Current News about Sexually Transmitted Disease

Background Despite the availability of curative penicillin treatment for syphilis during pregnancy, congenital syphilis (CS) cases have surged in the United States, including in Oregon. Methods We conducted a retrospective analysis of individual- and county-level predictors of CS among pregnant people with syphilis in Oregon from 2013 to 2021. Data were collated from surveillance reports, County Health Rankings, and other sources with upstream county-level data. We used multilevel Poisson regression models to assess associations between CS and individual- and county-level factors. Results Among 343 people with syphilis during pregnancy, 95 (27.6%) were associated with a case of CS. At the individual level, a history of injection drug use and a history of corrections involvement were associated with an increased risk of CS, whereas a recent gonorrhea diagnosis was associated with a decreased risk of CS. County-level violent crime rate, unemployment, income inequality, and adverse childhood experiences increased the risk of CS. Higher county-level socioenvironmental challenges exacerbated CS risk, particularly among people with corrections involvement. Conclusions Injection drug use, corrections involvement, and county-level socioenvironmental challenges increased CS risk among pregnant people with syphilis in Oregon. Urgent interventions are needed, including innovative care models, policy reforms targeting systemic issues, and enhanced collaboration with community services to address the escalating CS crisis. 09/02/2024 01:00 AM
 

Background Reportable sexually transmitted infections (STIs) have increased in California, with dramatic rises in prenatal and congenital syphilis. In response, in 2018 Planned Parenthood Northern California implemented 2 opt-out screening protocols: (1) HIV, chlamydia, gonorrhea, and syphilis co-screening for pregnant patients at pregnancy diagnosis and (2) linking HIV and syphilis screening for all patients. Methods Using qualitative analyses, we explored implementation barriers and facilitators that can be addressed by clinical leadership and staff to expand uptake of enhanced screening protocols. Sixteen staff were interviewed across 3 Planned Parenthood Northern California clinics. Primary thematic analysis followed by secondary subanalysis identified themes. Analyses of questions were only included for each interviewee if answered and applicable. Results Five themes of commentary emerged, featuring both facilitators and barriers for protocol implementation: patient education/communication, staff education/communication, workflow; patient willingness, and (for protocol 1 only) visit complexity at the time of pregnancy diagnosis. Additional findings included the following: 93% (13 of 14) stated protocols increased syphilis screening and identification; 100% (12 of 12) reported positive impacts on patient care; 42% (5 of 12) noted increases in staff workload, 25% (3 of 12) reported workload improvements over time, and 33% (4 of 12) reported no workload-related impacts; and 86% (13 of 15) reported decreased screening during the COVID-19 pandemic. Conclusion Addressing patient and staff education during the beginning stages of implementation may have positive impacts on willingness to adopt new protocols. Consideration of workflow and visit complexity at pregnancy diagnosis may also aid in successful implementation of expanded STI screening protocols in family planning clinics. 09/27/2024 01:00 AM
 

Background In the United States, gaps in health care insurance coverage correlate with lower use of preventive care. We aimed to determine whether part-year or year-round uninsurance was associated with lower use of testing for sexually transmitted infections (STIs). Methods We identified women aged 19 to 49 years in the 2017–2019 National Survey of Family Growth. Completion of any STI testing in the past year and location of STI testing were regressed on pattern of insurance coverage, classified as continuous private, continuous public, part-year uninsured, or year-round uninsured. Results Based on the analytic sample (N = 4119), 12% of women aged 19 to 49 years experienced part-year uninsurance, and 8% experienced year-round uninsurance, whereas 31% received an STI test in the past year. On multivariable analysis, respondents with part-year uninsurance were the group most likely to have received STI testing (odds ratio compared with continuous private coverage, 1.56; 95% confidence interval, 1.09–2.23; P = 0.015), whereas respondents with year-round uninsurance were the group least likely to receive STI testing (odds ratio vs. continuous private coverage, 0.37; 95% confidence interval, 0.25–0.55; P < 0.001). Year-round uninsurance was associated with higher likelihood of receiving a test at locations other than public or private clinics, such as at a hospital or at an in-store clinic. Conclusions Low use of STI testing among women with year-round uninsurance indicates a need for expanded insurance coverage and greater access to STI testing. However, high rates of STI testing among women with part-year uninsurance challenge the presumed association of insurance continuity with higher uptake of preventive care. 09/16/2024 01:00 AM
 

