Effectiveness of Incentivized Peer Referral to Increase Enrollment in a Community-Based Chlamydia Screening and Treatment Study Among Young Black Men.

OBJECTIVES: Young Black men are under-represented in sexual health services and research, a condition likely magnified during COVID-19 shutdowns due to disruption of STI screening and treatment services. We examined the effect of incentivized peer referral (IPR) increasing peer referral among young Black men in a community-based chlamydia screening program. METHODS: Young Black men in New Orleans, LA, age 15-26 years enrolled in a chlamydia screening program between 3/2018 and 5/2021 were included. Enrollees were provided with recruitment materials to distribute to peers. Starting July 28, 2020, enrollees were also offered a $5 incentive for each peer enrolled. Enrollment was compared before and after the incentivize peer referral program (IPR) was implemented using multiple time series analysis (MTSA). RESULTS: The percentage of men referred by a peer was higher during IPR compared to pre-IPR (45.7% vs. 19.7%, p < 0.001). After the COVID-19 shutdown was lifted, there were 2.007 more recruitments per week (p = 0.044, 95% CI (0.0515, 3.964)) for IPR, compared to pre-IPR. Overall, there was a trending increase in recruitments in the IPR era relative to the pre-IPR era (0.0174 recruitments/week, p = 0.285, 95% CI (- 0.0146, 0.0493)) with less recruitment decay during IPR compared to pre-IPR. CONCLUSIONS: IPR may be an effective means of engaging young Black men in community-based STI research and prevention programs, particularly when clinic access is limited. CLINICAL TRIALS REGISTRY SITE AND NUMBER: Clinicaltrials.gov identifier NCT03098329.

50. Creating Adolescent-centered Sexual and Reproductive Care for a Mobile Health Unit

Purpose: Exacerbated by the COVID-19 pandemic, adolescents from structurally marginalized communities face barriers to accessing sexual and reproductive health (SRH) care. Mobile health units (MHUs) may be effective in reaching these adolescents but few studies have assessed their feasibility in this population. Methods: We assessed the feasibility of an MHU to provide SRH care to adolescents in community settings. Adolescents were invited to community demonstrations of hypothetical MHU care ("Demonstration events”). Adolescents completed surveys (demographics, likelihood of future MHU-based care, and access to health care) and staff documented field notes. We then partnered with adolescents, health care providers, and community leaders to create adolescent-centered SRH care for MHU delivery ("Clinical events”). Free and confidential services provided on the MHU included contraceptive care, condoms, testing for pregnancy, Neisseria gonorrhea (GC), Chlamydia trachomatis (CT), Syphilis, and Human Immunodeficiency virus (HIV). Initially, we provided electronic prescriptions for contraception during MHU visits. We later designed a system to dispense contraception [I.e., emergency contraception (EC) for future use, combined hormonal oral contraceptives (CHOCs), patches and Medroxyprogesterone] in the MHU. After MHU care, adolescents completed surveys to report satisfaction while staff documented feedback through field notes. Results: At 8 community "Demonstration events”, 98 teens (mean age 15.8 years, 67% female at birth, 17% Genderfluid/Non-Binary/Trans, 49% heterosexual, 24% Hispanic, 49% Black, 40% White) were enrolled. Most (70%) reported no previous vaginal/penile sex. Many (46%) had forgone needed health care in the previous year. Most (77%) said they were very/somewhat likely to get care on the MHU if available in the future and 82% would recommend it to friends. Most thought the MHU would be a great way to increase access to SRH care because it eliminated transportation obstacles and appointment delays. Many felt the MHU would provide adequate privacy and advised bringing the MHU to school or community events. Teens recommended collecting urine specimens in nearby restrooms and using a brown bag to transport them to the MHU. Utilizing their feedback, we partnered with teen-serving community organizations and schools to host the MHU. At two "Clinical events”, we provided care for five patients (4 biologic females, 1 biologic male). Accepted health services included condom provision (n=5) and, pregnancy (n=3), GC/CT (n=4), and Syphilis/HIV (n=2) testing. Two MHU patients received contraceptive prescriptions, one received contraception onsite (EC and CHOCs), and one with a positive CT test was contacted and treated. Four adolescents completed a post-care survey. All (100%) were very satisfied with MHU care and said they would recommend it to a friend. All (100%) agreed/strongly agreed they learned something new about SRH and reported the information was helpful. Field notes revealed patients communicated appreciation for the care, felt comfortable on the MHU, and found school-based SRH care acceptable. We plan to host five additional MHU "Clinical events” (Fall 2022). Conclusions: As COVID-19 continues to negatively impact adolescent SRH care-seeking, our work offers key insights to customizing MHU-based SRH care to meet the unique needs of adolescents from structurally marginalized communities. Sources of Support: Institutional expansion of NIH-funded KL2 program (RB), 3R21HD098086-02S1 (MM), K23HD098299 (KM).

