STI Screening Research Articles

Health Care Provider Discussions Regarding HIV/Sexually Transmitted Infection Risk Factors and Associations with HIV/Sexually Transmitted Infection Screening Among Men.

Little is known regarding the specific discussions health care providers (HCP) have with their patients and how these discussions may increase rates of HIV/STI screening. The main objective of this study was to examine the content of HCP-patient discussions and associations with HIV/STI screening while adjusting for patient characteristics. Using the 2017-2019 National Survey of Family Growth data, seven survey-weighted multivariable multinomial/binary logistic regression models were analyzed in men ages 15-49years old (N = 4260). Patients had significantly higher odds of a lifetime HIV test when their HCP asked about number of sexual partners (adjusted odds ratio [aOR] = 2.325; 95% CI 1.379-3.919) and discussed HIV/AIDS (aOR = 4.149; 95% CI 2.877-5.983). Odds of a recent STI screening were higher among patients with HCP that asked about: sexual orientation (aOR = 1.534; 95% CI 1.027-2.291), number of sexual partners (aOR = 2.123; 95% CI 1.314-3.430), use of condoms (aOR = 2.295 95% CI 1.484-3.548), type of sexual intercourse (aOR = 1.900; 95% CI 1.234-2.925), and discussed HIV/AIDS (aOR = 1.549; 95% CI 1.167-2.056). Results may provide insight on how HCPs may potentially promote HIV/AIDS and STI screening among men and which patient groups are more likely to receive a discussion of risks factors from their HCPs.

Prevalence of Vulvo-Vaginitis and Risk Factors Among Women of Reproductive Age in Port Harcourt

Background: The yeast-like fungus Candida albicans, a common resident of the mouth, vagina, and intestinal tract, is the source of the infectious disease known as candidiasis. Aim: This research is aimed at determining the prevalence of vulvo-vaginitis and risk factors among women of reproductive age in Port Harcourt. Methodology: This research study was a cross-sectional study consisting 450 randomly selected women attending Rivers State University Teaching Hospital. The participants were categorized into four groups; Out Patients, Pregnant women, HIV positive women and Healthy volunteers. A total of 150 urine samples were collected from out patients, 100 urine samples were collected from pregnant women, 100 urine samples were collected from HIV positive women and 100 urine samples were collected from students (healthy volunteers). A total of 200 HVS samples were collected across all groups and 50 samples from each groups. Via a well-structured questionnaire, data regarding risk factors (awareness, personal hygiene and lifestyle) of candida infection were obtained. Urine samples were tested macroscopically, microscopically and by culturing. HVS samples were tested microscopically and culturing using germ tube test. Results: There was no association (p-value>0.05) between candidiasis and awareness parameters in urine and HVS. There is association (p-value<0.05) between candidiasis and washing, wash private parts, wash with, tight underwear in HVS. Under personal hygiene, there is association (p-value<0.05) between candidiasis and clean after urination in urine but there was no association (p-value>0.05) between candidiasis and repeat underwear. Under lifestyle, there is association (p-value<0.05) between candidiasis and unprotected sex and STI screening of partner in HVS. There was no association (p-value>0.05) between candidiasis and sexually active, protect with and STI screening self in both urine and HVS. Conclusion: This study personal hygiene practice and lifestyle are factors that affect the spread of candidiasis among women attending RSUTH.

Implementation of Sexual Health Curriculum Series: Educational Initiative to Increase STI Screening and Treatment in Dallas, Texas.

A new monthly virtual education curriculum on sexual healthcare was launched in 2021. This is an analysis of the pilot education series designed to increase primary care providers' knowledge of sexual health best practices including taking thorough sexual histories, STI screening and treatment, and PrEP prescribing. A Sexual Health Curriculum Series was developed as part of a quality improvement initiative at a large urban safety-net hospital in Dallas County, Texas. Didactic sessions were administered to primary care providers and staff via a virtual meeting platform once a month from May 2021 to April 2022. A total of 52 participants completed the pre-series survey, and 21 participants filled out the final post-series survey. 70% of respondents who completed the post-series survey reported that they learned new information that was incorporated into their practice. The average percentage correct on individual pre-session surveys was 60% compared to 63% on individual post-session surveys (p = 0.03). Sexual health education is an important tool to help primary care providers adhere to sexual health best practices. There is a need for ongoing implementation of innovative strategies to improve knowledge and adherence to sexual health best practices. A sexual health curriculum may be effective in helping primary providers recognize patients at increased risk and apply evidence-based guidelines to their practices.

