Testing rates for sexually transmitted infections among HIV-infected men who have sex with men attending two different HIV services

This study compares the testing rates of bacterial sexually transmitted infections (STIs) among HIV-positive men who have sex with men (MSM) attending two HIV clinics in Melbourne. Data on STI testing over a 12-month period were obtained for all HIV-positive MSM who attended the clinics between January and March 2006. Screening rates for bacterial STIs were significantly higher at a sexual health clinic (n = 254) compared with an infectious diseases clinic (n = 351), whether this was measured according to: at least one STI test being performed for chlamydia, gonorrhoea or syphilis (69% vs. 38%, P < 0.01); serological testing for syphilis alone (67% vs. 34%, P < 0.01); or 'complete' STI screening for pharyngeal gonorrhoea, urethral chlamydia, anal gonorrhoea, anal chlamydia and syphilis (41% vs. 6%, P < 0.01). Substantial differences in STI testing rates among HIV-positive MSM may exist between HIV clinical services depending on the measures in place that promote STI screening.     

Concurrent gonococcal and chlamydial infections among men attending a sexually transmitted diseases clinic

The aim of this retrospective study was to determine the prevalence of Chlamydia trachomatis co-infection in men with gonorrhoea attending a sexually transmitted diseases clinic in Edinburgh, Scotland. During the study period, there were 660 cases of culture-proven gonorrhoea. Chlamydial DNA was detected in the urethra in 79 (31%; 95% confidence interval [CI], 25-37%) heterosexual men who have sex with women (MSW); the median age was significantly lower than those with gonorrhoea alone (24.0 versus 30.0; P <0.0005). The prevalence of urethral chlamydial infection among MSW was significantly higher than among men who have sex with men (MSM) (32 [12%; 95% CI, 8-16%] of 268 MSM) (chi2 = 27.21; P <0.001). Sixteen (24%; 95% CI, 14-34%) of 68 MSM with rectal gonorrhoea had concurrent rectal chlamydial infection. The high prevalence of concurrent gonorrhoea and chlamydiae therefore warrants empirical treatment and/or testing for chlamydia in all men with urethral gonorrhoea.     

Prevalence of sexually transmitted infections among HIV-infected women in Brazil

This study aimed to evaluate the prevalence of sexually transmitted infections (STIs) and associated risk factors in HIV-infected pregnant women followed for prenatal care in Salvador, Bahia. This was a cross-sectional study of 63 women seeking prenatal care at a reference center. Participants were interviewed regarding socio-epidemiological and clinical history, and were tested for HBsAg, anti-HCV, anti HTLV I/II, VDRL, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Ureaplasma urealyticum, CD4 count, and HIV plasma viral load. The main outcome variable was the presence of any STI. The mean age of patients was 28.2 years (16-40 years). 23 (36.5%) were diagnosed with at least one STI. The frequency of diagnoses was: HBV, 3.2%; HCV, 8.1%; HTLV I/II, 3.4%; syphilis, 9.5%; Chlamydia trachomatis, 11.1%; HPV, 15.0%; Mycoplasma hominis, 2.1%, and Ureaplasma urealyticum, 2.1%. No case of Neisseria gonorrhoeae was identified. No association was found between socio-epidemiological variables and the presence of an STI. CD4 T lymphocyte < 500 cells/μL (p = 0.047) and plasma viral load >1,000 copies (p = 0.027) were associated with the presence of STI. STIs are frequent in pregnant women infected with HIV, and all HIV-infected pregnant women should be screened to decrease transmission of these pathogens and to protect their own health.     

Prevalence of sexually transmitted infections among women attending antenatal clinics in Tanga, north eastern Tanzania

This study aimed to determine the prevalence of sexually transmitted infections (STIs) among HIV-infected and uninfected pregnant women in Tanga, Tanzania. Retrospective data on syphilis and HIV status during 2008-2010 were collected from antenatal clinic (ANC) records. Prospective data were collected from HIV-infected (n = 105) and HIV-uninfected pregnant women (n = 100) attending ANCs between April 2009 and August 2010. Syphilis prevalence showed a declining trend (3.1%, 1.4% and 1.3%), while HIV prevalence was stable (6.1%, 6.4% and 5.4%) during 2008-2010. HIV-infected women had significantly higher prevalence of trichomoniasis (18.8% versus 5.0%; P < 0.003) and candidiasis (16.5% versus 2.0%; P < 0.001) while the higher rate of gonorrhoea (3.5% versus 0%; P = 0.095) was not statistically significant when compared with HIV-uninfected women. There were no statistically significant differences in prevalence of chlamydial infection (0% versus 3.0%; P = 0.156) or syphilis (2.4% versus 3.0%; P = 1) between HIV-infected and uninfected women. Other STIs were common in both HIV-infected and uninfected pregnant women.     

