Delay in Seeking Health Care Services After Onset of Urethritis Symptoms in Men

When tomorrow comes too late-the silent threat: why people delay needed medical care in Türkiye

BACKGROUND

Healthcare demand procrastination is a public health concern in Türkiye, with limited research available. This study examines the prevalence of healthcare procrastination and identifies associated factors among patients at Pamukkale University Hospital.

METHODS

This cross-sectional study was conducted from 2 to 13 February 2023 in Denizli and involved 503 patients from 15 outpatient clinics. Data on sociodemographic characteristics, healthcare utilization and procrastination behaviors were collected via a structured questionnaire, including the Healthcare Demand Procrastination Scale (HDPS). Descriptive statistics and linear regression were used for analysis.

RESULTS

The participants had a mean age of 41.46 years (±15.34), with 52.9% being female. A significant 77.3% reported delaying healthcare despite needing it. The primary reasons for delays were difficulty in getting appointments (51.5%), long waiting times (21.9%) and COVID-19 concerns (19.9%). The mean HDPS score was 2.29 ± 0.65, indicating moderate procrastination. Regression analysis revealed that younger age (≤35 years) and rural residence significantly predicted higher HDPS scores, whereas receiving health information from professionals was linked to lower procrastination.

CONCLUSIONS

Healthcare procrastination is common among patients in Türkiye, particularly among younger individuals and rural residents. Improving healthcare accessibility, reducing wait times and implementing targeted interventions are essential to mitigate this issue and enhance health outcomes.

Factors Associated With Delays in Presentation and Treatment of Gonorrhea, Massachusetts 2015-2019

BACKGROUND

Rates of gonorrhea are increasing across the United States. Understanding and addressing contributing factors associated with longer time to diagnosis and treatment may shorten the duration of infectiousness, which in turn may limit transmission.

METHODS

We used Massachusetts data from the US Centers for Disease Control and Prevention Sexually Transmitted Disease Surveillance Network collected between July 2015 and September 2019, along with routinely reported surveillance data, to assess time from gonorrhea symptom onset to presentation to care, and time from presentation to care to receipt of treatment. Factors associated with longer time to presentation (TTP) and time to treatment (TTT) were assessed using Cox proportional hazard models with a constant time variable.

RESULTS

Among symptomatic patients (n = 672), 31% did not receive medical care within 7 days of symptom onset. Longer TTP was associated with younger age, female gender, reporting cost as a barrier to care, and provider report of proctitis. Among patients with symptoms and/or known contact to gonorrhea (n = 827), 42% did not receive presumptive treatment. Longer TTT was associated with female gender, non-Hispanic other race/ethnicity, and clinics with less gonorrhea treatment experience. Among asymptomatic patients without known exposure to STI (n = 235), 26% did not receive treatment within 7 days. Longer TTT was associated with sexually transmitted disease clinic/family planning/reproductive health clinics and a test turnaround time of ≥3 days.

CONCLUSIONS

Delays in presentation to care and receipt of treatment for gonorrhea are common. Factors associated with longer TTP and TTT highlight multiple opportunities for reducing the infectious period of patients with gonorrhea.

Lower Urinary Tract Inflammation and Infection: Key Microbiological and Immunological Aspects

The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches.

Time to healthcare seeking following the onset of symptoms among men and women attending a sexual health clinic in Melbourne, Australia

BACKGROUND

Timely diagnosis and treatment of sexually transmitted infections (STIs) underpin their control by reducing the duration of infectiousness. There are currently limited data exploring healthcare seeking among individuals with STI symptoms.

METHODS

We analyzed data on individuals reporting STI symptoms at the Melbourne Sexual Health Centre (MSHC) between August 2017 and December 2020. We calculated the time between symptom onset and clinic attendance by risk group for 13 STI diagnoses. We performed univariable and multivariable logistic regression analyses to explore factors associated with delayed healthcare seeking (greater than 7 days).

RESULTS

Among 7,032 symptomatic clinic attendances, the shortest time to healthcare seeking was among individuals diagnosed with gonococcal urethritis (median 3 days), and the longest was among individuals diagnosed with genital warts (median 60 days). Individuals diagnosed with gonococcal urethritis sought care earlier than individuals diagnosed with non-gonococcal urethritis (median 3 vs. 6 days, p < 0.001), and individuals diagnosed with genital herpes sought care earlier than individuals diagnosed with primary syphilis (median 4 vs. 14 days, p < 0.001). Men who have sex with men, and men taking human immunodeficiency virus pre-exposure prophylaxis (PrEP), were least likely to delay healthcare seeking. Both men and women who delayed healthcare seeking were more likely to live further from the clinic than those who did not delay their presentation [p trend < 0.001 (men) and p trend = 0.049 (women)].

CONCLUSION

Improved local access to healthcare alongside targeted strategies to encourage early healthcare seeking among groups at increased likelihood of delay may reduce STI-associated morbidity and transmission.

Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis

BACKGROUND

Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM.

METHODS

Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence.

RESULTS

Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection.

