Current News about Sexually Transmitted Disease

No abstract available 12/03/2024 01:00 AM
 

The dramatic increase in syphilis cases in the United States in recent years is a serious public health concern. Periodic shortages of benzathine penicillin G (BPG), the mainstay of syphilis treatment, create challenges for management of syphilis in the United States and worldwide. The National Institute of Allergy and Infectious Diseases convened working groups of experts to assess the landscape of syphilis treatments for uncomplicated adult syphilis, syphilis in pregnant women, congenital syphilis, and neurosyphilis. The working groups came together at a workshop entitled “Alternative Therapies to Penicillin for the Treatment of Syphilis” on February 13 to 14, 2024, to share their findings regarding promising alternative treatments, research gaps, and challenges. Discussions focused on using existing antibiotics, with a preference for those with favorable safety profiles and demonstrated success against syphilis or other infectious diseases. Clinical research on alternative treatments is complicated by the high effectiveness of penicillin and by differences in clinical, physiological, cultural, and socioeconomic considerations across different patient populations and geographic settings. In addition, current diagnostic tests and tests-of-cure create challenges for clinical trial design. Various potential trial designs were discussed, focusing on subjects with different types and stages of disease. This summary of the workshop is presented to inform plans for future research, including clinical trials on alternatives to penicillin for the treatment of syphilis. 11/29/2024 01:00 AM
 

Congenital syphilis (CS) continues to pose a significant global challenge. There has been a marked increase in reported cases in the United States, with 102.5 cases per 100,000 live births in 2022 compared with 11.6 cases per 100,000 live births in 2014. Congenital syphilis can lead to a range of severe complications, including premature birth, intrauterine growth restriction, miscarriage, perinatal death, stillbirth, and postnatal complications that may persist into later life. Maternal/parental factors such as age, race/ethnicity, occupation, income level, access to health care services, and incarceration have been linked to higher rates of CS. In addition, pregnant individuals who engage in high-risk behaviors such as sex work, having multiple sexual partners, or substance use are at a higher risk of exposure and subsequent infection. Routine screening for syphilis during pregnancy is crucial for its detection, timely management, and prevention of CS. The asymptomatic nature of the latent stage of syphilis further underscores the importance of prenatal syphilis screening. Studies in various countries have shown that early or first antenatal care visit screening for CS is cost-effective. This review article critically evaluates the current knowledge of CS in the United States, including its prevalence, social determinants of health, prevention efforts, challenges, the significance of screening, and the call to action to address the rising trend. (See Graphical Abstract) 10/31/2024 01:00 AM
 

Over the past 2 decades, congenital syphilis cases have risen 11-fold in the United States. Although disparities across geography, race, and ethnicity exist, lack of timely screening or treatment is identified in 88% of cases nationally. Congenital syphilis is a public health and medical problem rooted in systematic and societal structural determinants of health and health care limitations. Early syphilis in pregnancy leads to congenital syphilis if untreated in 50% to 70% of cases, with risk for fetal demise, and among survivors, congenital anomalies, organ damage, and central nervous system disease. Prevention of congenital syphilis lies in early detection and treatment in pregnant persons. In this narrative review, we describe the evolving epidemiology of syphilis and congenital syphilis, highlighting unique aspects among women. We explore the role of novel screening and treatment strategies, public health policy, and medical considerations in terms of congenital syphilis prevention. Readers of this review will understand congenital syphilis as a complex public health and medical disease that can be prevented through innovative and coordinated strategies in public health policy, expanded screening, and research opportunities. 11/05/2024 01:00 AM
 

Background Partner services (PS) have been integral to syphilis control in the United States since the early 20th century but have not been evaluated in a controlled study. Methods We compared PS outcomes among gay, bisexual, and other men who have sex with men (GBMSM) diagnosed with syphilis from May 2020 to June 2021 for whom health department staff initiated PS efforts (PS group) and a randomly selected control group for whom no PS efforts were initiated. We interviewed participants about partner outcomes and used χ2 tests and Poisson regression to test for differences in outcomes between groups. Results We attempted to contact 350 GBMSM and offered participation to 184 men, of whom 92 (51%) participated, including 41 men in the PS group and 51 controls. The percentage of participants who reported notifying ≥1 sex partner after diagnosis was similar in the PS and control groups (83% vs. 80%, P = 0.80). Mean number of partners notified or tested did not differ between PS and control groups (notified mean [range], 2.5 [0–10] vs. 3.3 [0–20], P = 0.16; tested mean [range]: 1.2 [0–8] vs. 1 [0–10], P = 0.66); multivariate results were similar. Among those contacted for PS, approximately half (48%) reported PS staff helped them with medical care for syphilis, and 31% said that PS staff connected them to preexposure prophylaxis. Conclusions This small, controlled evaluation suggests that syphilis PS may have no impact on partner treatment among GBMSM, although most men support the intervention. A randomized trial is needed to definitively define the contemporary effectiveness of syphilis PS among GBMSM. 12/24/2024 01:00 AM
 

