Sexually transmitted infections (STIs) remain a significant global health burden. In Saudi Arabia, limited awareness, stigma, and inconsistent provider competence impede effective prevention and counseling. This study aimed to assess primary care physicians' (PCPs) competence and physician perceived barriers (attitudes) in STI prevention and counseling across Saudi primary care. A cross-sectional survey was conducted from July 2024 to July 2025 among PCPs in Saudi Arabia. Data were collected using a validated, self-administered electronic questionnaire through social media and official email lists. The survey collected sociodemographic data, STI-related practices (including risk assessment, counseling, and testing), and perceived barriers to care. Practices were scored as continuous variables using a 5-point Likert scale (Never to Always), while perceived barriers were assessed across five domains using a 5-point Likert scale (Strongly Disagree to Strongly Agree) and subsequently dichotomized into 'high' or 'low' based on the median score. Descriptive statistics summarized responses, and non-parametric tests evaluated group differences. Multivariable logistic regression was used to identify factors associated with higher practice scores, while logisitc regression identified predictors of high perceived barriers. Both models included age, gender, years of experience, practice sector, and number of STI patient consultations as independant variables and confounders. A total of 133 physicians participated (55% male, 45% female); most were aged 36-45 years (40%) and practicing in primary healthcare centers (38%) or governmental hospitals (35%). Training in STI counseling was most often obtained during residency (38%), though 12% reported no formal training. Clinical exposure was limited, with 51% managing 1-5 STI cases in the past six months. Mean scores were 2.59 for risk assessment, 3.76 for counseling, 3.75 for testing, and 3.64 for attitudes. Multivariable analysis revealed that the absence of recent clinical exposure to STI cases (managing zero cases in the past 6 months) was significantly associated with a lower risk assessment (β = -0.888, p = 0.0031), testing (β = -0.951, p = 0.0024), and attitude scores (β = -0.281, p = 0.0319). Counseling scores were significantly higher among physicians with 16-20 years' experience (β = 1.333, p 0.0108). PCPs in Saudi Arabia demonstrate moderate STI-related competence, with gaps in risk assessment and pervasive barriers to counseling. Targeted continuing education, structured training in sexual health, and standardized screening protocols are needed to enhance STI prevention and care in primary care settings.
Understanding the role of other sexually transmitted diseases (STDs) in the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in alterations of natural history, diagnosis, or response to therapy of STDs is critical to the development of optimal strategies for HIV control. One hundred sixty-three studies on the interrelationships between HIV infection and other STDs were examined. Of 75 studies on the role of STDs in HIV transmission, the 15 analyses of examination or laboratory evidence of STDs adjusted for sexual behavior showed that both ulcerative and nonulcerative STDs increase the risk of HIV transmission approximately 3- to 5-fold. Due to limited data, the role of STDs in progression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcers). If coinfection with HIV prolongs or augments the infectiousness of individuals with STDs, and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another. This "epidemiological synergy" may be responsible for the explosive growth of the HIV pandemic in some populations. Effective STD control programs will be essential to HIV prevention in these communities.
Despite its known effectiveness, pre-exposure prophylaxis (PrEP) remains underutilized, particularly among Black women who experience disproportionately high rates of human immunodeficiency virus (HIV). This quality improvement (QI) project evaluated the impact of a provider education intervention, combined with a culturally tailored patient educational video, on PrEP prescribing, uptake, and documentation at an urban sexually transmitted infections (STI) clinic in Detroit, Michigan. Using a pre-post design, data were collected for 3 months before and after implementation of the intervention. Among 549 eligible Black women, PrEP prescribing increased from 3.6% pre-intervention to 11.4% post-intervention (p = 0.001). Among a small sample, nearly one-third of post-intervention patients who were prescribed PrEP received the medication within 30 days, compared with zero pre-intervention. This difference did not reach statistical significance (p = 0.08), likely due to limited sample size, but may be clinically meaningful. Documentation using the recommended International Classification of Diseases, 10th Revision (ICD-10) code Z29.81 for PrEP-related encounters improved from 21.5% to 88.3% (p < 0.001). Multivariable logistic regression analyses showed that post-intervention encounters were independently associated with higher odds of PrEP prescribing within 7 days of the clinical encounter and higher odds of the recommended ICD-10 code Z29.81 being utilized for PrEP-related services. Findings suggest that combining culturally responsive strategies with patient and provider education may improve PrEP prescribing, uptake, and documentation practices. The intervention was successful in addressing persistent disparities while offering a scalable model for similar clinical settings.
