Barriers to STI testing among youth in a Canadian oil and gas community

Northeastern British Columbia, Canada, is undergoing in-migration of young people attracted by jobs in the oil/gas sectors. Chlamydia rates among youth ages 15-24 are increasing and exceed the provincial average by 22%. Testing for sexually transmitted infections (STIs) reduces the disease burden, contributing to prevention. We conducted ethnographic fieldwork, including interviews with 25 youth and 14 service providers, to document their perceptions regarding youth's access to STI testing. Five key barriers to access were identified: limited opportunities for access, geographic inaccessibility, local social norms, limited information, and negative interactions with providers. To address youths' needs, we recommend active STI prevention and testing service delivery models that incorporate a locally tailored public awareness campaign, outreach to oil/gas workers, condom distribution, expanded clinic hours and drop-in STI testing, specialized training for health care providers, and inter-sectoral partnerships between public health, non-profit organizations, and industry.     

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

ObjectiveTo examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30 months following vaccination.MethodsParticipants included 112 sexually experienced girls aged 13–21 years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30 months and including 30 months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30 months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.ResultsMean age was 17.9 years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p = 0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30 months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p = 0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.ConclusionsThe finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.     

Current opinion: Consensus statement on intrauterine contraception

Forty-five experts from around the world attended a 1-day seminar in September 2001 in Chapel Hill, North Carolina, USA, to identify ways that they might collaborate to overcome unnecessary barriers to the use of intrauterine devices (IUDs). Seminar participants formed working groups that produced at least three specific recommendations relating to: training/performance improvement; service delivery improvement; general public information; and clinical and programmatic research. Key recommendations included: integrating reproductive health knowledge and skills into curricula for all healthcare professionals; reviewing and reinforcing with providers evidence-based guidelines for IUD use; encouraging evidence-based review of the IUD label and package insert; and conducting further research about IUD client eligibility, potential health benefits, acceptability among clients and providers, and use by HIV-infected women. At the meeting’s conclusion, a number of participants, representing the fields of research, policy, communications, donors, women’s advocacy, and medicine, expressed an interest in refining and acting upon the recommendations. Hosted by Family Health International, the meeting was supported by the Mellon Foundation.     

Current opinion: consensus statement on intrauterine contraception

Forty-five experts from around the world attended a 1-day seminar in September 2001 in Chapel Hill, North Carolina, USA, to identify ways that they might collaborate to overcome unnecessary barriers to the use of intrauterine devices (IUDs). Seminar participants formed working groups that produced at least three specific recommendations relating to: training/performance improvement; service delivery improvement; general public information; and clinical and programmatic research. Key recommendations included: integrating reproductive health knowledge and skills into curricula for all healthcare professionals; reviewing and reinforcing with providers evidence-based guidelines for IUD use; encouraging evidence-based review of the IUD label and package insert; and conducting further research about IUD client eligibility, potential health benefits, acceptability among clients and providers, and use by HIV-infected women. At the meeting’s conclusion, a number of participants, representing the fields of research, policy, communications, donors, women’s advocacy, and medicine, expressed an interest in refining and acting upon the recommendations. Hosted by Family Health International, the meeting was supported by the Mellon Foundation.     

性罪错人员性病感染情况的调查

目的:了解深圳市性罪错人员的性病感染情况。方法:对2 0 0 2年深圳市某收教所的1 3 87名性罪错人员进行体检以及性病实验室检测,并收集相关资料作流行病学分析。结果:在1 3 87名被检测者中,共检出1 86名学员感染性病,检出率为1 3.5 %。其中HIV感染者4例,男、女学员各2例。女学员性病检出率明显高于男学员。结论:性罪错人员是性病的重要传染源,加强对性罪错人员的性病流行病学监测是预防和控制性病流行的有效措施之一     

