Sexually Transmitted Infections

Swayze, Emma Jane; Liske, Emily; DeCarr, Kimberly; Wendel, Paul; Swailes, Alexa; VanDillen, Michael; Nakahara, Angela

doi: 10.1136/sextrans-2025-056601pmid: 41015531

ObjectiveTo identify factors associated with inadequate or no syphilis treatment during pregnancy within an urban low-income safety-net hospital.MethodsWe conducted a retrospective case control study of pregnant patients diagnosed with new syphilis infections between July 2019 and July 2024 to determine predictors of inadequate or no treatment. Treatment was considered adequate if patients received appropriate doses of intramuscular benzathine penicillin G consistent with syphilis stage. Fisher’s exact test and χ2 test were performed for categorical variables. After adjusting for age, body mass index, substance use during pregnancy, diagnosis before 24 weeks and syphilis stage, a multivariable logistic regression was used to calculate adjusted OR (aOR) with a 95% CI. Statistical significance tests relied on a two-sided α=0.05.ResultsA total of 150 pregnant patients were diagnosed with syphilis; approximately 36.7% (n=55) received no or inadequate treatment. Late latent and unknown syphilis stages were predictors of inadequate syphilis treatment with the following respective aORs: aOR 4.52; 95% CI 1.10 to 18.6 and aOR 7.64; 95% CI 2.19 to 26.7. Infection diagnosis before 24 weeks’ gestation (aOR 0.18; 95% CI 0.07 to 0.42) was a significant predictor of adequate treatment. Partner treatment status was unknown or none for 89.3% of patients (n=134).ConclusionsPatients diagnosed with syphilis stages that require multi-dose treatments are at higher risk for inadequate treatment. Efforts to promote early diagnosis and staging in this community are needed. Widespread neglect of partner treatment may be contributing to this epidemic.

Himschoot, Lisa; Vanraepenbusch, Aylien; Selis, Nina; Meakin, Paul; Blumin, Yevgeniy; Schmid, Daphné A; Bruisten, Sylvia M; Cools, Piet

doi: 10.1136/sextrans-2025-056642pmid: 40992941

ObjectivesVulvovaginal candidiasis is the second most common cause of vaginitis among women of childbearing age worldwide and is often self-diagnosed and self-treated by women. However, self-management of vaginal symptoms has been shown to have very poor outcomes. Hence, reliable self-tests are essential for improving the management of VVC. Here, we evaluated and compared the diagnostic performance of four marketed Candida self-tests.MethodsRemnant diagnostic material was collected from 140 vaginal samples analysed by culture in the Netherlands. This was used in four commercially available Candida self-tests: Candida albicans Rapid Test Beright, StrongStep Candida albicans Antigen Rapid Test, Tigsun VVC-TV-GV Combo Antigen Test and VagiQUICK. Furthermore, DNA was extracted and used to quantify Candida using qPCR. The performance of each test was compared with culture and qPCR results using appropriate statistical methods.ResultsThe Beright, StrongStep, Tigsun and VagiQUICK tests exhibited sensitivities of 47.3%, 30.8%, 73.0% and 66.3% and specificities of 100%, 100%, 100% and 97.4%, respectively, compared with culture. Compared with qPCR, the tests exhibited a sensitivity of 43.4%, 60.2%, 60.8% and 54.7% and a specificity of 89.7%, 73.3%, 80.0% and 75.9%, respectively. Sensitivity improved with increasing Candida concentration thresholds.ConclusionsThe investigated self-tests demonstrated varying performances, with both sensitivity and specificity being consistently lower than manufacturer claims. These findings underscore the urgent need for developing and validating more reliable self-tests to support adequate management of women’s health. The sensitivity of currently marketed tests is only slightly better than empirical or self-diagnosis, which limits their clinical utility.

Tam, Alexander CT; Mohammadi, Tima; Snow, M. Elizabeth; O’Byrne, Patrick; Rourke, Sean B; Anis, Aslam H; Zhang, Wei

doi: 10.1136/sextrans-2025-056553pmid: 40903274

ObjectiveTo quantify preferences for sexually transmitted and blood-borne infections (STBBI) testing in the general adult population in Canada.MethodWe developed an online discrete choice experiment survey and administered it to a sample of the general Canadian population aged 19 and up recruited using an online market research panel. We included six attributes based on the literature and a qualitative study: location of test administration; requisition and personal information requirement; specimen collection method; test accuracy (false-negative rate); time to result and out-of-pocket costs. The final design consisted of six blocks of 10 choice tasks, plus three choice tasks that were used for consistency checks. Data were analysed using conditional logit, mixed logit and latent class models.ResultsAnalyses were based on 5113 respondents. There were positive preferences for STBBI testing using less invasive methods of testing, missing fewer infections, having a shorter time to result and lower costs. Latent class analysis identified four classes: non-testers, accuracy-driven testers, doctor’s office testers and multiattribute testers. Regardless of class, accuracy and costs remained the two most important attributes. These classes had different preferences for the location of testing and requisition and personal information requirements. Compared with non-testers, multiattribute testers were more likely to be African, Caribbean and/or black; under 25 years; indicate sexual activities that would place people at high risk for acquiring HIV; and use injection drugs.ConclusionAdults in the general population in Canada indicated strong preferences for low-cost and accurate tests. A variety of testing locations may be needed to reach diverse populations.