Frontline STI Screening Starts with Primary Care.

In this supplement to Family Practice, Heather M. Territo, MD, and Gale R. Burstein, MD, MPH discuss how primary care physicians play an essential role in screening for STIs in young patients.

Characteristics associated with the adoption of consumer-based ­self-sampling methods for sexually transmitted infection screening

Objective: To identify theory-based innovation characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Participants: Guided by the Diffusion of Innovation, survey data from people assigned female at birth (AFAB) (n = 92) were analyzed. Methods: Forward regression models and a path analysis were used to predict adoption by characteristics, using maximum likelihood estimation. Measures included acceptability, comfort, addresses healthcare needs, willingness to adopt self-sampling methods, and innovation characteristics. Results: Predictors of willingness to adopt were no clinic visit (relative advantage), convenient pick-up (relative advantage), and low cost. Variables with direct effects on adoption included: addresses healthcare needs, comfort, acceptability, and no clinic visit. Conclusions: Relative advantage was a salient factor and prioritizing this construct in intervention development may facilitate adoption. Results can guide the development of an innovative, theory-based intervention that promotes adoption of self-sampling methods, ultimately improving STI screening rates.

2212. Improving Sexually Transmitted Infection Co-testing in a Large Urgent Care Network

Abstract Background Sexually transmitted infections (STIs) remain a serious public health concern. The state of Utah has the lowest percentage of adults 18-64 years-old ever tested for HIV (26.5%) and the lowest percentage tested for HIV in the previous 12 months (6.5%). Increasing HIV testing in Utah is of the utmost importance. Delayed diagnoses and missed testing opportunities for HIV and other STIs exist. Encounters for evaluation of possible gonorrhea (GC) or chlamydia (CT) infection is a critical opportunity to co-test for HIV and syphilis. With continued growth, urgent care (UC) sites are well-positioned to increase STI diagnosis and treatment. We aimed to develop a multi-faceted quality improvement (QI) bundle to increase STI testing in our UC centers. Methods Intermountain Healthcare (IH) is a vertically integrated healthcare network predominantly in Utah and operates a network of 35 UC clinics across the state. In 2020, qualitative interviews to evaluate barriers to STI testing were performed with UC clinicians. Based on these interviews a QI initiative was designed and implemented throughout 2021. The bundle included clinician education, electronic health record (EHR) improvements, and automatic referral for patients with a new diagnosis of HIV to an Infectious Diseases (ID) physician (Methods Image 1). We compared co-testing rates before (July 2018 – December 2020) and after the intervention began (March 2021 – April 2022). Methods Table 1 The quality improvement (QI) initiative began in 2021 and consisted of multiple components as detailed below. Results 13,715 and 5,628 UC encounters were associated with GC/CT testing during the pre-intervention and intervention periods, respectively. HIV co-testing was performed in 2,784 (20.3%) GC/CT testing encounters in the pre-intervention period and in 1,674 (29.7%) encounters during the intervention, a relative increase of 37.6%. HIV/syphilis co-testing was performed in 2,304 (16.8%) GC/CT testing encounters and 1,225 (21.8%) encounters during the pre-intervention and intervention phases, respectively. From January 1 2022 – April 1 2022 3 new outpatient HIV diagnoses were identified. The average time from diagnosis to contact with an ID provider was 30.0 hours. Results Image 1 Co-testing rates for GC/CT UC encounters are presented for HIV (blue), syphilis (green), and HIV/syphilis (orange). Testing reagent quality issues in early 2022 lead to an abrupt decline in syphilis co-testing and once these issues were resolved co-testing trends returned to similar rates prior to the reagent quality issue and testing limitation. Conclusion Multi-modal QI initiatives may increase STI testing rates within UC centers of integrated healthcare systems. Further study is needed to optimize STI screening, diagnosis, and care in UC centers. Disclosures Kimberly D. Brunisholz, PhD, MST, Johnson and Johnson: Advisor/Consultant.