Sexually transmitted infections (STIs) diagnostics in Lithuania

In Lithuania, various clinicians (general practitioners, urologists, g ynaecologists, dermatovenereologists, infectionists, etc.) diagnose and treat STIs. Therefore it's important to make updated STI management guidelines available for all health care specialists to designate adequate laboratory diagnosis and timely initiate appropriate treatment. From 2010-2020, the reported cases of syphilis ranged from 10.3 to 2, chlamydial infection 11.0 to 6, and gonococcal infection 9.4 to 1 per 100,000 inhabitants. After the coronavirus pandemic, syphilis cases increased, but the numbers of chlamydial, gonococcal, and mycoplasmal infections remained similar. A data review of the Hospital of LUHS Kauno Klinikos shows that in 2021, there were twice as many registered syphilis cases compared to 2020 or 2019. IUSTI guidelines on bacterial STI management are being adopted at a national level and distributed among clinicians through publications in the journal Lithuanian General Practitioner. Though theoretically, there are no major discrepancies concerning diagnostics and treatment schemes, in practice there are some inequalities in the country of the performing laboratory diagnostics for different STI microorganisms. The international guidelines on the organization of consultation for STIs indicate the necessity to offer all patients testing for syphilis, Chlamydia trachomatis, Neisseria gonorrhoeae (NAAT), and HIV. But in rural districts, the main test for STIs is genital smear microscopy in a laboratory as the primary level where most patients with STIs are processed have no laboratory facilities to determine the etiological agents by performing NAATS. First choice antibiotics for the treatment of Syphilis, Chlamydia trachomatis, and Mycoplasma genitalium are acceptable and being prescribed for patients. Uncomplicated gonorrhoeae treatment goes with chinolones more often than ceftriaxone because of the inconvenient organization of the administration of the latter. CONCLUSIONS. In Lithuania, the international guidelines on STIs diagnostics and treatment are followed in University hospitals considering all its aspects but at the district level, discrepancies in the adherence to it are common.

Case report: post-Covid-19 arthritis and peri arthritis

We present the case of a 63 years old male patient known for type 2 diabetes and sleep apnoea. He was admitted as inpatient for a nontraumatic severe and disabling left hip pain. The pain started progressively one month ago. The medical history was otherwise irrelevant, with no general symptoms nor other symptoms suggestive of an inflammatory disease. To mention a history of an asymptomatic SARS-COV2 infection, diagnosed by a naso-pharyngial PCR, approximately 10 days before the onset of the pain. On physical examination, the patient was afebrile. The palpation of the inguinal region was tender on palpation with marked limitation of the hip range of motion. The spine and other peripheral joints were painless without inflammatory sign. Moreover, there was no skin lesion nor inguinal lymph nods enlargement. Due to the importance of pain with marked functional limitation, the patient is hospitalized for investigations and pain-management. On blood sample there was a mild increase of inflammatory markers (CRP 25mg/l, VS 20mm/h) with normal cell count. Standard X-rays of the pelvis and hip were normal. The MRI of the hip showed a mild coxo-femoral arthritis with marked inflammation of the surrounding musculature. An arthrocentesis was performed and 2ml of serous fluid was aspirated. There were no crystals. The cellularity could not be tested due to small amounts of fluid. The synovial culture showed a polymicrobious growth compatible with contamination. In summary, we were facing a patient with an acute and very painful hip monoarthritis. There was no history of gastrointestinal or urinary tract infection, the search for C. trachomatis and N. gonorrhoea in urines was negative. An extensive serologic testing (HIV, HBV, HCV, HBV, HCV, HIV, Lyme, Syphilis, Coxiella, Bartonella, Brucella & Quantiferon) and the search for T. whipplei were negative as well. There was no HLA-B27 and rheumatoid factor, ACPA, ANA, ANCA and specific antibodies related to polymyositis were negative. The chest-abdomen-pelvis scan showed no sign of neoplasia. To rule out a vasculitis we proceeded to a PET-CT, which showed no sign of vasculitis or myositis. Considering the timing of the onset of the symptoms and the absence of any other diagnosis, the patient was diagnosed with reactive arthritis caused by SARS-COV2. The patient was treated with Diclofenac 150 mg/day and opioids. The clinical evaluation one month after discharge showed a spontaneous significant improvement.

