[Sexually transmitted infections in Germany : The current epidemiological situation]

[An STI rarely comes alone-An overview of sexually transmitted infections]

Sexually transmitted infections (STI) or sexually transmitted diseases (STD) can be caused by bacteria, viruses, fungi, protozoa and arthropods. The most frequent bacterial STIs include Chlamydia infections, syphilis and gonorrhea; viral STIs include herpes genitalis (herpes simplex virus 1 and 2), human papillomavirus (HPV) and human immunodeficiency virus (HIV). An empathetic medical history taking in cases of a clinical suspicion can provide important information for adequate diagnostics. When an STI is detected, a complete screening for other STIs should be carried out. The STIs result in a wide variety of symptoms and it is often difficult to make a clear diagnosis to a certain pathogen based on the clinical symptoms. To avoid reinfections, it is recommended to also test recent sexual partners. For certain pathogens highly effective postexposure prophylaxis or preventive vaccinations are available.

Evaluating the global, regional, and national impact of syphilis: results from the global burden of disease study 2019

Syphilis is a global public health concern. This study aimed to assess the global and regional burden of syphilis from 1990 to 2019. Disease burden was evaluated using disability-adjusted life-years (DALYs) and prevalence. Data were extracted from the 2019 global burden of disease Study, an open database available for download. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were calculated to evaluate the syphilis burden over time. In 2019, the total number of prevalent cases of syphilis was 49.71 million worldwide. The ASR of prevalence was stable from 1990 to 2019 with an EAPC of 0.00 (95% CI - 0.10-0.11). The number of DALYs caused by syphilis was 7.36 million in 2019, reflecting a reduction of 16.38% compared with that in 1990 (8.80 million). The ASR of DALYs exhibited a decreasing trend from 1990 to 2019 (EAPC =  - 1.01; 95% CI - 1.19 to - 0.84), with the highest rates observed in the younger age group (< 14 years old). In 2019, the highest ASR of DALYs was found in low sociodemographic index (SDI) regions (239.21/100,000), and the lowest in high SDI regions (3.14/100,000). Generally, the ASR of DALYs decreased as the SDI increased. The top three countries with the highest ASR of DALYs for syphilis were the Solomon Islands, Equatorial Guinea, and Liberia. While the global prevalence of syphilis remained persistently high from 1990 to 2019, there has been a recent decrease in the ASR of DALYs. Increased attention should be dedicated to younger populations and regions characterized by low SDIs.

Serological testing for syphilis in the differential diagnosis of cognitive decline and polyneuropathy in geriatric patients

BACKGROUND

In the 19th century, neurosyphilis was the most frequent cause of dementia in Western Europe. Now dementia caused by syphilis has become rare in Germany. We studied whether routine testing of patients with cognitive abnormalities or neuropathy for antibodies against Treponema pallidum has therapeutic consequences in geriatric patients.

METHODS

A Treponema pallidum electrochemiluminescence immunoassay (TP-ECLIA) is routinely performed in all in-patients treated at our institution with cognitve decline or neuropathy and no or insufficient previous diagnostic workup. Patients with a positive TP-ECLIA treated from October 2015 to January 2022 (76 months) were retrospectively evaluated. In cases of positive TP-ECLIA, further specific laboratory investigations were performed to assess whether antibiotic therapy was indicated.

RESULTS

In 42 of 4116 patients (1.0%), TP-ECLIA detected antibodies directed against Treponema in serum. Specifity of these antibodies was ensured by immunoblot in 22 patients (11 × positiv, 11 × borderline values). Treponema-specific IgM was detectable in the serum of one patient, in 3 patients the Rapid Plasma Reagin (RPR) test, a modified Venereal Disease Research Laboratory test (VDRL), in serum was positiv. CSF analysis was performed in 10 patients. One patient had CSF pleocytosis. In 2 other patients, the Treponema-specific IgG antibody index was elevated. 5 patients received antibiotic therapy (4 × ceftriaxone 2 g/d i.v., 1 × doxycycline 300 mg/d p.o.).

CONCLUSION

In approx. 1‰ of patients with previously undiagnosed or not sufficiently diagnosed cognitive decline or neuropathy, the diagnostic workup for active syphilis resulted in a course of antibiotic treatment.

