Woode Owusu, Melvina; Estupiñán Fdez. de Mesa, Mar; Mohammed, Hamish; Gerressu, Makeda; Hughes, Gwenda; Mercer, Catherine H
doi: 10.1136/sextrans-2023-055798pmid: 37137709
Seidu, Abdul-Aziz; Aboagye, Richard Gyan; Okyere, Joshua; Adu, Collins; Aboagye-Mensah, Richard; Ahinkorah, Bright Opoku
doi: 10.1136/sextrans-2022-055424pmid: 36202610
ObjectiveSexually transmitted infections (STIs) constitute major public health problems because of their prevalence and contribution to mortality and morbidity worldwide. Healthcare seeking for STIs plays a significant role in the global prevention of STIs. We examined the prevalence and factors associated with healthcare seeking for STIs or STI symptoms among women in sub-Saharan Africa (SSA).MethodsData on 38 394 women of reproductive age from the most recent Demographic and Health Surveys of 28 countries in SSA were analysed. Percentages were used to summarise the prevalence of healthcare seeking for STIs or STIs symptoms. The factors associated with healthcare seeking for STIs or STI symptoms were examined using multilevel binary logistic regression analysis. We presented the results using adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsOverall, the proportion of women with STIs or STI symptoms who sought healthcare was 66.1%, with the highest and lowest proportion found in Liberia (85.6%) and Ethiopia (37.9%) respectively. The likelihood of seeking healthcare for STIs or STI symptoms increased with increasing wealth quintile and level of education. Working women, older women, cohabiting women, women with comprehensive HIV/AIDS knowledge, women exposed to mass media, those who had no barrier to healthcare access, and those covered by health insurance had greater odds of seeking treatment for STIs or STI symptoms. On the contrary, the odds of seeking treatment for STIs or STI symptoms was lower among married women and women who lived in rural areas.ConclusionThe findings of the study call for strengthening of policies, programmes, and interventions geared towards improving thehealthcare-seeking behaviour of women with STIs, taking into consideration the factors identified in this study.
van den Elshout, Mark AM; Hoornenborg, Elske; Coyer, Liza; Anderson, Peter L; Davidovich, Udi; de Vries, Henry JC; Prins, Maria; Schim van der Loeff, Maarten F
doi: 10.1136/sextrans-2022-055499pmid: 37258273
ObjectivesAdherence is key to the effectiveness of oral pre-exposure prophylaxis (PrEP) to prevent HIV. Therefore, we aimed to explore factors associated with adherence to daily PrEP (dPrEP).MethodsMen who have sex with men (MSM) using dPrEP (emtricitabine/tenofovir disoproxil) within the Amsterdam PrEP demonstration project at the Public Health Service of Amsterdam, provided dried blood spots (DBS) 12 and 24 months after PrEP initiation. From DBS, we determined intracellular tenofovir diphosphate (TFV-DP) concentrations to assess adherence; TFV-DP ≥700 fmol/punch was considered adequate. We assessed associations of sociodemographic, clinical and behavioural characteristics with TFV-DP concentrations using multivariable linear regression.ResultsOf 263 participants who attended 12-month or 24-month study visits while on dPrEP, 257 (97.7%) provided DBS at one or both visits (492 DBS in total). Median TFV-DP concentration was 1299 (IQR 1021–1627) fmol/punch (12 months: 1332 (1087–1687); 24 months: 1248 (929–1590]). Higher TFV-DP concentrations were associated with: older age (p=0.0008), condomless anal sex with a casual partner in 6 months preceding PrEP initiation (+166 fmol/punch; 95% CI 36.5 to 296) and using a mobile application providing visualised feedback on PrEP use and sexual behaviour (+146 fmol/punch; 95% CI 28.1 to 263). Lower TFV-DP concentrations were associated with longer duration of PrEP use (24 vs 12 months; −91.5 fmol/punch; 95% CI −155 to −28.1). Time-updated number of sex partners, diagnosed STIs and chemsex were not associated with TFV-DP concentrations.ConclusionsOverall, TFV-DP concentrations were high among MSM using dPrEP, indicating excellent adherence. Especially older participants, those who reported condomless anal sex with a casual partner prior to PrEP initiation and those who used an app with visualised feedback showed higher levels of adherence. As TFV-DP concentrations had decreased slightly at 2 years of PrEP use when compared with 1 year, we emphasise the importance of adherence counselling to those who continue using PrEP.Trial registration numberNL5413.