Assessing the Effect of the COVID-19 Pandemic on the Rate and Management of Ectopic Pregnancy

<h3>Study Objective</h3> To evaluate the impact of the COVID-19 pandemic on the rate and management of ectopic pregnancies. With the decrease of in-person wellness visits, there is concern for decreased STI screening and treatment of asymptomatic infections that may contribute to ectopic pregnancy rate. In addition, patient delay in presentation to care leads to later diagnoses of ectopic pregnancy and increased need for utilization of surgical management. <h3>Design</h3> This is a retrospective cohort study. The pre-Covid-19 data were collected from March 2019 through February 2020 and compared to data from October 2020 through September 2021. Data compared included the number of ectopic pregnancies and management strategy. <h3>Setting</h3> Tertiary care, academic medical center. <h3>Patients or Participants</h3> 54 diagnosed ectopic pregnancies in the pre-pandemic phase and 66 diagnosed ectopic pregnancies in post-pandemic phase. <h3>Interventions</h3> Billing diagnosis codes and surgical cases were reviewed for the pre-COVID-19 period and from the post-COVID-19 period. Data for each ectopic subject included site of ectopic, laterality, quantitative HCG, ultrasound findings of free fluid and whether surgical or medical management was performed. <h3>Measurements and Main Results</h3> 54 ectopic pregnancies were diagnosed pre-COVID-19 and 66 were diagnosed post-COVID. The rate of surgical management in the post-COVID-19 group was 77.8% vs 61.1% in the pre-COVID-19 group (p < 0.05). Thus, ectopic pregnancies in post-pandemic period were more likely to require surgery. Further, the total rate of ectopic pregnancy is also rising to a statistically significant degree. <h3>Conclusion</h3> There is a statistically significant increase in rate of ectopic pregnancies requiring surgical management since the start of the COVID-19 pandemic. This is significant as early diagnosis and management of ectopic pregnancies can oftentimes prevent surgical management. Further study to be completed to evaluate the reasons for this during a time when resource management and allocation has been so tightly managed.

Provider uptake of extragenital screening for gonorrhea and chlamydia in a cohort of Air Force members with incident HIV diagnosis.

The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. Although national guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. All USAF members with incident HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016 to 2018 (n = 98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Patients were predominantly male (98%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis. A previous history of STIs was reported in 53 (54%) patients and the majority of males self-identified as MSM (66%) or bisexual (23%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62%) patients. EG-STI screening was conducted in 3 (3%) patients overall and in (3%) MSM/bisexuals. A total of 31 (32%) patients had missed STIs; the majority due to EG-STIs of the rectum (59%) and pharynx (19%). All EG-STIs would have been missed by urethral GC/CT screening alone. EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored.

Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States.

Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one’s HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM.

Prevalence of Human Immunodeficiency Virus Infection and Risky Sexual Behaviours among Clients Attending HIV Testing Service in Ogun State, Nigeria

Background: HIV testing services (HTS) are a component of HIV prevention and care programs in developed countries and have proven to be a cost-effective way of monitoring the disease, reducing risky behaviours and leading patients to other services. Objective: To determine the prevalence and risky behavioural factors associated with HIV among the attendees of HIV testing services in a part of Ogun state, Nigeria. Methods: This was a descriptive cross-sectional study of HTS clients in health facilities within Ogun State, Nigeria. A multi-stage sampling technique was used for data collection using a pretested, close-ended, interviewer-administered questionnaire. Results: A total of 800 respondents with a mean age of 32.57±10.39 years were surveyed. The prevalence of HIV was 1.6%. The majority (93.6%) of the respondents were sexually experienced. The percentage tested previously among study participants was 5.0%. This significantly comprised those below the age of 18 years (X2 = 22.01, p = 0.0001) and female respondents (Χ2 = 4.84, p = 0.028). Only 21 (2.6%) have had unprotected sex with a casual partner. Significantly more of the female respondent had been involved in this risky sexual behaviour (X2 = 4.52, p = 0.034). Only 7 (0.9%) had sex with multiple sexual partners in the last three months, and 17 (2.1%) were positive for symptomatic STI screening. Conclusion: The prevalence of HIV was low to be 1.6%, and the percentage tested previously was 5.0%. The practice of free HIV screening should be maintained to encourage more people to undergo the test.

