Current News about Sexually Transmitted Disease

Background Doxycycline postexposure prophylaxis (doxyPEP) is a promising strategy to prevent bacterial sexually transmitted infections. Limited data exist evaluating patient and provider experiences since doxyPEP has become widely available. We aimed to explore such factors among providers and patients during real-world implementation within one community health center. Methods Doxycycline postexposure prophylaxis was rolled out at Fenway Health on February 2, 2023. To support rollout, electronic health record tools, 3 provider training sessions, and a community town hall were developed and implemented. All providers who participated in doxyPEP trainings were surveyed as well as patients with evidence of a doxyPEP discussion during a clinic encounter who were retrospectively identified via chart review. Results Between rollout and September 3, 2024, there were 3770 doxyPEP prescriptions. Among 45 providers, the median score of comfort having conversations about doxyPEP increased from 78 (interquartile range, 52–100) out of 100 after the second training to 100 (interquartile range, 88–100) after the third training. Of 150 patient responses, 90 (60.0%) were from individuals prescribed doxyPEP; reasons for use included sex with a random partner (65.6%) and condomless anal intercourse (63.3%). Among 60 patients not prescribed doxyPEP, 25 (41.7%) reported they did not feel it was warranted due to low perceived risk. Eleven (18.3%) reported they felt the risks outweighed the benefits. Conclusion Without national guidelines, the uptake of doxyPEP was robust, supported by electronic support tools and provider training sessions for clinicians, as well as community engagement efforts. Differences in risk perception were important factors in the choice to use doxyPEP. 06/02/2025 01:00 AM
 

Background With the COVID-19 pandemic, telehealth services emerged as an effective care-delivery tool to increase equitable access to care. The Chicago Department of Public Health's (CDPH) sexually transmitted infections (STI) specialty clinics provide comprehensive, no-cost care for STIs and HIV. Telehealth services may facilitate expanded services, but the acceptability to patients is unknown. Methods We analyzed data collected from participants seeking care at one of 2 CDPH STI specialty clinics from July 6 to September 12, 2023. Modified Poisson regression was used to assess factors associated with (1) using any telehealth services in the past 12 months, and (2) likelihood of not using future telehealth services at STI specialty clinics. Results Of 251 respondents, most were 18–29 years old (56%), 36% non-Hispanic (NH) White, 28% NH Black, and 71% male. Nearly half (46%) had used past telehealth services and 33% reported being unlikely to use telehealth services at specialty clinics. In adjusted analyses, compared with NH White, NH Black participants were more likely to report no intention to use future telehealth services (adjusted prevalence ratio, 1.55; 95% confidence interval, 1.02–2.35). Among those who did not previously use telehealth services, choosing CDPH STI specialty clinics for privacy concerns/confidentiality was significantly associated with a lower likelihood of using future telehealth services. Conclusions A reported moderate-high acceptance of telehealth services at CDPH STI specialty clinics may suggest telehealth implementation could have successful uptake. Next steps toward implementing a telehealth program will need to consider which services to include, provider training and needs, and system factors, such as integration with electronic medical records and establishment of a patient portal. 05/27/2025 01:00 AM
 

Background For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection. Methods We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure. Results Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3%, and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% in the genital, anal, and oral samples, respectively. If only genital screening had been performed, 71.4% of CT infections and 67.3% of NG infections in GBMSM would have gone undetected. Among 96 men who only have sex with women (MSW), 10 (10.4%) had chlamydial infection—all detected in genital samples with no extragenital infections detected. Nine gonococcal infections (9.4%) were detected in MSW, with positivity of 6.3%, 2.1%, and 3.1% in the genital, anal, and oral samples, respectively. If only genital testing had been performed, no CT infections would have been missed among MSW; however, 33.3% of NG infections would have been missed. Among 329 cisgender women, 35 (10.6%) had CT with positivity of 7.9%, 6.1%, and 1.8% in the genital, anal, and oral samples, respectively. In the same group, 17 (5.2%) had NG with positivity of 4.0%, 2.1%, and 2.4% in the genital, anal, and oral samples, respectively. Among these women, 25.7% and 23.5% of CT and NG infections, respectively, would not have been detected. Conclusions The increased case finding when including extragenital testing for GBMSM and women was confirmed in this analysis. However, the benefit-cost ratio and the clinical or public health value of extragenital screening in these different populations require further study. 08/07/2025 01:00 AM
 