CONCLUSIONS

Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.

Correlates of time to clinical presentation for symptomatic individuals with gonorrhoea in South China: results from a cross-sectional study

OBJECTIVES

This study aimed to determine the variation in the interval between the onset of symptoms and clinical presentation, and its associated factors among symptomatic individuals with gonorrhoea.

DESIGN

A cross-sectional study was conducted between 1 June and 30 July 2017.

SETTING

129 sexually transmitted disease clinics from 21 cities of Guangdong, China.

PARTICIPANTS

Using convenience sampling method to recruit symptomatic individuals with gonorrhoea over 18 years old.

OUTCOME MEASURE

Time to clinical presentation.

RESULTS

Among 1664 participants, the median age was 29 (24-36) years old, and the majority were male (92.5%) and married (52.9%). The median time to clinical presentation was 3 (2-6) days. About 471 (28.3%) patients had sexual contact while symptomatic. After adjusting for covariates, participants who were female (aβ=0.44, 95% CI: 0.22 to 0.80), from east Guangdong region (aβ=0.44, 95% CI: 0.22 to 0.80) and had the absence of dysuria (aβ=0.26, 95% CI: 0.06 to 0.46) had increased time to clinical presentation. Participants who had commercial sex in the past 6 months (aβ=-0.11, 95% CI: -0.21 to -0.01) had decreased time to clinical presentation. Participants who were female (adjusted odds ratio (aOR)=1.66, 95% CI: 1.08 to 2.50) and delayed in seeking healthcare more than 7 days (aOR=46.71, 95% CI: 24.27 to 89.93) were more likely to have sexual contact while symptomatic.

CONCLUSION

The time to clinical presentation for individuals with symptomatic gonorrhoea is variable and a high proportion of participants continued to have sexual behaviour while symptomatic. Strategies to increase health literacy may help to minimise the sequelae of gonorrhoea and reduce onward transmission.

Indifferent, ambiguous, or proactive? Young men's discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

INTRODUCTION

Chlamydia trachomatis (C. trachomatis) infection is the most commonly reported sexually transmitted infection in Sweden and globally. C. trachomatis is often asymptomatic and if left untreated, could cause severe reproductive health issues. In Sweden, men test for C. trachomatis to a lesser extent than women.

AIM

To explore factors facilitating and constraining Swedish young men's health care utilization for C. trachomatis detection and treatment.

METHOD

A qualitative situational analysis study including data from 18 semi-structured interviews with men (21-30 years). Data collection took place in Stockholm County during 2018. A situational map was constructed to articulate the positions taken in the data within two continuums of variation representing men's risk perception and strategies to test for C. trachomatis.

RESULTS

Based on the informants' risk perception, strategies adopted to test and the role of social support, three different discourses and behaviours towards C. trachomatis testing were identified ranging from a) being indifferent about C. trachomatis -not testing, b) being ambivalent towards testing, to c) being proactive and testing regularly to assure disease free status. Several factors influenced young men's health care utilization for C. trachomatis detection, where the role of health services and the social support emerged as important factors to facilitate C. trachomatis testing for young men. In addition, endorsing traditional masculinity domains such as leaning on self-reliance, beliefs on invulnerability and framing men as more carefree with their sexual health than women delayed or hindered testing.

CONCLUSION

Testing must be promoted among those young men with indifferent or ambivalent discourses. Health systems aiming to increase testing among those at risk should take into consideration the positive role that young men's social support have, especially the level of social support coming from their peers. Additionally, endorsement of traditional masculinity values may delay or hinder testing.

Prevalence of Sexually Transmitted Infections and Risk Factors Among Young People in a Public Health Center in Brazil: A Cross-Sectional Study

INTRODUCTION

Sexually transmitted infections (STI) significantly affect the health of sexually active people, especially young people, and can cause low sexual dysfunction, low self-esteem, infertility, increased transmission of HIV, and death.

METHODS

We reviewed the medical records of a cross-section of users of a public health services center and verified the prevalence of STI and its associated predictors for male and female individuals 13-24 years of age in an interior county of southern Brazil.

RESULTS

The records of 1703 adolescents and young adults, stratified by age (13-18 and 19-24 years, respectively) and sex, admitted between April 1, 2012, and March 31, 2017, were reviewed in this retrospective study. Epidemiological, clinical, and laboratory data of medical records were analyzed using the chi-square test and odds ratio, with confidence interval of 95% by the Stata® 9.0 program. During the study period, a total of 3448 patients were attended to; of these, 1703 (49.39%) were 13-24 years of age, with 86.56% of those 19-24 years having at least 1 STI. The prevalence of STI among men and women, respectively, was 35.40% and 47.67% for condylomata, 8.46% and 7.00% for herpes, 26.35% and 18.80% for syphilis, and 20.06% and 6.27% for urethral discharge syndrome. The risk for STI acquisition was the highest in young adults (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.17-2.06, P = .002), female individuals (OR 1.51, 95% CI 1.14-2.00, P = .004), those with multiple sexual partners (OR 1.62, 95% CI 1.22-2.16, P < .001), and those not using or irregularly using prophylactics (OR 1.62, 95% CI 1.22-2.16, P < .001).

