Impact of point-of-care gonorrhea and chlamydia testing in the emergency department on reducing overtreatment rates.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections continue to increase in the United States. Advancement in technology with point-of-care (POC) testing can improve the overall treatment of sexually transmitted infections (STI) in the emergency department (ED) by shortening the time to test result and administration of accurate treatment. The purpose of this study was to assess if the POC test reduced the rate of overtreatment for CT and/or NG compared to the standard-of-care (SOC) test. METHODS: This retrospective cohort study included adult patients tested for CT and NG at two urban EDs between August 2020 and October 2022. This cohort excluded hospital admissions, elopement, pregnancy, rectal and oral samples, victims of sexual assault, and diagnoses for which antimicrobial treatment overlapped that of CT/NG. The primary outcome assessed overtreatment, defined as receiving treatment in the ED or a prescription prior to discharge for patients who tested negative for CT and/or NG. Secondary outcomes included undertreatment rates, overtreatment rates in select populations, test turnaround time, and ED length of stay (LOS). RESULTS: Of 327 patients screened, 97 patients were included in the SOC group and 100 in POC. Overtreatment for CT was provided in zero POC patients and 29 (29.9%) SOC patients (p < 0.001). NG was overtreated in 1 (1%) POC and 23 (23.7%) SOC (p < 0.001). POC was associated with undertreatment of CT and/or NG in two patients, compared to four patients tested with SOC. Overall, treatment was deemed inappropriate for 5 (5%) of those tested with POC, compared to 35 (36%) tested with SOC (p < 0.001). There was no difference in ED LOS (2.7 vs 3.01 h, p = 0.41). CONCLUSIONS: POC testing facilitated the return of results prior to patients being discharged from the ED. Compared to standard testing, POC improved appropriateness of CT and NG treatment by reducing the rates of overtreatment.

Corrigendum: Patterns of within-host spread of Chlamydia trachomatis between vagina, endocervix and rectum revealed by comparative genomic analysis.

[This corrects the article DOI: 10.3389/fmicb.2023.1154664.].

Follmann balanitis in secondary syphilis.

Syphilitic balanitis is an uncommon rather underreported manifestation of primary syphilis initially described by Eugene Follmann and subsequently named after him. It is characterized by balanitis with or without a primary chancre and inguinal lymphadenopathy. Given its rarity, Follmann balanitis may be misdiagnosed with other causes of balanitis. Therefore, a strong clinical suspicion and awareness are crucial, particularly in the current resurgence of syphilis. With this background, we hereby report a case of Follmann balanitis in secondary syphilis, diagnosed based on clinical features, positive syphilis serology, and response to benzathine penicillin treatment.

Spatial and trend analysis of gestational syphilis cases in Brazil from 2011 to 2020: an ecological study.

OBJECTIVES: To analyze the rate of gestational syphilis (GS) based on temporal trends over 11 years, as well as the spatial distribution of GS in Brazil, based on the identification of spatial clusters. METHODOLOGY: An ecological, using Brazil and its regions as an analysis unit, based on gestational syphilis data reported in the Notifiable Diseases Information System (SINAN), from 2011 to 2020. Thematic maps were built for spatial data analysis, and the Prais-Winsten autoregressive model was used to verify the trend. Spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of distribution of GS across Brazilian municipalities, using a 5% significance level. RESULTS: Gestational syphilis experienced a considerable increase in cases during the studied period, with a peak of 37,436 cases in 2018. The spatial distribution of the disease is heterogeneous in the country. A growing trend was observed in all states of Brazil, except for Espírito Santo, where it remained stationary, with a monthly variation of 10.32%. CONCLUSION: The spatial and temporal trend analysis point to syphilis as an important public health problem. The numbers are alarming and show the urgent need for measures to prevent and control syphilis during pregnancy.

[The venereal morbidity in Russia in 1914-1924].