Summary of the 31st meeting of the international task force for disease eradication, 20-21 October 2020

This article provides a brief overview of the 31st meeting of the International TaskForce for Disease Eradication (ITFDE) that was convened at The Carter Center in Atlanta, GA, USA on 20-21 October 2020 to discuss "The impact of the COVID-19 pandemic on eradication and elimination programmes and the way forward." It highlights the results of 7 eradication programmes, with specific conclusions and recommendations for each: Guinea Worm Eradication Programme(dracunculiasis;GWEP);Global Polio Eradication Initiative (GPEI);elimination programmes for measles and rubella (MR), malaria, river blindness (onchocerciasis;RB), and lymphatic filariasis (LF);and the program for the Global Elimination of Trachoma.

THE PATTERN of POST COVID-19 REACTIVE ARTHRITIS

Background: According to the recent medical literature, COVID-19 disease can lead to a constellation of clinical syndromes lasting well beyond the frst 30 days of infection. The most common post COVID sequalae includes pulmonary, nervous system and neurocognitive, mental, metabolic, cardiovascular, gastrointestinal and several other clinical manifestations. Regarding joint involvement and particularly reactive arthritis (ReA), literature data is limited and describes case reports or series of cases of patients diagnosed with this condition following COVID-19 disease. Objectives: To describe the pattern and the management of post-COVID reactive arthritis. Methods: We have conducted a descriptive study of consecutive adult patients who presented to rheumatology outpatient clinic for joint or peri-articular pain/swelling/stiffness and received a diagnosis of post-COVID 19 reactive arthritis, by excluding other types of rheumatological conditions. The assessed clinical variables were: visual analogue scale (VAS) pain, swollen joint count (SJC), tender joint count (TJC), duration of morning stiffness, presence of enthesitis/tendinitis and axial involvement. Biochemistry and serology was performed: rheumatoid factor, ACPA, ANA, HLA B27, antiChlamydia Trachomatis, Ureaplasma Urealyticum and Mycoplasma Hominis Ab, anti HBs and HBc Ab, and anti HCV. COVID-19 disease prior to diagnosis of ReA was confrmed by PCR test. Results: In the study were included 16 patients with confrmed post COVID-19 ReA. The mean age of the study group was 43.5±10.8 (range 21-60), the female: male ratio was 4:1 and the duration of joint symptoms was 10.4±11.8 (range 1-42) weeks. The severity of COVID-19 disease was mild in 68.7% cases, moderate in 18.7% and severe in only 6.2% of the cases. The duration between COVID-19 diagnosis and ReA varied between cases, with a mean value of 4.3±4.2 (range 1-12) weeks. In 43.7% of the cases patients had peripheral joint involvement (synovitis), in 37.5%-periarticular involvement (enthesitis), 6.25%-isolate axial involvement (sacroiliac joints), 6.25% enthesitis and axial involvement (cervical spine) and 6.25% synovitis and enthesitis. In patients with peripheral joint pattern, the distribution of pain was symmetric (71.4%). The pattern of synovitis was determined by a TJC of 6.25±5.2 (range 1-16) joints and SJC 1.6±2.4 (range 0-7) joints. Both TJC and SJC correlated positively with the duration of morning stiffness (r=0.9 and r=0.6), but did not correlate with the VAS pain scale. In most of the cases synovitis affected the hand (wrist, MCP and PIP) 62.5% and the knee, feet and ankles-50%. Two patients presented with monoarthritis, 1 with oligoarthritis and 5 with polyarthritis, in the majority of cases, involvement being symmetric (75%). Periarticular pattern was determined by enthesi-tis, affecting the elbow and shoulder (50%), costo-sternal enthesitis (25%) and trochanteritis (25%). From the entire study group, 31.2% had elevated serum infammatory markers (ESR and/or CRP). Patients responded well to NSAIDs alone in 68.7% cases, local (intra-articular or peri-articular infltrations) or and systemic corticoids (5 mg Prednisolone equivalent) were administered in 5.3% and 12.5% cases respectively, in 12.5% cases (two patients) Methotrexate was administered. Conclusion: Reactive arthritis represents a post COVID-19 sequelae. The time of onset of ReA varied between 1 and 12 weeks after COVID-19 diagnosis. The clinical pattern of the disease was expressed by joint or periarticular involvement, mainly affecting the hand, feet and knee symmetrically. Cases of axial manifestations were less common. Most of the patients responded well to NSAIDs, only in a few particular cases, low doses of corticoids and/or Methotrexate were recommended.