Background The rapidly evolving drug resistance of Neisseria gonorrhoeae to various drugs used in its treatment has posed significant challenges, especially in developing countries. A rise in cephalosporin minimum inhibitory concentrations (MIC) among N. gonorrhoeae was identified in parts of Asia, as early as the late 1990s. Drugs such as penicillin, tetracycline, and ciprofloxacin, which were effective in the past, are now almost never used in treating gonorrhea. This research aimed to study the resistance trends of N. gonorrhoeae over a temporal span of 5 years. Methods For 5 years, samples from STI clinic attendees were collected and processed for isolating N. gonorrhoeae. Confirmed isolates were subjected to antimicrobial susceptibility tests using the MIC E-strip method. Results A total of 231 isolates of N. gonorrhoeae were studied, with 97.5% from male patients. Decreased susceptibility to third-generation cephalosporins (cefixime and ceftriaxone) was 6.06%. Azithromycin resistance was reported in 13.4% of isolates, with three-fourths from the states of North India (Delhi and Chandigarh). Of these isolates, 22.5% showed high-level resistance to azithromycin. In addition, 16 isolates were multidrug-resistant, and 1 isolate was an extensively drug-resistant N. gonorrhoeae. Conclusions These findings highlight the urgent need for concerted efforts to address the burgeoning threat of antimicrobial resistance (AMR) in N. gonorrhoeae. Continued surveillance of drug resistance is crucial. Efforts should be made to explore novel, effective treatment options to resolve this issue. 06/02/2025 01:00 AM
 

Background One-quarter of all veterans who deployed to Iraq and Afghanistan post-9/11 developed posttraumatic stress disorder (PTSD). No known longitudinal study has examined the associations between PTSD and sexually transmitted infections (STIs). Objectives were to (1) examine trends in incidences of PTSD and STIs, (2) estimate the associations between individually measured assessments of PTSD and STI incidence, (3) measure effect modification by deployments and combat exposure, and (4) explore time-varying associations. Methods In this prospective cohort study of all veterans who deployed to Iraq and Afghanistan in 2001 to 2022 and receive care in the Department of Veterans Affairs (n = 1,570,654), patients contributed a total of 15,535,454 person-years of follow-up. Joinpoint regression models, marginal structural Poisson models, and marginal structural shared frailty models were fitted with a time-dependent exposure, adjusted for time-independent and time-dependent confounding and informative censoring. Results Incidences in PTSD, hepatitis C virus, and human papillomavirus significantly decreased, but those of chlamydia, human immunodeficiency virus, and syphilis significantly increased. Posttraumatic stress disorder was associated with increased rates (adjusted rate ratio, 95% confidence interval) of HPV by 3% (1.03 [1.00–1.05]), human immunodeficiency virus by 8% (1.08 [1.02–1.15]), hepatitis B virus by 9% (1.09 [1.01–1.18]), genital HSV by 9% (1.09 [1.07–1.11]), syphilis by 11% (1.11 [1.05–1.17]), chlamydia by 20% (1.20 [1.17–1.24]), gonorrhea by 21% (1.21 [1.13–1.31]), and hepatitis C virus by 69% (1.69 [1.62, 1.77]), and remained statistically significant. Discussion Posttraumatic stress disorder was associated with increased rates of all STIs, and these associations did not diminish with time. Results may help guide preventive efforts and medical decisions for those with PTSD. 06/02/2025 01:00 AM
 

Background Intimate partner violence (IPV) has become a global public health issue, including in men who have sex with men (MSM). This study, based on minority stress theory, examines the relationship between minority stress and IPV perpetration among Chinese MSM, emphasizing the role of hazardous alcohol use. We propose 3 hypotheses: (1) enacted stigma, internalized stigma, identity concealment, and hazardous alcohol use contribute to IPV perpetration; (2) hazardous alcohol use mediates the effect of minority stress on IPV perpetration; and (3) proximal stressors (internalized stigma and identity concealment) serve as mediators between enacted stigma and IPV perpetration. Methods A total of 915 valid questionnaires were collected in China via snowball sampling for analysis, using structural equation modeling to examine the relationships between variables. Results Among 915 MSM, the IPV perpetration prevalence was 18.6% in the past year. The structural equation model showed that enacted stigma (β = 0.414, P < 0.001), internalized stigma (β = 0.179, P < 0.01), and hazardous alcohol use (β = 0.245, P < 0.001) significantly contributed to IPV perpetration. Although identity concealment (β = −0.134, P < 0.01) had a protective effect. Hazardous alcohol use mediated the relationship between minority stress and IPV perpetration, except for internalized stigma. Proximal stressors also partially mediated the link between enacted stigma and IPV perpetration. Conclusions Findings suggest that enacted stigma, internalized stigma, identity concealment, and hazardous alcohol use are associated with IPV perpetration. Reducing stigma toward MSM and addressing hazardous alcohol use are crucial for IPV perpetration. 06/02/2025 01:00 AM
 