Background Chlamydia and gonorrhea are 2 of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the United States. Incarcerated women have a particularly elevated risk of these infections, which can result in serious sequelae if left untreated. On December 13, 2021, the Los Angeles County Jail system began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated women. Methods We retrospectively analyzed electronic health record data for completed urogenital chlamydia/gonorrhea screening among newly incarcerated women between December 13, 2021, and May 31, 2023. We used multivariable logistic regression to examine the association of STIs and treatment non-initiation outcomes with various demographic and self-reported variables. Results Of the 13,739 female entrants offered STI testing, 10,717 (78%) completed screening, with 1151 (11%) having a chlamydial infection, 788 (7%) having a gonococcal infection, and 1626 (15%) having ≥1 infection. Sexually transmitted infection positivity was associated with age 18 to 34 years, reported houselessness, amphetamine use, and history of a positive prior treponemal antibody test result. Sexually transmitted infection treatment non-initiation was associated with shorter jail stay for both chlamydial (adjusted odds ratio, 87.4; 95% confidence interval, 34.2–223.2) and gonococcal (adjusted odds ratio, 9.0; 95% confidence interval, 5.2–15.7) infections. Conclusion The STI prevalence among female detainees tested was many-fold higher than that of the general population. The implementation of routine opt-out STI screening in carceral settings provides a unique opportunity to benefit the health of both the correctional population and potentially that of the surrounding community. 08/08/2024 01:00 AM
 

Background Sexual violence (SV) increases human immunodeficiency virus (HIV) susceptibility in a sustained manner. This study evaluated genital cytokines and colposcopy findings in women reporting both recent and more remote SV. Methods A cross-sectional study of HIV-1 negative Kenyan women who engage in sex work was performed. Cervicovaginal fluid was collected by menstrual cup and cytokines (IFNγ, TNFα, IL-1β, IL-6, IL-10, MIP-1α, MIP-1β, and CXCL10) measured using chemiluminescence. Cervical injury was assessed by colposcopy. Associations between recent (≤30 days prior), more remote (>30 days prior), and no (reference category) SV exposure and cytokine concentrations were evaluated using linear regression. Results Among 282 participants, 25 (8.9%) reported recent SV and 123 (43.6%) reported more remote SV. Only two cytokines (IL-10 and CXCL10) were associated with the 3-category SV variable in bivariable modeling at the prespecified cutoff (P < 0.2) and carried forward. In multivariable analyses, more remote SV (β = 0.72; 95% confidence interval [CI], 0.06–1.38; P = 0.03), but not recent SV (β = 0.20; 95% CI, −0.99 to 1.39; P = 0.74) was associated with cervicovaginal IL-10 compared with no SV. Recent (β = 0.36; 95% CI, −0.94 to 1.67; P = 0.58) and more remote (β = 0.51; 95% CI, −0.21 to 1.24; P = 0.16) SV were not associated with CXCL10 compared with no SV. Cervical epithelial friability (χ2 = 1.3, P = 0.51), erythema (χ2 = 2.9, P = 0.24), vascular disruption (χ2 = 1.4; P = 0.50), epithelial disruption (χ2 = 2.6, P = 0.27), or any colposcopy finding (χ2 = 1.2, P = 0.54) were not associated with SV category by χ2 test. Conclusions The mechanism linking SV to sustained increases in HIV susceptibility may not be related to persistent genital inflammation or injury. 09/05/2024 01:00 AM
 

Background The incidence of sexually transmitted infections (STI) continues to increase worldwide. Patient incentives are one proposed intervention to increase STI testing and treatment. Methods We conducted a retrospective cohort study comparing incentivized versus routine care for STI outreach test and treat services between October 2018 and June 2019. Incentivized care included a $10 gift card for testing visits and an additional $10 gift card for results and/or treatment visits. Incentivized visits were offered to clients with a lack of housing, who were difficult to locate, or had a history of being lost to follow-up. All test and treatment visits included chlamydia, gonorrhea, syphilis, and HIV testing and/or treatment by Registered Nurses and outreach workers from an STI Clinic. Outreach visits were offered at subsidized housing locations, community-based organizations, and street outreach. Results From October 2018 to June 2019, 2384 outreach clients were reached: 453 (19.0%) received incentives and 1931 (81.0%) received routine care. There were no significant differences in case-finding rates for chlamydia (4.8%), gonorrhea (2.9%), and HIV (0.1%); however, there was for syphilis (3.8% for incentivized vs. 1.9% for routine visits; P = 0.02). All newly diagnosed infections identified in the incentivized group received treatment compared with routine visits (chlamydia 100% vs 79.1%, P = 0.008, gonorrhea 100% vs 59.7%, P = 0.002, and syphilis 100% vs. 86.7%, P = 0.08). Conclusions Incentives were associated with increased case-finding rates of syphilis and were associated with 100% treatment rates. Incentives are a promising approach to decreasing the burden of STI among outreach populations. 08/22/2024 01:00 AM
 

Background Stigmatization of sexually transmitted infections (STIs) threatens provider-patient relationships and contributes to the underutilization of STI services. Media can shape public attitudes toward health care topics by perpetuating or reducing stigma. Given the high prevalence of STIs and the widespread consumption of media, it is essential for health care providers to be cognizant of factors influencing societal perceptions of STI symptoms, transmission, diagnosis, and treatment. Methods This study is a scoping review of popular films depicting STIs. Full-length English-language narrative films featuring characters with confirmed or suspected STIs were included. Descriptive statistics were used to determine the proportion of characters accurately portrayed with STI symptoms, transmission, diagnosis, and treatment. Results The final analysis comprised 128 characters from 77 films, with human immunodeficiency virusbeing the most frequently featured STI (42 films, 54.5%). The overall accuracy across all 4 clinical variables of symptoms, transmission, diagnosis, and treatment was 87.4%. Transmission was the most depicted clinical variable, represented in 74 characters (57.8%). All 4 clinical variables were simultaneously depicted in only 4 (3.1%) characters, with 2 characters portraying all 4 clinical variables accurately. Death occurred in 39 characters (30.5%), with human immunodeficiency virus accounting for the majority (82.1%). Conclusions Most films accurately portrayed STI clinical variables, including symptoms, transmission, diagnosis, and treatment. Rates of individual variable depiction were inconsistent, whereas death secondary to STIs was common. Understanding the portrayal of STIs in popular films can provide valuable insights for clinicians, enabling them to effectively address patient misconceptions and knowledge gaps. 09/13/2024 01:00 AM
 

Background Online support groups afford new opportunities to help individuals affected by HIV/AIDS to seek social support from peers. The study aimed to understand the willingness and associated factors of joining online support groups among men who have sex with men living with HIV. Methods The study followed a mixed methods approach, with qualitative in-depth interviews followed by a quantitative cross-sectional survey in 3 cities of Shandong Province, China, from 2019 to 2020. The in-depth interviews were audio-taped, transcribed verbatim, and analyzed using a thematic approach. In the quantitative analysis, explanatory variables included sociodemographic, behavioral, clinical, psychological, and demand factors. Univariate and multivariable logistic regressions were conducted to examine the associated factors of willing to join online support groups. Results A total of 576 and 20 participants were included in the quantitative survey and qualitative interviews, respectively. Only 24.7% (142 of 576) of participants in the quantitative study were willing to join the online support group. Multivariable analysis showed that the associated factors included income level, sexual orientation, and availability of information. The barriers to joining online support groups included privacy disclosure concern and psychological pressure exposed to HIV-related information. Facilitators included information acquisition, mutual medication reminding, and emotional support. Conclusions Men who have sex with men living with HIV in China had relatively low willingness to join the online support groups. This study highlighted the importance of safeguarding privacy, involving professional mental health providers, and providing high-quality information when establishing online support groups for people living with HIV. 08/06/2024 01:00 AM