Protecting Their Privacy: Teenagers & Telemedicine

Introduction: Telemedicine utilization has grown exponentially since the start of the COVID-19 pandemic. Virtual encounters provided a safe platform to continue patient care while mitigating the spread of COVID-19. However, we present a case that highlights the limitations and challenges of telemedicine, especially amongst sexually active teenagers. Case Description: A 15-year-old female presented to the ED with worsening abdominal pain and new onset bilious emesis. Six weeks earlier, she developed diarrhea and abdominal pain which was diagnosed as C. diff colitis. During this time, she had 10 virtual encounters between her pediatrician and GI team. Antibiotics were completed for C. diff with partial improvement, but were restarted after symptoms returned. She also reported vaginal discharge that was treated empirically with antifungals. Given the onset of bilious emesis and acute worsening abdominal pain, she was directed to the ED. She tested positive for COVID-19 and computed tomography of the abdomen/pelvis showed a partial small bowel obstruction (SBO). The first HEADSS exam during this illness was done on admission;she initially denied recent sexual activity. However, when expectations around confidentiality were clarified, she disclosed sexual intercourse ten weeks ago. Chlamydia trachomatis testing was positive and diagnostic laparoscopy for her SBO revealed diffuse adhesive disease consistent with pelvic inflammatory disease (PID) and Fitz-Hugh-Curtis syndrome. Adhesions were successfully lysed, she was started on appropriate antibiotics, her abdominal pain resolved and she was discharged home. Discussion: Telemedicine allows patients access to their physicians with the click of a button. It can prevent delays in diagnosis that would otherwise occur due to the inability to come into the clinic or hospital. However, managing patients through telemedicine can be challenging;this case highlights some of the difficulties. Firstly, there is no physical exam to aid diagnosis. It can also be difficult to discuss sensitive issues over video. Even during inperson visits, confidentiality remains an important yet challenging component for adolescents. With the added component of telemedicine and more family members at home, teen privacy may be at risk and needs to be confirmed during every encounter. Despite the ease, telemedicine must be carefully utilized to ensure adequate adolescent sexual healthcare and confidentiality. Conclusion: This case illustrates a rare presentation of SBO caused by PID in an adolescent female and should remind clinicians to approach abdominal pain in a sexually active adolescent with a broad differential. Moreover, the increased utilization of telemedicine during the COVID-19 pandemic creates opportunities for patient care, though comes with its imperfections. As telemedicine is here to stay, pediatricians must recognize these current limitations to avoid delays in diagnosis and care. (Figure Presented).

RAPID POINT-OF-CARE DIAGNOSIS OF CT/NG USING EXPAR DNA AMPLIFICATION COUPLED TO A NOVEL OPTICAL DETECTION SYSTEM

Introduction The Covid-19 pandemic has dramatically accelerated the point of care (POC) landscape, increasing awareness and demand for rapid diagnostics of other diseases. STIs are a major current health issue, with Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) being highly prevalent. Current diagnostic methods are not POC and the most rapid takes around 20 mins. We have developed a new molecular assay, taking < 10 minutes for a diagnostic result, and combined it with a novel, rapid detection mechanism to produce a fully integrated POC device. Methods Our assay will make use of the exponential amplification reaction (EXPAR), a rapid isothermal DNA amplification technique, to produce an output detectable by Linear Dichroism (LD). LD is a highly sensitive optical detection technique, relying on exploiting structural properties of a scaffold such as M13 bacteriophage. Adapting EXPAR and combining it with a DNA sensitive LD assay allows detection of specific DNA sequences, signalling the presence of CT and/or NG. A principal advantage of our system is it allows multiplexing on the same detection scaffold. Results Initial clinical trials using EXPAR show detection of CT/NG patient samples within 10 minutes of DNA amplification at a constant temperature. The sequences detected represent specific and well conserved regions of CT and NG. Large signal changes give M13 a high analytical sensitivity. Discussion Our systems will ensure faster and more accurate diagnosis and ultimately better patient health outcomes. We are currently focused on an expansion of the scope of diseases that we can detect, using our in-house sequence selection process. (Figure Presented).

