Adolescent STIs for primary care providers

Risk factors associated with sexually transmitted infections and HIV among adolescents in a reference clinic in Madrid

Introduction

Adolescents have a higher incidence of sexually transmitted infections (STIs) than persons of older age groups. The WHO emphasises the need to adopt specific and comprehensive prevention programmes aimed at this age group. The objective of this work was to analyse the prevalence of HIV/STIs among adolescents and to identify the sociodemographic, clinical and behavioural markers associated with these infections, in order to promote specific preventive strategies.

Methodology

Retrospective descriptive study of adolescents, aged 10–19 years, who were attended to for the first consultation between 2016 and 2018 in a reference STI clinic in Madrid. All adolescents were given a structured epidemiological questionnaire where information on sociodemographic, clinical and behavioural characteristics was collected. They were screened for human inmmunodeficiency virus (HIV) and other sexually transmitted infections (STIs). The processing and analysis of the data was done using the STATA 15.0 statistical package.

Results

The frequency of HIV/STIs detected among all adolescents was: gonorrhoea 21.7%, chlamydia 17.1%, syphilis 4.8% and HIV 2.4%. After conducting a multivariate analysis, the independent and statistically significant variables related to the presence of an STI were having first sexual relations at a young age and having a history of STIs. Latin American origin was just below the level of statistical significance (p = 0.066).

Discussion/Conclusions

Adolescents who begin sexual relations at an early age or those who have a history of HIV/STIs are at higher risk of acquiring STIs. Comprehensive prevention programmes aimed specifically at adolescents should be implemented, especially before the age of 13 years.

Sexually transmitted infections in young people and factors associated with HIV coinfection: an observational study in a large city

OBJECTIVES

Young people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe the epidemiological characteristics and trends in the incidence of gonorrhoea, syphilis, HIV and venereal lymphogranuloma (LGV) among 15-24-year-olds in Barcelona, and to determine factors associated with HIV coinfection.

DESIGN

We performed a population-based incidence study covering the 2007-2015 period.

PARTICIPANTS

All new cases of STI-HIV, gonorrhoea, infectious syphilis and LGV-notified to the epidemiological surveillance system in Barcelona between 2007 and 2015. 1218 cases were studied: 84.6% were men, 19.3% were 15-19 years old and 50.6% were born in Spain. Among men, 73.7% were men who have sex with men (MSM); among women, 85.6% were women that have sex with men.

PRIMARY AND SECONDARY OUTCOMES

Incidence of HIV, gonorrhoea, infectious syphilis and LGV. HIV coinfection.

RESULTS

There was an increase in the incidence of gonorrhoea, from 1.9 cases per 10 000 people in 2007 to 7.6/10 000 in 2015 (p<0.01), in MSM from 27.1 to 228.8/10 000 (p<0.01). The incidence of syphilis increased from 0.4/10 000 in 2007 to 3.1/10 000 in 2015 (significant in men only, p<0.01), in MSM from 18.1 to 116.9/10 000 (p<0.01). The incidence of HIV showed a non-significant increase in men (p=0.27), and that of LGV remained stable (p=0.59). Factors associated with increased risk of HIV coinfection included being MSM (adjusted OR[ORa]=14.14, 95% CI 3.34 to 59.91) and having >10 sexual partners (ORa=4.11, 95% CI 1.53 to 11.01) or STI diagnosis during the previous 12 months (ORa=2.06; 95% CI 1.13 to 3.77).

CONCLUSIONS

The incidence of gonorrhoea and syphilis among 15-24-year-olds increased, while HIV infection remained stable but with a high incidence among MSM. Being MSM, having sex with multiple partners and having a diagnosis of an STI in the previous 12 months were factors associated with HIV coinfection.

Determinants of Chlamydia, Gonorrhea, and Coinfection in Heterosexual Adolescents Attending the National Public Sexually Transmitted Infection Clinic in Singapore

BACKGROUND

Amidst recent trends in rising rates of chlamydia and gonorrhea among Singaporean adolescents, there are limited data on risk factors associated with these infections that may inform prevention strategies in this population.

METHODS

A cross-sectional study of chlamydia and gonorrhea positivity was conducted among 1458 sexually active heterosexual adolescents between 14 and 19 years old attending the national public sexually transmitted infection clinic from 2006 to 2013. The association with demographic and behavioral characteristics was assessed by crude prevalence ratio, and negative binomial regression modeling was used to obtain adjusted prevalence ratios (aPRs).

RESULTS

Chlamydia positivity was found in 23.6% of males and 36.6% of females, gonorrhea positivity in 33.1% of males and 15.9% of adolescent girl, and coinfection positivity in 10.2% of males and 10.1% of females. In multivariable analysis, chlamydia was positively associated with being Malay (aPR, 1.6; 95% confidence interval [CI], 1.1-2.1) and inconsistent condom use for vaginal sex (aPR, 6.5; 95% CI = 2.4-17.4) in males and with being Malay (aPR, 1.9; 95% CI = 1.5-2.4), inconsistent condom use for vaginal sex (aPR, 2.0; 95% CI = 1.1-3.9), and number of lifetime partners in females (aPR, 1.1; 95% CI = 1.0-1.1). Gonorrhea was positively associated with being Malay (aPR, 3.2; 95% CI = 2.4-4.4), inconsistent condom use for vaginal sex (aPR, 5.4; 95% CI = 2.1-14.4), and number of lifetime partners (aPR, 1.1; 95% CI = 1.0-1.1) in males and with being Malay (aPR, 3.7; 95% CI = 2.4-5.7) in females. Malays had a higher proportion of sexual risk behaviors compared with the non-Malays.

CONCLUSIONS

Ethnicity and high-risk sexual behaviors are important determinants of chlamydia, gonorrhea, and coinfection for adolescents attending this clinic. Targeted interventions are needed to lower the prevalence of high-risk sexual behaviors for the Malay adolescents in this clinic.