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1.
Sci Rep ; 14(1): 10496, 2024 05 07.
Article in English | MEDLINE | ID: mdl-38714714

ABSTRACT

The use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), human papillomavirus (HPV), Mycoplasma genitalium (MG), Neisseria gonorrhoea (NG), Treponema pallidum and Trichomonas vaginalis (TV) in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations.


Subject(s)
Health Personnel , Sexually Transmitted Diseases , Specimen Handling , Humans , Female , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/microbiology , Specimen Handling/methods , Neisseria gonorrhoeae/isolation & purification , Gonorrhea/diagnosis , Chlamydia trachomatis/isolation & purification
2.
BMJ Open ; 14(5): e084918, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38692732

ABSTRACT

INTRODUCTION: A prototype lateral flow device detecting cytokine biomarkers interleukin (IL)-1α and IL-1ß has been developed as a point-of-care test-called the Genital InFlammation Test (GIFT)-for detecting genital inflammation associated with sexually transmitted infections (STIs) and/or bacterial vaginosis (BV) in women. In this paper, we describe the rationale and design for studies that will be conducted in South Africa, Zimbabwe and Madagascar to evaluate the performance of GIFT and how it could be integrated into routine care. METHODS AND ANALYSIS: We will conduct a prospective, multidisciplinary, multicentre, cross-sectional and observational clinical study comprising two distinct components: a biomedical ('diagnostic study') and a qualitative, modelling and economic ('an integration into care study') part. The diagnostic study aims to evaluate GIFT's performance in identifying asymptomatic women with discharge-causing STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG)) and BV. Study participants will be recruited from women attending research sites and family planning services. Several vaginal swabs will be collected for the evaluation of cytokine concentrations (ELISA), STIs (nucleic acid amplification tests), BV (Nugent score) and vaginal microbiome characteristics (16S rRNA gene sequencing). The first collected vaginal swab will be used for the GIFT assay which will be performed in parallel by a healthcare worker in the clinic near the participant, and by a technician in the laboratory. The integration into care study aims to explore how GIFT could be integrated into routine care. Four activities will be conducted: user experiences and/or perceptions of the GIFT device involving qualitative focus group discussions and in-depth interviews with key stakeholders; discrete choice experiments; development of a decision tree classification algorithm; and economic evaluation of defined management algorithms. ETHICS AND DISSEMINATION: Findings will be reported to participants, collaborators and local government for the three sites, presented at national and international conferences, and disseminated in peer-reviewed publications.The protocol and all study documents such as informed consent forms were reviewed and approved by the University of Cape Town Human Research Ethics Committee (HREC reference 366/2022), Medical Research Council of Zimbabwe (MRCZ/A/2966), Comité d'Ethique pour la Recherche Biomédicale de Madagascar (N° 143 MNSAP/SG/AMM/CERBM) and the London School of Hygiene and Tropical Medicine ethics committee (LSHTM reference 28046).Before the start, this study was submitted to the Clinicaltrials.gov public registry (NCT05723484). TRIAL REGISTRATION NUMBER: NCT05723484.


Subject(s)
Biomarkers , Sexually Transmitted Diseases , Vaginosis, Bacterial , Humans , Female , Vaginosis, Bacterial/diagnosis , Prospective Studies , Biomarkers/analysis , Sexually Transmitted Diseases/diagnosis , Cross-Sectional Studies , Point-of-Care Testing , Feasibility Studies , Interleukin-1alpha/metabolism , Interleukin-1alpha/analysis , Interleukin-1beta/analysis , Adult , Cytokines/metabolism , Cytokines/analysis , South Africa , Zimbabwe , Observational Studies as Topic , Multicenter Studies as Topic
3.
BMC Prim Care ; 25(1): 150, 2024 May 04.
Article in English | MEDLINE | ID: mdl-38704552

ABSTRACT

BACKGROUND: The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic. METHODS: We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses. RESULTS: We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019. CONCLUSIONS: After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.