PrEP RATHER THAN COVID-19 INFLUENCED SEXUAL ACTIVITY among MSM in TOKYO

Background: COVID-19 drastically changed life style in Japan. However, the influence of COVID-19 on sexual activity among men who have sex with men (MSM) have not been fully understood. Although, the number of new HIV infection in Japan in 2020 decreased by 11.4%, the number of public HIV and sexually transmitted infection (STI) tests at health centers decreased by half due to overwhelmed burden by COVID-19, which made it difficult to access concise situations. Thus, we retrospectively evaluated incidence of HIV/STIs among MSM in Japan before and after COVID-19 endemic in a non HIV-infected MSM cohort in Tokyo, Japan. Methods: MSM over 16 years old have been recruited in the cohort at Sexual Health Clinic in Tokyo, Japan since 2017. The participants were examined for HIV infection, syphilis (quantitative RPR/TPHA), and rectal/pharyngeal Chlamydia trachomatis and Neisseria gonorrhea infections every 3 months in the cohort. In the participants of the cohort, incidence of HIV and STI were evaluated before and after COVID-19 pandemic. The period between July 2018 and December 2019 was defined as before COVID-19 (BC) and the period between January 2020 and June 2021 was defined as after COVID-19 (AC). As other factors to influence on sexual activity, use of pre-exposure prophylaxis (PrEP) was also evaluated before and after COVID-19 pandemic. Results: 1614 MSM were recruited in the cohort as of June 2021 (348 prior to June 2019, 661 in BC and 605 in AC). 21 (3.2%) and 14 (2.3%) MSM were excluded from the cohort due to HIV infection at the enrollment in BC and AC. The number and average age of MSM with at least 2 HIV/STI tests were 935 (34.4 years) in BC and 1324 (34.9 years) in AC, respectively. The table demonstrated that while the incidence of STIs showed no substantial changes from BC to AC in all MSM, the incidence of STIs decreased in the non-PrEP users and increased in the PrEP users consistently from BC to AC. The differences in the incidence of STIs between the non-PrEP and the PrEP users were more remarkable in AC than BC. In AC, the incidence of STIs almost tripled in the PrEP users compared to the non-PrEP users. These findings might be explained that increasing recognition of PrEP rather than the impact of COVID-19 leads to initiation of PrEP by MSM with higher risk in addition to risk compensation in the cohort. Conclusion: PrEP should be implemented with intensive STI tests in Japan for further decrease in STIs in the long run.

IMPACT of COVID OUTBREAK on PREVENTION and CARE for HIV and STIs at A LARGE HOSPITAL

Background: Routine medical care was drastically affected by the overwhelming irruption of COVID-19 pandemic. We comprehensively assessed the impact of the COVID-19 pandemic on the prevention and care for HIV and other sexually transmitted infections at a large reference hospital providing preventive and clinical services for HIV infection and other sexually transmitted infections. Methods: We retrospectively compared clinical and laboratory data from March to December 2020 (first ten months of the SARS-CoV-2 epidemics in Spain) vs. the same period 2019 in the setting of Hospital Clínic of Barcelona which provides preventive and clinical services for HIV infection and other sexually transmitted infections for the region of Catalonia and is the largest of its kind in Spain. Monthly clinical data on HIV pre-exposure and post-exposure prophylaxis users and on adults with HIV infection were retrieved from the administrative hospital database. Monthly tests for HIV, hepatitis B and C, Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis, and plasma lipids and glucose were recovered from the laboratory database. De novo HIV, hepatitis B, or hepatitis C diagnosis were considered whenever a person had a first known positive laboratory test. Results: There were less (28% reduction) but more advanced (mean [SD] CD4 cell counts per mm3 at HIV diagnosis 305 [167] vs. 370 [170], P<0.001;26 (18%) persons had AIDS-defining conditions at HIV diagnosis vs. 20 (10%), P=0.03) HIV cases and more gonorrhea (39% increase, P<0.001) and chlamydia (37% increase, P<0.001) infections in 2020 vs. 2019. In people with HIV, rates of viral load above the level of detection remained stable (11% vs 11%, P=0.147) despite less scheduled visits (25% reduction, P<0.001). However, they had less antiretroviral prescription changes (10% reduction, P=0.018), worse plasma lipids (mean total cholesterol 190 vs 185 mg/dL, P<0.001;mean LDL cholesterol 114 vs 110 mg/dL, P<0.001;mean triglycerides 136 vs 125 mg/dL, P<0.001;mean HDL cholesterol 47 vs 48 mg/dL, P=0.006), and an excess of mortality (29 deaths vs 11, 264% increase, P=0.006) due in great part to COVID-19 (n=11) but also to other non-COVID-19 causes. Conclusion: In the setting of a large Spanish reference hospital, SARS-CoV-2 epidemics was associated with an increase of some prevalent sexually transmitted infections, with less but more advanced de novo HIV infections, and with worse non-virologic healthcare outcomes and higher mortality in people living with HIV.