It is accepted to explain increasing of venereal diseases during years of the Revolution by degradation of morality and general disorder of system of state administration and sanitary services in Russia. The cross-verification of information presented in scientific publications and primary information sources makes it possible to look into following issues: degree of venereal (syphilitic) contamination of population of pre-revolutionary Russia; influence on sanitary statistics by erroneous diagnostics and convictions of Zemstvo medicine about predominantly non-sexual path of transmission of syphilis pathogen in Russian countryside; dynamics and sources of venereal morbidity in wartime. The high indicators of pre-revolutionary statistics of venereal infections could be affected by diagnostic errors. The "village syphilis" encountered in public milieu could be completely different disease not sexually transmitted and not chronic form of disease. The primary documents allow to discuss increasing of the number of venereal patients during war years, that however, does not reach catastrophic numbers that can be found even in scientific publications. This is also confirmed by data of Chief Military Sanitary Board of the Red Army for 1920s and statistical materials of People's Commissariat of Health Care of the RSFSR. The high morbidity was demonstrated by same Gubernias that were problematic before the Revolution and only later by those ones through which during the war years passed army masses. In Russia, total level of syphilis morbidity after the end of Civil War occurred to be more than twice lower than in pre-war 1913 and continued to decrease under impact of sanitary measures of Soviet public health.

Syphilis Among U.S.-Bound Refugees, 2015 - 2018.

We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December 31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade.

Point-of-care STI testing in rural settings: A feasibility project.

Sexually transmitted infections (STIs) continue to be a health concern in the United States, particularly in rural settings. Point-of-care (POC) STI testing is useful in overcoming access barriers in these settings. The purpose of this project was to implement POC STI testing to increase access to care in rural settings and test the feasibility of this model. Six mobile health clinics were implemented by a nurse-led team in three rural communities in the Blackbelt region of Alabama utilizing the Binx IO® to test for chlamydia and gonorrhea. Mobile clinic volunteers participated in focus groups to determine provider satisfaction with clinic workflow. The mobile health clinics were a feasible way to increase access to STI testing in rural settings with reported provider and client satisfaction in work flow.

Alcohol Misuse and Sexually Transmitted Infections: Using the CAGE Questionnaire as a Screening Tool.

Background: While the connection between alcohol and risky behavior is well known, a clear correlation between alcohol misuse and contracting sexually transmitted infections (STIs) has not been determined. The 4-question CAGE questionnaire-the acronym stands for attitudes and activities related to alcohol use-is often administered at primary care annual visits to screen patients for alcohol abuse. This study assessed the relationship between CAGE scores and STI results to determine if the CAGE questionnaire could help determine the need for STI screening at annual visits. Methods: All patients who received a CAGE screening from 2015 to 2022 at a Gulf South health system were included in the analysis. The primary outcome of the study was the relationship between a positive CAGE score (a score ≥2) and a positive STI result. STIs included in the primary analysis were human immunodeficiency virus (HIV), hepatitis B, syphilis, chlamydia, gonorrhea, and trichomoniasis. The correlation between a positive CAGE score and hepatitis C was examined as a secondary outcome. Results: A total of 40,022 patients received a CAGE screening during the study period, and 757 (1.9%) scored ≥2 on the CAGE questionnaire. Significant associations were found between a positive CAGE score and hepatitis B (odds ratio [OR]=2.69, 95% CI 1.91, 3.80; P<0.001), gonorrhea (OR=5.43, 95% CI 1.80, 16.39; P=0.003), and hepatitis C (OR=2.10, 95% CI 1.57, 2.80; P<0.001). No associations were found between a positive CAGE score and HIV, chlamydia, or trichomoniasis. No patients with a CAGE score ≥2 had a syphilis diagnosis; therefore, no syphilis analysis was possible. Conclusion: Based on the results of this study, patients with a CAGE score ≥2 may benefit from screening for hepatitis B, hepatitis C, and gonorrhea at their primary care annual visit. Early STI detection could lead to prompt treatment and prevent further transmission and complications.

BD Vaginal Panel assay results on the high-throughput BD COR system compared to the BD MAX system.

