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Help and Care Seeking for Sexually Transmitted Infections Among Youth in Low- and Middle-Income Countries

imageBackground: The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet. Methods: We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (age, 10–24 years) and/or health service providers. Eighteen studies were identified for inclusion from 18 countries. Thematic analyses identified key themes across the studies. Results: The majority of studies included discussion of youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many youth still do not seek timely care for STIs. Youth desired more information on sexual health and cited barriers related to fear or taboos in obtaining help or information, especially from providers or parents. Many did not recognize symptoms or waited until symptoms worsened. However, many youth were able to identify a number of sources for STI related care including public and private clinics, pharmacies, alternative healers, and nongovernmental organizations. Youth's help seeking and care seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost. Conclusions: Youth in low- and middle-income countries experience significant barriers in help seeking for STIs and often do not seek or postpone medical care. Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality, and cultural norms related to youth sexuality. 06/01/2017 01:00 AM

Assortativity and Mixing by Sexual Behaviors and Sociodemographic Characteristics in Young Adult Heterosexual Dating Partnerships

imageBackground: Assortative sexual mixing, the tendency for individuals to choose partners with similar characteristics to themselves, may be an important contributor to the unequal distribution of sexually transmitted infections in populations. We analyzed the tendency for assortative mixing on demographic and sexual behaviors characteristics in newly formed young adults dating partnerships. Methods: Women aged 18 to 24 years and their male sexual partners of no more than 6 months were recruited during 2005 to 2010 at universities in Montreal, Canada. New dating partners were also prospectively recruited during the 2-year follow-up. We used Spearman and Newman coefficients to examine correlations between partners' demographic characteristics and sexual behaviors, and multivariable logistic modeling to determine which characteristics were assortative. Results: Participants in 502 recruited partnerships were assortative on age (Spearman P = 0.60), smoking behavior (P = 0.43), ethnicity (Newman coefficient=0.39), lifetime number of sexual partners (P = 0.36), sex partner acquisition rates (P = 0.22), gap length between partnerships (P = 0.20), and on whether they had concurrent partners (P = 0.33). Partners were assortative on number of lifetime partners, sexual partner acquisition rates, concurrency, and gap length between partnerships even after adjustment for demographic characteristics. Reported condom use was correlated between initial and subsequently recruited partners (P = 0.35). There was little correlation between the frequencies of vaginal/oral/digital/anal sex between subsequent partnerships. Conclusions: Dating partnerships were substantially assortative on various sexual behaviors as well as demographic characteristics. Though not a representative population sample, our recruitment of relatively new partnerships reduces survivor bias inherent to cross-sectional surveys where stable long-term partnerships are more likely to be sampled. 06/01/2017 01:00 AM

Can Social Network Analysis Help Address the High Rates of Bacterial Sexually Transmitted Infections in Saskatchewan?

imageBackground: Saskatchewan has one of the highest rates of gonorrhea among the Canadian provinces—more than double the national rate. In light of these high rates, and the growing threat of untreatable infections, improved understanding of gonorrhea transmission dynamics in the province and evaluation of the current system and tools for disease control are important. Methods: We extracted data from a cross-sectional sample of laboratory-confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu'Appelle Health Region. The database was stratified by calendar year, and social network analysis combined with statistical modeling was used to identify associations between measures of connection within the network and the odds of repeat gonorrhea and risk of coinfection with chlamydia at the time of diagnosis. Results: Networks were highly fragmented. Younger age and component size were positively associated with being coinfected with chlamydia. Being coinfected, reporting sex trade involvement, and component size were all positively associated with repeat infection. Conclusions: This is the first study to apply social network analysis to gonorrhea transmission in Saskatchewan and contributes important information about the relationship of network connections to gonorrhea/chlamydia coinfection and repeat gonorrhea. This study also suggests several areas for change of systems-related factors that could greatly increase understanding of social networks and enhance the potential for bacterial sexually transmitted infection control in Saskatchewan. 06/01/2017 01:00 AM

Chlamydia trachomatis Incidence Using Self-Reports and Serology by Gender, Age Period, and Sexual Behavior in a Birth Cohort

imageBackground: Although understanding chlamydia incidence assists prevention and control, analyses based on diagnosed infections may distort the findings. Therefore, we determined incidence and examined risks in a birth cohort based on self-reports and serology. Methods: Self-reported chlamydia and behavior data were collected from a cohort born in New Zealand in 1972/3 on several occasions to age 38 years. Sera drawn at ages 26, 32, and 38 years were tested for antibodies to Chlamydia trachomatis Pgp3 antigen using a recently developed assay, more sensitive in women (82.9%) than men (54.4%). Chlamydia incidence by age period (first coitus to age 26, 26–32, and 32–38 years) was calculated combining self-reports and serostatus and risk factors investigated by Poisson regression. Results: By age 38 years, 32.7% of women and 20.9% of men had seroconverted or self-reported a diagnosis. The highest incidence rate was to age 26, 32.7 and 18.4 years per 1000 person-years for women and men, respectively. Incidence rates increased substantially with increasing number of sexual partners. After adjusting age period incidence rates for partner numbers, a relationship with age was not detected until 32 to 38 years, and then only for women. Conclusions: Chlamydia was common in this cohort by age 38, despite the moderate incidence rates by age period. The strongest risk factor for incident infection was the number of sexual partners. Age, up to 32 years, was not an independent factor after accounting for partner numbers, and then only for women. Behavior is more important than age when considering prevention strategies. 06/01/2017 01:00 AM