Changes in testing and incidence of Chlamydia trachomatis and Neisseria gonorrhoeae - the possible impact of the COVID-19 pandemic in the three Scandinavian countries.

BACKGROUND: This study aimed to investigate what impact the COVID-19 pandemic and its associated restrictions had on Chlamydia trachomatis and Neisseria gonorrhoeae infections in Sweden, Denmark and Norway, countries with very different governmental strategies for handling this pandemic. METHODS: Retrospective analysis of data collected via requests to Swedish regions and to health authorities in Denmark and Norway. The data were collected for the years 2018-2020 and the data from Sweden were more detailed. RESULTS: When the pandemic restrictions were installed in 2020, the number of reported chlamydia cases decreased. The decline was most pronounced in Norway 10.8% (2019: n = 28,446; 2020: n = 25,444) while it was only 3.1% in Denmark (2019: n = 35,688; 2020: n = 34,689) and 4.3% in Sweden (2019: n = 34,726; 2020: n = 33,339). Nucleic acid amplifications tests for chlamydia decreased in Sweden (10%) and Norway (18%) in 2020 compared to 2019, while in Denmark a 21% decrease was noted in April 2020 but thereafter increased to a higher level than 2019. The number of reported gonorrhoea cases decreased in Sweden (17%) and in Norway (39%) in 2020 compared to 2019, while a 21% increase was noted in Denmark. CONCLUSIONS: Pandemic restrictions had an impact on the number of reported chlamydia infections in all three countries, but only temporarily and did not seem to be correlated to the restriction levels. The number of reported gonorrhoea infections in Sweden and Norway significantly decreased but not in Denmark. Pandemic restrictions appear to have had a limited effect on the spread of chlamydia and gonorrhoea.

Use of Mail-Out Sexually Transmitted Infection Test Kits in a Telehealth Pre-exposure Prophylaxis Clinic

Background. Standard of care for patients receiving pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) includes HIV screening and testing for sexually transmitted infections (STIs) at all sites of potential exposure every three months. We implemented a provider and pharmacist telehealth based PrEP program as part of the HIV, Hepatitis Specialty Telehealth Access Resource (H-START) Collaborative. Due to the COVID-19 pandemic and care via telehealth, we had limited ability to collect pharyngeal or rectal swabs in clinic. We created mail-out kits including swabs and instructions for self-collection to test for rectal and pharyngeal Neisseria gonorrhea and Chlamydia trachomatis. Methods. Kits were mailed out to patients between June 2020 and May 2021. Providers first confirmed patient comfort with self-swab collection during telehealth appointments. Kits included: an instruction sheet with visual diagrams for collection, swabs with appropriate labels;and a pre-paid envelope for patients to mail swabs back to our facility for laboratory testing. Prospective data collection included the date kits were mailed out to patients, the date of kit receipt at our facility and the test result. Charts were retrospectively reviewed to determine treatment completion. Results. 54 self-swab kits were mailed to patients. 53 of the patients were male and the average age was 41.3 years old. 38 (70.3%) swabs were returned. The median time for return of swabs was 21 days (Range 2-289). Of those returned, 5 (13.1%) were positive and all 5 patients were treated for their infection. Conclusion. Mail-out STI testing was effective in identifying STIs for a telehealth PrEP program and for maintaining standard of care practice during the COVID-19 pandemic. This model may increase rates of testing compliance for care provided via telehealth and decrease rates of STI transmission and complications. Better communication around returning kits in a timely-manner and understanding reasons for non-return warrant further investigation.