Subject(s)
COVID-19 , Electronic Health Records , Primary Health Care , Sexually Transmitted Diseases , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/diagnosis , Primary Health Care/statistics & numerical data , Retrospective Studies , Spain/epidemiology , Female , Male , Adult , SARS-CoV-2 , Adolescent , Middle Aged , Pandemics , Young Adult
4.
Obstet Gynecol Clin North Am ; 51(2): 405-424, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38777492

ABSTRACT

Gynecologists play a critical role in the office evaluation of transgender and gender diverse individuals. This includes the provision of essential healthcare services including the treatment and prevention of human immunodeficiency virus and sexually-transmitted infections and screening for human papillomavirus infection-related diseases and cancers. Caring for patients who identify as transgender or gender diverse (TGD) and who have undergone gender-affirming surgical treatments is challenging due in part to clinical gaps in knowledge resulting from insufficient training and educational resources. A patient-centered approach to the care of TGD individuals requires knowledge of the general principles of affirming, holistic care with attention to the risk factors, and anatomic considerations unique to this population. This review aims to provide basic knowledge needed for the successful gynecologic evaluation of a gender diverse patient.


Subject(s)
Sexual Health , Sexually Transmitted Diseases , Transgender Persons , Humans , Female , Male , Sexually Transmitted Diseases/prevention & control , Sexually Transmitted Diseases/diagnosis , Mass Screening/methods , Papillomavirus Infections/prevention & control , Papillomavirus Infections/diagnosis , HIV Infections/prevention & control , HIV Infections/diagnosis
5.
Biosensors (Basel) ; 14(5)2024 May 20.
Article in English | MEDLINE | ID: mdl-38785734

ABSTRACT

Sexually transmitted diseases (STDs) are a global concern because approximately 1 million new cases emerge daily. Most STDs are curable, but if left untreated, they can cause severe long-term health implications, including infertility and even death. Therefore, a test enabling rapid and accurate screening and genotyping of STD pathogens is highly awaited. Herein, we present the development of the DNA-based 6STD Genotyping 9G Membrane test, a lateral flow strip membrane assay, for the detection and genotyping of six STD pathogens, including Trichomonas vaginalis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Mycoplasma genitalium. Here, we developed a multiplex PCR primer set that allows PCR amplification of genomic materials for these six STD pathogens. We also developed the six ssDNA probes that allow highly efficient detection of the six STD pathogens. The 6STD Genotyping 9G Membrane test lets us obtain the final detection and genotyping results in less than 30 m after PCR at 25 °C. The accuracy of the 6STD Genotyping 9G membrane test in STD genotyping was confirmed by its 100% concordance with the sequencing results of 120 clinical samples. Therefore, the 6STD Genotyping 9G Membrane test emerges as a promising diagnostic tool for precise STD genotyping, facilitating informed decision-making in clinical practice.


Subject(s)
Chlamydia trachomatis , Genotype , Neisseria gonorrhoeae , Sexually Transmitted Diseases , Humans , Chlamydia trachomatis/genetics , Chlamydia trachomatis/isolation & purification , Neisseria gonorrhoeae/genetics , Neisseria gonorrhoeae/isolation & purification , Sexually Transmitted Diseases/microbiology , Sexually Transmitted Diseases/diagnosis , Trichomonas vaginalis/genetics , Trichomonas vaginalis/isolation & purification , Genotyping Techniques , Mycoplasma hominis/isolation & purification , Mycoplasma hominis/genetics , Ureaplasma urealyticum/genetics , Ureaplasma urealyticum/isolation & purification , DNA , Mycoplasma genitalium/genetics , Mycoplasma genitalium/isolation & purification , Biosensing Techniques , DNA, Bacterial/analysis , Multiplex Polymerase Chain Reaction/methods
6.
PLoS Med ; 21(5): e1004385, 2024 May.
Article in English | MEDLINE | ID: mdl-38768094

ABSTRACT

BACKGROUND: Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). METHODS AND FINDINGS: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies. CONCLUSIONS: In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management. PROSPERO NUMBER: CRD42022348045.


