Sexually transmitted infections-Research priorities for new challenges

Prevalence of human papillomavirus infection and associated factors among women attending cervical cancer screening in setting of Addis Ababa, Ethiopia

Human papillomaviruses (HPVs) are circular, nonenveloped small double-stranded DNA viruses that infect stratified epithelium and can cause a number of life-threatening diseases. HPV is the central risk factor for developing cervical cancer and is estimated that approximately 98% of this disease is associated with oncogenic types of HPV. HPV infection leads to an estimated 266,000 cervical cancer deaths annually. Therefore, the objective of this study was to determine the prevalence of HPV infection and risk factors associated with cervical lesion among women attending the cervical cancer screening clinic at the Ethiopian Family Guidance Association, Addis Ababa. A cross-sectional study was conducted to determine the prevalence of HPV infection. Data were collected using a questionnaire and samples leftover from cervical screening were taken. The leftover swab was air dried and DNA was extracted and amplified by using a PCR. A total of 247 women were included in the study. The prevalence of HPV was 9.72% among the population studied. Of all participants, 27.13% were positive for cervical intraepithelial neoplasia-1 (CIN1). CIN1 positivity was found in half of HPV positive women. Among HPV positive women, half of them had started sexual intercourse at ages 12-17 years and 41.66% were women who gave birth at ages 12-17 years. The high prevalence of HPV and the CIN1 positive group were ages 36-57 and women with multiple sexual partners. The other groups with the highest CIN1 positive were 22.39% grade (9-12) and 20.9% primary (1-8) and uneducated women. Among HPV positive women, 83.33% had an abortion history and 80% miscarried in the first trimester. Among the CIN1 positives, 53.73% had more than two sexual partners. Among HPV positive women, half of them were users of contraception methods. In conclusion, the highest prevalence of HPV is among women who began sexual intercourse earlier and who gave birth at 12-17 years of age, have an abortion history, with MSP and oral contraceptive methods users. In addition to HPV, early pregnancy and sexual intercourse at 12-17 years of age, abortion, MSP, and oral hormonal contraceptives are factors in cervical cancer. Finally, most women do not have enough knowledge and awareness about cervical cancer and the risk factor.

Assessment of Antibiotic Resistance and Efflux Pump Gene Expression in Neisseria Gonorrhoeae Isolates from South Africa by Quantitative Real-Time PCR and Regression Analysis

Introduction

Treatment of gonorrhoea infection is limited by the increasing prevalence of multidrug-resistant strains. Cost-effective molecular diagnostic tests can guide effective antimicrobial stewardship. The aim of this study was to correlate mRNA expression levels in Neisseria gonorrhoeae antibiotic target genes and efflux pump genes to antibiotic resistance in our population.

Methods

This study investigated the expression profile of antibiotic resistance-associated genes (penA, ponA, pilQ, mtrR, mtrA, mtrF, gyrA, parC, parE, rpsJ, 16S rRNA, and 23S rRNA) and efflux pump genes (macAB, norM, and mtrCDE), by quantitative real-time PCR, in clinical isolates from KwaZulu-Natal, South Africa. Whole-genome sequencing was used to determine the presence or absence of mutations.

Results

N. gonorrhoeae isolates, from female and male patients presenting for care at clinics in KwaZulu-Natal, South Africa, were analysed. As determined by binomial regression and ROC analysis, the most significant (p ≤ 0.05) markers for resistance prediction in this population, and their cutoff values, were determined to be mtrC (p = 0.024; cutoff <0.089), gyrA (p = 0.027; cutoff <0.0518), parE (p = 0.036; cutoff <0.0033), rpsJ (p = 0.047; cutoff <0.0012), and 23S rRNA (p = 0.042; cutoff >7.754).

Conclusion

Antimicrobial stewardship includes exploring options to conserve currently available drugs for gonorrhoea treatment. There is the potential to predict an isolate as either susceptible or nonsusceptible based on the mRNA expression level of specific candidate markers, to inform patient management. This real-time qPCR approach, with few targets, can be further investigated for use as a potentially cost-effective diagnostic tool to detect resistance.