The effectiveness of an extra-curricular lecture for STI prevention and sexual education

While the incidence of infections with the human immunodeficiency virus largely remained unchanged in Germany, an increase of other sexually transmitted infections (STIs) was observed. The aim was to analyse the effectiveness of our sexual education lecture for students in improving the awareness, knowledge and prevention of STIs. We conducted a cross-sectional survey after students had attended our extra-curricular lecture at the Department of Dermatology of the Ludwig-Maximilians-University of Munich, Germany (LMU). We compared the data with a previously performed study in which the same survey was carried out before the lecture had started. A total of 5866 questionnaires were included in the analysis. After attending the lecture significantly more students were aware of STIs (syphilis: 36.8% (before) vs. 63.5% (after); chlamydia: 30.5% vs. 49.3%; gonorrhoea: 22.4% vs. 38.2%; human papillomaviruses (HPV): 17.7% vs. 30.2%), the transmission pathways of STIs (oral: 36.6% vs. 82.6%; vaginal: 81.8% vs. 97.3%; anal: 42.8% vs. 94.0%; penile: 68.7% vs. 92.1%), knew that the HPV vaccination is directed against a virus (36.8% vs. 56.9%) and were interested in receiving a vaccination (57.7% vs. 78.8%). This study demonstrates the positive educative effects of our lecture for awareness and improved knowledge of STIs. To satisfy the need for a comprehensive sexual education, a combination of school and health facility-based programmes should be implemented as one single lecture cannot convey the entire information about STIs.

Utilization of point-of-care tests among general practitioners, a cross-sectional study

Background

Point-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs).

Methods

A questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany.

Results

A total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful.

Discussion/conclusion

The most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results.

Trial registration

In accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01643-9.

Long-term follow-up after introduction of a systematic sexually transmitted infection screening program for men having sex with men living with HIV in a primary care setting: uptake, STI incidence, and risk factors for infection and reinfection

Purpose

Annual screening for asymptomatic infections with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is recommended by international guidelines in people living with HIV but uptake in routine care remains poor. This study analyzed the effects of the implementation of a CT/NG screening program in a primary HIV treatment center.

Methods

In this single-center cohort study, we included men having sex with men (MSM) living with HIV during the study period from January 2016 to December 2019. From January 2018 on, annual sexual health counseling including CT/NG screening was proactively offered to all MSM presenting at the center. CT/NG screening rates, test positivity rates and case detection rates in the years 2018 and 2019 were compared to those in the years 2016 and 2017.

Results

A total of 234 patients were enrolled in the study contributing to 798.7 patient years (py) during the four-year study period. Screening rates increased from 3.1% and 3.9% in 2016 and 2017 to 51.1% in 2018 and decrease to 35.4% in 2019. Over the study period, 19.7% (46/234) had at least one positive CT/NG result. After the intervention, case detection per 100 py increased for CT (2016: 2.6, 2017: 3.7, 2018: 7.7, 2019: 7.1) and NG (2016: 3.2, 2017: 3.1, 2018: 5.3, 2019: 7.6). The number needed to test was 8.9 for CT and 10.4 for NG.

Conclusion

Regular CT/NG screening is feasible in a primary care setting, leads to an increase in case detection and may contribute to decrease transmission and complications of CT/NG.

Trial registration

The trial is registered in ClinicalTrials.gov (NCT02149004).

Sexuell übertragbare Infektionen (STDs) und Prävention

Auch im Lichte aktueller, infektionsimmunologischer Erkenntnisse über Entstehung und Behandlung spielen im Zeitalter der modernen Therapien einschließlich Antisepsis und Antibiotika sexuell übertragbare Erkrankungen nach wie vor, und speziell für bestimmte Risikogruppen, eine bedeutende Rolle. Die grundsätzliche Behandelbarkeit lange Zeit tödlich verlaufender Infektionen wie AIDS hat andererseits sogar vielfach zu vermehrter Sorglosigkeit geführt, wodurch nicht nur die HIV-Infektion und häufig ko-akquirierte Infektionen wie Syphilis nach wie vor wichtige Infektionskrankheiten auch in entwickelten Ländern darstellen, sondern grundsätzlich viele eindämmbare Erkrankungen z.T. auch wieder vermehrt auftreten und entsprechende Probleme bereiten. Daher ist und bleibt es unumgänglich, dass sich Ärzte und sexualmedizinisches Personal ständig auch über die Möglichkeiten der Übertragung wie der Prävention sexuell übertragbarer Krankheiten auf dem Laufenden halten.