Oral HIV pre-exposure prophylaxis (PrEP) users are generally screened for sexually transmitted infections (STIs) every 3 months. The need for such frequent screening is debatable. We compared STI diagnoses and associated care between PrEP users who underwent 6-monthly versus 3-monthly PrEP monitoring. We conducted a secondary analysis of the EZI-PrEP study- a 2 × 2 factorial randomized controlled trial examining 6-monthly versus 3-monthly and online versus in-clinic PrEP monitoring among men who have sex with men (MSM) and transgender or gender-diverse persons in the Netherlands (2021-2024). Participants were followed for 24 months. Scheduled PrEP monitoring included bacterial STI screening (i.e., Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis). Unscheduled STI testing in-between monitoring visits was permitted. This secondary analysis compared several outcomes between the 6-monthly and 3-monthly monitoring groups, using Poisson regression: (i) visit rates as number of visits per person-year (PY), (ii) STI detection rates as number of STI diagnoses per 100PY (to assess STI detection and potential (over)treatment), and (iii) STI positivity as number of STI diagnoses per 100 visits (as proxy for diagnostic delay). We stratified outcomes by visit type (i.e., scheduled/unscheduled) and adjusted for sexual behavior. 451 participants (99% MSM) were followed for median 22.7 months (IQR 19.2-23.8). Compared to 3-monthly PrEP monitoring, 6-monthly monitoring led to 31% fewer visits in total (rate ratio = 0.69, 95%CI = 0.64-0.74), but 67% more unscheduled visits (rate ratio = 1.67, 95%CI = 1.42-1.98). The STI detection rate was 18% lower in the 6-monthly monitoring group (adjusted rate ratio = 0.82, 95%CI = 0.70-0.95). STI positivity at PrEP monitoring visits did not differ between monitoring groups (6-monthly: 23.8 STIs/100 visits; 3-monthly: 23.2 STIs/100 visits; adjusted positivity ratio = 1.09, 95%CI = 0.90-1.30). Reduced-frequency PrEP monitoring resulted in fewer total clinic visits, but more self-initiated STI testing. Furthermore, fewer STIs were diagnosed during follow-up, yet the number of STIs detected per scheduled monitoring visit was similar between groups. These findings suggest that less frequent PrEP monitoring could reduce the burden of PrEP care and the number of STIs that are detected and treated, without leading to a substantial rise in STIs. The trial has been registered with ClinicalTrials.gov, trial number NCT05093036 (https://clinicaltrials.gov/study/NCT05093036).
To establish a rapid multiplex PCR capillary electrophoresis (MPCE) method for the simultaneous detection of seven sexually transmitted infection pathogens, and to evaluate its clinical utility. We designed specific primers and optimized multiplex PCR conditions. Capillary electrophoresis enabled fragment analysis. We assessed diagnostic performance, including sensitivity, specificity, anti-interference capacity, and repeatability. Using commercially available reagents as references, we evaluated the agreement of MPCE with 205 clinical samples. Kappa consistency test and McNemar test were used to evaluate the consistency and difference between this method and the reference methods. The detection system was successfully constructed, with a detection time of three hours. It enabled simultaneous detection of seven common genital tract pathogens, including Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Mycoplasma hominis (MH), Herpes simplex virus type 2 (HSV-2), and Ureaplasma parvum (UP). The method demonstrated good specificity and anti-interference capacity, with a limit of detection (LOD) ranging from 325 to 900 copies/mL across all targets. Repeatability results showed minimal fragment length fluctuations (0.13-0.20 nt), and the coefficient of variation (CV) for log peak area ranged from 0.78% to 5.56%. Agreement between the developed method and commercial reference assays was good for all seven pathogens: CT, 94.93% (Kappa = 0.84); MG, 95.12% (Kappa = 0.88); NG, 96.59% (Kappa = 0.91); UP, 95.61% (Kappa = 0.88); MH, 97.07% (Kappa = 0.82); HSV-2, 100% (Kappa = 1.00); and UU, 91.71% (Kappa = 0.69). The positivity rates of MG and NG detected by this method were higher than those by the reference methods (P = 0.008 and P = 0.011, respectively), and there was no statistical difference for the other pathogens (P>0.05). This study successfully established a MPCE-based assay for the simultaneous detection of seven common genital tract pathogens (CT, UU, MG, NG, MH, HSV-2, and UP) in a single reaction. The method demonstrated high sensitivity, excellent repeatability and strong agreement with commercial reference assays. With its high throughput and rapid turnaround time, this method is well-suited for clinical screening and large-scale epidemiological surveillance of genital tract infections.