Strategies for successful designing of immunocontraceptive vaccines and recent updates in vaccine development against sexually transmitted infections - A Review

Background

Objective

Methods

Results

Conclusion

Current Progress of Interfacing Organic Semiconducting Materials with Bacteria

Microbial bioelectronics require interfacing microorganisms with electrodes. The resulting abiotic/biotic platforms provide the basis of a range of technologies, including energy conversion and diagnostic assays. Organic semiconductors (OSCs) provide a unique strategy to modulate the interfaces between microbial systems and external electrodes, thereby improving the performance of these incipient technologies. In this review, we explore recent progress in the field on how OSCs, and related materials capable of charge transport, are being used within the context of microbial systems, and more specifically bacteria. We begin by examining the electrochemical communication modes in bacteria and the biological basis for charge transport. Different types of synthetic organic materials that have been designed and synthesized for interfacing and interrogating bacteria are discussed next, followed by the most commonly used characterization techniques for evaluating transport in microbial, synthetic, and hybrid systems. A range of applications is subsequently examined, including biological sensors and energy conversion systems. The review concludes by summarizing what has been accomplished so far and suggests future design approaches for OSC bioelectronics materials and technologies that hybridize characteristic properties of microbial and OSC systems.

Sexually transmitted infection (STI) research priority-setting: a two-stage study including the perspectives of patients, the public, clinicians and stakeholders

Objectives

Patient and public involvement (PPI) in research priority-setting remains limited, especially for non-HIV STI. We identify and compare the top 10 patient and public STI research priorities with those of clinicians and STI stakeholders.

Methods

This two-stage study was conducted in May–August 2019. First, STI research priorities were canvassed through qualitative questionnaires issued to all patients attending a large sexual health clinic, all clinicians in region-wide mailing lists, all stakeholders identified through existing networks and the Charity Commission database, and to the Liverpool public. Raw responses were organised by theme into a shortlist of 25. In stage 2, these were ranked through priority-setting activities by telephone with patients and the public (n=8) and some clinicians (n=3), and in two workshops with clinicians (n=26) and stakeholders (n=5), respectively. The top 10 priorities were compared.

Results

Of 373 surveys submitted, 106 were analysed (83 patient and public; 23 clinician and stakeholder). Exclusions included lack of completion and responses out of scope. Among patient and public respondents, 55% (n=46) were aged 18–24 years, 51% (n=42) identified as heterosexual women and 23% (n=19) as men who have sex with men. Clinicians included all cadres; stakeholders were academics, commissioners and third sector representatives. In stage 2, 4 of 10 themes (STI education, targeted services for high-risk groups, antibiotic resistance and counselling for those with STI) were prioritised by all. Remote STI services and rapid diagnostics also ranked highly but the rationale differed between groups.

Conclusion

This is the first non-HIV STI research priority-setting exercise to be reported in the UK. It identifies overlaps and differences between public and provider concerns, highlights gaps in the public understanding of STI research, and shows how PPI can promote research responsive to the concerns of both those who use and deliver services.

Knowledge about sexually transmitted infections among young men presenting to the Brazilian Army, 2016: A STROBE-compliant national survey-based cross-sectional observational study

Global burden of sexually transmitted infections (STIs) remains high and has a profound impact on health and lives of children, adolescents and adults worldwide. For over a decade, the Brazilian Department of Chronic Condition Diseases and Sexually Transmitted Infections and the Ministry of Defense have been conducting the Conscripts Survey aiming to assess the STI prevalence and obtain data on knowledge regarding STIs and risk factors among youth.A cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire containing 74 questions, 25 questions related to awareness and knowledge of STIs and their associated symptoms, routes of transmission, complications and risk factors.A total of 37,282 young men across Brazil were considered for the analysis. The majority resided in the Northeast and Southeast regions (38.9% and 30.0%, respectively), followed by the South (13.9%), North (9.7%), and Central-west (7.5%) regions. Of the conscripts, 97.2% have the knowledge they may be at risk if they do not use condoms during sex. Conscripts with a higher level of education have almost 2 times greater chance of having knowledge of having sex without a condom (OR 3.23 CI95% 2.82-3.70 P = .000) and sharing needles and syringes (OR 2.84 CI95% 2.62-3.07 P = .000) represents a risk. Those with higher education also have an almost 50% greater chance of having knowledge regarding STI transmission from mother to child (OR 1.54 CI95% 1.44-1.64 P = .000), and knowledge of no transmission by mosquito bite (OR 1.61 CI95%1.51-1.72 P = .000), by kissing (OR 1.45 CI95% 1.36-1.55 P = .000) or by using public toilets (OR 1.51 CI95% 1.41-1.61 P = .000). Television (71.8%) and internet (69.4%) are the preferred forms to obtain STIs information regardless of the level of education.Conscripts with higher level of education have greater knowledge regarding transmission of STIs. However, there are gaps regarding their knowledge about HIV pre-exposure prophylaxis and the fact that other STIs can increase the chances of acquiring HIV.