Subject(s)
Ulcer , Vaginal Discharge , Humans , Africa South of the Sahara/epidemiology , Female , Vaginal Discharge/epidemiology , Vaginal Discharge/etiology , Ulcer/epidemiology , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/diagnosis , Vaginosis, Bacterial/epidemiology , Vaginosis, Bacterial/diagnosis , Vaginosis, Bacterial/complications , Chlamydia Infections/epidemiology , Chlamydia Infections/complications , Chlamydia Infections/diagnosis , Urethral Diseases/epidemiology , Urethral Diseases/etiology , Genital Diseases, Female/epidemiology
7.
West J Emerg Med ; 25(3): 358-367, 2024 May.
Article in English | MEDLINE | ID: mdl-38801042

ABSTRACT

Introduction: Bacterial urinary tract infections (UTI) and some sexually transmitted infections (STI) can have overlapping signs and symptoms or nonspecific findings, such as pyuria on urinalysis. Furthermore, results from the urine culture and the nucleic acid amplification test for an STI may not be available during the clinical encounter. We sought to determine whether gonorrhea, chlamydia, and trichomoniasis are associated with bacteriuria, information that might aid in the differentiation of STIs and UTIs. Methods: We used multinomial logistic regression to analyze 9,650 encounters of female patients who were aged ≥18 years and who underwent testing for STIs. The ED encounters took place from April 18, 2014-March 7, 2017. We used a multivariable regression analysis to account for patient demographics, urinalysis findings, vaginal wet-mount results, and positive or negative (or no) findings from the urine culture and testing for Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis. Results: In multivariable analysis, infection with T vaginalis, N gonorrhoeae, or C trachomatis was not associated with having a urine culture yielding 10,000 or more colony-forming units per mililiter (CFU/mL) of bacteria compared with a urine culture yielding less than 10,000 CFU/mL or no urine culture obtained. The diagnosis of a UTI in the ED was not associated with having a urine culture yielding 10,000 or more CFU/mL compared with a urine culture yielding less than 10,000 CFU/mL. Conclusion: After adjusting for covariates, no association was observed between urine culture results and testing positive for trichomoniasis, gonorrhea, or chlamydia. Our results suggest that having a concurrent STI and bacterial UTI is unlikely.


Subject(s)
Gonorrhea , Sexually Transmitted Diseases , Urinalysis , Urinary Tract Infections , Humans , Female , Adult , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology , Urinary Tract Infections/urine , Sexually Transmitted Diseases/urine , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/microbiology , Gonorrhea/diagnosis , Gonorrhea/urine , Urinalysis/methods , Chlamydia Infections/urine , Chlamydia Infections/diagnosis , Middle Aged , Chlamydia trachomatis/isolation & purification , Emergency Service, Hospital , Trichomonas vaginalis/isolation & purification , Bacteriuria/diagnosis , Bacteriuria/urine , Bacteriuria/microbiology , Young Adult , Neisseria gonorrhoeae/isolation & purification , Urine/microbiology , Retrospective Studies , Adolescent , Trichomonas Infections/diagnosis , Trichomonas Infections/urine
8.
West J Emerg Med ; 25(3): 382-388, 2024 May.
Article in English | MEDLINE | ID: mdl-38801045

ABSTRACT

Introduction: The incidence of sexually transmitted infections (STI) increased in the United States between 2017-2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED. Methods: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018-May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18-64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics. Results: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%). Conclusion: Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals.


Subject(s)
Coinfection , Emergency Service, Hospital , Gonorrhea , HIV Infections , Hepatitis C , Mass Screening , Sexually Transmitted Diseases , Syphilis , Humans , Cross-Sectional Studies , Female , Retrospective Studies , Adult , Male , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Coinfection/epidemiology , Coinfection/diagnosis , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Syphilis/diagnosis , Syphilis/epidemiology , Prevalence , Middle Aged , Hepatitis C/epidemiology , Hepatitis C/diagnosis , Mass Screening/methods , HIV Infections/epidemiology , HIV Infections/diagnosis , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Adolescent , Young Adult
9.
Sex Health ; 212024 May.
Article in English | MEDLINE | ID: mdl-38743839