Testing and diagnosis of HIV, hepatitis B and C, and bacterial STI in French STI clinics (CeGIDD) in 2020: individual data from SurCeGIDD surveillance. (S..ropositivit.. au VIH: diagnostic, pr..vention et v..cu au temps de la Covid-19.) [French]

Introduction - The CeGIDDs are centres of information, screening and diagnosis for HIV, viral hepatitis and bacterial sexually transmitted infections (STIs), a network of French free-to-use clinics created in 2016. This article describes the characteristics of CeGIDD visitors as well as the screening and diagnostic activities carried out by the structures for the year 2020, comparing them with 2018. Method - We present a repeated cross-sectional study, based on continuous monitoring data from the SurCeGIDD system, which relies on the secure transmission of individual visitor data according to a predefined format. The socio-demographic and behavioural data of the visitors, and their reasons for consultation, are described. The proportions of visitors tested and the positivity rates for HIV, hepatitis B (HBV) and C (HCV), syphilis, gonococcus (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are described according to sexual practices. Results - In 2020, 336,333 consultations were reported by 50.3% of the 336 CeGIDDs identified in 2020. Attendance at CeGIDDs fell sharply in the second quarter of 2020 (-58% compared to the first quarter). In 2020, the visitors were mostly men (62.1%) and young people under 30 (64.5%). About a quarter (23.5%) of the visitors were born abroad. The proportion of men having sex with men (14.8%) and trans people (0.38%) had increased compared to 2018. The most frequent reasons for consultation remained risk exposure (60.4%) and systematic screening (43.3%). Some reasons for consultation increased between 2018 and 2020, such as initiating or monitoring a post-exposure prophylaxis. An increase in positivity rate between 2018 and 2020 is observed for HIV (from 0.37% to 0.41%), but especially for NG (from 2.8% to 4.0%), undoubtedly related to changes in visitor characteristics. At the same time, positivity rates decreased for HBV (from 1.3% to 0.93%) and HCV (from 0.94% to 0.60%). They are relatively stable for CT (7.0% in 2020), MG (6.8%) and syphilis (1.0%). Conclusion - Despite a drop in consultations in 2020 related to the COVID-19 pandemic, the CeGIDDs continued to carry out their screening/diagnostic missions in a comprehensive sexual health approach. SurCeGIDD surveillance provides elements for monitoring the national sexual health strategy, hence the need to improve the comprehensiveness and completeness of the data collected.

Potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden, 2020.

The COVID-19 pandemic has challenged the societies and health care systems globally, and resulted in many social and physical distancing restrictions to limit the spread of SARS-CoV-2. These restrictions have also likely affected the frequency of intimate contacts and the spread of sexually transmitted infections (STIs). Compared to most other countries, Sweden especially in Spring-Autumn 2020 pursued mainly milder voluntary, that is, not mandatory enforced by laws, recommended restrictions and the impacts of these on society and spread of STIs remain largely unknown. We describe the potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden in 2020. Compared to 2019, we found a significant decrease in incidence of chlamydia (-4.5%) and gonorrhoea (-17.5%), and in diagnostic testing (-10.5% for chlamydia, -9.4% for gonorrhoea) in 2020. However, the decrease in chlamydia incidence, which has mainly been decreasing in the last 10 years, was not significant when compared with the average incidence in 2017-2019. The largest decrease in national incidence of both infections was observed among young and heterosexual patients, however, some Swedish regions showed an increased incidence, particularly of chlamydia. Increased "internet-based self-sampling" testing approach partly compensated for a decreased attendance at STI clinics. Studies, including sexual behaviour, prevention, reasons for attending STI health care, STIs in different anatomical sites and management of STIs, are required to elucidate the impact of COVID-19-associated social and physical distancing restrictions on sexual activity and the incidence and epidemiology of chlamydia and gonorrhoea in Sweden.

Host-Pathogen Interactions of Chlamydia trachomatis in Porcine Oviduct Epithelial Cells.