澄江陆良两县农村妇女下生殖道感染的流行情况及危险因素的研究

１９９３—１９９４年对云南省澄江、陆良两县农村育龄妇女采用分层整群抽样方法，对２０２０名妇女进行下生殖道感染的流行情况及危险因素的研究。通过病史询问、妇科检查及阴道、子宫颈拭子的病原学检查。结果发现阴道有念珠菌感染率为３９．０％，毛滴虫为１６．２％，加特纳氏菌（Ｇａｒｄｎｅｒｅｌａｖａｇｉｎａｌｉｓ）为１４．４％；子宫颈有砂眼衣原体感染率为５．５％，淋球菌为０．３％，总感染率５５．１％。应用非条件Ｌｏｇｉｓｔｉｃ回归分析表明：性生活、个人卫生、经期卫生、年龄及家庭经济收入等是发病主要危险因素。加强健康教育及下生殖道感染的筛查和治疗是防治本病的重要措施。     

2011 - 2015年唐山市STDs的流行病学分析

目的 分析唐山市2011 - 2015年性传播疾病（Sexually Transmitted Diseases, STDs）的流行病学特征,为制定防治措施提供科学依据。方法 对唐山市2011 - 2015年STDs的流行情况进行趋势及描述性分析。结果 近5年来,唐山市STDs报告病例数为9 104例,年均发病率为23.74 /10万,其中梅毒、艾滋病、GH和CT的发病率成上升趋势,淋病和CA的发病率呈下降趋势;病种构成以梅毒比例最高（68.46%）,其次为CA（11.94%）,淋病局第3位 （10.13%）。5年内STDs男女性别比为1.18∶1,总体男性患者多于女性;以20～29岁年龄比例最大（34. 86%）;农民、家务及待业和工人为主要发病人群,分别占总发病人数的36.42%、18.21%和8.18%;5年STDS总发病率位于前5位的县（市）区依次为:路北区（44.79/10万）、滦县（34.00/10万）、古冶区（32.86/10万）、路南区（31.26/10万）和开平区（28.75/10万）;一年四季均有发病。结论 唐山市近5年STDs发病整体呈上升趋势,梅毒是STDs防治工作的重点。加强STDs防治知识的宣传和教育工作,努力控制STDs的传播和蔓延,提倡安全性行为,降低STDs的发病率是当前和今后唐山市STDs防治工作的重中之重。     

女性性工作者性传播感染相关因素研究

[目的]认识云南女性性工作者最近一年性传播感染(sexually transmitted Infections,STIs)现状和感染STIs的相关因素,为针对女性性工作者开展STIs的有效干预提供依据。[方法]采用典型抽样的方法确定调查地点,以目前从事商业性服务的女性为调查对象。利用自行设计问卷进行面对面的调查,由调查员询问女性性工作者最近一年的STIs感染情况和相关状况。[结果]2436名女性性工作者中最近一年出现过性传播感染的比例为32.8%。不同的年龄、婚姻状况、户口所在地和民族之间感染STIs的比例存在统计学差异(P﹤0.05),女性性工作者年龄越小感染STIs的比例越高;同居者感染STIs的比例高于未婚者;户口为云南省的女性性工作者感染STIs的比例高于外省。[结论]女性性工作者自述最近一年出现过性传播感染的比例可能低于实际情况,STIs感染者中具有当地的年轻女性性工作者、有同居者更容易感染等特征。     

The global roadmap for advancing development of vaccines against sexually transmitted infections: Update and next steps

In 2014, the World Health Organization, the US National Institutes of Health, and global technical partners published a comprehensive roadmap for development of new vaccines against sexually transmitted infections (STIs). Since its publication, progress has been made in several roadmap activities: obtaining better epidemiologic data to establish the public health rationale for STI vaccines, modeling the theoretical impact of future vaccines, advancing basic science research, defining preferred product characteristics for first-generation vaccines, and encouraging investment in STI vaccine development. This article reviews these overarching roadmap activities, provides updates on research and development of individual vaccines against herpes simplex virus, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, and discusses important next steps to advance the global roadmap for STI vaccine development.     