Factors associated with non-use of condoms among heterosexually-active single people in Germany: Results from the first representative, population-based German health and sexuality survey (GeSiD)

Background: Against the backdrop of rising STI incidence among the heterosexual population, sexually active single people are at particularly high STI transmission risk. Gaining insight into circumstances related to condoms non-use in this population is therefore important for developing effective health interventions. Methods: The nationally-representative survey, GeSiD (German Health and Sexuality Survey) undertaken 2018-2019, interviewed 4,955 people aged 18-75 years. A total of 343 heterosexually-active single participants answered a question about condom use at last sex. Data on sociodemographic characteristics, sexual behaviours and circumstances of last sex were analysed to identify independently associated factors. Results: Condom non-use at last sex was reported more commonly by participants aged >35 years than by younger participants (48.5 vs 33.7%, respectively) and more likely among longer relationships (adjusted odds ratio [AOR]: 2.43) or early loving relationships (AOR: 3.59) than in one-night-stands. It was also associated with not discussing using condoms before sex (AOR: 6.50) and with reporting non-use of condoms at sexual debut (AOR: 4.75). Conclusions: Non-use of condoms is a common STI risk behaviour among heterosexually-active single people in Germany and so needs promoting from sexual debut throughout the life course, regardless of relationship type and age, but particularly among middle-aged and older people.

Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system

Background

Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings.

Methods

Urine specimens from participants from population-based health examination surveys of children (2014–17) and adults (2008–11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014–16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason.

Results

Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0–7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0–23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0–5.3%; sexually active: 3.1%; 95% CI 1.3–7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6–7.7%; sexually active: 3.3%; 95% CI 1.3–7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9–6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5–12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8–11%) and 19-year-old men (24%; 95% CI 22–26%).

Conclusions

Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.

[Sexual behavior and prevention of sexually transmitted infections taking the SARS-CoV-2 pandemic into account. Data from a sexual healthcare and medicine center-WIR]

Hintergrund

Anwendungsbezogene Daten zu sexueller Gesundheit und sexuellem Verhalten in unterschiedlich sexuell aktiven Populationen stehen nur begrenzt zur Verfügung, sind aber für Präventions- und Versorgungsstrategien sehr relevant. Das multisektorale Versorgungszentrum WIR – Walk In Ruhr hat aufgrund seiner Besucher*innenstruktur Zugang zu Daten aus diversen Lebenswelten.

Ziel der Arbeit

Aus verschiedenen WIR-internen Datenquellen sollen populationsbezogene Erkenntnisse zu Alter, Geschlecht, sexueller Orientierung, Sexual- und Risikoverhalten gewonnen und Bedarfe für Prävention abgeleitet werden. Einflüsse der SARS-CoV-2-Pandemie auf das Sexualverhalten sollen durch den Vergleich verschiedener Zeiträume untersucht werden.

Methoden

Ausgewertete Datenquellen sind der Onlinerisikotest für HIV und STI, die COWIR- und PrEP-Studie sowie die Immunologische Ambulanz und das Gesundheitsamt im WIR.

Ergebnis

Sexuell übertragbare Infektionen (STI) sind von 2019 auf 2020 trotz Kontaktbeschränkungen gestiegen. Generell haben junge Menschen, Männer, die Sex mit Männern, und Frauen, die Sex mit Frauen haben, ein erhöhtes STI-Risiko aufgrund der gewählten Sexualpraktiken und der Anzahl sexueller Kontakte. Eine hohe Zahl bi- und transsexueller Kontakte ist festzustellen. SARS-CoV‑2 führte zu einer Reduzierung der Sexualkontakte. Sexualpraktiken wurden weiter gelebt. Die STI-Testquote und die Behandlungsrate stiegen an.

Diskussion

Die Daten aus dem WIR belegen, dass eine junge Klientel mit aktivem Sexualleben erreicht wird. Die Ergebnisse aus Fragebögen und dem Onlinerisikotest zeigen den Zusammenhang von erhöhten positiven STI-Tests mit Sexualverhalten und sexuellen Präferenzen, weshalb spezifische Strategien zu Sexualaufklärung, Prävention, Tests und Therapien erforderlich sind.