Factors associated with repeat visits among clients attending a clinic for sexually transmitted infections in Kisumu, Kenya

To identify factors associated with repeat visits among patients attending a clinic for sexually transmitted infections (STIs) in Kisumu, Kenya, we examined records of clinic visits from March 2009 to May 2010. Multivariable logistic regression identified factors associated with repeat visits occurring >30 days after the initial visit. Among 1473 clients (1296 single-visit individuals versus 177 individuals with repeat visits), the median age was 24 years, 67% were men and 8.6% self-reported being HIV-positive. In adjusted analyses, men with repeat visits were more likely to report ≥ 2 recent sexual partners (adjusted odds ratio [aOR] = 1.60) and being HIV-positive (aOR = 2.35). They were less likely to have been referred from other health facilities (aOR = 0.14) and more likely to have urethral discharge at their initial visit (aOR = 2.46). Among women, repeat visits were associated with vaginal discharge (aOR = 2.22), but attending the clinic with a partner was protective (aOR = 0.38). The association between sexual risk, HIV positivity and repeat visits among male clients highlights the need to focus intervention efforts on this group. For women, attending with a partner may reflect a decreased risk of re-infection if both partners are treated and counselled together.     

The changing prevalence of hepatitis B virus infection among men who have sex with men who attended a sexually transmitted infections clinic in Edinburgh, Scotland between 1989 and 2003

The aim of the study was to discover if the prevalence of serological markers of hepatitis B virus infection among men who have sex with men (MSM) who attended a sexually transmitted infections clinic in Edinburgh, Scotland had changed in a 15-year period. This was a retrospective study of 3334 MSM attending the clinic as new patients. Forty-four men (1%) had hepatitis B surface antigenaemia. Overall, sera from 398 (12%) men gave positive results for anti-HBc. The seroprevalence of HBV in men aged 25-34 years and older men declined significantly during the study period. There was no significant change in seropositivity for anti-HBc in men aged 16-24 years. The proportion of men who had been vaccinated previously rose significantly during the most recent three-year period. Although there has been a decline in the prevalence of infection in clinic attendees, there is continued transmission of HBV in the local community.     

Lymphocyte subsets and urinary excretion of cytomegalovirus among homosexual men attending a clinic for sexually transmitted diseases

A significantly higher frequency of urinary excretion of human cytomegalovirus (HCMV) was noted in homosexual men (29 [18%] of 161) than in heterosexual men (3 [4%] of 77) attending a clinic for sexually transmitted diseases. However, differences were not significant when only persons with antibody to HCMV were compared (29 of 157 vs. 3 of 33). The homosexual men who excreted HCMV had a significantly lower mean ratio of T-helper (OKT4+) to T-suppressor (OKT8+) cells (1.13 +/- 0.09) than did the homosexuals who did not excrete HCMV (1.67 +/- 0.1) or than did the heterosexual men (2.28 +/- 0.2). The abnormal ratio resulted from both a decrease in the percentage of OKT4+ and an increase in percentage of OKT8+ lymphocytes. The urinary excretion of HCMV by asymptomatic individuals who exhibit serological evidence of previous infection by this virus may be an indicator of impaired immune competence.     

HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: using a novel approach for detecting recent infections

OBJECTIVE: Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic. METHODS: HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined. RESULTS: Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months. CONCLUSION: HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.     

The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic

BACKGROUND: The spectrum of genital herpes (GH) has been understudied in men, especially African American men. METHODS: Consecutive men attending a sexually transmitted diseases clinic were enrolled in a study of GH epidemiology. Consenting participants answered questionnaires detailing their sexual and social activities and underwent serological testing for herpes simplex virus types 1 and 2 (HSV-1 and -2) and collection of genital swabs for viral detection. RESULTS: Of the 516 men enrolled, 465 (90%) were African American. Antibodies to HSV-1 were present in 315 (61%) of participants, and 233 (45%) had antibodies to HSV-2. Factors associated with HSV-2 infection included older age and African American race. HSV was detected in genital swabs from 52 men; 43 (82.7%) swabs were HSV-2 positive, and 9 (17.3%) were HSV-1 positive. The overall viral shedding rate among men (n = 247) with evidence of GH (HSV-1 or HSV-2 infection) was 21.1%, and the asymptomatic shedding rate in this same group was 5.2%. The sensitivities of culture for detection of HSV-1 and HSV-2 were .22 and .58, respectively, compared with that of polymerase chain reaction. CONCLUSIONS: Genital HSV infections are common and largely unrecognized among this segment of the population. HSV-1 infection constitutes a nontrivial proportion of GH in these men.     