Coinfections with multiple sexually transmitted pathogens in Republic of Korea, 2018-2020.

BackgroundSexually transmitted infections (STIs) can have serious consequences, and the global STI incidence remains high. However, there is little information on the frequency of STIs with multiple pathogens according to age. Accordingly, we conducted a study to determine the trends of coinfection with sexually transmitted pathogens according to age in the Republic of Korea from 2018 to 2020.MethodsFrom January 2018 to December 2020, 65,191 samples of swab, urine, and other types submitted for STI screening were obtained from U2Bio Co. Ltd. (Seoul, Republic of Korea). Multiplex polymerase chain reaction, a sensitive and rapid method for simultaneous detection of STIs caused by multiple different pathogens, was performed using an AccuPower STI4C‐Plex Real‐Time PCR kit, AccuPower STI8A‐Plex Real‐Time PCR kit, and AccuPower STI8B‐Plex Real‐Time PCR kit with an Exicycler 96 Real‐Time Quantitative Thermal Block.ResultsOf the 65,191 samples tested, 35,366 (54.3%) tested positive for one or more sexually transmitted pathogens. The prevalence of coinfections with two or more sexually transmitted pathogens was inversely proportional to age. Furthermore, the rates of coinfection with sexually transmitted pathogens and age distribution differed according to sex and the sexually transmitted pathogen type.ConclusionThis study confirmed that a significant proportion of patients with STIs are coinfected with multiple pathogens. Public health managers could use these results to recognize and prevent STIs according to age.

HIV testing in a high prevalence urban area in the US: Identifying missed opportunities two ways.

Routine opt-out HIV testing in healthcare settings is often not implemented to its fullest extent. We assessed factors contributing to missed HIV testing opportunities at an academic medical center in Chicago, Illinois, with a routine HIV screening program. Retrospective analysis of HIV testing in clinical encounters was performed using multivariate regession models. Missed opportunities were defined as 1) an encounter during which an HIV test was not conducted on a patient later diagnosed with HIV, or 2) an encounter in which a bacterial STI test was performed without HIV testing. Of 122 people newly diagnosed with HIV from 2011-2018, 98 patients had 1215 prior encounters, of which 82.8% were missed opportunities. Female gender, persons not known to be men who have sex with men, and encounter location other than inpatient had higher odds of a missed opportunity. Nearly half (48.4%) of 104,678 bacterial STI testing encounters were missed opportunities. Female gender, older age, lack of syphilis testing, and location outside the emergency department had higher odds of a missed opportunity. We found a high number of missed HIV testing opportunities, which could be reduced by strengthening routine screening and increasing targeted testing concurrent with STI screening.

Post gender-based violence care, support services and health outcomes among victims of gender-based violence in Akwa Ibom and Cross-River States Nigeria

Background: Gender-based violence has a negative impact on the physical and mental health of the victim, especially younger adults. Methodology: This cross-sectional descriptive study was carried out in Cross River and Akwa Ibom States of Nigeria using both qualitative and quantitative approaches. The study population comprised young adults aged 15-39 years in Cross River and Akwa Ibom States. The principal researcher and three field assistants administered 426 copies of the questionnaire to respondents. The data were analyzed using Statistical Packages for the Social Sciences software (SPSS) version 22. Thematic analysis was used for the qualitative data. Results: The majority of respondents 346(83.8%) knew that gender-based violence affects the health and wellbeing of victims; there were 267(64.6%) young adults who identified that gender-based violence poses both long-term and short-term effects on the health of the victims with 198(47.9%) who have suffered at least, one form of gender-based violence. Shame, (32.7%), anger, (27.8%), Bruises/injuries (25.2%) and low self-esteem (22.5) were the most frequently reported physical and emotional health effects of GBV. Many do not seek care due to shame. For those who sought care, counseling 97(49%), HIV/AIDS counselling and screening 66 (33.3%), STI screening 52(26.2%), and oral pills 24(12.2%) were some of the services accessed by victims. Discussion: This finding is consistent with reports from other GBV studies whose respondents suffered depression (48.8%), fear and anxiety (31.0%), which they argued were more serious conditions than the physical health impact of gender-based violence. Mental and emotional health outcomes of GBV are mostly invisible to others, making it harder for victims to seek help. Conclusion: Gender-based violence has negative impact on the physical and mental health of the victim, especially younger adults.