Govender, Yashini; Morrison, Charles S; Chen, Pai-Lien; Gao, Xiaoming; Yamamoto, Hidemi; Chipato, Tsungai; Anderson, Sharon; Barbieri, Robert; Salata, Robert; Doncel, Gustavo F; Fichorova, Raina Nakova
doi: 10.1136/sextrans-2022-055458pmid: 36104248
ObjectivesTo examine innate immunity predictors of HIV-1 acquisition as biomarkers of HSV-2 risk and biological basis for epidemiologically established HIV-1 predisposition in HSV-2 infected women.MethodsWe analysed longitudinal samples from HIV-1 negative visits of 1019 women before and after HSV-2 acquisition. We measured cervical and serum biomarkers of inflammation and immune activation previously linked to HIV-1 risk. Protein levels were Box-Cox transformed and ORs for HSV-2 acquisition were calculated based on top quartile or below/above median levels for all HSV-2 negative visits. Bivariate analysis determined the likelihood of HSV-2 acquisition by biomarker levels preceding infection. Linear mixed-effects models evaluated if biomarkers differed by HSV-2 status defined as negative, incident or established infections with an established infection cut-off starting at 6 months.ResultsIn the cervical compartment, two biomarkers of HIV-1 risk (low SLPI and high BD-2) also predicted HSV-2 acquisition. In addition, HSV-2 acquisition was associated with IL-1β, IL-6, IL-8, MIP-3α, ICAM-1 and VEGF when below median levels. Systemic immunity predictors of HSV-2 acquisition were high sCD14 and IL-6, with highest odds when concomitantly increased (OR=2.23, 1.49–3.35). Concomitant systemic and mucosal predictors of HSV-2 acquisition risk included (1) serum top quartile sCD14 with cervical low SLPI, VEGF and ICAM-1, or high BD-2; (2) serum high IL-6 with cervical low VEGF and ICAM-1, SLPI, IL-1β and IL-6; and (3) serum low C reactive protein with cervical high BD-2 (the only combination also predictive of HIV-1 acquisition). Most cervical biomarkers were decreased after HSV-2 acquisition compared with the HSV-2 negative visits, with incident infections associated with a larger number of suppressed cervical biomarkers and lower serum IL-6 levels compared with established infections.ConclusionsA combination of systemic immunoinflammatory and cervical immunosuppressed states predicts HSV-2 acquisition. A persistently suppressed innate immunity during incident HSV-2 infection may add to the increased HIV-1 susceptibility.
