Sexually Transmitted Infections

IntroductionHIV pre-exposure prophylaxis (PrEP) demonstrates the value of biomedical interventions as part of combination prevention. Some gay, bisexual and other men who have sex with men (GBMSM) use antibiotics to prevent sexually transmitted infections (STIs), primarily as post-exposure prophylaxis (PEP). We aimed to understand variations in awareness and use of HIV PrEP and STI PEP/PrEP among people attending specialist sexual health services (SHS) in England. MethodsWe collected data from SHS attendees aged >16 years in London and the East of England using an online questionnaire between April 2022 and December 2023, including awareness and use of HIV-PrEP and STI PEP/PrEP. We ran regression analyses: one to identify demographic factors associated with STI PEP/PrEP use among all SHS attendees, and a second to identify behavioural factors (controlling for socio-demographic factors) associated with antibiotic prophylaxis use among GBMSM. ResultsThe study recruited 1,732 participants (50% GBMSM, 12% men who had reported sex with women only [MSW], 31% women). 74% had heard of HIV-PrEP but this varied by group (GBMSM:98%, MSW:39%, women:49%). 34% of GBMSM had heard of STI PEP/PrEP and 11% reported using it (MSW:15%/5%, women:18%/4%). 61% of STI PEP/PrEP users reported taking doxycycline, mostly to prevent chlamydia, gonorrhoea and syphilis. 80% of all participants reported being somewhat/very likely to use event-based STI PEP/PrEP, with a higher proportion of GBMSM saying they would be likely to use STI PEP/PrEP in this way. In the behavioural regression model of GBMSM, use was independently associated with reporting higher-risk sexual behaviour. ConclusionWe found that a sizeable minority of GBMSM already use STI PEP/PrEP but some MSW and women also use or have an interest in antibiotic prophylaxis, suggesting potential benefits may exist for populations other than GBMSM. Communication should therefore should emphasise appropriate antibiotic use and the risks of antibiotic resistance among all populations. Key messagesO_ST_ABSKWhat is already known on this topicC_ST_ABSO_LIDespite widespread availability of HIV-PrEP, heterosexual men and women with a need for HIV-PrEP are less likely to have this met than GBMSM C_LIO_LISome GBMSM use antibiotics to prevent bacterial STI infections in the absence of guidelines on STI PEP/PrEP in England C_LI What this study addsO_LIAwareness of HIV-PrEP is low among heterosexual men and women C_LIO_LIThe study shows that some heterosexual men and women are currently using or have an interest in STI PEP/PrEP C_LI How this study might affect research, practice or policyO_LIThis study could inform HIV-PrEP awareness activities for people at risk of HIV C_LIO_LIIt could also inform communication strategies for any future introduction of STI PEP/PrEP C_LI

In the UK, gay, bisexual, and other men who have sex with men (GBMSM) at risk of sexually transmitted infections (STIs) are recommended quarterly testing, but it is not known how many are following this recommendation. We described the prevalence and correlates of frequent STI testing amongst GBMSM. We analysed data on participants of the community-based Reducing Inequalities in Sexual Health (RiiSH) online survey of GBMSM, recruited in November-December 2024 via social media and dating apps. Participants were UK residents aged [≥]16 years who reported sex with a man in the previous year. We described the frequency of STI testing amongst individuals recommended quarterly testing, using proxies for national guidelines for quarterly testing eligibility (over the past three months: new male sexual partner, condomless anal sex, [≥]10 male partners, or chemsex). We explored factors associated with frequent testing ([≥]4 tests/past year) using univariate and multivariable logistic regression, adjusting for country of birth and residence, ethnicity, employment, and education. Among 2758 participants (median age 45 years, 88% white), we estimated that 2366 (86%) would be recommended quarterly STI testing. Over the past year, 562 individuals (24%) met or exceeded this recommendation (testing [≥]4 times), 1107 (47%) had 1-3 tests, and 673 (28%) no tests. Factors associated with frequent testing were: reporting using PrEP in the past year (adjusted odds ratio 7.66 (95% confidence intervals 5.77-10.30)), STI diagnosis in the past three months (1.96 (1.45-2.64)), and younger age (1.50 (1.04-2.16), aged 16-29 years vs [≥]45 years). Straight/bisexual orientation was associated with less frequent testing than gay/homosexual (0.71 (0.52-0.96)). Overall, data from a large UK community survey suggest that only 1 in 4 GBMSM who are recommended frequent STI testing meet this recommendation, and testing levels vary by PrEP use, STI history, age, and sexual orientation. Interventions are needed to address these inequalities.