Methodology of the German National Sex Survey - GeSiD (German Health and Sexuality Survey)

The German Health and Sexuality Survey (GeSiD) was carried out in 2018/2019 to provide up-to-date measures of sexual behavior, sexual attitudes and sexual lifestyles of the adult population. We describe the methods used in GeSiD which surveyed the general population in Germany aged 18-75 years (with oversampling of younger adults aged 18-35 years). This article focuses on study design, recruitment, and response rate and discusses the strategies implemented to enhance the response rate compared to the pilot study. Overall, 4.955 interviews were completed with a response rate of 30.2%. The data were weighted by age, gender, education, nationality, and region to reduce possible bias. Compared to the German 2018 census, the weighted sample provides good representativeness for selected respondent characteristics. The computer-assisted interviews consisted of a combination of face-to-face and self-completion components. They covered a broad perspective on sexual health, which included topics such as online sexual activities, pleasure, sexual dysfunction, and sexual violence. Reliable data on sexual and reproductive health in Germany are urgently needed for evidence-based prevention and health promotion work, to inform sexual health policy and for cross-national comparisons of the development of sexual behavior in Europe.

[Unplanned pregnancy-now what? : Effectiveness and acceptance of medical teaching units for primary and secondary prevention in schools]

BACKGROUND

The German Medical Society for Health Promotion (ÄGGF) has developed a school-based teaching unit for students in grade 8 and higher that aims at primary and secondary prevention of unplanned pregnancies.

AIMS

The accompanying evaluation study analyzes the effects of the teaching unit on the students' knowledge and their experience with self-efficacy concerning unplanned pregnancies.

METHODS

A two-armed cluster-randomized controlled study was conducted using a ten-page anonymous questionnaire with a closed answer format before and after the intervention.

RESULTS

In the first survey, 1855 students participated; 1523 students participated in the second. Participants in the intervention group showed a greater increase in knowledge over time. Compared to the control group, they showed an increased intention to use the pill and condoms as well as a marked increase in self-efficacy in the case of an unplanned pregnancy. Furthermore, they significantly corrected their perception of the age at which same-aged boys start having sexual intercourse. All effects remained stable when covariates were controlled. The teaching units were highly accepted: more than 90% of the participants stated that they would recommend them to other students.

DISCUSSION

A school-based medical teaching unit about the prevention of unplanned teenage pregnancies was able to contribute to the improvement of students' knowledge and competency. The intervention itself was highly accepted within the target group.

Stigma Surrounding Sexually Transmitted Infections among Medical Students in Germany

Stigmatization by health care professionals leads to decreased help-seeking behaviors in those being stigmatized. Prejudicial attitudes are especially pronounced concerning sexually transmitted infections (STIs), which is crucial in light of rising prevalence rates of STIs in recent years. We aimed to examine stigmatization against patients with sexually versus non-sexually transmitted infections among medical students in Germany. We also assessed how a person's sexual orientation or gender might contribute to stigma. Medical students (N = 332) read about a fictious patient with symptoms of pharyngitis after having had a casual sex encounter. Gender (female/male) and sexual orientation (hetero-/bi-/homosexual) of the patient as well as the pathogen causing the infection (gonococcus/H1N1-virus) were randomly varied. Afterwards, stigma against the patient was assessed. Patients with a gonococcal pharyngitis were perceived as more prone to engage in risky behavior, dumber, and less responsible than patients with a H1N1-virus pharyngitis. Bisexual patients were perceived as more prone to engage in risky behavior than hetero- and homosexual individuals. The predictability of the consequences of the patient's actions was rated higher in bisexual patients. Stigmatizing attitudes toward patients with a STI were frequent, especially against bisexual patients. More education should be dedicated to sexual/LGB health during medical school to reduce existing stigma.

Patient Perception of Mobile Phone Apps for the Care and Prevention of Sexually Transmitted Diseases: Cross-Sectional Study

Background

In the emerging era of digitalization and electronic health, various health-related apps have been launched, including apps for sexually transmitted diseases. Until now, little has been known about how patients perceive the value of such apps.