BACKGROUNDFrom 1 March 2020, the Centre for Sexual Health Amsterdam limits presumptive treatment for chlamydia or gonorrhoea to clients notified by steady partners. Treatment after notification by non-steady partners requires a positive test result.AIMWe aimed to evaluate this change in policy on unnecessary antibiotic treatment, time to treatment and lost to follow-up clients.METHODSWe included consultations (with testing) following partner notification for chlamydia or gonorrhoea between 1 March 2017 and 1 March 2023. Primary outcome was unnecessary antibiotic treatment (presumptive treatment with negative test result) before vs after the policy change. We also assessed return for treatment of confirmed and not presumptively treated individuals after the policy change.RESULTSFrom 4,579 consultations, unnecessary antibiotics were prescribed for 786/1,318 (59.6%) clients for chlamydia and 729/1,117 (65.3%) clients for gonorrhoea before 1 March 2020. After 1 March 2020, this decreased to 324/1,275 (25%) and 341/1,369 (25%), respectively, corresponding to a relative reduction of 58% for chlamydia (adjusted relative risk (aRR): 0.42; 95% confidence interval (CI): 0.37-0.47) and 63% (aRR: 0.37; 95% CI: 0.33-0.42) for gonorrhoea. After the policy change, clients not given presumptive treatment but later diagnosed returned after a median of 7 days (interquartile range (IQR): 5-8) for chlamydia and 6 days (IQR: 4-7) for gonorrhoea. Missed treatment occurred in 4/155 (2.6%) of chlamydia and 5/158 (3.2%) of gonorrhoea consultations.CONCLUSIONThe new partner management protocol substantially reduced unnecessary antibiotic treatment for chlamydia and gonorrhoea. The majority of confirmed infections still received appropriate treatment.
Infectious diseases remain a major source of health loss, yet long-term, cause-comparable assessments that jointly integrate incidence, disability-adjusted life-years (DALYs), age patterns, and risk attribution for China are fragmented and not comprehensively synthesized within a unified framework. We aimed to evaluate the trends in incidence and DALYs of infectious diseases in China from 2000 to 2023 to inform current priority setting by clarifying long-term trends and changes observed during the COVID-19 pandemic. Data on the number and rate of incidence and DALYs of five major infectious-disease cause groups (HIV/AIDS and sexually transmitted infections, respiratory infections and tuberculosis, enteric infections, neglected tropical diseases and malaria, and other infectious diseases) and 40 specific infectious diseases in China were obtained from the Global Burden of Disease Study (GBD) 2023. Estimated annual percentage changes (EAPCs) in age-standardized incidence rates (ASIRs) and age-standardized DALY rates (ASDRs) were calculated overall and by sex and age group to quantify temporal trends from 2000 to 2023. We conducted comparative risk assessment using population attributable fractions (PAFs) to quantify risk-attributable DALYs, and decomposition analyses to assess the contributions of population growth, population ageing and epidemiologic change to changes in incident cases, deaths, and DALYs. Sensitivity analyses were also conducted to examine the robustness of the results. From 2000 to 2023, age-standardized DALY rates declined in four of the five major infectious disease cause groups in China. The largest decrease was observed for enteric infections, with DALY rates falling from 365.4 to 43.8 per 100,000 (EAPC -11.0% [95% CI -12.2 to -9.7]). Among all groups, respiratory infections and tuberculosis had the highest DALY burden throughout the study period, while their DALY rates decreased from 2559.5 to 688.1 per 100,000 (EAPC -8.1% [-9.2 to -7.0]). It's estimated that HIV/AIDS and sexually transmitted infections were the only cause group with an increasing DALY rate, rising from 79.7 to 103.7 per 100,000 (EAPC 1.0% [0.6 to 1.4]). The increase was greatest among adults aged 20-54 years, in whom DALY rates rose from 71.1 to 152.0 per 100,000 (EAPC 3.3% [2.7 to 3.9]). Risk attribution varied by cause and age group. Unsafe sex accounted for most DALYs for sexually transmitted infections excluding HIV and more than 70% of HIV/AIDS DALYs. For lower respiratory infections, child and maternal malnutrition accounted for 42.2% of DALYs in those aged < 20 years, whereas tobacco use accounted for 38.1% in adults aged 20-54 years. Enteric infection DALYs were mainly attributable to unsafe water, sanitation, and handwashing, accounting for more than 70% across age groups. Decomposition analysis showed that epidemiologic change was the main driver of changes in infectious disease burden from 2000 to 2023. China's infectious disease DALY burden declined from 2000 to 2023, but progress was uneven across causes and increasingly concentrated in older adults. Persistent incidence-DALY discordance and heterogeneous age-specific risk profiles indicate that current priority setting should move beyond incidence-led targets towards reducing preventable disability and premature mortality through age- and mechanism-tailored prevention and care. Prevention and Control of Emerging and Major Infectious Diseases-National Science and Technology Major Project.
