, and exposure data. Among 117 women, we observed a CT prevalence of 6.8% (8/117) and an NG prevalence of 2.6%(3/117). No significant associations between CT/NG infection rates and factors such as age, HIV status, VIA results, or high-risk HPV (hrHPV) was observed. We found a 47% prevalence of hrHPV infections among participants with cervical lesions; no significant association between hrHPV and CT/NG infections was observed. This study highlights the prevalence of CT and NG in VIA-positive women in Mozambique, emphasizing the STI burden and suggesting integration of STI screening in cervical cancer prevention strategies.

Asymptomatic Rectal Bacterial Pathogens Show Large Prospective Relationships With HIV Incidence in a Cohort of Young Sexual and Gender Minorities: Implications for STI Screening and HIV Prevention.

We estimated the predictive value of rectal (bacterial sexually transmitted infection [bSTI]) pathogen detection for future HIV seroconversion among young adult sexual and gender minorities (YSGMs) assigned male at birth (AMAB). Data were collected between March 2018 and August 2022 from RADAR, a longitudinal cohort study of YSGMs AMAB living in the Chicago metropolitan area (n = 1022). Rates of rectal bSTIs and the proportion of self-reported rectal bSTI symptoms are reported. We examined whether the presence of rectal bSTIs predicted HIV seroconversion using generalized estimating equations (GEEs). Participants tested reactive for rectal Mycoplasma genitalium (MGen), Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) at a rate of 20.8 (95% CI, 18.4-23.5), 6.5 (95% CI, 5.0-8.2), and 8.4 (95% CI, 6.8-10.3) cases per 100 persons, respectively. There were no statistically significant pairwise differences in self-reported rectal bSTI symptoms between participants with self-collected swabs testing nonreactive vs reactive for rectal MGen (χ2 = 0.04; P = .84), NG (χ2 = 0.45; P = .37), or CT (χ2 = 0.39; P = .46). In multivariate GEE analysis, rectal NG (adjusted odds ratio, 5.11; 95% CI, 1.20-21.77) was a statistically significant predictor of HIV seroconversion after controlling for other bSTIs, demographics, and sexual risk behavior. Our findings provide a robust longitudinal estimation of the relationship between primarily asymptomatic rectal NG nucleic acid detection and HIV infection. These findings highlight the importance of asymptomatic screening for bSTIs and targeting biobehavioral intervention to prevent HIV infection among YSGMs with rectal bSTI agents detected.

Characterising HIV acquisition risk, treatment gaps and populations reached through venue-based outreach and clinical services in Blantyre, Malawi: findings from a district-wide CLOVE Study.

In 2017, Blantyre district had the highest adult HIV prevalence in Malawi (17.7%) and lowest viral suppression (60%). In response, the Ministry of Health expanded prevention and treatment services. We assessed whether outreach to social venues could identify individuals with increased HIV acquisition risk or with unsuppressed HIV not currently reached by clinic-based services. We conducted a cross-sectional bio-behavioral survey in Blantyre, Malawi, from January to March 2022. We visited social venues where people meet new sexual partners and government clinics providing HIV testing or STI screening. Participants aged > 15 years were interviewed, and tested for HIV infection if not on ART. HIV recency tests were performed on those testing positive, and dried blood spots (DBS) was collected to quantify viral load and also to identify acute infection in those with HIV- results. HIV prevalence (18.5% vs 8.3%) and unsuppressed HIV infection (3.9% vs 1.7%) were higher among venue-recruited (n=1802) compared with clinic-recruited participants(n=2313). Among PLHIV at both clinics (n=199) and venues (n=289), 79% were virally suppressed. Few had acute(n=1) or recent infection(n=8). Among women, HIV prevalence was four times higher (38.9% venue vs 8.9% clinic). At clinics, PLHIV reporting visiting venues were less likely to be suppressed (54.6 vs 82.6%). More men at venues than at clinics reported paying for sex (49% vs 30%) or having multiple sex partners in the past 4 weeks (32% vs 16%). Enhanced venue-based prevention and testing for men and women could reduce treatment lapses, HIV treatment outcomes and reduce onward transmission.