Objective

To investigate patient’s attitudes and awareness toward sexually transmitted disease–related apps in an outpatient sexually transmitted disease clinic setting.

Methods

A cross-sectional study was conducted at a dermatovenereological outpatient unit between April and July 2019. Patients completed a self-administered questionnaire on their perceptions of the popularity and usefulness of sexually transmitted disease–related apps. Descriptive analysis was performed with expression of categorical variables as frequencies and percentages. For continuous variables, the median, range, and interquartile range were indicated. Contingency tables and chi-square tests were used to investigate associations between sociodemographic data and items of the questionnaire.

Results

A total of 226 patients were surveyed (heterosexual: 137/193, 71.0%; homosexual: 44/193, 22.8%; bisexual: 12/193, 6.2%); 11.9% (27/225) had previously used health-related apps. Nearly half of the patients (97/214, 45.3%) specifically considered sexually transmitted disease–related apps useful, 47.8% (100/209) voted that they could supplement or support the consultation of a physician. Interestingly, only 35.1% (74/211) preferred a printed patient brochure on sexually transmitted diseases over downloading and using an app, but 64.0% (134/209) would download a sexually transmitted disease–related app recommended by their physician. General information regarding sexually transmitted diseases (93/167, 55.7%), evaluation of skin diseases based on photos or videos (78/167, 53.3%), information on the prevention of sexually transmitted diseases (76/167, 45.5%), mediation of nearby contact points or test sites (74/167, 44.3%), anonymous medical advice (69/167, 41.3%), and calculation of the risk of having a sexually transmitted disease (63/167, 37.3%) were rated as the most important features. Men were more likely than women to find sexually transmitted disease–related apps useful in general (P=.04; χ²=6.28) and to pay for such apps (P=.01; χ²=9.19). Patients aged <40 years would rather download an app recommended by their physician (P=.03; χ²=7.23), whereas patients aged >40 years preferred reading a patient brochure on sexually transmitted diseases (P=.02; χ²=8.14).

Conclusions

This study demonstrated high general interest in the use of sexually transmitted disease–related apps in this sample of dermatovenereological outpatients. In particular, young age and male sex were significantly associated with a positive perception, underlining the high potential of apps in the prevention and early recognition of sexually transmitted diseases in this group. Future studies are warranted to validate these findings in other populations.

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr-area, Germany: PreYoungGo study

BACKGROUND AND OBJECTIVES

STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time.

METHODS

In this study, 272 subjects (14-31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert^® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time - TAT) and (ii) test to therapy initiation was documented.

RESULTS

Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h.

CONCLUSION

Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert^® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day.

Comparison of Self-Reported Sexual Activity Among Heterosexuals with Sexual Spread of Poorly Transmittable Agents: A Minimalistic Approach to Estimating Sexual Activity Based on HIV Incidence

The aim of this study was to assess whether epidemics of sexually transmitted infections caused by poorly transmittable agents corresponded to self-reported sexual activity in a distinct population. To exemplify this, a model was used to investigate whether HIV infection incidences corresponded to the extent of sexual activity as assessed by a questionnaire-based study. The model suggested between 97 and 486 sexual contacts per German individual during a sexually active lifetime based on the annual HIV incidence of 680 among the heterosexual population reported by the German National Health Authority. This is in line with the estimated 296 sexual contacts during one's lifetime, which was indicated by questionnaire respondents. The model confirms the correspondence of self-reported sexual activity with HIV incidence as reported by the German National Health Authority. Accordingly, HIV incidence- and prevalence-based modeling of sexual activity in a population provides crude estimations in situations where a range of uncertainty is acceptable. The model's veracity is limited by a number of assumptions necessitated by the paucity of data. Nevertheless, the model may be suitable in settings where severe reporting bias has to be expected for legal or socio-cultural reasons.