ObjectivesThe purpose of this study was to determine the prevalence of type 2 diabetes, hypertension, and mental health conditions among female sex workers with HIV in Santo Domingo, Dominican Republic.MethodsWe conducted a cross-sectional survey, blood draw, and medical exam with women (n = 200) recruited by peer navigators. We determined prevalence and used multivariable logistic regression to assess the relationship between conditions.ResultsMean participant age was 46.1 years (SD: 9.15). Most participants (89.0%) were virally suppressed. Diabetes prevalence was 7.0% and hypertension was 63.0%. Nearly half reported moderate-to-severe depressive symptoms (46.0%) and over half (65.8%) anxiety. Women with moderate-to-severe depressive symptoms were over 4 times more likely to be virally unsuppressed (adjusted odds ratio [aOR]=4.17 [95% CI: 1.37-12.68]) and over 3 times more likely to have diabetes (aOR=3.45 [95% CI: 1.00-11.91]).ConclusionFindings indicate the need for holistic, integrated healthcare models to address multiple health conditions and support overall wellbeing. Understanding the Burden of HIV, Noncommunicable Diseases, and Mental Health Conditions Among Female Sex Workers with HIV in the Dominican RepublicPeople with HIV are aging and increasingly developing noncommunicable chronic diseases (NCDs), which are leading causes of death in Latin America and the Caribbean. We conducted a study with female sex workers with HIV in Santo Domingo, Dominican Republic to determine the prevalence of type 2 diabetes, hypertension, and mental health conditions. We used statistical analysis to describe the levels of each condition and determine the relationship between mental health conditions, viral suppression, and NCDs. Mean participant age was 46.1 years (SD: 9.15). Nearly all participants (89.0%) were virally suppressed. Diabetes prevalence was 7.0% and hypertension was 63.0%. Nearly half reported moderate-to-severe depressive symptoms (46.0%) and over half (65.8%) anxiety. Women with moderate-to-severe depressive symptoms were over 4 times more likely to be virally unsuppressed (adjusted odds ratio [aOR]=4.17 [95% CI: 1.37-12.68]) and over 3 times more likely to have diabetes (aOR=3.45 [95% CI: 1.00-11.91]). Findings indicate the need for holistic, integrated healthcare models to address multimorbidity and support overall wellbeing. Future research is needed to develop and test such models.
During the 2022 mpox outbreak, some LGBTQ+ populations in the United States experienced elevated risk, yet motivations for mpox vaccination remain unclear. This study examined whether mpox vaccination intent/uptake was associated with uptake or intent to vaccinate for other sexually transmitted vaccine preventable diseases (VPDs), including a future HIV vaccine, and whether mpox concern, HIV vaccination intent, and sociodemographic factors predicted mpox vaccination intent/uptake. LGBTQ+ adults in New Jersey and New York completed a cross-sectional web-based survey assessing vaccine behaviors and mpox-related attitudes. Individuals reporting the intent to vaccinate for HIV were more likely to report mpox vaccination intent/uptake, whereas uptake or intent for other sexually transmitted VPDs was not associated with mpox vaccination intent/uptake. In multivariate models adjusting for sociodemographics, higher mpox concern, greater HIV vaccination intent, and employment were associated with higher odds of mpox vaccination intent/uptake. Findings suggest that mpox and HIV vaccination intentions may reflect shared, outbreak-specific prevention orientations shaped by heightened risk.