Randomized Controlled Trial on the Promotion of Sexual Health Using "Self-Care Interventional Package" in Men Who have Sex with Men

Purpose:

Men who have sex with men (MSM) is a vulnerable group, who have been neglected and discriminated. Such discrimination decreases their access to health care and increases the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV).

Aims and Objective:

The objective is to evaluate the effectiveness of “self-care interventional package” on the promotion of sexual health, among MSM.

Materials and Methods:

A randomized controlled trial was conducted on MSM from two nongovernmental organization centers of Chandigarh, which were randomized by simple random sampling into a control and experimental group. Over a period of 1 month, a total of 115 MSM were found eligible; 55 in control group and 60 in experimental group. Data were collected by a personal interview, after taking consent, in a comfortable and private environment. The Self-Care Interventional Package on the promotion of sexual health was developed in the form of flash book and booklet, and delivered by one-to-one interaction. Three follow-ups were done weekly for motivation in both the groups. Postintervention assessment was conducted after 1 month.

Results:

There was a statistically significant (P < 0.01) improvement in knowledge about prevention and management of STIs and HIV, getting vaccinated for Hepatitis B and regular self check-up. Statistically significant reduction in unsafe sexual practices was noted among the MSM of experimental group.

Conclusion:

The self-care interventional package for the promotion of sexual health was effective in improving the sexual heath of the MSM population.

The Risk of Sexually Transmitted Infections Following First-Episode Schizophrenia Among Adolescents and Young Adults: A Cohort Study of 220 545 Subjects

Young people are disproportionately affected by sexually transmitted infections (STIs). The risk of STIs in young people following first-episode schizophrenia is unknown. This study using Taiwan's National Health Insurance Research Database enrolled 44 109 adolescents and young adults with first-episode schizophrenia and 176 436 age- and sex-matched controls without schizophrenia from 2001 through 2009 and followed to the end of 2011. New-onset STIs were identified. Survival analysis was performed. Cox regression analysis was used to examine the effects of comorbid substance use disorder (SUD), schizophrenia medications, and schizophrenia severity. The E value for causality of evidence was calculated. We found that young people had a higher risk of STIs following first-episode schizophrenia compared with controls without schizophrenia (hazard ratio [HR] = 2.35, 95% CI = 2.08-2.64); these STIs included human immunodeficiency virus (HIV) (3.70, 2.60-5.28) and syphilis (5.35, 3.96-7.23). They also showed a disproportionate distribution of STIs, with an increased proportion of syphilis (20.4% vs 8.2%) and HIV (9.1% vs 6.0%). When presenting with SUD, the risks of HIV (11.00, 7.02-17.25) and syphilis (9.11, 6.16-13.47) were further increased. The severe schizophrenia group had an extremely high risk of syphilis (41.26, 27.69-61.47) and HIV (7.50, 3.85-14.62). Schizophrenia medications may provide beneficial effects against contracting STIs (0.77, 0.68-0.89). We concluded that following first-episode schizophrenia, young patients are at higher risk of STIs, particularly HIV and syphilis. The risk further increased when subjects presented with SUD or severe schizophrenia. Importantly, antipsychotic treatment may lower the risk of STIs.

Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort

OBJECTIVE

A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs.

METHODS

We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidence (syphilis, gonorrhoea and chlamydia) as well as incare viral load (ICVL) and percentage with all viral loads less than the limit of detection (%<LLOD) by year (2012-2016) among those with incident STIs.