Accessibility and Utilization of Sexual and Reproductive Health Services among People with Disabilities in Nepal

The study aims to assess the factors determining the access and utilization of sexual and reproductive health (SRH) services among people with disabilities residing in the Kathmandu Valley of Nepal. A cross-sectional study was conducted among randomly selected 422 people with disabilities in Kathmandu Valley. Data were collected through face-to-face interviews using structured questionnaires. Bivariate and multivariate logistic regression analyses were conducted. Among a total of 422 participants, 32.7% had utilized SRH-related education, information, and counselling services. Contraceptive-related services were utilized by 47.6% of participants, pregnancy-related services by 27.7%, safe abortion-related services by 13.0%, and HIV testing and treatment services by 3.6%. Likewise, 16.8% of participants utilized STI screening, diagnosis, and management services. Males were 2.5 times more likely to utilize SRH services compared to females (AOR = 2.5, 95% CI = 1.4-4.2), whereas unmarried participants were less likely to utilize SRH services as compared to single/separated/divorced (AOR = 0.2, 95% CI = 0.0-0.5). Similarly, participants who were living with their families compared to those living alone (AOR = 3.4, 95% CI = 1.4-7.7), and participants who were unemployed compared to employed (AOR = 1.8, 95% CI = 1.0-3.5) had higher odds for utilization of SRH services. There are significant variations depending on the intersections of various characteristics affecting the utilization rate across different SRH services among people with disabilities. Contraceptive-related services were the most utilized service, whereas safe abortion, pregnancy related services, STI screening and management services and HIV testing and treatment services were less utilized services.

Trends in HIV testing and HIV stage at diagnosis among people newly diagnosed with HIV.

To identify groups more likely to be referred for HIV testing because of symptomatic presentation rather than as part of asymptomatic screening. A retrospective analysis of Australian National HIV Registry (NHR) surveillance data including sociodemographic and clinical data, as well as reasons for HIV test. Using notification records from 2017 to 2022, we summarised reasons for testing leading to an HIV diagnosis. Reasons for testing were combined with clinical status at diagnosis to derive HIV testing categories: testing while symptomatic; asymptomatic HIV screening; seroconversion; and other test reason. We stratified these categories by stage of HIV at diagnosis with late-stage HIV defined as a CD4 count <350 cells/μL at time of diagnosis. Among 4,134 HIV notifications with at least one reason for testing recorded, STI screening was the predominant reason for test referral (38%), followed by HIV indicative symptoms (31%), and risk behaviour (13%). By testing category, people aged 50 years or older (24%), people with HIV attributed to heterosexual sex (21%), people born in Sub-Saharan Africa (19%), and women (17%) had lower levels of asymptomatic screening. More late-stage HIV diagnoses resulted from testing while symptomatic (58%) compared with asymptomatic screening (25%). Older people and heterosexuals may not access HIV focused healthcare where HIV screening is routinely offered. Instead, HIV testing opportunities may arise in other settings. By normalising HIV testing and offering low-cost HIV screening in a range of settings, it may be possible to facilitate earlier HIV diagnoses, better health outcomes, and reduced onward transmission.

HIV seroconversion among female sex workers: retrospective cohort study from a large-scale HIV prevention and sexual and reproductive health program in Tanzania.

In 2016, UNAIDS set ambitious targets to reduce global HIV infections by 75% by 2020 and 90% by 2030, based on the 2.1 million new infections reported in 2010. However, by 2022, new HIV infections had only decreased by 38%, from 2.1 million in 2010 to 1.3 million in 2022, raising concerns about reaching the 2030 goal. Female sex workers (FSWs) in sub-Saharan Africa face a disproportionately high risk of HIV acquisition, contributing 5%-20% of all new infections in several countries in the region. This analysis investigates HIV seroconversion and associated factors among FSWs, offering insights into critical interventions for preventing HIV transmission in this population and advancing the goal of ending the HIV pandemic by 2030. We conducted a retrospective cohort study involving 17,977 FSWs who initially tested HIV negative upon enrollment in the Sauti project between October 2016 and September 2018. HIV incidence rates were calculated by dividing the number of new HIV cases by observed person-time within the cohort. Cox regression analysis identified factors associated with seroconversion. The study revealed an HIV incidence rate of 8.6 per 100 person-years among FSWs [95% confidence interval (CI): 8.1-9.1]. Factors independently associated with HIV seroconversion included age 35 years or older [adjusted hazard ratio (aHR): 2.53; 95% CI: 2.03-3.14], unprotected sex (aHR: 1.27; 95% CI: 1.13-1.42), STI symptoms (aHR: 1.99; 95% CI: 1.67-2.38), and alcohol consumption before sex (aHR: 1.20; 95% CI: 1.07-1.34). Targeted interventions are vital in curbing HIV transmission among FSWs, with a focus on expanding access to primary HIV prevention services, particularly for older FSWs who face heightened risk. Tailored sexual health education programs are imperative to encourage consistent condom use and enable informed decision-making. Accessible and timely STI screening and treatment services are crucial to mitigate HIV transmission risk. Collaborative partnerships between healthcare providers, community organizations, and government agencies are essential in implementing these interventions among FSWs.