The features of patients attending walk-in compared with booked clinics for sexually transmitted infections

Few data are available on the comparison of access of patients at risk of sexually transmitted infections (STIs) to different models of genitourinary (GU) medicine services. The aim of this study was to compare the characteristics and STIs results of patients attending walk-in clinics with those of patients attending booked-in clinics in a department of GU medicine. The study was carried out at the Department of GUM at Walsall Manor Hospital. This was a prospective study on consecutive new patients attending first come first served walk-in and booked clinics between 1 January and 1 April 2006. Patients' demography, sexual behaviour and results of screening for STIs were recorded. During the study period, 346 and 234 patients attended walk-in and booked clinics, respectively. Default rate for booked clinics was 27%. Significantly higher proportions of patients attending walk-in clinics were screened for an STI. All patients with HIV (n = 2) or with trichomonal (n = 4) infections attended walk-in clinics. In regression analysis, patients with genitourinary symptoms were more likely to attend walk-in clinics (odds ratio [OR]: 2.371; [95% confidence interval [CI]: 1.545-3.639; P = 0.0005). There was no difference between the prevalence of STIs among patients attending either service model. In conclusion, there was no significant difference between the proportion of patients with or at-risk of STIs who attended booked and walk-in clinics.     

Increased HIV prevalence among individuals attending a sexually transmitted infection clinic in Yaounde,Cameroon

Monitoring HIV prevalence among selected groups provides important data on infection trends. The present study assessed current HIV prevalence and risk correlates among 255 men and women consecutively attending a sexually transmitted infection clinic in Yaounde, Cameroon. Prevalence of 21.96% and 5.5% were found for HIV and syphilis, respectively, with a significant correlation between the two infections. Although marriage was not a significant predictor for HIV, married men were twice as likely as unmarried men to be infected; no such difference was observed for women. Inconsistent condom use was positively, but not significantly, associated with HIV. Also, age, education, and number of sex partners were not significant correlates of HIV infection. Compared to data collected in 1997, HIV prevalence in this clinic has increased nearly 6%. Our findings highlight the increasing spread of HIV infection in Cameroon and the need for additional control strategies to curb the epidemic.     

Syphilis seroprevalence among patients attending a sexually transmitted disease clinic in West Bengal, India

Syphilis is a sexually transmitted disease (STD) and is a major public health concern in India. The trend of syphilis infection was studied in attendees aged 15-49 years in an STD clinic in West Bengal from 2004 to 2008. Blood samples were collected from 250 consecutive patients per year (a total of 1,250 samples over 5 years); the patients attended the STD clinic for 12 weeks (October-December) each year, and the serostatus of syphilis was determined qualitatively with the Venereal Disease Research Laboratory (VDRL) test using serum samples. A quantitative VDRL test was then performed at a dilution of 1:8 using serum samples that yielded positive results in the qualitative VDRL test. Finally, serum samples that yielded positive results in the quantitative VDRL test were also subjected to the Treponema pallidum hemagglutination assay (TPHA). The serum samples that yielded positive results in both the tests were considered syphilis seropositive. All seropositive serum samples from the quantitative VDRL test were also found to be positive results in TPHA. The total seropositivity for syphilis in the STD patients was 8.2% (women, 8.9%; men, 7.7%). Review of the data from 5 consecutive years showed a statistically significant (χ(2) = 9.968, df = 4, P < 0.05) decrease in syphilis positivity from 10.8% (2004) to 3.6% (2008). The results of the study also revealed that the highest seroprevalence was in the 20-24 age group (16.3%), and the lowest seroprevalence was in the 45-49 age group (3.3%). The study indicates the effectiveness of current interventions with a need to focus further on reducing the burden in the 20-24 age group.     

High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management

Trichomonas is a cause of nongonococcal urethritis (NGU); however, studies of its prevalence in men have been hampered by the lack of sensitive diagnostics. DNA amplification allows for reappraisal of the extent of infection in men. Men attending a sexually transmitted diseases clinic were tested for trichomonas, chlamydia, and gonorrhea. The prevalence of these pathogens was 17%, 19.6%, and 17.7% respectively. In men with NGU, 19.9% were infected with trichomonas. These data have implications for treatment of NGU and control of trichomoniasis.     