Evidence from real-world studies suggests that 3-monthly screening for asymptomatic chlamydia/gonorrhoea is not reducing incidence and is driving increased antibiotic use and antimicrobial resistance (AMR). While some countries are recommending less screening, changes to guidelines require clinician buy-in. This study explored the views of Australian sexual health clinicians to changing practices around asymptomatic screening for chlamydia/gonorrhoea in gay, bisexual and other men-who-have-sex-with-men (GBMSM) and attitudes to not automatically treating positive diagnoses. We conducted thematic analysis of 16 semi-structured interviews with clinicians working in a range of settings. Interviews covered: evidence on test and treat, perspectives on reducing screening and treatment for chlamydia/gonorrhoea in GBMSM, AMR, and managing patient conversations. Clinicians had variable knowledge about the limited effectiveness of asymptomatic screening. Many were open to reduced screening, if provided supporting evidence. Given challenges in reducing medical interventions, they recommended public education to drive changes. While some clinicians supported patient dialogue in treatment decision-making, most felt uncomfortable not treating. Concerns included: ideas about their role as doctors; onward transmission (particularly to women); and, complications/uncomfortable symptoms/patient psychological well-being. AMR considerations were less salient. While the test and treat paradigm is engrained, clinicians were open to reduced screening, if provided with clear evidence, but were generally reluctant to not treat. A flexible approach that supports patient empowerment in decision-making about screening frequency and choices around treatment could present a way forward. Changing practice requires education to shift patient/clinician mindsets around what it means to have a positive chlamydia/gonorrhoea diagnosis.

BackgroundRectal sexually transmitted infections (STI) are prevalent among men who have sex with men (MSM) and transgender women (TGW). Self-collection of rectal specimens is widely used globally, but limited data exist on its implementation in Africa. We report experiences of MSM/TGW self-collecting rectal STI specimens in Kigali. MethodsFrom March to August 2018, 738 MSM/TGW were recruited in a cross-sectional study using respondent-driven sampling in Kigali. We tested for Neisseria gonorrhea and Chlamydia trachomatis using the Cepheid GeneXpert CT/NG platform on self-collected rectal swabs. Likert scales assessed self-collection difficulty and comfort. Ordered logistic regression analyses were performed to characterize factors associated with self-collection difficulty. ResultsOverall, 14%(106) identified as TGW. In total, 78%(577) found rectal swab self-collection easy/very easy, while 15%(108) found it difficult/very difficult. Most, 92%(679), were comfortable/very comfortable with the test, and 98%(730) said they would repeat the test in the future. In multivariable RDS-adjusted analyses, discomfort with the swab was positively associated with difficulty in self-collection (adjusted cumulative odds ratios ((aCOR): 7.9(95%CI: 4.9-12.8)) and having a prevalent rectal STI (aCOR: 4.19, 95%CI: 2.02-8.72) was significantly associated with difficulty. Furthermore, 10%(75) of rectal swabs returned indeterminate results (65 invalid results and 10 errors). ConclusionMost MSM/TGW found self-collection of rectal swabs easy, comfortable, and collected valid samples. Self-collection of rectal swabs could be used alongside clinic- and community-based STI testing to improve diagnosis and treatment in Rwanda. However, measures to optimize sample collection and processing are needed to reduce the cost and clinical implications of indeterminate results