Molecular-based assays demonstrate excellent sensitivity for the detection of vaginitis causes. Here, the high-throughput BD Vaginal Panel for BD COR System (VP-COR) performance was compared to that of the predicate, BD MAX Vaginal Panel for BD MAX System (VP-MAX). Clinical or contrived samples were used to determine the agreement between VP-COR and VP-MAX. Acceptance criteria for VP-COR agreement were as follows: bacterial vaginosis (BV) required a positive percent agreement (PPA) point estimate of ≥95% and a negative percent agreement (NPA) point estimate of ≥98%; Candida group, Candida glabrata, Candida krusei, and Trichomonas vaginalis (TV) required a PPA and NPA point estimate of ≥95% [with lower bound of 95% confidence interval (95% CI) ≥90%]. PPA was 99.5% (95% CI: 97.5-100) and 97.9% (95% CI: 96.5-98.8) for BV contrived (n = 516) and BV clinical (n = 1,050) specimens, respectively. For the Candida group (clinical; n = 724), C. glabrata (contrived; n = 544), C. krusei (contrived; n = 522), and TV (clinical; n = 702), PPA was 99.4% (95% CI: 98.0-99.9), 100% (95% CI: 97.9-100), 100% (95% CI: 97.6-100), and 99.7% (95% CI: 98.3-100), respectively; the lowest lower bound CI value was 97.6%. NPA was >95% for BV contrived and BV clinical specimens. For the Candida group, C. glabrata, C. krusei, and TV, NPA was ≥98.9%; the lowest lower bound CI value was 97.3%. These results demonstrate the equivalent performance of the VP-COR assay when compared to VP-MAX.IMPORTANCEVaginitis is common among women of reproductive age, resulting in around 10 million office visits a year. Diagnosis is often difficult due to its multiple causes-including bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis-as well as variation in symptom presentation. Typically, cases are identified with a combination of symptomology, medical history, physical examination, and office- or laboratory-based testing. These traditional techniques involve subjective elements and demonstrate varying sensitivity and specificity. Inaccurate or delayed diagnosis leads to continued symptoms, repeat visits, inappropriate treatment, and unnecessary costs. Alternatively, the use of molecular-based assays increases sensitivity for the detection of vaginitis causes. With the validation of the vaginal panel molecular assay on COR (a high-throughput platform), a workflow can be streamlined in high-demand laboratories while providing high sensitivity for vaginitis detection.

Concepciones de usuarios sobre nuevas vías de administración de profilaxis pre-exposición para el VIH / Users' expectations of the new pre-exposure prophylaxis for the HIV modalities

Resumen Este artículo tiene como objetivo discutir las concepciones de los Hombres Gay, Hombres Bisexuales y una Mujer Transgénero que usan o quieren usar profilaxis previa a la exposición por el virus de la inmunodeficiencia humana oral (PrEP) sobre nuevas vías de administración. Fueron entrevistados 17 usuarios del BCN Checkpoint. Las entrevistas fueron grabadas en audio, sometidas a análisis categorial temático teniendo en cuenta la perspectiva praxeográfica. Todos están adaptados al uso de la PrEP diaria y a demanda. En relación con las nuevas vías de administración (PrEP inyección intramuscular cada dos meses; pastilla mensual; inyección subcutánea cada seis meses) todos son muy receptivos a esas posibilidades, pero les falta información sobre las especificidades de cada una de ellas y una evaluación específica de sus necesidades. Tanto la satisfacción con el uso de PrEP oral, como las expectativas sobre las nuevas vías de administración son positivas. Sin embargo, lo más importante para los/a entrevistados/a es la garantía de que tendrán seguimiento para continuar cuidando de la salud afectivo-sexual, lo que no depende del tipo de vía de administración.

Abstract This article aims to discuss the expectations of Homosexual Men, Bisexual Men and a Transgender Woman, who use or want to use an oral pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) about PrEP modalities. Sixteen PrEP users, who are followed up in the BCN Checkpoint, were interviewed,. The interviews were audio-recorded, subjected to thematic categorical analysis within the theoretical framework from the praxiographic perspective. They are all adapted to the use of daily oral and event-based PrEP. In relation to the new PrEP modalities (monthly pill; intramuscular injection every two months; subcutaneous injection every six months), they are all very receptive to these possibilities, but they lack information on the specificities of each and specific assessment of their needs. Comments about the use of oral PrEP are positive, and expectations regarding the new PrEP modalities are visibly high. However, the most important thing for the interviewees is the guarantee that they will have follow-up appointments to continue taking care of their affective-sexual health, which is not dependent on the type of PrEP modalities.

Sexual risk behavior and knowledge about sexually transmitted infections in a university population in Sorocaba, Brazil

Introduction: Sexually transmitted infections (STIs) are a major public health problem to which young people are highly exposed and knowledge about vulnerabilities that affect them is needed. Objective: To evaluate the knowledge about STIs and sexual behavior of a university population in the city of Sorocaba/SP. Methods: A descriptive, cross-sectional study was conducted with data collection realized by an online application with qualitative and quantitative characteristics. Results: Four hundred and seventy-seven (477) university students from different areas of knowledge were analyzed. The majority pointed to the beginning of sexual life between 15 and 18 years old. Information about sex education was obtained mainly through parents and/ or guardians, while little additional knowledge was obtained after entering higher education. Biological and Health Sciences students achieved a higher score on the knowledge questionnaire and were less likely (0.391) to contract STIs when compared to Applied Social Sciences or Engineering students (2.8 and 2.9 more likely, respectively). Conclusion: Students who demonstrated greater knowledge about STIs and acquired more information on the subject during graduation were less likely to become infected, suggesting that campaigns aimed at the university public are essential for the prevention and control of these pathogens.