Chemsex and Mental Health of Men Who Have Sex With Men in Germany

Background: Chemsex is defined as using certain substances immediately before or during sexual activities to facilitate, prolong and/or intensify sexual experience, mainly by some communities of men who have sex with men (MSM). Four substances are typically associated with chemsex: methamphetamine, mephedrone, GHB/GBL, and ketamine. While there is a lot of evidence for increased prevalence of HIV, sexually transmitted infections and other sexual health measures among MSM, who engage in chemsex, there has been little research on mental health aspects. This study aims to describe aspects of mental health among a sample of German men who have sex with men (MSM) who engage in chemsex and to describe potentially adverse consequences of chemsex behavior. Method: This paper refers to a subset of participants from the German Chemsex Survey, an MSM-community recruited, self-completed online survey with a self-selected convenience sample. The survey comprised 420 different items considering recreational substance use, substance use in sexual settings, mental health, sexual transmitted infections, adverse consequences of chemsex behavior, and experiences of non-consensual sex acts. A group of participants who used methamphetamine, mephedrone, GHB/GBL, and/or ketamine in a sexual setting in the last 12 months (n = 280, chemsex group) was analyzed regarding symptoms of depression (PHQ-9), general anxiety disorder (GAD-7), somatization (PHQ-15), and PTSD (Primary Care PTSD Screen). Group comparisons were conducted between the chemsex group and men who did not use substances in a sexual context (n = 177, non-chemsex group). Mean scores of mental health measures were compared, as well as scores above a cut-off that indicates clinically relevant symptoms. Logistical regression was utilized to determine whether mental health measures can predict adverse consequences of engagement in chemsex behaviors. Results: A total of 1,583 men started the survey; 1,050 participants provided information on substance use. Twenty-seven percent of participants (n = 280) reported that they used methamphetamine, mephedrone, GHB/GBL and/or ketamine in a sexual setting in the last 12 months. The chemsex group showed significantly higher mean scores for depression, anxiety, and somatization than the non-chemsex group, but effect sizes were low. Even though mean scores were heightened, they were still far below the cut-off for clinically relevant symptoms. The chemsex group reported significantly higher incidences of non-consensual sex acts compared with the non-chemsex group. Some men in the chemsex-group experienced potentially adverse consequences, such as loss of control regarding time and money spent for chemsex activities or amount of substances used at one occasion (49.6%), negative impacts on social functioning (33.6%), psychotic symptoms (13.2%), and physically aggressive behavior toward others (2.9%). Clinically relevant symptoms did not predict a higher likelihood for adverse consequences. Discussion: Mean scores for depression, anxiety, and somatization were significantly higher in the chemsex-group, but effect sizes were low. Both groups reported poorer mental health compared to men in the German general population. Mental health measures did not contribute to predict potentially adverse consequences of chemsex behavior.

[Current diagnosis and treatment of sexually transmitted infections]

BACKGROUND

In recent years, there has been an increasing incidence of sexually transmitted infections (STI), which in turn play a major role in urological clinical routine.

OBJECTIVES

Which STIs are relevant in urological clinical routine? What kind of recommendations for diagnosis and treatment exist?

MATERIALS AND METHODS

Review of evidence-based recommendations from the literature, current guidelines of the European Association of Urology and the Robert-Koch-Institute.

RESULTS

STIs can be differentiated into those that cause genital, anal, perianal or oral ulcers from STIs that cause urethritis, cervicitis, or urethral or vaginal discharge. Asymptomatic courses are frequently observed. For diagnosis predominantly amplification methods are recommended. The local resistance situation should be considered. Special attention is paid to the worldwide increasing resistance of gonococci. The sexual partner should also be treated. In addition, diagnosis and therapy of other STIs should be made due to the high rate of co-infection.

CONCLUSIONS

Due to the increasing incidence of STIs, the recognition and evidence-based treatment of these infections is essential to avoid ascending infections, long-term consequences, and further transmissions. It is important to assure the infectious material before initiating therapy to be able to switch from the initially initiated calculated therapy (also considering the local resistance situation) to a test-appropriate therapy.

Sexually-transmitted infections: what is the true prevalence? A cross-sectional online survey of men who have sex with men in the Veneto Region of Italy

INTRODUCTION

Rates of sexually-transmitted infections (STIs) remain high among men who have sex with men (MSM), posing serious public health concerns. The MSM population is recognized as a vulnerable, high-risk group due to barriers to preventive healthcare services and homophobic stigma.

METHODS

A cross-sectional online survey was conducted using a questionnaire based on European Man-for-Man Internet Survey 2010 (EMIS 2010) and European Centre for Disease Prevention and Control (ECDC) core indicators specific for behavioral risks. MSM were reached between June and August 2017, using Facebook and dating apps. Descriptive statistics and multivariate logistic regression were used to analyze the data.