Zinsli, Kaitlin A; Srinivasan, Sujatha; Balkus, Jennifer E; Chambers, Laura C; Lowens, M Sylvan; Morgan, Jennifer; Rowlinson, Emily; Robinson, Tashina S; Romano, Sarah S; Munch, Matthew M; Manhart, Lisa E; Fredricks, David N
Nieuwenburg, Silvia Achia; Hoornenborg, Elske; Davidovich, Udi; de Vries, Henry John Christiaan; Schim van der Loeff, Maarten
doi: 10.1136/sextrans-2022-055550pmid: 36400527
BackgroundSyphilis incidence is rising among men who have sex with men (MSM). An online tool based on a risk score identifying men with higher risk of infectious syphilis could motivate MSM to seek care. We aimed therefore to develop a symptoms-based risk score for infectious syphilis.MethodsWe included data from all consultations by MSM attending the Amsterdam Centre for Sexual Health in 2018–2019. Infectious syphilis (ie, primary, secondary or early latent syphilis) was diagnosed according to the centre’s routine protocol. Associations between symptoms and infectious syphilis were expressed as odds ratios (OR), with 95% confidence intervals (CI). Based on multivariable logistic regression models, we created risk scores, combining various symptoms. We assessed the area under the curve (AUC) and cut-off based on the Youden Index. We estimated which percentage of MSM should be tested based on a positive risk score and which percentage of infectious syphilis cases would then be missed.ResultsWe included 21,646 consultations with 11,594 unique persons. The median age was 34 years (IQR 27–45), and 14% were HIV positive (93% on antiretroviral treatment). We diagnosed 538 cases of infectious syphilis. Associations with syphilis symptoms/signs were strong and highly significant, for example, OR for a painless penile ulcer was 35.0 (CI 24.9 to 49.2) and OR for non-itching rash 57.8 (CI 36.8 to 90.9). Yet, none of the individual symptoms or signs had an AUC >0.55. The AUC of risk scores combining various symptoms varied from 0.68 to 0.69. For all risk scores using cut-offs based on Youden Index, syphilis screening would be recommended in 6% of MSM, and 59% of infectious syphilis cases would be missed.ConclusionSymptoms-based risk scores for infectious syphilis perform poorly and cannot be recommended to select MSM for syphilis screening. All MSM with relevant sexual exposure should be regularly tested for syphilis.
Desmoulin, Anissa; Joly, Elisa; Tran, Phuong; Derancourt, Christian; Bertolotti, Antoine
doi: 10.1136/sextrans-2023-055796pmid: 36948589
IntroductionAnogenital warts (AGWs) are among the most common STDs. Many therapy options are available but are not codified. Systematic reviews (SRs) and meta-analyses (MAs) are helpful to elaborate recommendations on the management of AGWs. The objective of our study was to assess the quality and consistency of SRs for the local management of AGWs using three international tools.MethodsSeven electronic databases were searched from inception to 10 January 2022 for this SR. The intervention of interest was any local treatment of AGWs. There was no restriction on language and population. The methodological quality, reporting quality and risk of bias (ROB) of the included SRs for the local treatments of AGWs were assessed independently by two investigators with A Measurement Tool to Assess systematic Reviews version II (AMSTAR II), Risk of Bias in Systematic Reviews (ROBIS) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).ResultsTwenty-two SRs/MAs met all inclusion criteria. According to the results of the AMSTAR II, nine included reviews were rated critically as being of low quality, and only five were of high quality. Based on the ROBIS tool, only nine SRs/MAs had a low ROB. The domain-assessed ‘study eligibility criteria’ were mostly rated at a low ROB, unlike the other domains. With PRISMA, the reporting checklist was relatively complete for ten SRs/MAs, but some reporting weaknesses remained in the topics of the abstract, protocol and registration, ROB and funding.DiscussionSeveral therapy options are available for the local management of AGWs and are widely studied. However, due to the many ROB and low quality of these SRs/MAs, only a few of them have the sufficient methodological quality to support guidelines.PROSPERO registration numberCRD42021265175.