Emergence and Spread of Neisseria gonorrhoeae Isolates With Decreased Susceptibility to Extended-Spectrum Cephalosporins in Argentina, 2009 to 2013

imageBackground: The emergence of Neisseria gonorrhoeae strains with decreased susceptibility to cephalosporins represents a major concern globally. The aim of this study was to examine the phenotypic and molecular characteristics of N. gonorrhoeae isolates with decreased susceptibility to ceftriaxone and cefixime in Argentina. Methods: A total of 1987 isolates were collected during 2009 and 2013. The susceptibility to penicillin G, tetracycline, ciprofloxacin, cefixime, ceftriaxone, and azithromycin was determined using the agar dilution method. The major extended-spectrum cephalosporin resistance determinants (penA, mtrR, and porB1b) were sequenced in 42 N. gonorrhoeae isolates that showed decreased susceptibility to ceftriaxone (minimum inhibitory concentration [MIC], 0.06–0.125 mg/L) and cefixime (MIC, 0.125–0.25 mg/L). Genotyping by N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed. Results: Between 2009 and 2013, there was a shift in the modal MICs for ceftriaxone. Among the 42 isolates exhibiting decreased susceptibility to ceftriaxone and cefixime, 95.2% were resistant to penicillin G, 95.2% to tetracycline, 97.6% to ciprofloxacin, and 33.3% to azithromycin. Thirty-five (83.3%) of the 42 isolates had a mosaic penA allele XXXIV, which has been previously associated with resistance to ceftriaxone and cefixime as well as treatment failures. The isolates that contained the mosaic penicillin-binding protein 2 (PBP2) XXXIV were associated with NG-MAST ST1407 or closely related genotypes. Conclusions: In Argentina, N. gonorrhoeae isolates with decreased susceptibility to cefixime and ceftriaxone have now emerged, mostly due to the introduction of the internationally spread multidrug-resistant NG-MAST ST1407. 06/01/2017 01:00 AM

Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010–2015

imageAbstract: Perinatal transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) can result in conjunctivitis in infants. We examined national rates of reported CT/GC conjunctivitis among infants. Surveillance of these infections is heavily affected by the completeness of reported data on specimen source and age. Alternative data sources should be evaluated. 06/01/2017 01:00 AM

Retrospective Review of Gonococcal and Chlamydial Cases of Epididymitis at 2 Canadian Sexually Transmitted Infection Clinics, 2004–2014

imageAbstract: Fifty-seven cases of gonococcal and chlamydial infections complicated by acute epididymitis seen at 2 Alberta STI clinics from 2004 to 2014 were reviewed. The majority responded to treatment recommended by national guidelines. Three of 6 treatment failures were not treated according to guidelines. 06/01/2017 01:00 AM

Impact of Eligibility Criteria on Participant Enrollment for a Randomized Clinical Trial of Gonorrhea Treatment

imageBackground: High rates of failure to qualify for clinical trial participation increase time and cost required for study completion. Identification of remediable reasons for prescreen failure can help reduce prescreen failure rates and improve study cost effectiveness. Methods: Reasons for prescreen failure to qualify for participation in a phase 2 randomized clinical trial of treatment of uncomplicated urogenital gonorrhea were collected from prescreening logs. Reasons were categorized based on whether the reason was that the subject failed to meet eligibility criteria or declined participation. Subjects who failed prescreening but could have been enrolled under protocol amendments were used to estimate potential cost savings had enrollment completed sooner. Results: Over 88% (1373/1554) of potential study candidates were not enrolled. The majority (68.8%) of nonenrolled subjects failed prescreening due to not meeting eligibility criteria, whereas 31.0% declined to participate. The most common reasons for failure to qualify were having only nonurogenital gonorrhea (16.4%), limited time (13.1%), and being on antiretroviral therapy (7.5%). Potential cost savings if protocol amendments affecting eligibility had been instituted earlier were estimated at US $127,500. Conclusions: Careful attention to reasons for prescreen failure can inform clinical trial protocol development to address trial design features that may impact successful enrollment. More efficient subject enrollment can result in substantial cost savings. 06/01/2017 01:00 AM