Knowledge of human papillomavirus and anal cancer among men who have sex with men attending a New York City sexually transmitted diseases clinic

Men who have sex with men (MSM) are at risk for human papillomavirus (HPV) infection and anal cancer (AC) yet little is known regarding MSM knowledge and risk perception for these outcomes. We surveyed 116 MSM attending a sexually transmitted disease clinic and found that over a quarter (27%) did not know HPV is transmitted via anal sex and most (77%) were unaware of the link with AC. Many MSM (60%) perceived risk for HPV; far fewer (35%) perceived risk for AC. In adjusted logistic regression analyses, having friends or acquaintances with HPV or genital warts was associated with knowledge of anal HPV transmission (odds ratio [OR] = 4.3; 95% confidence interval [CI] = 1.4, 13.4) and AC risk-perception (OR = 6.2; 95% CI = 2.3, 16.7); reporting a regular source of care was associated with awareness of a link between HPV and AC (OR = 3.1; 95% CI = 1.1, 9.1); and MSM and women versus MSM, had less perceived risk for HPV (OR = 0.05; CI = 0.01, 0.29). Nearly all expressed hypothetical acceptance of HPV vaccine. In our sample, many MSM were unaware of a link between MSM sexual practices and HPV-related outcomes.     

Predicting the diagnosis of HIV and sexually transmitted infections among men who have sex with men using machine learning approaches

ObjectivesWe aimed to develop machine learning models and evaluate their performance in predicting HIV and sexually transmitted infections (STIs) diagnosis based on a cohort of Australian men who have sex with men (MSM).MethodsWe collected clinical records of 21,273 Australian MSM during 2011–2017. We compared accuracies for predicting HIV and STIs (syphilis, gonorrhoea, chlamydia) diagnosis using four machine learning approaches against a multivariable logistic regression (MLR) model.ResultsMachine learning approaches consistently outperformed MLR. Gradient boosting machine (GBM) achieved the highest area under the receiver operator characteristic curve for HIV (76.3%) and STIs (syphilis, 85.8%; gonorrhoea, 75.5%; chlamydia, 68.0%), followed by extreme gradient boosting (71.1%, 82.2%, 70.3%, 66.4%), random forest (72.0%, 81.9%, 67.2%, 64.3%), deep learning (75.8%, 81.0%, 67.5%, 65.4%) and MLR (69.8%, 80.1%, 67.2%, 63.2%). GBM models demonstrated the ten greatest predictors collectively explained 62.7-73.6% of variations in predicting HIV/STIs. STIs symptoms, past syphilis infection, age, time living in Australia, frequency of condom use with casual male sexual partners during receptive anal sex and the number of casual male sexual partners in the past 12 months were most commonly identified predictors.ConclusionsMachine learning approaches are advantageous over multivariable logistic regression models in predicting HIV/STIs diagnosis.     

Comparative epidemiology of Chlamydia trachomatis infection among men attending sexually transmitted disease clinics with and without indication for testing

Understanding the epidemiology of Chlamydia trachomatis infection in men without indication for testing (without symptoms, signs, or a report of sexual contact with an infected partner) is of crucial importance to reduce the heavy burden of this infection, particularly because this group of men is not usually offered testing in different clinical settings. Using electronic medical records of two STD clinics in Connecticut, 2000-02, this study identified the risk factors of C. trachomatis infection in men with and without indication for testing. In both groups, men who were younger than 30, African-American, or had a prior history of C. trachomatis infection were significantly more likely to be infected. Since a system for routine reproductive health care of young men does not currently exist, health-care providers need to promote an increased awareness of C. trachomatis infection among their male patients who are at increased risk of infection.     

Risky sexual practices among youth attending a sexually transmitted infection clinic in Dar es Salaam,Tanzania

Background  

Youth have been reported to be at a higher risk of acquiring STIs with significant adverse health and social consequences. Knowledge on the prevailing risky practices is an essential tool to guide preventive strategies.     

Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States

The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades. The disproportionate and worsening burden of HIV and other STIs among MSM requires an urgent re-assessment of what we have been doing as a nation to reduce these infections, how we have been doing it, and the scale of our efforts. A sexual health approach has the potential to improve our understanding of MSM's sexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM.