Current News about Sexually Transmitted Disease

Background Doxycycline used as postexposure prophylaxis (doxyPEP) within 72 hours of sex reduces the risk of bacterial sexually transmitted infections (STIs) in people assigned male sex at birth. Little is known about current use of antibiotics as STI prophylaxis in US populations likely to benefit from doxyPEP. Methods We conducted an online survey in September 2023 of US adults recruited via sexual networking apps used mainly by gay and bisexual men (GBM). Respondents were asked about the use of antibiotics around the time of sex to prevent bacterial STIs. Results Of 903 respondents, most (96.2%) identified as GBM; 19.0% were living with HIV and 42.5% were using HIV preexposure prophylaxis (PrEP). Half (49.1%) had heard of using antibiotics to prevent STIs, and 95.6% were interested in use. Overall, 21.0% had used antibiotic STI prophylaxis, and 15.9% had done so in the past year. Among those reporting any use, most (78.1%) had used doxycycline; some used amoxicillin (16.7%), azithromycin (14.5%), or other antibiotics (14.1%). Among those reporting use in the past year, 46.9% used it for some, 28.1% for most, and 25.0% for all sex acts with casual partners during that period. Most (78.3%) of STI prophylaxis users reported their condom use did not change during periods of STI prophylaxis use, 17.2% indicated their condom use declined, and 4.5% indicated their condom use increased. For doxyPEP specifically, 35.7% had heard of it, and 13.0% had used it in the past year, of whom 21.0% had used a dosage other than the 200-mg dose shown to be effective. Conclusions In this sample of primarily GBM, interest in bacterial STI prophylaxis was nearly universal. However, some of the use was not informed by current clinical guidance or evidence from research studies. Efforts are needed to increase awareness of effective dosing and monitor real-world use. 08/08/2024 01:00 AM
 

This is a retrospective study on men who have sex with men (MSM) diagnosed with rectal lymphogranuloma venereum (LGV), treated with 7 or 21 days of doxycycline between 2015 and 2022. Overall, 143 MSM were included: 58 (41%) had LGV. One hundred percent of microbiologic cure was found among MSM with symptomatic or asymptomatic LGV treated with 7 and 21 days of doxycycline. 08/06/2024 01:00 AM
 

Congenital syphilis rates increased 10-fold from 2012 to 2022 in the United States. Currently, the therapeutic standard of care is 10 days of intravenous aqueous crystalline penicillin G, with very limited evidence for alternatives. A long course of intravenous antibiotic requires hospitalization that is both costly and burdensome for the child and the family. Fortunately, Treponema pallidum retains susceptibility to other antibiotics based on minimum inhibitory concentrations. Based on the evidence of safety and efficacy of different antibiotics for use in neonates, ceftriaxone emerges as a potential parenteral candidate, and amoxicillin emerges as a potential oral candidate for the treatment of congenital syphilis. Other therapeutic alternatives include cefotaxime (where available), ampicillin, doxycycline, cefixime, and linezolid. 07/24/2024 01:00 AM
 

This retrospective cohort study drawing data from 48 major tertiary children's hospitals found heterogeneity in the diagnosis and management of congenital syphilis despite Centers for Disease Control and Prevention guideline recommendations. The noted overall rise in the number of congenital syphilis cases mirrors the nationwide increase. 07/24/2024 01:00 AM
 

Background Genital herpes etiology has been shifting to include a greater proportion of herpes simplex virus type 1 (HSV-1) infection in the last few decades. A prior study published in 2003 found that 48.9% of infections in a college health population were HSV-1. Methods We evaluated the number of positive HSV polymerase chain reaction test results obtained from anogenital sites from undergraduate and graduate students from 2013 to 2022 in a college health clinic setting and analyzed the number caused by HSV-1 and HSV type 2 and compared by sex. This was then compared with the prior study from 1993 to 2001. Results We received 691 (of 2685 samples) positive polymerase chain reaction results for HSV of both types in the period analyzed. Overall, 600 (86.8%) of these were HSV-1, and 520 (75.2%) were in female patients. The prior study in 1993 to 2001 found that 48.9% (244 of 675) of all positive test results were HSV-1; we observed an increase in the percentage of positive HSV-1 over all positive test results of 1.8 (χ2 = 16.548; P < 0.001). Conclusions Our study shows that 86.8% of the positive genital HSV test results from 2013 to 2022 were HSV-1. This shows that most positive HSV test results in this setting are now HSV-1, a substantial increase from the previous study in our clinic. 08/08/2024 01:00 AM
 