Silvestri, Francesca; Alvarez, Natalie; Afzal, Omara; Urbina, Antonio E; Dolan, Siobhan M; Ramirez Zamudio, Andres
doi: 10.1136/sextrans-2022-055691pmid: 37015803
ObjectiveWe aimed to evaluate the efficacy of PrEP (pre-exposure prophylaxis) training sessions for OBGYN (obstetrician gynaecologist) providers given underutilisation of PrEP among women despite a high HIV burden.MethodsThree separate training sessions were held for providers in the OBGYN department at an academic medical centre in New York City from 2019 to 2021. The 1-hour training sessions were conducted by HIV specialists as in-person lectures or online live lectures. Participants were surveyed after the training on metrics of PrEP awareness, knowledge and comfort with management. Two-sample t-tests were used to compare difference in proportions of binomial variables and difference in means of Likert-scored answers pretraining and post-training events.Results63 respondents completed the surveys. There were low rates (13%) of past PrEP prescription among the respondents, while awareness of PrEP as an HIV prevention strategy was high before (95%) and after (98%) the training. After the training, there was an increase in understanding the epidemiology of HIV transmission (40% to 97%, p<0.00), familiarity with the PrEP clinical trials (18% to 97%, p<0.00), comfort in determining PrEP candidacy (mean score 2.3 to 4.1, p<0.00) and comfort prescribing PrEP (mean score 2.0 to 3.6, p<0.00). After the trainings, the majority of participants reported feeling ‘comfortable’ or ‘very comfortable’ in determining candidacy for PrEP and prescribing PrEP with follow-up.ConclusionImplementation of PrEP training courses for OBGYN providers increased knowledge and comfort in identifying and managing patients who may benefit from PrEP services. Increasing training among OBGYN providers serving women at risk for HIV infection is an effective tool to narrow gaps in PrEP access.
Sokoll, Paulo Roberto; Migliavaca, Celina Borges; Siebert, Uwe; Schmid, Daniela; Arvandi, Marjan
doi: 10.1136/sextrans-2022-055687pmid: 36759179
ObjectivesTo summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users.MethodsWe searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsA total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate.ConclusionWe observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population.PROSPERO registration numberCRD42022310597.
Showing 1 to 10 of 13 Articles
doi: 10.1136/sextrans-2022-055494pmid: 36601742
ObjectivesBacterial vaginosis-associated bacterium 2 (BVAB2), Mageeibacillus indolicus and Sneathia spp are highly predictive of bacterial vaginosis (BV) in cisgender women. They have been associated with non-gonococcal urethritis (NGU) in cisgender men in some but not all populations. We evaluated this association in a cross-sectional study of cisgender men who have sex with women only (MSW).MethodsMSW without gonorrhoea attending a sexual health clinic (SHC) from 2014 to 2018 completed a computer-assisted self-interview, clinical interview and examination. NGU was defined as ≥5 polymorphonuclear leucocytes/high-power field in urethral exudates plus either urethral symptoms or visible discharge. Urine was tested for Chlamydia trachomatis and Mycoplasma genitalium using Aptima (Hologic) and for BVAB2, M. indolicus, Sneathia spp, Trichomonas vaginalis, Ureaplasma urealyticum, Haemophilus influenzae, herpes simplex virus and adenovirus using quantitative PCR.ResultsOf 317 MSW age 17–71, 67 (21.1%) had Sneathia spp, 36 (11.4%) had BVAB2, and 17 (5.4%) had M. indolicus at enrolment. Having ≥3 partners in the past 2 months was the only characteristic that was more common among MSW with than those without these bacteria (BVAB2: 47% vs 23%, M. indolicus: 53% vs 24%, Sneathia spp: 42% vs 22%; p≤0.03 for all). One-hundred seventeen men (37%) were diagnosed with NGU at enrolment. There was no significant association of BVAB2, M. indolicus or Sneathia spp with NGU (adjusted OR=0.59, 95% CI 0.14 to 2.43; aOR=3.40, 95% CI 0.68 to 17.06; aOR=0.46, 95% CI 0.16 to 1.27). Of 109 MSW with monthly samples, 34 (31.2%) had one of the bacteria at one or more follow-up visits, 22 of which were co-colonised with >1. Median persistence over 6 months did not differ significantly (BVAB2=30.5 days, IQR=28–87; M. indolicus=87 days, IQR=60–126; Sneathia spp=70 days, IQR=30–135; p≥0.20 for each comparison).ConclusionsNeither BVAB2, M. indolicus nor Sneathia spp were associated with increased risk of prevalent NGU in MSW attending an SHC.