Antimicrobial resistance determinants in the oropharyngeal microbiome of 'men having sex with men' attending an sexually transmitted infection clinic.

'Men having sex with men' (MSM) represent a key population with a significant prevalence of pharyngeal Neisseria gonorrhoeae (NG) infections and a high rate of antimicrobial resistance genes in the pharyngeal microbiome. As NG can acquire antibiotic resistance genes from other commensal oropharyngeal bacteria, monitoring the prevalence of these resistance determinants is critical to curtail the spread of NG-resistant strains. Here, we assessed the distribution of five resistance genes (pen (A), mtr (R), gyr (A), par (C), msr (D)) in the oropharynx of 164 MSM, attending an Outpatient clinic for STI screening. The most frequently detected resistance gene was msr (D) (88.4%), followed by gyr (A) (67.1%). The distribution of resistance genes was not influenced by pharyngeal gonorrhea nor by the HIV status, whereas a younger age was associated with mtr (R) presence (p = .008). Subjects using mouthwash exhibited significantly lower levels of mtr (R) (p = .0005). Smoking habit was associated with a higher prevalence of par (C) (p = .02). A noteworthy association was observed between the presence of msr (D) gene and the use of antibiotics (p = .014). Our findings reveal an enrichment of antimicrobial resistance genes in the oropharynx of MSM. These insights could aid in the development of screening programs and antimicrobial stewardship initiatives targeting populations at heightened risk of pharyngeal gonorrhea.

39. Do adolescents with disabilities have lower rates of STI screening than non-disabled peers?

39. Do adolescents with disabilities have lower rates of STI screening than non-disabled peers?

Barriers to Early Treatment Seeking among Patients with Sexually Transmitted Infections in a Rural Community Setting at Kaproron Health Centre IV

Our study aimed to establish barriers to early treatment seeking among patients with sexually transmitted infections at Kaproron Health Centre IV. This was a facility-based cross-sectional survey employing quantitative methods. The study enrolled a total of 122 randomly selected participants who had consented to participate in the study. Data was collected using a pretested interviewer-administered questionnaire and analysed using STATA software version 14. Descriptive statistics were used to present data as graphs and tables of frequencies while for inferential statistics odds ratios and P-value set at 0.05 corresponding to a 95% confidence interval were used. The study revealed that 56.86% of the participants sought their STI treatment late. Participants’ age, sex, symptom severity and cost of services at Kaproron Health Centre IV presented as significant barriers to early STI treatment seeking. Participants aged 36-45 (AOR-0.16, p-0.04, CI-0.03-0.88) and ≥46 years (AOR-0.17, p-0.05, CI-0.03-0.98) had lower odds of seeking treatment early which was similar for female participants (COR-0.38, p-0.02, CI-0.17— 0.86). Conversely, participants with severe STI symptoms (COR-2.8, p-0.02, CI-1.19-6.58) and those who reported STI services at Kaproron Health Centre IV as affordable (AOR-3.73, p-0.011, CI-1.35-10.25) were 3.73 times more likely to seek early treatment. A higher proportion sought STI treatment late. Age, gender, symptom severity and service costs presented significant barriers to seeking early treatment. Mass STI screening programs should target individuals aged 26 and above, females and impoverished communities. Keywords: STI treatment, Patients, Age, Gender, Symptom severity.

Incidence of sexually transmitted infections and screening models among pre-exposure prophylaxis users

IntroductionThere is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening models in order to optimise the follow-up. MethodologyA prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR). ResultsThe overall CI by quarterly screening was 8.3 (95% CI: 7.6–9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68–0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5–0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73–0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32–0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25–0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24–0.42). ConclusionsThe incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.

Who benefits from frequent asymptomatic STI screening?

Who benefits from frequent asymptomatic STI screening?

Slovenia's national HIV PrEP programme: Evaluation of real-world implementation.