Background Gonorrhea remains a significant burden in central Ohio, particularly in socially disadvantaged communities. This study evaluates gonorrhea case rates and changes from 2020 to 2021, focusing on geographic patterns associated with social vulnerability. Methods We analyzed gonorrhea case data from the Columbus STD Surveillance Network for 2020 and 2021. Cases were linked to census tracts and categorized into low (0–0.66) or high (0.67–1.0) vulnerability groups based on the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI). We mapped gonorrhea case rates per 100,000 population, stratified by SVI group, and compared changes using Jenks natural breaks to determine cutpoints. High case rates were defined as ≥605 (2020) and ≥532 (2021). A change in case rates was defined as <154 (decrease/no change) or ≥154 (increase). Demographic factors were summarized for both years. Results In 2020 and 2021, nearly half of high-SVI tracts had high gonorrhea rates, compared with about 4% to 7% of low-SVI tracts. Median rates in high-SVI tracts were approximately 5 times higher than in low-SVI tracts, with rates of 546 and 598 per 100,000 in 2020 and 2021, compared with 98 and 104 per 100,000, respectively. Gonorrhea rates increased in 23 (9%) of low-SVI tracts and 37 (25%) of high-SVI tracts. Demographic characteristics remained consistent between the 2 years. Conclusions Gonorrhea rates increased in central Ohio between 2020 and 2021, with higher burdens in high-SVI census tracts. Understanding the dynamics of social vulnerability at the community level is crucial for targeting limited STD resources effectively. 08/08/2024 01:00 AM
 

Background National case rates of chlamydia and gonorrhea (CT/GC) among American Indian and Alaska Native (AI/AN) persons are disproportionately high. The Indian Health Service (IHS), which provides health care to members of federally recognized tribes, does not currently have a dedicated CT/GC surveillance system. The purpose of this study was to validate the use of CT/GC diagnostic codes for estimating diagnosed CT/GC infections among AI/AN persons who use IHS services. Methods We conducted a retrospective study using IHS medical records from all persons 15 years and older from 2016 to 2021. We linked records with CT (A56, A74) and GC (A54, O98.2) International Classification of Diseases, 10th Revision, Clinical Modification diagnostic codes to laboratory results within 30 days for each person. We calculated the sensitivity, specificity, and positive and negative predictive values of CT/GC diagnostic codes using laboratory test results as the reference standard. Results We identified more than 1.6 million CT/GC laboratory tests, and 52,815 CT and 19,971 GC diagnostic codes. Diagnostic code sensitivity was slightly higher for CT (54%) than GC (50%). Specificity, positive predictive value, and negative predictive value were high for CT and GC (range, 83.3%–99.8%). About one-third of CT/GC diagnostic codes could not be linked to a test result. Conclusions The validation indicates that diagnostic codes align well with linked laboratory test results. However, because of the relatively large number of diagnostic codes and positive test results that could not be linked, combining the 2 would inform more reliable estimates of diagnosed CT/GC infections among AI/AN persons who use IHS for health care. 08/10/2024 01:00 AM
 

Background Despite national testing guidelines, rates of testing for HIV, sexually transmitted infections (STIs), and hepatitis C remain lower than recommended for men who have sex with men in the United States. To help address this, the TakeMeHome (TMH) program was started in March 2020 by Building Healthy Online Communities, a consortium of public health organizations and dating apps, to work with health departments to increase access to HIV testing for men who have sex with men on dating apps. Methods Users of participating dating apps were sent messages about opportunities for testing with self-collected specimens through TMH. Program users were eligible to receive test kits if they lived in a participating zip code and were aged at least 18 years. Users who were interested in testing could order kits to be mailed to them for laboratory-based testing of HIV, hepatitis C, chlamydia, gonorrhea, and/or syphilis, depending on risk and availability in their zip code. Orders were sent via application programming interface to Molecular Testing Labs for fulfillment; kits were provided at no cost to the program user. Within approximately 24 hours of order receipt, Molecular Testing Labs mailed program users a kit with required collection supplies, directions, and a link to a video instruction for self-collection. Program users received an automated email after testing was complete with a link to access results through their online account. Individuals with positive results on any of the relevant tests were directed to additional information and to local providers for linkage to additional testing or treatment, depending on local protocols. Results The positivity rate of specimens processed through TMH was 1.4% for HIV, 0.6% for hepatitis C, and 2.9% for all STIs combined. The per-person positivity rate was 15.3% across all STIs. Conclusions The TMH program demonstrates that self-collected laboratory-processed testing is feasible and effective at identifying new HIV and STI cases. 08/01/2024 01:00 AM