Addressing Sexually Transmitted Infections Due to Neisseria gonorrhoeae in the Present and Future.

It was in the 1800s when the first public publications about the infection and treatment of gonorrhoea were released. However, the first prevention programmes were only published a hundred years later. In the 1940s, the concept of vaccination was introduced into clinical prevention programmes to address early sulphonamide resistance. Since then, tons of publications on Neisseria gonorrhoeae are undisputed, around 30,000 publications today. Currently, the situation seems to be just as it was in the last century, nothing has changed or improved. So, what are we doing wrong? And more importantly, what might we do? The review presented here aims to review the current situation regarding the resistance mechanisms, prevention programmes, treatments, and vaccines, with the challenge of better understanding this special pathogen. The authors have reviewed the last five years of advancements, knowledge, and perspectives for addressing the Neisseria gonorrhoeae issue, focusing on new therapeutic alternatives.

HLA-DR and HLA-DQ Polymorphism Correlation with Sexually Transmitted Infection Caused by Chlamydia trachomatis.

Background and Objectives: Chlamydia trachomatis (C. trachomatis) represents one of the most prevalent bacterial sexually transmitted diseases. This study aims to explore the relationship between HLA alleles/genotypes/haplotypes and C. trachomatis infection to better understand high-risk individuals and potential complications. Materials and Methods: This prospective study recruited participants from Transylvania, Romania. Patients with positive NAAT tests for C. trachomatis from cervical/urethral secretion or urine were compared with controls regarding HLA-DR and -DQ alleles. DNA extraction for HLA typing was performed using venous blood samples. Results: Our analysis revealed that the presence of the DRB1*13 allele significantly heightened the likelihood of C. trachomatis infection (p = 0.017). Additionally, we observed that individuals carrying the DRB1*01/DRB1*13 and DQB1*03/DQB1*06 genotype had increased odds of C. trachomatis infection. Upon adjustment, the association between the DRB1*01/DRB1*13 genotype and C. trachomatis remained statistically significant. Conclusions: Our findings underscore the importance of specific HLA alleles and genotypes in influencing susceptibility to C. trachomatis infection. These results highlight the intricate relationship between host genetics and disease susceptibility, offering valuable insights for targeted prevention efforts and personalized healthcare strategies.

Estimating Partnership Duration among MSM in Belgium-A Modeling Study.

Mathematical modeling is widely used for describing infection transmission and evaluating interventions. The lack of reliable social parameters in the literature has been mentioned by many modeling studies, leading to limitations in the validity and interpretation of the results. Using data from the European MSM Internet survey 2017, we developed a network model to describe sex acts among MSM in Belgium. The model simulates daily sex acts among steady, persistent casual and one-off partners in a population of 10,000 MSM, grouped as low- or high-activity by using three different definitions. Model calibration was used to estimate partnership duration and homophily rates to match the distribution of cumulative sex partners over 12 months. We estimated an average duration between 1065 and 1409 days for steady partnerships, 4-6 and 251-299 days for assortative high- and low-activity individuals and 8-13 days for disassortative persistent casual partnerships, respectively, varying across the three definitions. High-quality data on social network and behavioral parameters are scarce in the literature. Our study addresses this lack of information by providing a method to estimate crucial parameters for network specification.

The Great Mimicker Gets Caught: A Rare Case of Syphilis in the Gastrointestinal Tract.

Syphilis is a sexually transmitted disease that impacts multiple organ systems and can mimic various diseases and is an extremely rare cause of proctitis in men who have sex with men and transgender females. We present a case of a 49-year-old transgender female with a medical history significant for diabetes mellitus and hyperlipidemia who presented to the emergency department with dull abdominal pain in the left upper and lower quadrants for two days. She had non-bloody, nonbilious emesis, 10-pound weight loss over 1 month, and constipation for 2 weeks. Laboratory results showed a cholestatic pattern. Computed tomography of the abdomen showed rectal wall thickening, multiple enlarged perirectal adenopathy, and mild inflammatory infiltration around the rectum suggesting superimposed proctitis. On colonoscopy, a possible rectal mass or severe proctitis with near complete obstruction was seen with initial pathology concerning for lymphoma or a rare type of colitis. The patient was empirically started on ceftriaxone and doxycycline leading to improvement in inflammation. Special stains requested were positive for Treponema pallidum confirming the diagnosis of syphilitic proctitis and highly suggestive syphilitic hepatitis. Few cases of syphilitic proctitis imitating rectal malignancy and syphilitic hepatitis have been reported. Syphilis requires exclusion as well as confirmation of spirochetes for high-risk populations with special staining. It is important to diagnose syphilis in special populations that are at high risk of contraction.