ABSTRACT

Artificial Intelligence (AI) applications have shown promise in the management of pandemics. In response to the global Monkeypox (Mpox) outbreak, the HeHealth.ai team leveraged an existing tool to screen for sexually transmitted diseases (STD) to develop a digital screening test for symptomatic Mpox using AI. Before the global Mpox outbreak, the team developed a smartphone app (HeHealth) where app users can use a smartphone to photograph their own penises to screen for symptomatic STD. The AI model initially used 5000 cases and a modified convolutional neural network to output prediction scores across visually diagnosable penis pathologies including syphilis, herpes simplex virus, and human papillomavirus. A total of about 22,000 users had downloaded the HeHealth app, and ~21,000 images were analysed using HeHealth AI technology. We then used formative research, stakeholder engagement, rapid consolidation images, a validation study, and implementation of the tool. A total of 1000 Mpox-related images had been used to train the Mpox symptom checker tool. Based on an internal validation, our digital symptom checker tool showed specificity of 87% and sensitivity of 90% for symptomatic Mpox. Several hurdles identified included issues of data privacy and security for app users, initial lack of data to train the AI tool, and the potential generalisability of input data. We offer several suggestions to help others get started on similar projects in emergency situations, including engaging a wide range of stakeholders, having a multidisciplinary team, prioritising pragmatism, as well as the concept that 'big data' in fact is made up of 'small data'.


Subject(s)
Artificial Intelligence , Mobile Applications , Sexually Transmitted Diseases , Humans , Sexually Transmitted Diseases/diagnosis , Male , Smartphone , Mass Screening/methods
11.
Article in English | MEDLINE | ID: mdl-38597520

ABSTRACT

The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.


Subject(s)
Gonorrhea , HIV Infections , Mpox (monkeypox) , Sexual and Gender Minorities , Sexually Transmitted Diseases , Adult , Humans , Male , Brazil/epidemiology , Cross-Sectional Studies , Demography , Disease Outbreaks , Gonorrhea/diagnosis , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Infections/complications , Homosexuality, Male , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology
12.
Emerg Med Clin North Am ; 42(2): 335-368, 2024 May.
Article in English | MEDLINE | ID: mdl-38641394

ABSTRACT

As the United States faces a worsening epidemic of sexually transmitted infections (STIs), emergency departments (EDs) play a critical role in identifying and treating these infections. The growing health inequities in the distribution and disproportionate impact of STIs add to the urgency of providing high-quality sexual health care through the ED. Changes in population health are reflected in the new Centers for Disease Control recommendations on screening, diagnostic testing, and treatment of STIs. This review covers common, as well as and less common or emerging STIs, and discusses the state-of-the-art guidance on testing paradigms, extragenital sampling, and antimicrobial treatment and prevention of STIs.


Subject(s)
HIV Infections , Sexually Transmitted Diseases , Humans , United States/epidemiology , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/therapy , Emergency Service, Hospital , Quality of Health Care , HIV Infections/epidemiology
13.
Sex Health ; 212024 Apr.
Article in English | MEDLINE | ID: mdl-38683938

ABSTRACT

Background Sydney Sexual Health Centre (SSHC) is the largest sexual health clinic in New South Wales (NSW), servicing clients at high risk of sexually transmissible infections and bloodborne viruses. SSHC piloted a direct-to-pathology pathway that facilitated bloodborne virus/sexually transmissible infection testing at one of the ~500 participating pathology collection centres located across NSW. This qualitative study sought to understand SSHC client and provider perspectives of acceptability of the MyCheck intervention. Methods Semi-structured in-depth interviews were conducted with 11 clients who underwent testing via the MyCheck pathway and eight staff members involved in implementing MyCheck. The seven components of Sekhon's Theoretical Framework of Acceptability informed this analysis. Results Participants broadly conveyed 'affective attitude' toward the MyCheck pathway. The telehealth intervention reduced client 'burden' and 'opportunity cost' through enabling greater testing convenience at a location suitable to them and provided timely results. Issues of 'ethicality' were raised by clients and staff as pathology centre staff were, on a few occasions, regarded as being judgmental of SSHC clients. 'Intervention coherence' issues were largely attributed to pathology centre personnel being unfamiliar with the intervention, with billing issues being a recurrent concern. Participants perceived MyCheck as an 'effective' testing pathway. SSHC staff were able to offer the intervention with ease through seamless IT integration ('self-efficacy'). Conclusion The MyCheck intervention was perceived by both SSHC clients and staff as an acceptable bloodborne virus/sexually transmissible infection testing pathway. However, further work is required to address stigma experienced by some clients when attending pathology collection centres.