Background Three randomized controlled trials have demonstrated the efficacy of doxycycline for bacterial sexually transmitted infection postexposure prophylaxis (Doxy PEP). Few studies have assessed provider knowledge, attitudes, and practices (KAP) regarding Doxy PEP implementation. Between July of 2023 and January 2024, this study qualitatively assessed KAP and intention to prescribe Doxy PEP among health care providers in the New York City area. Methods In-depth, semistructured individual interviews were conducted with 18 health care provider key informants including physicians, nurse practitioners, and physician assistants from various practice settings. Transcripts were analyzed using inductive KAP codes, with additional deductive coding used to identify emergent subthemes. Results The following themes were identified: (1) STI Disparities, (2) Doxy PEP Experience, (3) Doxy PEP Benefits, (4) Doxy PEP Concerns, and (5) Doxy PEP Implementation. Doxy PEP knowledge was high, with all providers being aware and most (78%) having prescribed it to at least one patient at the time of interview. Providers were knowledgeable of factors contributing to high rates of STIs. Benefits included reducing STI anxiety. Concerns included contributing to antimicrobial resistance and impacts on microbiota. Practice implications included challenges getting Doxy PEP approved by the pharmacy. These factors were shown to affect Doxy PEP's perceived acceptability. Conclusions To ensure that Doxy PEP is implemented safely and equitably, KAP factors that may influence provider decision making should be examined. Understanding providers' KAP and how they affect intention to prescribe Doxy PEP, and to what patients, has important implications for successful implementation. 11/13/2024 01:00 AM
 

Background Men who have sex with men using HIV Pre-Exposure Prophylaxis are a vulnerable population with a high prevalence of sexually transmitted infections (STIs). Self-collection of specimens could improve STI testing, yet implementation in low-resource settings is limited. The study aimed to assess the feasibility and acceptability of self-collection for STI testing and to understand STI testing preferences among Pre-Exposure Prophylaxis clients in Hanoi, Vietnam. Methods From January to December 2022, men who have sex with men 16 years and older, participating in a clinic-based HIV PrEP program were enrolled. Participants self-collected pharyngeal, anal, and urine samples for Chlamydia trachomatis and Neisseria gonorrhoeae testing. Testing preferences were assessed through conjoint analysis using 8 hypothetical testing profiles across 5 testing attributes; each profile was rated on a Likert scale (0–5) to create an impact score. Differences between attributes were assessed using a 2-sided, 1-sample t test of the impact score. Results There were 529 participants enrolled; all were male. Specimens from 3 sites were provided by 97.9% (518 of 529). Mean satisfaction with self-collection was 4.3 (SD, 1.0), 99.4% reported they would perform again. In conjoint analysis, cost (free vs. US $17) had the highest impact on testing preference (impact score: 25.2; P < 0.001). A 1-week time to test result notification was preferred to 90 minutes (impact score: −0.8; P = 0.03). Conclusions We found high acceptability of self-collection for STI testing among HIV PrEP clients in Vietnam. Cost was the most important factor affecting testing uptake. Expanding self-collection and lowering costs could improve STI testing in HIV PrEP programs. 12/03/2024 01:00 AM
 

Background Sexually transmitted infections (STIs) and HIV disproportionately affect young people; gay, bisexual, queer, and other men who have sex with men (GBQMSM); transgender women; and persons of color. Our community-based participatory research partnership developed and implemented Impact Triad, a bilingual multilevel intervention harnessing peer navigation and mHealth to increase STI/HIV preventive behaviors and address 4 community-prioritized social determinants of health—education, employment, social support, and discrimination—among young African American/Black and Latine GBQMSM and transgender women. Methods Fifteen community-based peer navigators were trained to work within their social networks for 12 months. Each navigator engaged 5 social network members who completed baseline and immediate post-intervention assessments (retention rate, 97.3%). Regression modeling was used to assess changes in outcomes between baseline and follow-up. Results Among 74 enrolled social network members, the average age was 27.8 years; 61% identified as African American/Black, 31% as Latine, and 8% as multiracial/multiethnic. The majority self-identified as cisgender men and 8% as transgender women; 78% identified as gay. About half reported monthly income below $1000. Compared with baseline, at follow-up, social network members increased: STI screening (P = 0.001), HIV testing (P = 0.001), condom use (P = 0.03), and preexposure prophylaxis use (P = 0.02). Knowledge of preexposure prophylaxis (P < 0.0001) and of community-based educational (P = 0.047), job-training (P = 0.002), and job-finding resources (P = 0.02) also increased. Social support increased (P < 0.0001) and perceived discrimination decreased (P < 0.01). Conclusions Pilot findings suggest that Impact Triad is promising in increasing STI/HIV protective behaviors and addressing social determinants of health among young GBQMSM and transgender women of color; further testing is warranted. 11/25/2024 01:00 AM