Dating apps as health allies? Examining the opportunities and challenges of dating apps as partners in public health.

In recent years, dating apps have become important allies in public health. In this paper, we explore the implications of partnering with dating apps for health promotion. We consider the opportunities and challenges inherent in these collaborations, paying special attention to privacy, trust, and user care in a digital environment.Despite their potential as targeted health promotion tools, dating apps raise significant ethical concerns, including the commodification of user data and privacy breaches, which highlight the complexities of blending healthcare initiatives with for-profit digital platforms. Furthermore, the paper delves into issues of discrimination, harassment and unequal access within these apps, factors which can undermine public health efforts.We develop a nuanced framework, emphasising the development of transparent data policies, the decoupling of content moderation from health initiatives and a commitment to combat discrimination. We underscore the importance of embedding app-based health initiatives within broader care pathways, ensuring comprehensive support beyond the digital domain. This essay offers vital insights for public health practitioners, app developers and policymakers navigating the intersection of digital innovation and healthcare.

Impact of education and clinic site champion on extragenital testing for sexually transmitted infections.

BACKGROUND: Sexually transmitted infections (STIs) are on the rise in the United States. Infections at extragenital (EG) sites (throat or rectum) may serve as an overlooked reservoir for STIs. The aims of this project were to determine the proportion of patients receiving EG testing and to observe the impact of an educational intervention. METHODS: Phase I included four urgent care clinics and baseline data for adults receiving STI testing (Chlamydia trachomatis and Neisseria gonorrhoeae). Clinics received access to an educational presentation regarding the importance of EG testing. Two of these clinics served as pilot sites for the implementation of self-collection kits. Phase II involved further expansion and utilization of clinic site champions. RESULTS: Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were from EG sites. There was an increase in EG testing after the educational intervention and implementation of self-collection kits. A larger increase in EG testing was seen after utilization of a site champion in Phase II. CONCLUSION: EG infections serve as a potential source for STI transmission which makes multi-site testing necessary. Our interventions to improve EG testing were most effective in Phase II after implementing a clinic site champion.

The burden of infectious diseases throughout and after the COVID-19 pandemic (2020-2023) and Russo-Ukrainian war migration.

Understanding how the infectious disease burden was affected throughout the COVID-19 pandemic is pivotal to identifying potential hot spots and guiding future mitigation measures. Therefore, our study aimed to analyze the changes in the rate of new cases of Poland's most frequent infectious diseases during the entire COVID-19 pandemic and after the influx of war refugees from Ukraine. We performed a registry-based population-wide study in Poland to analyze the changes in the rate of 24 infectious disease cases from 2020 to 2023 and compared them to the prepandemic period (2016-2019). Data were collected from publicly archived datasets of the Epimeld database published by national epidemiological authority institutions. The rate of most of the studied diseases (66.6%) revealed significantly negative correlations with the rate of SARS-CoV-2 infections. For the majority of infectious diseases, it substantially decreased in 2020 (in case of 83%) and 2021 (63%), following which it mostly rebounded to the prepandemic levels and, in some cases, exceeded them in 2023 when the exceptionally high annual rates of new cases of scarlet fever, Streptococcus pneumoniae infections, HIV infections, syphilis, gonococcal infections, and tick-borne encephalitis were noted. The rate of Clostridioides difficile enterocolitis was two-fold higher than before the pandemic from 2021 onward. The rate of Legionnaires' disease in 2023 also exceeded the prepandemic threshold, although this was due to a local outbreak unrelated to lifted COVID-19 pandemic restrictions or migration of war refugees. The influx of war migrants from Ukraine could impact the epidemiology of sexually transmitted diseases. The present analysis indicates that continued efforts are needed to prevent COVID-19 from overwhelming healthcare systems again and decreasing the control over the burden of other infectious diseases. It also identifies the potential tipping points that require additional mitigation measures, which are also discussed in the paper, to avoid escalation in the future.