Access to Healthcare and the Utilization of Sexually Transmitted Infections Among Homeless Medicaid Patients 15 to 44 Years of Age.

Homelessness poses a direct threat to public health in the US as many individuals face debilitating health outcomes and barriers to adequate health care. Access to STI care for the homeless Medicaid populationof USA has not been well-studied using administrative claims data. Our study aims to compare health services utilization, STI screening and diagnoses among people experiencing homelessness (PEH) vs. those who are non-PEH using ICD10 codes. We used 2019 MarketScan Medicaid claims data to analyze men and women aged 15-44years with a diagnosis code for PEH (Z59.0), non-PEH (without Z59.0) and assessed their emergency department and outpatient visits and STI/HIV diagnoses and screening rates. We identified 5135 PEH men and 3571 PEH women among 1.3 million men and 2.1 million women in the 2019 USMedicaid database. PEH patients were more likely to have ED visits (94.80% vs 33.04%) and ≥ 20 outpatient clinic visits (60.29% vs 16.16%) than non-PEH patients in 2019. Higher diagnoses were observed for syphilis 1.57% (CI 1.32-1.86) vs 0.11% (CI 0.11-0.11), HIV 3.93% (CI 3.53-4.36) vs 0.41% (CI 0.41-0.42), chlamydia 1.94% (CI 1.66-2.25) vs 0.85% (CI 0.84-0.86) and gonorrhea 1.26% (CI 1.04-1.52) vs. 0.33% (CI 0.33-0.34) (p < 0.0001) among PEH compared to non-PEH. Among PEH, higher STI/HIV diagnoses rates indicate an increase in STI burden and suboptimal STI testing indicates an underutilization of STI services despite having a higher percentage of health care visits compared to non-PEH patients. Focused STI/HIV interventions are needed to address health care needs of PEH patients.

Can we screen less frequently for STI among PrEP users? Assessing the effect of biannual STI screening on timing of diagnosis and transmission risk in the AMPrEP Study

BackgroundIn many countries, HIV pre-exposure prophylaxis (PrEP) users are screened quarterly for STIs. We assessed the consequences of less frequent STI testing. We also assessed determinants of asymptomatic STI and...

Dysmenorrhea in adolescents

Studies show that between 41% and 91.5% of young women, school-aged and university-aged, are affected by dysmenorrhea. Primary dysmenorrhea, which is caused by the production of prostaglandins, is defined as cramping pain in the lower abdomen and/or pelvis occurring just before or during menstruation, in the absence of other diseases such as endometriosis, and typically lasting 1-3 days and with a negative physical examination. Secondary dysmenorrhea presents with similar signs and symptoms but is a result of underlying pelvic pathology, for example endometriosis or uterine fibroids. Dysmenorrhea most typically presents as abdominal cramping; however, it can also present with headaches, nausea, vomiting or other generalized symptoms. The diagnosis is mainly clinical, but other tests such as a pelvic examination, a pregnancy test and STI screening may be helpful in ruling out other sources of pain. Although the mainstay of treatment for dysmenorrhea is NSAIDs and hormonal therapy, lifestyle changes and complementary/alternative medicine can also be helpful approaches. Lifestyle changes include aerobic exercise and stretching, while complementary alternative medicine include peppermint, cinnamon, ginger and other herbs and supplements. Finally, endometriosis must be considered as a potential cause for secondary dysmenorrhea and would warrant a prompt referral to gynecology.

Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification

BackgroundSTIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in...

