Trends in age disparities between younger and middle-age adults among reported rates of chlamydia, gonorrhea, and infectious syphilis infections in Canada: findings from 1997 to 2007

Epidemiological Trends and Factors Associated With the Morbidity Rate of Gonorrhea: A CDC-WONDER Database Analysis

BACKGROUND AND OBJECTIVE

Gonorrhea is a prevalent sexually transmitted illness caused by the bacteria Neisseria gonorrhoeae, leading to serious health consequences such as pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and increased susceptibility to HIV infection. Despite advancements in prevention and treatment, gonorrhea remains a significant public health problem in the United States (US) due to its widespread incidence, potential consequences, and the growth of antibiotic resistance. This study investigates the epidemiological trends and morbidity rates of gonorrhea using the Centers for Disease Control and Prevention's (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. The aim is to identify temporal patterns, demographic characteristics, and notable changes in gonorrhea epidemiology to inform targeted therapies and interventions.

METHODS

The CDC WONDER database, which provides extensive national and state-level data on reported causes of death in the United States, was utilized for this study. We examined the developments in gonorrhea morbidity rates over time, identified demographic differences based on age, gender, and race/ethnicity, and analyzed the disease's regional distribution through a systematic analysis of the database. Aggregate data for selected time periods (1996-2014) were summarized using the morbidity rate per 100,000 people and the total number of cases across the years.

RESULTS

This database analysis identified a total of 6,454,097 individuals diagnosed with gonorrhea between 1996 and 2014. The calculated total morbidity rate during this period was 115.4 per 100,000 individuals. The highest morbidity rates were observed in the years 1999 (129.2 per 100,000 people), 1998 (129.1 per 100,000 people), and 2001 (126.8 per 100,000 people), respectively. The District of Columbia reported the highest morbidity rate (478.25 per 100,000 people). In males, the overall morbidity rate over the years was reported to be comparable to females (114 per 100,000 people and 116.3 per 100,000 people, respectively). The analysis revealed consistently higher morbidity rates among individuals aged between 19 and 24 years (525.2 per 100,000 people). Moreover, black or African American individuals consistently exhibited higher morbidity rates (506.1 per 100,000 people) compared to white individuals (16.1 per 100,000 people).

CONCLUSION

The analysis of gonorrhea cases between 1996 and 2014 revealed that the highest rates occurred during specific years, with a particular concentration observed in the District of Columbia. Additionally, certain demographic groups, such as individuals aged 19-24 and the black or African American population, consistently exhibited higher morbidity rates compared to others. These findings emphasize the importance of targeted interventions to address the observed temporal patterns and demographic disparities, in order to effectively combat the spread of gonorrhea.

The challenge of diagnosis and treatment of neurosyphilis in China: results from a nationwide survey

Background The uncertainty of how neurosyphilis is diagnosed and treated in clinical settings led us to investigate whether this serious manifestation of syphilis infection is properly managed in China.

METHODS

This national cross-sectional study of the diagnosis and treatment of neurosyphilis included 1392 clinicians at 398 hospitals located in 116 cities in China.

RESULTS

Of 398 hospitals, 244 (61.3%) failed to perform diagnostic laboratory tests and 181 (45.5%) failed to provide recommended treatment for neurosyphilis. Of 1392 clinicians, 536 (38.5%) had previously diagnosed patients with neurosyphilis, but 419 (78.2%) of the latter provided diagnoses that did not meet the criteria set by national guidelines. Of the 485 clinicians who had previously treated patients with neurosyphilis, 280 (57.7%) failed to follow national guidelines for treatment. Analysis indicated that clinicians working in North China (adjusted odds ratio (aOR), 4.24; 95% confidence interval (CI), 1.65-10.88), tertiary hospitals (aOR, 3.23; 95% CI, 1.63-6.41), and hospitals specialising in sexually transmitted infections (aOR, 2.49; 95% CI, 1.24-4.99) were more likely to follow national guidelines for neurosyphilis treatment.

CONCLUSION

Lack of knowledge in disease management poses a great obstacle to prevent the serious consequences of neurosyphilis in Chinese patients. More effective measures are urgently needed to improve this suboptimal situation.

Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study

Due to challenges in diagnosis and the need for complex laboratory tests, misdiagnosis of neurosyphilis and tertiary syphilis is common in China. We validated the diagnosis and examined the treatment of late neurosyphilis and tertiary syphilis in Guangdong Province, China. A cross-sectional study was conducted to collect data from late neurosyphilis and tertiary syphilis cases reported between 2009 and 2014 in Guangdong, China. Descriptive analysis, bivariate analyses and multiple logistic regressions were performed to determine the structural factors associated with correct diagnosis and standard treatment of late neurosyphilis and tertiary syphilis. Among the 3805 respondents (3805/3936, 96.7%), 1,837 (48.3%) met the misdiagnosed criteria. The misdiagnosis rate decreased over the study period (54.2% in 2009 and 41.8% in 2014). Only 27.1% and 24.9% of the correctly diagnosed late neurosyphilis and tertiary syphilis cases received standard treatment, respectively. Multiple logistic regression revealed that departments of dermatology or STDs [aOR = 3.24, 95% CI: 2.66-3.95], county or township level hospitals [aOR = 2.89, 95% CI: 2.14-3.89], and hospitals situated outside of Pearl River Delta area [aOR = 1.70, 95% CI: 1.46-1.97] had higher likelihood in misdiagnosis of neurosyphilis, compared to the reference groups. Targeted trainings for physicians and expanded syphilis screening services are urgently needed.

Factors influencing STI transmission in middle-aged heterosexual individuals

Research has shown that individuals aged 45-64, or the 'middle-aged' population, are at an increasing risk of contracting a sexually transmitted infection (STI). An exploration of the factors that may influence STIs in this age group was carried out to ascertain how to reduce the risk. A critical review identified 14 research papers that considered STIs in middle-aged people. The available evidence base highlighted an under-representation of women, the absence of a consistent definition of 'middle age', and a paucity of specific information on the sexual health needs of this group. Low condom use was found to be a possible contributor to increasing STI rates; men were shown to report particularly low use. Behaviours such as contact with sex workers and sexual encounters abroad were found to be additional risk factors in men, requiring further consideration. The breakdown and formation of relationships during middle age was also identified as a possible area to investigate, as were the behavioural traits of women and associated STI risk. Further research into these areas could facilitate the development of attitudes, knowledge, policy and practice that could help provide better support for individuals affected.

Sexual health information disparities between heterosexual and LGBTQ+ young adults: Implications for sexual health

Most studies on young adults' sources of sexual health information and confidence in sexual health practices have focused primarily on heterosexual university students. This study sought to bridge this gap in the literature by exploring where emerging adults, including LGBTQ+ individuals and those who do not pursue postsecondary education, obtain their sexuality information and how this relates to sexual self-efficacy. A total of 386 adults between the ages of 18 and 25 were divided into higher education (n=306) versus high school (n=80) groups and heterosexual (n=215) versus LGBTQ+ (n=171) emerging adults. Participants completed measures of sexual health information sources, as well as self-efficacy with regard to sexual health practices. Heterosexual participants obtained significantly more information from school/university courses and less from educational websites/news outlets than LGBTQ+ participants. Heterosexual participants were significantly more confident in their sexual health practices than LGBTQ+ participants. Different sources of information helped predict sexual self-efficacy across these four groups. Acquiring more information from significant others was the only significant predictor of sexual self-efficacy for all four groups. This study suggests that sexual health information should be discussed within a more relational or interpersonal framework, and that LGBTQ+ issues should be further incorporated and integrated in sex education curricula. Implications for healthcare providers, public health policy, sex educators, clinicians and future research are discussed.

Epidemiology of incident chlamydia and gonorrhoea infections and population attributable fractions associated with living in the inner-core of Winnipeg, Canada

Population attributable fractions help to convey public health significance of differential disease risk for chlamydia and gonorrhoea. Geographical residence serves as a useful proxy for complex processes creating ill health. Using population-based data, Poisson regression models were used to examine factors associated with chlamydia and gonorrhoea incidence. Population attributable fractions due to residency in the Winnipeg Health Region's inner-core were determined for chlamydia/gonorrhoea infections among 15-59-year olds (2005-2013), stratified by age group. For both chlamydia and gonorrhoea, it was found that the 15-24-year old age group had the highest incidence rates. There was also a stronger association between residency in the inner-core and incidence for gonorrhoea, compared to chlamydia. Overall, 24% (95% CI: 12-34%) of chlamydia infections were attributable to residency in the inner-core, compared to 46% (95% CI: 35-54%) for gonorrhoea ( p < .05). Within chlamydia/gonorrhoea, no statistically significant differences in population attributable fraction were observed by age group. The conclusion was that a concentration of efforts towards inner-core residents with gonorrhoea infections may result in a relatively larger decrease in incidence.

Foundations of life-long sexual health literacy

Purpose

– Sexual education in adolescence may represent the only formal sexual information individuals ever receive. It is unclear whether this early educational experience is sufficient to promote lifelong sexual health literacy. The purpose of this paper is to examine the influence of the timing and source of sexual knowledge on current safe sex knowledge and risky sexual behaviours among middle-aged and older adults in the USA.