Background Hyperosmolal lubricants may negatively affect the vaginal microenvironment, increasing the risk for bacterial vaginosis (BV). We compared the incidence of Amsel-defined BV in reproductive-age women exposed to hyperosmolal lubricant during transvaginal ultrasound to those without recent lubricant exposure. Methods We analyzed 2 observational cohorts over 10 weeks: 58 lubricant-exposed women from the Gynecology and Lubricants Effects study and 59 lubricant-unexposed women from a University of Alabama Birmingham cohort linked to the University of Maryland Human Microbiome Project. Bacterial vaginosis was diagnosed using Amsel criteria at baseline, mid-study (lubricant-exposed, week 2; lubricant-unexposed, week 5), and final visit (week 10), and categorized by symptomatology. Risks for incident BV and Amsel criteria were assessed using modified Poisson regression with robust standard errors. An additional outcome of new-onset/newly symptomatic BV included those with baseline asymptomatic BV. A secondary analysis focused on Black participants (N = 73) due to an observed higher BV incidence. Results Baseline demographics and behaviors were similar between the cohorts. Among all participants, lubricant was not associated with new-onset BV (adjusted relative risk [aRR], 1.32; 95% confidence interval [CI], 0.58–3.01). Eighty-eight percent (23/26) of all new-onset/newly symptomatic BV cases occurred in Black participants. Among Black participants, exposure to lubricant doubled the risk of developing new-onset BV (aRR, 2.18; 95% CI, 1.16–4.11) and new-onset/newly symptomatic BV (aRR, 1.91; 95% CI, 1.04–3.51), and increased the risk for new-onset clue cells (aRR, 2.18; 95% CI, 1.17–4.06) versus no lubricant exposure. Conclusion Hyperosmolal lubricants was associated with BV incidence in Black women. Factors contributing to this elevated risk require further research. 05/26/2025 01:00 AM
 

Background We evaluated human papillomavirus (HPV) vaccine effectiveness (VE) against prevalent anal HPV among men who have sex with men (MSM) by age, age at vaccination, and age at vaccination relative to age at first sex. Methods Residual anal specimens from 1092 MSM aged 18 to 45 years attending a Seattle, Washington, sexual health clinic in 2018 to 2020 were tested for 28 HPV types. Demographic, clinical, sexual behavioral, and HPV vaccination data were extracted from clinic and electronic medical records. We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between vaccination (≥1 dose of any HPV vaccine) and quadrivalent HPV vaccine (4vHPV)–type infection, by age group (18–26, 27–35, 36–45 years), vaccination age (among age groups 18–26, 27–35 years), and vaccination age relative to first sex (among those 18–26 years). Analyses were adjusted for race and ethnicity, preexposure prophylaxis use for HIV prevention, and lifetime number of sex partners. Vaccine effectiveness was calculated as (1 − aPR) × 100. Results Among persons aged 18 to 26 years, 4vHPV-type HPV prevalence was lower among those vaccinated before first sex (aPR, 0.12 [95% CI, 0.02–0.87]; VE, 88%) or at <18 years of age (aPR, 0.22 [95% CI, 0.07–0.68]; VE, 78%) versus unvaccinated, but no VE was observed in those vaccinated at 18 to 26 years of age. Among persons aged 27 to 35 years, 4vHPV-type HPV prevalence was lower among those vaccinated at 18 to 26 years of age versus unvaccinated (aPR, 0.56 [95% CI, 0.36–0.87]; VE, 44%). No VE was observed in persons aged 27 to 35 or 36 to 45 years who were vaccinated at >26 years of age. Conclusions Results highlight the importance of routine HPV vaccination in adolescence and support efforts to increase catch-up vaccination among MSM. 06/02/2025 01:00 AM