Chlamydia trachomatis (Ct) causes the most prevalent bacterial sexually transmitted disease leading to ectopic pregnancy and infertility. Swine not only have many similarities to humans, but they are also susceptible to Ct. Despite these benefits and the ease of access to primary tissue from this food animal, in vitro research in swine has been underutilized. This study will provide basic understanding of the Ct host-pathogen interactions in porcine oviduct epithelial cells (pOECs)-the counterparts of human Fallopian tube epithelial cells. Using NanoString technology, flow cytometry, and confocal and transmission-electron microscopy, we studied the Ct developmental cycle in pOECs, the cellular immune response, and the expression and location of the tight junction protein claudin-4. We show that Ct productively completes its developmental cycle in pOECs and induces an immune response to Ct similar to human cells: Ct mainly induced the upregulation of interferon regulated genes and T-cell attracting chemokines. Furthermore, Ct infection induced an accumulation of claudin-4 in the Ct inclusion with a coinciding reduction of membrane-bound claudin-4. Downstream effects of the reduced membrane-bound claudin-4 expression could potentially include a reduction in tight-junction expression, impaired epithelial barrier function as well as increased susceptibility to co-infections. Thereby, this study justifies the investigation of the effect of Ct on tight junctions and the mucosal epithelial barrier function. Taken together, this study demonstrates that primary pOECs represent an excellent in vitro model for research into Ct pathogenesis, cell biology and immunity.

The impact of physical restriction measures imposed during the two waves of COVID-19 on chlamydia and gonorrhea diagnoses in Belgium. Results of an sexually transmitted infection clinic.

Background: During the first two waves of COVID-19, several physical restriction measurements were imposed in Belgium. Our aim was to explore the impact of these restriction measures on the number of tests and positivity rate of Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) before, during, and after the two lockdowns in Belgium. Methods:Chlamydia trachomatis/Neisseria gonorrhoeae molecular data of a Belgian STI clinic were extracted for 2019 and 2020, and both years were divided into four periods (pre-lockdown 1, lockdown 1, after lockdown 1, and lockdown 2). Weekly testing rates and positivity rate for both STIs were estimated, and mixed-effects logistic regression was used to explore statistical significant changes between both years, and the different periods were compared with the corresponding time period in 2019. The same analysis was done for pre-exposure prophylaxis(PrEP) users only. Results: No overall significant changes in positivity rate were found for either CT (8.0% in 2019 and 7.8% in 2020) or NG (4.5% in 2019 and 5.5% in 2020). Besides a significant drop in the number of CT/NG tests during lockdown 1 (decrease of 87%) and a subsequent increase in NG positivity rate (p > 0.05), no changes in CT/NG positivity rate were found in the other periods. The highest positivity rate for either CT or NG was found in lockdown 2 (15.1% vs 12.4% in 2019). The number of CT/NG tests in lockdown 2 was still 25% lower than 2019 levels. Subanalysis of only PrEP users revealed the same trend; however, the number of CT/NG tests in lockdown 2 was exactly the same as in 2019. Conclusion: Despite a significant decline in absolute CT or NG cases in lockdown 1, which was most likely a consequence of both physical distancing and reduced testing, CT/NG testing and positivity rates returned to pre-corona levels in lockdown 2, which may depict physical distancing fatigue.

Changing from Clinician-Collected to Self-Collected Throat Swabs for Oropharyngeal Gonorrhea and Chlamydia Screening among Men Who Have Sex with Men.

The coronavirus disease 2019 (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was used primarily for genital and anorectal infections, with only limited studies on the performance of self-collection of oropharyngeal swabs for oropharyngeal STI detection. The Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhea and chlamydia screening on 16 March 2020 in order to reduce health care worker risk during the COVID-19 pandemic. We compared the proportions of valid and positive samples for gonorrhea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician collection period, between 20 January and 15 March 2020, and the self-collection period, between 16 March and 8 May 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for Neisseria gonorrhoeae was higher in the self-collection period (1.6% [24/1,497]) than in the clinician collection period (0.9% [23/2,600]) (P = 0.038), but the proportions did not differ for the detection of Chlamydia trachomatis The positivity rates of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio [PR], 1.07 [95% confidence interval {CI}, 0.85 to 1.34]) (P = 0.583) and oropharyngeal C. trachomatis (adjusted PR, 0.84 [95% CI, 0.51 to 1.39]) (P = 0.504) specimens did not differ between the two periods. Self-collected oropharyngeal swabs for the detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and, importantly, reduce health care worker exposure to respiratory infections.