Design/methodology/approach

– Participants (n=410, mean age=53.9, 50.7 per cent female) reported whether and when they received sexual knowledge from various sources. They were asked about their current safe sex knowledge and their lifetime sexual risk behaviours.

Findings

– Most of the participants (61.5 per cent) received formal sexual education in adolescence and 20.2 per cent reported formal sexual education post-adolescence. Across the life span, friends were the most common source of sexual information. The sample scored in the upper mid-range on the scale indexing safe sex knowledge (M=6.69, SD=1.64, range=0-8). Participants reported engaging in an average of approximately four (out of 16) risky sexual behaviours across their lifetime. Those with formal sex education in adolescence scored significantly higher on safe sex knowledge. However, they also engaged in more risky sex behaviours.

Originality/value

– This study is among the first to situate the normative, formal sexual education experience of adolescence within a life span context that not only accounts for time, but also multiple sources of influence. It would appear that there are more things to learn about the long-term influence of sexual education programmes during the formative years by studying adult sexual health and knowledge.

Male infertility: a public health issue caused by sexually transmitted pathogens

Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.

Sexually transmitted infections and prostate cancer risk: a systematic review and meta-analysis

Prostate cancer (PC) is the second most incident cancer and the sixth cause of death by cancer in men worldwide. Despite extensive research efforts, no modifiable risk factors have been consistently identified for PC risk. A number of studies have focused on possible relationships between sexually transmitted infections (STIs) and PC. We performed a meta-analysis to explore the association between infection caused by Neisseria gonorrheae, Treponema pallidum, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Herpes Simplex Virus types 1 and 2, Human Herpes Virus 8 and Cytomegalovirus, and PC. We conducted a comprehensive, systematic bibliographic search of medical literature to identify relevant studies. We calculated summary relative risk (SRR) and 95% confidence intervals (CI) for the association between each STI and PC through random effect models. Subgroup, meta-regression and sensitivity analyses were carried out to detect between-study heterogeneity and bias. We included 47 studies published between 1971 and 2011. Men who reported having ever had any STI in lifetime had an increased PC (SRR 1.49, 95% CI 1.19-1.92). We found a significantly increased PC risk in men having had gonorrhoea (SRR 1.20, 95% CI 1.05-1.37). No other single STI was significantly associated with PC. Due to high incidence of both STIs and PC worldwide, prevention of STIs may help preventing a considerable number of PC cases.

Infectious, inflammatory, and immunologic conditions resulting in male infertility

This article provides an overview of infectious and inflammatory conditions associated with male infertility. These conditions may affect several components of the male reproductive tract and therefore have the ability to potentially alter sperm function. The effect of these conditions on male fertility is poorly understood and often underestimated.

Midlife women online: evaluation of an internet-based program to prevent unintended pregnancy & STIs

BACKGROUND

Midlife women are an underserved population in the areas of unintended pregnancy and STI prevention yet remain at risk for both health conditions.

METHODS

A randomized controlled trial of an Internet-based multimedia program to reduce risk of unintended pregnancy and STIs among midlife women was conducted with 164 women ages 40-55 years of age.

RESULTS

Women in the treatment condition compared to the control condition reported significant gains in attitudes, self-efficacy, and behavioral intentions at posttest.

CONCLUSION

Interventions specifically targeted to midlife women can impact constructs known to reduce risk. Implications for future research and intervention development are presented.

Epidemiology of syphilis, gonorrhea and chlamydia in Romania, 1980-2009

OBJECTIVES

This study aims to analyze the epidemiology of syphilis, gonorrhea and genital chlamydial infections in Romania during 1980-2009 when radical changes occurred during transition from a communist regime to a democratic society.

METHODS

Surveillance data was retrieved from the National Center for Surveillance and Control of the Communicable Disease in Romania and the World Health Organization.

RESULTS

The mean annual incidences of syphilis, gonorrhea and genital chlamydia infections in Romania were 25.2 ± 15 cases per 100,000 inhabitants (1980-2009), 33.2 ± 26.6/100,000 (1980-2009) and 0.3 ± 0.4/100,000 (1994-2009), respectively. Although the infection rates for syphilis followed a significant ascending trend over the study period (p < 0.001), they declined dramatically since 2002 (p < 0.001). There was a significant decrease in gonorrhea-affected persons over the study period (p < 0.0001), while genital chlamydia infections registered a general ascending trend (p = 0.02) with insignificant decrease since 2006.

CONCLUSIONS

The declining trend of syphilis and gonorrhea infections in the general population especially during the last years is very encouraging but should not challenge the amount of resources dedicated to sexually transmitted infections. Consequently, compelling strategies and policies based mainly on education of the population should be put forth in order to advance efficient prevention.