Subject(s)
Sexually Transmitted Diseases , Telemedicine , Humans , Male , Female , Sexually Transmitted Diseases/diagnosis , New South Wales , Adult , Patient Acceptance of Health Care/psychology , Blood-Borne Infections/diagnosis , Attitude of Health Personnel , Qualitative Research , Mass Screening/methods , Middle Aged
14.
J Med Microbiol ; 73(4)2024 Apr.
Article in English | MEDLINE | ID: mdl-38591530

ABSTRACT

Sexually transmitted infections (STI) are a public health problem. Real-time PCR assays are the most sensitive test for screening and diagnosis of these infections. The aim of this study was to evaluate a new CT/NG/TV/MG Real-Time PCR (RT-PCR) kit (Vircell) for the detection of Chamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis for the diagnosis of sexual transmitted infections using the Allplex STI Essential Assay (Seegene) as the reference's method. A total of 497 samples from different anatomical sites (endocervical, urethral, rectal, pharyngeal and urine) were analysed from October 2022 to February 2023. A total of 108 (21.73 %) and 106 (21.33 %) positive samples were found for any of the assays used. The most commonly detected pathogen was N. gonorrhoeae (52 samples; 10.46 %), and the least commonly detected was T. vaginalis (three samples; 0.60 %). The anatomical site with the highest prevalence of micro-organisms was a non-urogenital site, the pharynx (26 positive samples; 5.23 %). Using the Allplex STI Essential Assay (Seegene) as the reference method, the diagnosis performance showed that the average specificity of CT/NG/TV/MG RT-PCR Kit (Vircell) was 99.84 % and the sensitivity was 99.53 %. The overall concordance was k=0.98 (CI95 %; 0.96-1). In conclusion, the CT/NG/TV/MG RT-PCR Kit (Vircell) assay shows a good sensitivity and specificity and constitutes a promising and additional alternative to routine procedures for distinct types of clinical specimen in diagnosis STI.


Subject(s)
Chlamydia Infections , Gonorrhea , Mycoplasma Infections , Mycoplasma genitalium , Sexually Transmitted Diseases , Trichomonas vaginalis , Humans , Real-Time Polymerase Chain Reaction , Chlamydia trachomatis/genetics , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Trichomonas vaginalis/genetics , Neisseria gonorrhoeae/genetics , Mycoplasma genitalium/genetics , Mycoplasma Infections/diagnosis , Mycoplasma Infections/epidemiology , Tomography, X-Ray Computed , Chlamydia Infections/diagnosis , Gonorrhea/diagnosis , Gonorrhea/epidemiology
15.
Sex Health ; 212024 Apr.
Article in English | MEDLINE | ID: mdl-38603545

ABSTRACT

Background The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend =0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault.


Subject(s)
Chlamydia , Gonorrhea , HIV Infections , Sex Offenses , Sexual Health , Sexually Transmitted Diseases , Male , Female , Humans , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control , Gonorrhea/epidemiology , HIV Infections/epidemiology , HIV Infections/prevention & control , Retrospective Studies , Australia/epidemiology , Clinical Audit
16.
Travel Med Infect Dis ; 59: 102719, 2024.
Article in English | MEDLINE | ID: mdl-38574784