'Not the swab!' Young men's experiences with STI testing

In Canada, STI rates are high and rising, especially amongst young men. Meanwhile, the needs of young men regarding STI testing services are poorly understood, as are the socio-cultural and structural factors that influence young men's sexual health-seeking behaviours. To better understand this phenomenon, we draw on interviews with 45 men (ages 15-25) from British Columbia, Canada. Our research reveals how structural forces ( e.g. STI testing procedures) interact with socio-cultural factors ( e.g. perceptions of masculinities and feminities) to shape young men's experiences with STI testing. STI testing was characterised as both a potentially sexualised experience ( e.g. fears of getting an erection during genital examinations), and as a process where young men experience multiple vulnerabilities associated with exposing the male body in clinical service sites. In response, participants drew on dominant ideals of masculinity to reaffirm their predominately hetero-normative gender identities. Despite growing up in an era where sexual health promotion efforts have been undertaken, participants did not feel they had permission to engage in discussions with other men about sexual health issues. Attending to young men's perspectives on STI testing represents a starting point in reforming our approaches to addressing how socio-cultural and structural factors shape these experiences.     

Toward global prevention of sexually transmitted infections (STIs): The need for STI vaccines

An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.     

Association between human papillomavirus vaccine status and sexually transmitted infection outcomes among females aged 18-35 with a history of sexual activity in the United States: A population survey-based cross-sectional analysis

BackgroundCurrent human papillomavirus (HPV) vaccine coverage in the United States (in 2019, 66–70%), remains below the Healthy People 2020 coverage goal of 80%. HPV vaccine misinformation, including parental concerns of sexual risk-compensation influence vaccine uptake. We examined the association between HPV vaccination and sexually transmitted infection (STI) outcomes.MethodsOf the 20,146 participants from 2013 to 2014 and 2015–2016 cycles of the National Health and Nutrition Examination Survey, 1050 females aged 18–35 with a history of sexual activity had complete case data. Roa-Scott Chi-squared and F-tests assessed survey-weighted socio-demographic differences between vaccinated and unvaccinated participants. Weighted logistic regression assessed crude and adjusted associations between self-reported HPV vaccination (none vs. ≥ 1dose) and lab-confirmed STIs (trichomonas and chlamydia) and vaccine-type HPV (6/11/16/18). As a sensitivity analysis, we conducted weighted-propensity score (PS) models and inverse probability weighting by vaccination status. PS and logistic regression were estimated through survey-weighted logistic regression on variables including race, education, income, marital status, US citizenship, cycle year and age.ResultsOverall, 325 (31.8%) females with a history of sexual activity were HPV vaccinated, of which 22 (6.1%) received the vaccine at the routine-recommended ages of 11–12, 65.7% were vaccinated after their self-reported sexual debut, 3.8% had a lab-confirmed STI and 3.5% had vaccine-type HPV. There was no association between HPV vaccination and any STIs (adjusted odds ratio [aOR] 0.67, 95%CI:0.38–1.20), and vaccinated participants had 61% reduced odds of vaccine-type HPV (vs. unvaccinated; aOR 0.39, 95%CI:0.19–0.83). Results from the PS sensitivity analysis were similar to the main findings.ConclusionAmong females who reported a history of sexual activity, HPV vaccination status was protective against vaccine-type HPV and not associated with lab-based STI outcomes. Although findings may be susceptible to reporting bias, results indicating low vaccine uptake at routine-recommended ages requires additional efforts promoting HPV vaccination before sexual-debut.     

Mobility and its liminal context: exploring sexual partnering among truck drivers crossing the Southern Brazilian border

Mobile populations, including truck drivers, are at elevated risk of acquiring HIV and other sexually transmitted infections (STI). However, measures of mobility have been poorly operationalized and little research exists exploring the psychosocial context of mobility and sexual risk taking. A systematic sample of 1775 male truck drivers underwent interview at two customs stations on the Southern Brazilian international border in 2003. The psychosocial effect of being mobile was assessed by clustering truckers based on perceptions of the liminal environment, or being outside of one's normal social environment. The relationship between physical mobility (nights spent at home) and liminal cluster with sexual partnerships was assessed. The clustering procedure yielded three dispositions towards the liminal environment. Compared to truckers in the baseline cluster, those who perceive the environment as (1) very, or (2) moderately permissive had increased odds of reporting a commercial sex partner in the past six months and reported increased numbers of commercial partners. For each week slept at home, the odds of reporting a commercial partner decreased by a factor of 0.73 and the average number of commercial partners decreased by a rate of 0.76. Physical and psychosocial measures of mobility were associated independently with increased partnering on the road. Additional exploration of how the liminal environment shapes mobile populations' sexual decision making and vulnerability to STI is warranted.     

Gonococcal vaccines: Public health value and preferred product characteristics; report of a WHO global stakeholder consultation,January 2019

Renewed interest in developing vaccines against Neisseria gonorrhoeae has been sparked by the increasing threat of gonococcal antimicrobial resistance (AMR) and growing optimism that gonococcal vaccines are biologically feasible. Evidence suggests serogroup B Neisseria meningitidis vaccines might provide some cross-protection against N. gonorrhoeae, and new gonococcal vaccine candidates based on several approaches are currently in preclinical development. To further stimulate investment and accelerate development of gonococcal vaccines, greater understanding is needed regarding the overall value that gonococcal vaccines might have in addressing public health and societal goals in low-, middle-, and high-income country contexts and how future gonococcal vaccines might be accepted and used, if available. In January 2019, the World Health Organization (WHO) convened a multidisciplinary international group of experts to lay the groundwork for understanding the potential health, economic, and societal value of gonococcal vaccines and their likely acceptance and use, and for developing gonococcal vaccine preferred product characteristics (PPCs). WHO PPCs describe preferences for vaccine attributes that would help optimize vaccine value and use in meeting the global public health need. This paper describes the main discussion points and conclusions from the January 2019 meeting of experts. Participants emphasized the need for vaccines to control N. gonorrhoeae infections with the ultimate goals of preventing adverse sexual and reproductive health outcomes (e.g., infertility) and reducing the impact of gonococcal AMR. Meeting participants also discussed important PPC considerations (e.g., vaccine indications, target populations, and potential immunization strategies) and highlighted crucial research and data needs for guiding the value assessment and PPCs for gonococcal vaccines and advancing gonococcal vaccine development.     

Evaluation of a peer network intervention trial among young methamphetamine users in Chiang Mai, Thailand

Since the 1990s, there has been a proliferation of methamphetamine use in Thailand, particularly among young people. Simultaneously, risky sexual behaviors among this population have increased. This study examined the effects of a peer network intervention and a life-skills intervention on methamphetamine and HIV risk behaviors among 18-25 year olds in Chiang Mai, Thailand. Between April 2005 and June 2007, we conducted a randomized behavioral trial to compare the efficacy of a peer educator, network-oriented intervention with a best practice, life-skills curriculum on methamphetamine use, sexual behaviors, and incident sexually transmitted infections (STIs). Follow-up occurred at 3-, 6-, 9-, and 12 months. Both conditions consisted of seven, 2h, small group sessions. Longitudinal analyses of the three outcomes were conducted by fitting repeated measures logistic regression models using generalized estimating equations. Participants (N=983) attended a median of six sessions, with no differences between arms. At each follow-up visit, retention was greater than 85%. Participants were 75% male and were a median of 19 years old. Over time, participants in both conditions showed a significant and dramatic decline in self-reported methamphetamine use (99% at baseline vs. 53% at 12 months, p<0.0001) and significant increase in consistent condom use (32% baseline vs. 44% at 12 months, p<0.0001). Incident STIs were common, with no differences between arms. Chlamydia had the highest incidence rate, 9.85/100 person years and HIV had a low incidence rate of 0.71/100 person years. Among young Thais, we found that a peer educator, network-oriented intervention was associated with reductions in methamphetamine use, increases in condom use, and reductions in incident STIs over 12 months. We also found parallel reductions with the life-skills condition. To our knowledge, this is the first such trial targeting this population. Small group interventions are an effective means of reducing methamphetamine use and sexual risk among Thai youth.     

“She'll be right”? National identity explanations for poor sexual health statistics in Aotearoa/New Zealand

The sexual health statistics around sexually transmitted infections (STIs) in Aotearoa (New Zealand) suggest two things: many STIs are increasing, and the STI rates are high compared to other ‘similar’ countries. What sense do ordinary New Zealanders make of these figures? Focusing on heterosexual sex, this paper discusses lay accounts that sought to make sense of Aotearoa's STI statistics. In total, 58 participants (38 women, 20 men) aged 16–36 years (mean age 25) took part in 15 focus group discussions related to sexual health. Participants were mostly Pākehā (of European ancestry) and heterosexual. Data were analysed thematically. The predominant category of explanation was national ‘identity’ accounts. National ‘identity’ explanations invoked a particular New Zealand persona to explain the sexual health statistics. New Zealanders were characterised, sometimes contradictorily, as binge drinkers; poor communicators; self-sufficient and stoic; conservative yet highly and complacently sexual; and ‘laid back’, which was associated with a lack of personal concern about sexual health risk. The emphasis on national identity shifts responsibility for sexual health from the individual, and suggests agency lies beyond the individual, who is fully embedded in their culture and acts according to its dictates. In terms of sexual health, this suggests a need to consider whether, and if so how, national ‘identity’ might be meaningfully invoked and deployed in sexual health promotion initiatives.     

对收容教育所妇女口腔牙周、黏膜感染的调查

目的了解2001年深圳市收容教育所被收容教养的妇女性传播疾病(STDs)流行情况,以及高危人群的口腔牙周、黏膜感染状况。方法收集整理2001年被收容教养的妇女体检及实验室检测资料,并作流行病学分析,牙周疾病、口腔黏膜病感染状况检查,以世界卫生组织1987年公布的标准。结果302例收容教育所妇女中,共检出性病60例,检出率19.8%,牙龈炎的发病率57.4%,牙结石检出率25.8%,早期牙周疾病患病率4.96%;晚期牙周疾病患病率0.99%;口腔黏膜异常2.3%。结论收容教育所妇女是性病传播的主要传染源,提示口腔医务人员从职业角度需要采取有效措施,保护自身及患者的健康;加强医院感染的控制。     

Youth United Through Health Education: Community-Level, Peer-Led Outreach to Increase Awareness and Improve Noninvasive Sexually Transmitted Infection Screening in Urban African American Youth

PurposeTo evaluate the effectiveness of the Youth United Through Health Education (YUTHE) program, a community-level, peer-led outreach program to increase awareness and improve noninvasive sexually transmitted infection (STI) screening in youth residing in the targeted community.MethodsSexually experienced youth, aged 12–22 years, anonymously participated in the YUTHE program (a 15-minute encounter, including a risk assessment with feedback and prevention messages). A street- and venue-based intercept approach using a nonequivalent control group design was implemented to evaluate the YUTHE program.ResultsYUTHE community respondents were more likely to know that STIs could be asymptomatic (odds ratios [OR] 1.36, 95% confidence interval [CI] 1.08–1.72), know about urine-based STI screening tests (OR 1.34, 95% CI 1.04–1.72), perceive themselves to be at risk for STIs (OR 1.71, 95% CI 1.11–2.62), and worried about acquiring an STI (OR 1.50, 95% CI 1.04–2.18). No other community differences were identified. However, respondents who reported a single contact (OR = 2.12, 95% CI = 1.11–4.03) or multiple contacts (OR 2.78, 95% CI 1.81–4.26) with the YUTHE program were more likely to have been tested for STIs in the previous six months.ConclusionsWe did not accomplish our overall goal of increasing STI screening in our outreach community relative to the comparison community; our findings suggest that a peer-led, street- and venue-based community outreach approach is a feasible means for reaching large numbers of adolescents for STI prevention.     

Parents' health beliefs and HPV vaccination of their adolescent daughters

Though many studies have documented correlates of HPV vaccine acceptability, our study is one of the first to examine correlates of vaccine initiation. The current study aimed to identify modifiable correlates of HPV vaccine initiation among adolescent girls in high risk communities and whether correlates varied by race and urban/rural status. In 2007, we conducted a cross-sectional survey of 889 parents of adolescent girls aged 10–18 living in areas of North Carolina, USA with high cervical cancer rates. We analyzed data using logistic regression. Health Belief Model constructs were associated with HPV vaccine initiation in multivariate analyses, including doctor's recommendation to get HPV vaccine, perceived barriers to obtaining HPV vaccine, and perceived potential vaccine harms. While exploratory stratified analyses suggested that many of the same parent beliefs were important correlates of HPV vaccine initiation regardless of racial group or urban/rural status, a few differences did exist. These potentially modifiable beliefs offer well-defined targets for future interventions designed to increase HPV vaccine coverage. However, the beliefs' relative importance may differ between racial groups and regions.