Chlamydia trachomatis (C. trachomatis) is the most commonly reported bacterial sexually transmitted infection among sexually active women. Although often asymptomatic or associated with non-specific clinical manifestations, it can cause inflammatory exudates and encapsulated fluid collections that are similar to adnexal masses on imaging. In rare cases, it may also present with massive ascites, a constellation of findings that may mimic ovarian malignancy. We report the case of a 32-year-old female with a nearly 3-month history of abdominal pain, adnexal masses and massive ascites. The initial workup did not reveal obvious evidence of infection and cytological examination showed no malignant cells. However, advanced gynecological originated cancer could not be fully excluded. Metagenomic next-generation sequencing (mNGS), which detected C. trachomatis in ascitic fluid, facilitated the diagnosis. The patient showed satisfactory clinical improvement following doxycycline treatment. For young, sexually active women presenting with unexplained ascites and adnexal masses, after excluding malignancy and common infectious diseases such as tuberculosis, C. trachomatis infection should be considered. Modern etiological detection methods, such as mNGS, can be employed to facilitate the diagnosis.
Globally, gonorrhea remains a common sexually transmitted infection that can lead to serious sexual and reproductive health complications if left untreated. Management has become more challenging due to the rapid progression of antimicrobial resistance in Neisseria gonorrhoeae. Currently, ceftriaxone-based regimens continue to be the standard treatment; however, the sudden demand for new treatment options is highlighted by concerns regarding resistance, the requirement for intramuscular administration, and the declining effectiveness of azithromycin. This review aims to evaluate the emerging role of zoliflodacin in the treatment of gonorrhea, with an emphasis on its potential to serve as a resistance-focused alternative, its oral administration, and its novel antimicrobial target. A narrative literature search was conducted using PubMed, Google Scholar, and Scopus to identify relevant studies published between 2016 and 2026. Randomized clinical trials, systematic reviews, narrative reviews, and international guidelines from the WHO, ECDC, and CDC were included. Literature selection was guided by SANRA. A single 3-g oral dose of zoliflodacin appears to exhibit high microbiological cure rates for uncomplicated urogenital and rectal gonorrhea, and it is not less effective than ceftriaxone plus azithromycin for urogenital infections, according to Phase 2 and recent global Phase 3 clinical trials, which reported mild gastrointestinal side effects. Its mechanism of action provides limited evidence of resistance and is effective against multidrug-resistant Neisseria gonorrhoeae. Zoliflodacin represents a potentially effective oral alternative to the current ceftriaxone-based regimen for gonorrhea. With routine observation and careful stewardship, these findings may contribute significantly to the expansion of future treatment strategies.
BackgroundFemale sex workers (FSWs) in sub-Saharan Africa (SSA) face higher risks of unintended pregnancies and sexually transmitted infections, including HIV. This risk can be reduced with correct and consistent use of dual contraception, defined as the concurrent use of a barrier method together with another modern contraceptive methods. However, there are limited and fragmented data on the prevalence and factors associated with dual contraception use among FSWs in SSA.ObjectivesOur systematic review and meta-analysis aimed to determine the pooled prevalence of dual contraceptive use and HIV infection prevalence among FSWs in the high HIV-burden settings of SSA.DesignA systematic review and meta-analysis.Data sources and methodsWe conducted a comprehensive search of PubMed, MEDLINE, EMBASE, Web of Science, and African Journal Online, from January 1980 up to October 2023. We also reviewed bibliographies of relevant articles to find additional studies. Only observational and interventional studies reporting dual contraceptive use among FSWs in Africa were included, while reviews, case reports, and case series were excluded. Two reviewers evaluated study quality using the modified Newcastle-Ottawa Scale. Data on dual contraceptive use, contraceptives methods, associated factors and HIV prevalence were extracted and analysed using random-effect or fixed-effect meta-analysis models to calculate the pooled prevalence estimates defined as combined average estimates across studies.ResultsWe included 11 studies, involving a total of 127,059FSWs from eight countries in SSA. HIV prevalence ranged from 1-55% across studies, with a pooled prevalence of 24% (95% confidence interval (CI): 14-35%, I2 = 99.57%, p<0.001). Dual contraception prevalence ranged from 3.8-66.2% across studies, with a pooled prevalence of 26% (95% CI: 12% - 39%, I2 =99.9%, p<0.001). The most frequently reported contraceptive method were condoms (n=41,200,32.1%) and oral contraceptive pills (n=20,735, 16.5%), followed by injectables (n=6,349, 5.1%), Implants (n=5,430, 4.3%) and intrauterine device (n=601, 0.5%).ConclusionsDual contraceptive utilization remains sub-optimal among FSWs in SSA, with fewer than one in three FSWs utilising this essential reproductive health strategy. Moreover, HIV prevalence remains high in this population. Targeted strategies to improve utilisation of dual contraception among this marginalised population is needed to reduce the risks of unintended pregnancies, HIV infection and other STIs and their negative impacts on FSWs, their clients, families and the entire healthcare systems.
Despite the transformative impact of direct-acting antivirals (DAAs) on hepatitis C control, acute/recent hepatitis C virus (HCV) infections continue to be diagnosed in contemporary clinical practice. We describe acute/recent HCV cases diagnosed at a tertiary hospital in Madrid among men who have sex with men (MSM), including people living with HIV (PLHIV) and pre-exposure prophylaxis (PrEP) users. We conducted a retrospective, single-centre descriptive study including acute/recent HCV cases reported between January 2023 and January 2025. Cases were defined by detectable HCV RNA following a previously negative HCV serology or after a cured HCV infection (reinfection). Chemsex was defined as intentional use of psychoactive substances in sexual contexts; slamsex as injecting drugs in sexual contexts. Patients initially managed with watchful waiting were reassessed at 12 weeks to assess spontaneous clearance. Ninety-two cases were included; median age was 43 years (IQR 36-52) and 24 (26.1%) were >50 years. In total, 91 out of 92 (98.9%) were MSM; 70 (76.1%) were PLHIV and 19 (20.7%) were PrEP users. Among 84 patients with genotype data, 55 (59.8%) had genotype 1a, 8 (8.7%) 1b, and 21 (22.8%) genotype 4. HCV RNA was >6 log in 41 (44.6%) and >7 log in 18 (19.6%). Chemsex was reported by 72 (78.3%); among them, 38 (52.8%) reported slamsex. Among those with available data, 17 out of 54 (31.5%) had another sexually transmitted infection. Watchful waiting was initially adopted in 73 (79.3%); 5 out of 73 (6.8%) achieved spontaneous clearance at 12 weeks. Of those observed, 68 (93.2%) initiated DAAs; 9 (9.8%) were treated at diagnosis. Ten (10.9%) were lost to follow-up before treatment initiation; sustained virological response was achieved in treated patients. Acute/recent HCV diagnoses occurred predominantly among MSM, including PLHIV and PrEP users, with frequent reporting of chemsex/slamsex. Low spontaneous clearance and losses before treatment initiation highlight the need for targeted HCV testing and linkage to care in HIV/PrEP and sexual health services, alongside harm reduction and substance use support.
Human T-cell leukemia virus type 1 (HTLV-1) and simian T-cell leukemia virus type 1 (STLV-1) primarily infect CD4+ T-cells and spread via cell-to-cell contact in vivo. However, the mechanism underlying viral establishment and persistence in local tissues remain poorly understood. From the perspective of sexually transmitted infections, this study aimed to visualize the infection status of the genital epithelium in relation to sexual STLV-1 infection before and after menopause. In this study, we evaluated viral localization in the genital epithelium of naturally infected female Japanese macaques with STLV-1, which is highly homologous to HTLV-1. A marked increase in the proviral load (PVL) of STLV-1 was observed in both the vaginal epithelium and peripheral blood in post-compared with premenopausal individuals. Immunostaining showed the expression of glucose transporter 1 (GLUT1), a receptor for HTLV-1, in the basal layer of the vaginal epithelium. Additionally, in situ hybridization revealed strong expression of the viral accessory factor SBZ, the STLV-1 homolog of HBZ, relative to the pX region, which contains the Tax and Rex genes within the vaginal epithelium, indicating its involvement in latent infections at that site. In postmenopausal macaques, thinning of the vaginal epithelium was observed in association with decreased estradiol levels. Furthermore, more diverse and unique clones were identified in the vaginal epithelium of postmenopausal macaques than in peripheral blood mononuclear cells. These findings highlight the vaginal epithelium may serve as a site for the maintenance of persistent and de novo STLV-1 infections within the genital tract.
Point-of-care (POC) testing for chlamydia and gonorrhea has seen significant advancements, with nucleic acid amplification tests yielding results within 30 min. The aims of this study were to: (1) describe implementation of POC nucleic acid amplification testing in urban non-clinical outreach settings, and (2) explore demographic and symptom correlates of test positivity to inform testing strategies. A program evaluation and retrospective data review was conducted of individuals undergoing POC sexually transmitted infection (STI) testing in non-clinical testing sites in Dallas, Texas, USA. Chi-squared and Fisher's exact tests were used to investigate the association between positive test results with demographic characteristics and presence of symptoms. Ninety-eight individuals were tested using the binx io CT/NG Assay. There were 12 cases of chlamydia and 5 cases of gonorrhea diagnosed within 30 min of testing, and all were referred for treatment within 1 day of testing. No statistically significant associations were detected between test positivity and demographics or symptoms; however, analyses were limited by small sample size. POC nucleic acid amplification testing enabled rapid diagnosis and referral in this urban outreach setting. Further evaluation of scalability, cost and treatment completion is warranted.