RESULTS

From 2012 to 2016, the incidence of STIs increased: chlamydia from 2.1 to 3.4 cases/100 person-years (p=0.0006), gonorrhoea from 2.1 to 4.0 (p<0.0001), syphilis from 1.7 to 2.6 (p=0.0042) and any STI episode from 5.3 to 8.8 (p<0.0001). STI incidence rates increased for those aged 18-34 (from 13.2 to 23.2 cases/100 person-years, p<0.0001), cisgender men (from 6.5 to 11.5, p<0.0001), non-Hispanic whites (from 8.6 to 16.1, p=0.0003) and men who have sex with men (from 9.3 to 15.7, p<0.0001). During 2012-2016, the ICVL among those with incident STIs improved from 108 to 19 copies/mL and %<LLOD from 23.6% to 55.1%. However, even in 2016, younger participants, cisgender and transgender women, non-Hispanic blacks and Hispanics had higher ICVLs and lower %<LLOD.

CONCLUSIONS

Rates of incident STIs rose among persons in care for HIV in Washington, DC, with improved but not optimal measures of HIV viral suppression. These findings inform focused interventions towards preventing STI transmission and ending the HIV epidemic.

Association between knowledge, risk behaviours, and testing for sexually transmitted infections among men who have sex with men: findings from a large online survey in the United Kingdom

Objectives

In the UK, men who have sex with men (MSM) bear a disproportionate sexually transmitted infection (STI) burden. We investigated MSM's STI knowledge; whether their STI testing behaviour met national guidelines (annually if sexually active; 3‐monthly if engaging in STI risk behaviours); and the relationship between STI testing in the last 3 months, STI knowledge and STI risk behaviours by HIV status.

Methods

Sexually active (in the last year) men aged > 15 years who were UK residents and were recruited from gay‐orientated online dating platforms completed an anonymous online survey about STI knowledge, STI risk behaviours, and STI testing (March–May 2017). This included 11 true statements about STIs. Respondents scored 1 for each statement they ‘knew’, with those scoring < 6 overall treated as having ‘poor’ STI knowledge. Descriptive and multivariable analyses were conducted, separately by HIV status, to test our hypothesis and calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results

Compared to HIV‐positive men (n = 489), the proportion of HIV‐negative/unknown‐status men (n = 3157) with ‘poor’ STI knowledge was significantly higher (46.4% versus 22.9% for HIV‐positive men) and the proportion with STI testing in the last 12 months was lower (71.6% versus 87.2%, respectively). In the last 3 months, 56.9% of HIV‐negative/unknown‐status and 74.1% of HIV‐positive men reported STI risk behaviours, of whom 45.8% and 55.1%, respectively, had been tested for STIs during this time. Among HIV‐negative/unknown‐status men, those reporting STI risk behaviours were more likely (AOR 1.52; 95% CI 1.26–1.84) and those with poor STI knowledge less likely (AOR 0.73; 95% CI 0.61–0.89) to have been tested during the last 3 months. However, neither factor was independently associated with 3‐monthly testing among HIV‐positive men.

Conclusions

Improving STI knowledge, especially among HIV‐negative/unknown‐status men, and promoting frequent STI testing among men engaging in STI risk behaviours are vital to address the poor sexual health of MSM.

Lack of Knowledge about Sexually Transmitted Diseases (STDs): Implications for STDs Prevention and Care among Dermatology Patients in an Urban City in Vietnam

Sexually transmitted diseases (STDs) are a substantial global burden of diseases, especially in developing countries. Lack of awareness of STDs may lead to a delay in treatment. This study aimed to assess knowledge about STDs and the associated factors among dermatological patients. A cross-sectional study was conducted among 622 patients at Vietnam National Hospital of Dermatology and Venereology (NHD). Structured questionnaires were used to investigate the knowledge about STDs. A multivariate Tobit regression was employed to determine factors associated with knowledge about STDs. The percentage of patients knowing that syphilis was an STD was highest (57.8%), followed by herpes warts (57.7%) and HIV/AIDS (57.4%). By contrast, 26.6% and 17.2% of patients knew that chlamydia and hepatitis C were STDs. The most commonly stated symptom of STDs was purulent genital (53.5%). Nearly two-thirds of participants were aware of the curability of STDs, and 34.7% knew about vaccines for STDs. Living with partners, young age, and acquired knowledge of STDs via the Internet, social networks, and health staff were positively related to having better knowledge about STDs. Based on the results of this study, peer education, informal conversations within clusters, mass community campaigns through the Internet and social networks, and the use of online health care providers should be promoted in order to improve awareness of STDs.