The aim of our study was to evaluate real-world implementation of Slovenia's national HIV PrEP programme, which is fully covered by our national health insurance. In retrospective cohort study we analysed the data from all men who have sex with men (MSM) who were enrolled in PrEP programme of our clinic between 1 January 2022 and 31 December 2022. A total of 190 MSM with an average age of 36.7years were included in our analysis. 151 (79.5%) decided for event-driven PrEP and 39 (20.5%) opted for daily PrEP. Self-reported adherence was 95%. Among eligibility criteria, unprotected sex was the most common one, followed by one or more STIs in the past, use of chemsex and use of HIV post-exposure prophylaxis in the past. No new cases of HIV infection and no significant deterioration of kidney or liver function were observed during the follow-up. Sixty-seven episodes of STIs were diagnosed and treated. Gonorrhea (32), chlamydia (14), and Mpox (10) were the most common ones. PrEP was successfully implemented into everyday clinical practice, proving to be both safe and effective. High number of diagnosed STIs suggests that the PrEP programme, combined with STI screening and vaccination, provides a strong public health impact among MSM in Slovenia.

Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service.

The UK pledged commitment to the global strategy of zero new HIV infections and HIV-related deaths by 2030. PrEP was commissioned in England in 2020 and is fundamental to achieving these targets, yet awareness and uptake are suboptimal in certain populations. Sexual Health London (SHL) incorporated questions on its e-triage questionnaire estimating need for PrEP amongst online service users. Two types of signposting messaging were shown to users directing them to more detailed online content: PrEP-discussion (potential need) and PrEP-eligible (assumed need). The effectiveness of this signposting was evaluated by reviewing demographics and triage responses in returning users. 426,149 SHL users requested STI screening between 1.7.21-31.10.22. 16% (69,867/426,149) and 32.2% (137,489/426,149) of individuals received PrEP-eligible and PrEP-discussion signposting. The PrEP-eligible cohort were: 41.0% gay/bisexual or other men who have sex with men (GBMSM), 16.3% heterosexual males, 33.1% heterosexual females, and 60.6% were of white ethnicity. The PrEP-discussion cohort were: 9.3% GBMSM, 34.3%% heterosexual males, 45.5% heterosexual females and 63.7% of white ethnicity. 50.4% (35,190/69,867) and 41.3% (56,808/137,489) of the PrEP-eligible and PrEP discussion cohorts ordered a subsequent SHL STI testing kit, during which 10.0% (3510/35,190) and 5.9% (3364/56,808) reported taking PrEP. Of those who denied taking PrEP, 59% (18,702/31,680) and 61.0% (32,559/53,444) triggered PrEP signposting again. 95.4% of PrEP starters were GBMSM (6562/6874) and 1.4% (97/6874) heterosexual males/females. The e-service demonstrated feasibility in estimating PrEP need and signposting service users. Up to 16% of returning users subsequently commenced PrEP. This highlights significant missed opportunities for the remaining online users, who continue to report HIV acquisition risk(s). Further efforts regionally/nationally to optimise uptake of PrEP, particularly among under-represented groups are warranted.

Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia.

There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.

Cultural acceptability of STI screening guidelines and sexual positioning assessments among black sexual minority men.

To identify attitudes towards HIV/STI screening guidelines and explore the acceptability of assessing sexual positioning practices among Black sexual minority men (SMM). Risks for HIV/STIs vary by sexual positioning practices. However, clinicians and Black SMM do not always discuss sexuality with each other. Therefore, HIV/STI screening and testing remain suboptimal. Qualitative study using focus groups. Data were obtained from 12 focus groups and one in-depth interview conducted in Baltimore, MD among HIV-negative Black SMM between October 2019 and May 2020 (N = 39). Groups were stratified into three age categories: 18-24, 25-34 and 35+. Participants were given the "5 P's" from the CDC's 2015 Sexual History Screening Guidelines and asked to discuss attitudes towards existing questions regarding sexual positioning practices. Themes were identified using an electronic pile sorting approach. Most identified as homosexual/gay/same gender-loving (68%), were employed (69%) and single (66%). Additionally, 34% had ever been diagnosed with an STI, of whom 38% had a history of repeated STI acquisition in their lifetime. Participants across age groups said clinicians should use the words "top" and "bottom" to demonstrate cultural familiarity and build trust. Some said that screening for sexual positioning was unnecessary and intrusive; others said that questions should be justified. Younger men wanted clinicians to ask questions in ways that make them feel cared for. Guidelines should include language for clinicians to use culturally specific language and better ways to prepare Black SMM patients for screening. Some Black SMM will not discuss sexual positioning practices without clinicians' demonstration of cultural understanding and respect. Screening should incorporate culturally responsive language, justification and convey care. Consolidated criteria for reporting qualitative research (COREQ). There was no patient or public involvement in the design or drafting of this discursive paper.