ABSTRACT

BACKGROUND: The aim of the study was to assess socio-demographical characteristics, clinical presentation, and outcomes in patients diagnosed with mpox. METHODS: A survey on patients diagnosed with mpox was performed in 14 countries from Central and Eastern Europe. Data was compared according to HIV status and country of origin (EU vs. non-EU). Mpox diagnosis was confirmed by RT-PCR from oropharyngeal swabs, skin lesions, and other body fluids. RESULTS: Out of 154 patients confirmed with mpox in 2022, 99.3% were males, with a median age (years) of 35 (IQR 30-39), 90.2% MSM and 48.7% PLWH. Compared to HIV-negative subjects, PLWH had more frequent high-risk behaviours:chemsex (p = 0.015), group sex (p = 0.027), and a history of sexually transmitted infections (STIs) (p = 0.004). Persons from EU were more often PLWH (p = 0.042), MSM (p < 0.0001), had multiple sexual partners (p = 0.025), practiced chemsex (p = 0.008) or group-sex (p = 0.005) and had more often history of STIs (p < 0.0001). The median CD4 cell count/mL at mpox diagnosis was 713 (IQR 486-996) and 73.5% had undetectable HIV VL. The commonest clinical features were fever (108 cases), lymphadenopathy (78), and vesiculo-pustular rash: penile (76), perianal (48), limbs (67). Fifty-one (31%) persons were hospitalized due to complications or epidemiological reasons. Three patients received tecovirimat or cidofovir. The outcome was favorable for all patients, including 4 with severe forms. CONCLUSIONS: Mpox was diagnosed predominantly in young MSM, with high-risk behaviors and history of STIs. Effective contact tracing and vaccination are important strategic pillars to control mpox outbreaks.


Subject(s)
Disease Outbreaks , Humans , Male , Female , Adult , Europe, Eastern/epidemiology , HIV Infections/epidemiology , Europe/epidemiology , Condylomata Acuminata/epidemiology , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/diagnosis , Middle Aged
17.
Menopause ; 31(5): 430-432, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38626377

ABSTRACT

Rates of sexually transmitted infections (STIs) are increasing in all age groups. Although STI incidence decreases with age, midlife women have risk factors that may lead to STI acquisition and underdiagnosis. Clinicians may assume that older women are not sexually active. Although many STIs are asymptomatic, when midlife women do experience vaginal symptoms, they may be erroneously attributed to menopause changes. Clinicians should follow evidence-based screening recommendations provided by the US Preventive Services Task Force and consider STIs in the differential diagnosis of vaginal symptoms. Treatment of STIs in midlife women are guided by the Centers for Disease Control and Prevention's STI Treatment Guidelines.


Subject(s)
Menopause , Sexually Transmitted Diseases , Humans , Female , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/diagnosis , Middle Aged , Risk Factors , United States/epidemiology , Sexual Behavior , Women's Health
20.
Actas Dermosifiliogr ; 115(6): T592-T595, 2024 Jun.
Article in English, Spanish | MEDLINE | ID: mdl-38648929

ABSTRACT

Human immunodeficiency virus (HIV) transmission remains an important health issue, with a high burden that is felt across the world. This work aims to analyze the demographic, clinical, and laboratory characteristics of newly diagnosed patients with HIV in a Department of Dermatology and Venereology. A retrospective observational study was conducted from all health records of newly diagnosed patients with HIV from a Dermatology unit from January 2011 to December 2020. A total of 134 patients with new HIV diagnoses were included in the analysis. Concurrent dermatological or venereal diseases were diagnosed in 91.0% of the patients (n=122), being the most common conditions syphilis (22.4%, n=30) and urethritis (14.9%, n=20). Out of all the patients with diagnoses of concurrent sexually transmitted infection (STI) (41.0%, n=55), syphilis was reported in 81.8% of the patients (n=45), gonorrhea in 9.1% (n=5), and chlamydia in 5.5% (n=3). We present a large patient database on the clinical conditions associated with newly diagnosed HIV, concluding that infectious diseases were the most common conditions associated with newly diagnosed HIV.


Subject(s)
Dermatology , HIV Infections , Venereology , Humans , Retrospective Studies , HIV Infections/epidemiology , HIV Infections/complications , HIV Infections/diagnosis , Male , Female , Adult , Middle Aged , Dermatology/statistics & numerical data , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/diagnosis , Hospital Departments/statistics & numerical data , Syphilis/epidemiology , Syphilis/diagnosis , Young Adult , Time Factors
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