CONCLUSIONS

The findings revealed a significant prevalence of STI among young people in public health service. The predictors associated with STI in these patients were being female, having multiple partners in the last year, and not using or irregularly using prophylactics. These predictors confirm the necessity to implement more aggressive strategies to prevent the occurrence of STI in specific populations with higher disease risk, thereby minimizing costs and damage caused by the infections.

HIV Testing among General Population with Sexually Transmitted Infection: Findings from Myanmar Demographic and Health Survey (2015-16)

BACKGROUND

Human Immunodeficiency Virus (HIV) testing and counseling is recommended for people with Sexually Transmitted Infections (STIs). In Myanmar, HIV testing and its predictors among those with STI in general population is unknown.

METHODS

This is a cross-sectional study using secondary data from Myanmar demographic and health survey 2015-16. We included all women and men aged 15-49 years that reported having STI in the past 12 months. Self-reported HIV testing and its predictors were assessed (using modified Poisson regression with robust variance estimates). We have provided weighted estimates as the analyses were weighted for the multistage sampling design.

RESULTS

Of 998 self-reported STIs, 96 [9.6%, 95% confidence interval (CI): 7.5, 12.1] had been tested for HIV in the past 12 months. Respondents who were residing in hilly regions [adjusted prevalence ratio (aPR): 2.28, 95% CI: 1.29, 4.04] were more likely to have taken the HIV test. However, people in the poorest quintile (aPR: 0.34, 95% CI: 0.12, 0.96) and those who were staying at the current residence for more than 12 months (aPR: 0.45, 95% CI: 0.25, 0.79) were less likely to have taken HIV test.

CONCLUSION

There is a necessity to promote HIV literacy and HIV testing among those with STI with focus on the poorest populations.

Factors associated with time to presentation for individuals with symptomatic uncomplicated genital gonorrhoea: a cross sectional cohort study of GToG trial participants

OBJECTIVES

To determine the variation in the time from onset of symptoms to clinical presentation (time to presentation [TTP]) in a cohort of sexual health attendees with symptomatic uncomplicated genital gonorrhoea and to identify factors associated with TTP.

METHODS

Participants were recruited from 14 clinics across England into the 'Gentamicin for the Treatment of Gonorrhoea (GToG)' trial between October 2014 and November 2016. Multivariable analysis was performed using prospectively collected demographic, behavioural and clinical data in a subset of the GToG study cohort presenting with genital discharge and/or dysuria who tested positive for Neisseria gonorrhoeae using a nucleic acid amplification test. The results were expressed as geometric mean ratios (GMR) with 95% CI for time to presentation after onset of symptoms.

RESULTS

316 participants (269 men and 47 women) with a median age of 27.6 years (IQR 23.0-34.8) were included. 194 (61%) were Caucasian, 29 (9%) Black African, 27 (9%) Asian and 66 (21%) of other ethnicities. Median TTP was 3 days for men (IQR 2-7) and 14 days for women (IQR 7-21). Participants reported genital discharge (297/316 [94%]), dysuria (251/316 [79%]), both genital discharge and dysuria (232/316 [73%]) and other concurrent symptoms 76/316 (24%) (e.g., rectal bleeding or genital itching). 45/316 (14%) participants reported sexual contact while symptomatic, of whom TTP was more than 7 days in 32/45 (71%). A longer TTP was associated with gender (female cf. male, GMR 2.34 [1.67 to 3.26]), no prior history of gonorrhoea (GMR 1.46 [1.15 to 1.86]), 'regular' or 'ex-regular' sexual relationship (regular cf. one off GMR 1.35 [1.05 to 1.72]); ex-regular cf. one off GMR 1.88 [1.12 to 3.14]), and being heterosexual (GMR 1.69 [1.31 to 2.19]).

CONCLUSION

Specific demographic and behavioural factors are associated with a longer TTP in individuals with symptomatic genital gonorrhoea. Detailed knowledge of these factors can be used to prioritise and optimise gonorrhoea management and prevention.

Kissing, saliva exchange, and transmission of Neisseria gonorrhoeae

Data from mathematical models suggest that kissing and saliva exchange during sexual activity might be major contributors to community gonorrhoea morbidity. Although there is little evidence to support this, it provokes discussion of the potential role of the oropharynx in gonorrhoea control. Improved sensitivity and ease of diagnostic testing, as well as increased screening for extragenital infections among men who have sex with men, have increased awareness of the high frequency of oropharyngeal gonorrhoea. However, there are insufficient data to determine the mechanisms of transmission for these infections. Innovative studies that use quantitative microbiological techniques are needed to accurately assess how oral gonorrhoea or saliva exchange in infected people contribute to the morbidity of gonorrhoea in the community. More empirical data on pharyngeal gonorrhoea infections, and the role of transmission to and from the oropharynx, are needed to inform prevention planning.