RESULTS

A total of 324 respondents were analyzed, 88 subjects (27.2% of the sample) reported having experienced at least one STI, the most common being gonorrhea and HPV. Ten respondents reported having HIV infection, and 7 subjects (70%) of them were co-infected with other STIs. The 49.7% (161 subjects) had seen a doctor specifically for STIs. As concerns HPV vaccination, only 4.0% of the total respondents had been vaccinated. Restricting the sample to the 161 respondents who consulted an STI clinic, the 88 individuals who reported having had at least one STI amount to 54.6%. A more consistent use of condoms and larger numbers of sexual partners were significantly associated with a lower and higher risk of STI, respectively.

CONCLUSIONS

Comprehensive STI prevention strategies are needed to improve sexual health among MSM. Such strategies should include implementing programs to improve awareness about routine screening, and promote a consistent use of condoms by MSM.

Incidence of sexually transmitted infections in men who have sex with men and who are at substantial risk of HIV infection - A meta-analysis of data from trials and observational studies of HIV pre-exposure prophylaxis

BACKGROUND

Men who have sex with men (MSM) and who engage in condomless anal intercourse with casual partners are at high risk of acquiring sexually transmitted infections (STIs), but reliable epidemiological data are scarce. Studies on HIV pre-exposure prophylaxis (PrEP) enrol MSM who indicate that they engage in behaviour that puts them at high risk of acquiring HIV. Because they also screen for STIs at regular intervals, these studies may serve as a valuable source to estimate incidence rates of STIs in this subpopulation of MSM.

METHODS

We systematically searched for trials and observational studies of PrEP in MSM that reported data on the incidence of STIs during the study period. Incidence rates were calculated as events per 100 person-years (py) with 95% confidence intervals (CI). Data from individual studies were pooled building subgroups along study types and geography. We performed sensitivity analyses, including data only from studies that met pre-defined quality criteria.

RESULTS

Twenty-four publications on 20 studies were included. The majority of studies reported that sexual behaviour and/or STI incidence remained stable or decreased during the study period. For syphilis, incidence rates ranged from 1.8/100py to 14.9/100py, the pooled estimate was 9.1/100py (95%-CI: 7.7-10.9). Incidence rates for gonorrhoea and chlamydia of any site ranged from 13.3/100py to 43.0/100py and 15.1/100py to 48.5/100py, respectively. Considering only studies that met the criteria for sensitivity analysis yielded pooled estimates of 39.6/100py (95%-CI: 32.9-47.6) and 41.8/100py (95%-CI: 33.9-51.5), respectively. The overall estimate for hepatitis C incidence was 1.3/100py (95%-CI: 1.0-1.8).

CONCLUSIONS

Despite partly heterogeneous results, the data depict high incidence rates of STIs among MSM who engage in higher-risk sexual behaviours such as condomless sex with casual partners. This subpopulation of MSM requires access to STI screening at close intervals. By offering access to structures that provide regular STI monitoring and prompt treatment, PrEP may not only decrease HIV incidence but also have beneficial effects in decreasing the burden of STIs.

STI Knowledge in Berlin Adolescents

Sexually transmitted infections (STIs) pose a significant threat to individual and public health. They disproportionately affect adolescents and young adults. In a cross-sectional study, we assessed self-rated and factual STI knowledge in a sample of 9th graders in 13 secondary schools in Berlin, Germany. Differences by age, gender, migrant background, and school type were quantified using bivariate and multivariable analyses. A total of 1177 students in 61 classes participated. The mean age was 14.6 (SD = 0.7), 47.5% were female, and 52.9% had at least one immigrant parent. Knowledge of human immunodeficiency virus (HIV) was widespread, but other STIs were less known. For example, 46.2% had never heard of chlamydia, 10.8% knew of the HPV vaccination, and only 2.2% were aware that no cure exists for HPV infection. While boys were more likely to describe their knowledge as good, there was no general gender superiority in factual knowledge. Children of immigrants and students in the least academic schools had lower knowledge overall. Our results show that despite their particular risk to contract an STI, adolescents suffer from suboptimal levels of knowledge on STIs beyond HIV. Urgent efforts needed to improve adolescent STI knowledge in order to improve the uptake of primary and secondary prevention.