152. Factors Impacting HPV Vaccination Rates Among Minority Adolescents and Young Adults (AYA)

In 2018, there were 43 million Human papillomavirus (HPV) infections, majority were among adolescent and young adults (AYA). To decrease risk of HPV, individuals aged 9-26 years old should get vaccinated. However, vaccination rates have remained stagnant in the last several years. There are racial/ethnic and gender disparities in knowledge, awareness, and overall vaccine uptake. Cost of the vaccine is a barrier to vaccine uptake among uninsured AYA. The purpose of this is to examine factors impacting HPV vaccination uptake and completion rates among AYA utilizing a clinic-system located in Southeast Texas. The setting was a nine-clinic system that, through state funds, provides free preventive primary and reproductive health services to >10,000 Medicaid, low-income, and uninsured AYA ages 13 – 24 years old annually. Services include free immunizations including the HPV vaccine. Majority (97.9%) of patients fall below the 250% Federal Poverty Level threshold and 96% belong to racial/ethnic minority groups. We retrospectively collected demographic information, immunization status, and billed services data among clinic AYAs from March 2018 to December 2020. We set statistical significance at p < 0.05. A total of 19,045 AYAs were seen between March 2018 and December 2020 with 2,258 HPV vaccines administered and 3,119 having completed their HPV vaccination series. There were statistically significant differences in HPV vaccine uptake between females and males (6.7% vs. 3.2%, respectively), minors and adults (6.9% vs. 3.1%, respectively), and between school-based and community-based clinic locations (7.8% vs. 2.1%, respectively). Around 49% of AYAs who received an HPV vaccine also received additional vaccines during their visit versus 51% who only got the HPV vaccine. Additionally, those who had any sexually transmitted infection screening during the visit had a lower HPV administration rate than those who did not have an STI screening (2.3% vs. 5.6%, respectively). A logistical regression model found age, income, sex, clinic location type and having additional vaccines given during the visit were significantly correlated with receiving an HPV vaccine (R2=0.28). There were statistically significant differences in series completion between females and males (17.7% vs. 12.7%, respectively), minors and adults (19.3% vs. 15.3%), and clinic location type (27.0% vs. 10.9%). A logistical regression model found age, income, sex, and clinic location type were significantly correlated with series completion (R2=0.06). However, both logistical regression models had negligible to weak correlation meaning there are additional factors impacting HPV vaccination uptake and series completion. Clinic HPV completion rates were lower than state and national averages. Some barriers may be the lack of vaccine records for AYAs that access primary care elsewhere, and health seeking behavior specifically for sexual health. The findings support policies such as removing cost barriers, and creative strategies including gender-neutral and school-based sexual health messaging that includes HPV vaccine promotion as it may provide a critical time window for AYA to get vaccinated earlier. Targeting AYA who only utilize reproductive health care may be another tactic to reach unvaccinated AYA. Future studies should explore other factors such as systems-related factors impacting HPV vaccination uptake and series completion.

Is there an association between previous infection with Neisseria gonorrhoeae and gonococcal AMR? A cross-sectional analysis of national and sentinel surveillance data in England, 2015–2019

ObjectivesQuarterly STI screening is recommended for high-risk gay, bisexual and other men who have sex with men (MSM) in the UK, but frequent antibiotic exposure could potentially increase the risk...

Recent insights suggest the need for the STI field to embrace a more eco-social conceptual framework: A viewpoint.

A large number of countries are being confronted with twin epidemics of increasing STI incidence and antimicrobial resistance (AMR). This has led to calls to intensify STI screening of high STI prevalence populations. The available evidence suggests that this will have little impact on STI prevalence but a significant deleterious effect on AMR. We suggest that this call to intensify STI screening is one of the several errors that stem from the way that the STI-field has been dominated by a biomedical individualistic conceptual framework. This framework views STIs as obligate pathogens that can and should be eradicated by intensive seek-and-destroy activities. We evaluate five types of evidence that suggest that a multi-level, socio-ecological framework would provide a more accurate portrayal of the important determinants of STI prevalence and AMR spread. By incorporating concepts such as limiting STI screening to scenarios with clear evidence of net-benefit and considering 'antimicrobial footprint' thresholds, this framework would be more likely to result in a better balance between targeting STI prevalence whilst minimizing the risk of AMR emerging.