1501. Characterizing Engagement in Care and STI Screenings among DC Cohort Participants with HIV and Mpox

Abstract Background A high proportion of people with HIV (PWH) in the 2022-2023 mpox outbreak (approx. 40% of US cases) has raised questions about the association between HIV and mpox. Increased encounters with the healthcare system may be contributing to this association. This study sought to elucidate whether detection bias drives the relationship between mpox and HIV by determining whether engagement in care and STI screening are associated with having an mpox diagnosis. Methods We conducted a 5:1 matched case-control study among DC Cohort participants, a longitudinal cohort of PWH receiving care in Washington, DC. Cases were matched on age (+/-5 years), gender, race/ethnicity, HIV transmission risk factor, time since HIV diagnosis (+/-5 years), years enrolled (+/-3 years), and HIV care site (community or hospital) with up to 5 controls. Engagement in care was defined as two or more CD4 or HIV RNA tests at least 90 days apart during the last year. STI screening was any test for gonorrhea, chlamydia, or syphilis in the past year. Cases were participants with an mpox diagnosis identified by providers or an ICD10 code in the EHR. We used unadjusted conditional logistic regression to assess the relationship between engagement in care, STI screening, and mpox diagnosis. Results We identified 68 cases of mpox in the DC Cohort and 65 could be matched to 300 controls (n = 365). Participants were majority male (98.9%), Black (70.7%), MSM (89.3%), and 51.5% of participants had an STI diagnosis since cohort enrollment. Cases were significantly more likely to be engaged in care (50.8% vs. 26.3%; OR: 3.24), receive an STI screening (69.2% vs. 41.3%; OR: 3.45), have a historical STI (72.3% vs. 47.0%; OR: 3.58), and have a CD4 count &amp;lt; 500 (40.4% vs. 21.9%; OR: 2.51). Conclusion Among a cohort of PWH, those with an mpox diagnosis were significantly more likely to be engaged in care and received an STI screening in the year prior, suggesting increased encounters for HIV care may account for a higher rate of PWH among mpox cases. The high proportion of CD4 &amp;lt; 500 among mpox cases suggests more clinically evident manifestations in this population. Future analyses should examine unmeasured behavioral factors to explain the association between mpox diagnosis, increased engagement in care and STI screening. Disclosures All Authors: No reported disclosures

Modeling the impact of changing sexual behaviors with opposite-sex partners and STI testing among women and men ages 15–44 on STI diagnosis rates in the United States 2012–2019

ObjectiveTo estimate the potential contributions of reported changes in frequency of penile-vaginal sex (PVS), condom use and STI screening to changes in gonorrhea and chlamydial diagnoses from 2012 to 2019. MethodsAn agent-based model of the heterosexual population in the U.S. simulated the STI epidemics. Baseline was calibrated to 2012 diagnosis rates, testing, condom use, and frequency of PVS. Counterfactuals used behaviors from the 2017-2019 NSFG, and we evaluated changes in diagnosis and incidence rates in 2019. ResultsHigher testing rates increased gonorrhea and chlamydia diagnosis by 14% and 13%, respectively, but did not reduce incidence. Declining frequency of PVS reduced the diagnosis rate for gonorrhea and chlamydia 6% and 3% respectively while reducing incidence by 10% and 9% respectively. Declining condom use had negligible impact on diagnosis and incidence. ConclusionUnderstanding how changing behavior drives STI incidence is essential to addressing the growing epidemics. Changes in testing and frequency of PVS likely contributed to some, but not all, of the changes in diagnoses. More research is needed to understand the context within which changing sexual behavior and testing are occurring.

Anorectalis régiót érintő STI fertőzések

The authors present the case of a 20-year-old male patient, who was refered to their department by his family doctor with suspected drug allergy. He had several proctological examinations in the last half year, because of a chronic intermittently bleeding anal fissure, which has been treated with analgesic rectal cream and wound healing gel. During physical examination multiple maculopapular rash all over the body, infiltrated brownish papules on the soles and purulent discharge on the pharyngeal wall were detected. Differential diagnosis included secondary syphilis, viral exanthema and drug eruption. The syphilis serological tests confirmed the diagnosis of secondary syphilis. The patient received benzathine-penicillin treatment. Due to the non-healing anal fissure pelvic MR was performed, which did not reveal definitive fistula. Further STI screening tests showed Neisseria gonorrhoeae infection of the anus and after ceftriaxon administration the patient’s anorectal symptoms healed. Our case emphasizes the importance of sexually transmitted co-infections.