Despite the human papillomavirus (HPV) vaccine being available to males for the past 12 years, adolescent males continue to lag in HPV vaccine uptake due to a variety of factors. With the ubiquitous nature of social media use among this population, further research is needed to improve HPV vaccine confidence among young adolescent males using these platforms. Using the Elaboration Likelihood Model (ELM), this study sought to better understand knowledge, attitudes, and beliefs about HPV and HPV vaccination among male adolescents aged 14-17 years and examine how social media messaging influences vaccine perceptions and explore the characteristics of persuasion and trustworthiness of digital content narratives across age and vaccination status. The study team recruited 18 adolescent males to participate in a series of online focus groups and interviews stratified by age (14-15 years and 16-17 years) and HPV vaccination status. The study team worked with our in-house national probability survey panel, AmeriSpeak Teen Panel, to recruit for the discussion groups and interviews. All discussions were recorded, transcribed, and coded using NVivo 14 (Lumivero). ELM was used to develop discussion guides, codebook, and analysis. Emergent themes were identified, and the full team participated in double-coding and analysis. Data were analyzed using rigorous thematic analysis to identify patterns across groups. Knowledge of HPV varied by age and vaccination status. Older, vaccinated adolescents were more likely to understand that HPV affects both genders and is sexually transmitted, whereas younger, unvaccinated adolescents often had little to no prior awareness. Parents-especially mothers-were the primary decision-makers for vaccinated adolescents, with older adolescents more likely to be engaged in that decision. Trust in social media health messages was low overall, with participants relying on perceived source credibility over content format or style. Trusted sources included parents, physicians, and well-known health organizations. Younger adolescents were more influenced by personal anecdotes, whereas older adolescents preferred statistics, facts, and reliable sources. Our findings highlight the importance of tailoring HPV vaccine messaging by age and developmental stage. Trusted messengers, clear factual content, and platform appropriateness are critical for engaging adolescent males. ELM provides a useful lens for interpreting these findings: younger adolescents were more influenced by peripheral cues, personal stories, or visual appeal, whereas older adolescents engaged in more central processing, evaluating the credibility of the source and the factual content of the message. This underscores the need to match message strategies with adolescents' cognitive and motivational readiness. Future interventions should consider dual strategies targeting both youth and parents, especially for younger adolescents. As the digital landscape continues to evolve, further research should also examine how generative artificial intelligence (AI) may serve as a trusted source or tool for communicating accurate, engaging health information to adolescent audiences.
Sexually transmitted infections (STIs), including HIV and syphilis, are increasing. In 2023, there were over 2.4 million reported cases of chlamydia, gonorrhea, and syphilis in the United States, a 32.5% increase from 2014. Emergency departments (EDs) are vital touchpoints for STI testing, yet HIV and syphilis testing among patients undergoing Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) testing is suboptimal. We aimed to determine testing frequency and to identify factors associated with HIV and syphilis co-testing among ED patients undergoing NG/CT testing. We conducted a retrospective observational study of all patients tested for NG/CT from 2021-2024 at two Los Angeles EDs. Covariates including sociodemographic and behavioral data were extracted from the medical record. The primary outcome was complete STI testing, defined as both HIV and syphilis testing during or up to six months prior to an ED encounter with NG/CT testing. Multivariable logistic regression was used to evaluate factors associated with complete STI testing. Of 3,940 patients, 459 (11.7%) received complete STI testing. Among patients receiving complete STI testing, 176 (38.3%) were female, 282 (61.4%) were male, 96 (20.9%) were Hispanic, 98 (21.4%) were non-Hispanic Black, 195 (42.5%) were non-Hispanic White, 220 (47.9%) had Medicare insurance, 132 (28.8%) had private insurance, 225 (49.0%) were experiencing homelessness, 14 (3.1%) identified as bisexual, and 90 (19.6%) identified as heterosexual. In multivariable analysis, patients who were bisexual (adjusted odds ratio [aOR] 2.51; 95% CI, 1.32-4.80; P = .005); had Medicare insurance (aOR 1.89; 1.20-2.98; P = .006); or were experiencing homelessness (aOR 5.21; 4.00-6.78; P < .001) had higher odds of complete STI testing. Patients who were Hispanic (aOR 0.69; 0.52-0.92; P = .01); non-Hispanic Black (aOR 0.75; 0.56-1.00, P = .05); or female (aOR 0.68; 0.54-0.85; P = .001) had lower odds. Of 261 patients with multiple ED encounters, 217 (83.1%) never received complete testing. Complete HIV and syphilis testing among ED patients tested for N. gonorrhoeae and C. trachomatis was low, even among patients with multiple ED encounters. Lower testing among Hispanic and non-Hispanic Black patients may exacerbate existing disparities in STIs. Implementation research is needed to improve the integration of STI testing in EDs.
Testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is indicated for diagnostic purposes in symptomatic individuals and for screening purposes in certain populations including sexually active females younger than 25 and partners of individuals who test positive. Using 2023 insurance claims data from 2 million US individuals in the Marketscan database with commercial insurance or with Medicaid, we quantified rates of CT/NG testing and patterns of co-ordering of tests for additional infections. We assessed variation in testing rates and patterns using mixed effects logistic regression models. The overall testing rate for CT/NG in 2023 was 23.7% (23.4-24.0%, 95% CI) in females 16-24 and 6.9% (6.7-7.1%) in males 16-24; rates were lower in older males and older females. Among females 16-24 with at least one outpatient ObGyn visit, the testing rate was only 56%. Testing rates varied by US state with a median odds ratio of 1.34 in females 16-24. Symptomatic females tested for CT/NG were also tested for Trichomonas vaginalis, Mycoplasma genitalium and HSV in 62%, 6% and 4% of cases, respectively. Patterns of test co-ordering varied widely by reason for testing and specific provider. CT/NG testing rates were low. Differences between rates of testing and sexual activity in females under 25 suggest guideline non-adherence (sexual activity estimated based on our analysis of NHANES survey data and prior literature including Halpern, 2012 and Rimsza, 2005). Wide geographic and interprovider variation in testing patterns argues for improved testing systems and practice.
Spouses and partners play a crucial role in the well-being of women living with HIV (WLWH), especially in family-oriented cultures. This scoping review examined partner-inclusive interventions to strengthen support systems for WLWH. We searched PubMed, Embase, and the Cochrane Library for peer-reviewed studies from 2004 to 2024. Of 1,375 records screened, six randomized trials conducted in the U.S., China, Ethiopia, and sub-Saharan Africa met the inclusion criteria. Four involved WLWH-partner dyads, two included other family members. Interventions varied in format and were facilitated by health care/social service providers and peer leaders. Most interventions were theory-driven and used psychosocial and behavioral strategies. Positive outcomes included improved medication adherence, HIV knowledge, safe sex behaviors, mental/physical health, gender norms, partner relationships, and coping behaviors. However, gaps remain, notably the lack of approaches addressing power imbalances within the dyad. Future research should consider culturally tailored interventions that emphasize gender empowerment and shared decision-making.
Globally, over 37.9 million people are living with human immunodeficiency virus (PLWHA), with significant proportion developing cutaneous manifestations. Fungal dermatoses are common in PLWHA; their prevalence largely influenced by the immunosuppression caused by the virus. The introduction of highly active anti-retroviral therapy (HAART) has changed the epidemiology of these infections. However, there is limited data on how HAART impacts the prevalence and patterns of fungal dermatoses in PLWHA. This study investigates the effect of HAART on the prevalence and severity of fungal dermatoses in PLWHA. This comparative cross-sectional study was conducted at the University of Benin Teaching Hospital (UBTH), Benin city, Nigeria, involving 150 HAART-experienced and 150 HAART-naïve patients. Prevalence and severity of fungal dermatoses were assessed through clinical examination and laboratory investigations. Data was analyzed using SPSS version 25, with significance set at P < 0.05. Mean age of HAART-experienced group was 45.02 ± 11.23 years, while the HAART-naïve group had 42.62 ± 12.22 years. There was statistically significant difference in the CD4 count ( χ ² = 77.99, P < 0.0001) and prevalence of fungal dermatoses ( χ ² = 5.47, P < 0.02) between the two groups; with 14% of the HAART-experienced group and 24.6% of the HAART-naïve group affected. Additionally, severity of fungal dermatoses was significantly lower in the HAART-experienced group, with fewer cases of severe infection (23.8% vs. 54.1%, P < 0.02). HAART reduces the prevalence and severity of fungal dermatoses in HIV-infected patients, likely due to improved immune function. This highlights the benefits of HAART in managing HIV-related fungal infections and underscores the importance of early initiation of therapy.