BackgroundSexually transmitted infections (STIs) and bacterial vaginosis (BV) are frequently asymptomatic in women. They cause genital inflammation and can increase transmission and acquisition of HIV. GIFT (Genital InFlammation Test) is a novel, point-of-care (POC) device under development for detecting genital inflammation in women. We aimed to obtain consensus to inform the development of GIFT and its integration into management guidelines. MethodsWe employed a Delphi technique through two rounds of online surveys. Respondents included service providers, health programmers, researchers, and policy makers. Round one questions generated ideas, and round two built consensus on the strategies from round one. Survey sections included demographics, implementation of the test, integration into current guidelines and purpose. Round two survey employed a five-point Likert scale from strongly agree to strongly disagree. Consensus was reached if [≥]70% of participants selected strongly agree or agree. ResultsWe received 28 to the first and 68 to the second round. From both rounds, participants were healthcare providers (41%) or researchers (26%), residing in Africa (57%), Europe (21%) and America (10%). Most participants agreed that GIFT should be used as a screening tool to be followed by confirmatory STI testing before treatment: 75% (round 1), 69% (round 2). There was consensus that populations to benefit most from GIFT were young asymptomatic women (16-24 years) in high HIV prevalence settings, and high-risk women like female sex workers and those with multiple partners of any age. Attributes of GIFT ranked as most important included ease-of-use, stability at room temperature, high diagnostic accuracy and barriers were test stock-outs, complexity of use and high cost, ConclusionWhile the Delphi process suggests the purpose of GIFT is as a POC screening tool, factors like supply chain, storage and stakeholder engagement are crucial for its integration into management guidelines. Key messagesO_LIThere is a need to identify BV and STIs in asymptomatic women, however, laboratory diagnostics services are severely limited in most low- and middle-income countries C_LIO_LIIf the GIFT test has high diagnostic accuracy, it promises to be a valuable point-of-care screening tool for detecting genital inflammation in asymptomatic women and may be useful to inform the management of women with symptoms. C_LIO_LIIt is important to obtain feedback from a variety of stakeholders when considering test design and implementation to increase the tests utility and likely adoption in policy and routine care. C_LI

BackgroundHuman papillomavirus (HPV) infection is the most common sexual transmitted disease (STD) and a risk factor for penile, oral and anal cancer. Human immunodeficiency virus (HIV) coinfection increases the risk of cancer. While HPV anal infection is well studied in men-who-have-sex-with-men (MSM), HPV genitalia and oral infection is less known. MethodsThis prevalence study of HPV infection in genitalia and oral cavity in HIV-MSM patients included 107 HPV non-vaccinated subjects. HPV-DNA was detected with Anyplex II HPV28 method. Participants completed a questionnaire on lifestyle and sexual behavior. ResultsMedian age was 43 years (range 35-54 years); 97 patients were on antiretroviral treatment (ART); 81 (75.7%) had undetectable HIV-RNA; median CD4-lymphocyte count was 746 cell/mm3; 70 (65.4%) participants had a previous STD. HPV was detected in genitalia in 37 (34.6%) subjects; 26 (24.3%) in oral cavity and 12 (11.2%) in both locations. High-risk HPV genotypes were detected in 24 (22.4%) patients in genitalia and 15 (14%) in oral cavity. ConclusionsHPV infection is common in unvaccinated HIV-MSM patients. Detectable HIV-RNA was associated with higher HPV prevalence in genitalia. High oncogenic risk HPV genotypes were more common in genitalia than in mouth. Summary textHPV infection is common in HIV infected subjects and it is a risk factor for many types of cancer. Although anal conduct is the most studied location, HPV can also infect genitalia and oral cavity. However, the frequency and distribution of HPV strains is different in both locations.

BackgroundRecent increases in syphilis diagnoses among heterosexual individuals are a growing public health concern. We aimed to qualitatively assess the risk factors, lifestyles, and contexts facilitating syphilis transmission among heterosexually-identifying individuals in England through the NEXUS study. Methods and FindingsNEXUS was a qualitative study based on semi-structured one-to-one interviews conducted between December 2023 and September 2024. Heterosexually-identifying individuals diagnosed with primary, secondary, or early latent syphilis in the previous year at a sexual health service in one of three regions in England were recruited. Interviews were also conducted with healthcare professionals involved in syphilis management. An analytical framework approach identified salient themes from interview transcripts. The service-user data were triangulated using healthcare professional data. Interviews were conducted with 19 service-users and seven healthcare professionals. Syphilis acquisition was primarily associated with condomless vaginal or oral sex. Half (10/19) reported multiple partners around the time of diagnosis; other known risk factors, like swinging (multiple concurrent partners) (1/19), sex work (3/19), or transmission among heterosexually-identifying men who have sex with men (1/19), were linked to a minority of infections. Of those reporting a single partner (9/19), four were in a believed exclusive relationship. Many had low perceptions of STI risk but intended to alter sexual behaviours post-diagnosis. Syphilis knowledge was limited among heterosexual individuals and initially seeking medical advice for symptoms from non-sexual health specialists sometimes led to diagnosis delays. Service-users suggested information on syphilis epidemiology, symptoms, and prevention, conveyed through National Health Service sources and mass media, would have been beneficial. ConclusionsWe identified a range of contexts associated with syphilis transmission. While multiple partners were common, infections also occurred through infrequent or novel practices or among those with few sexual encounters. Increasing awareness of syphilis among heterosexually-identifying individuals and healthcare professionals working in specialties other than sexual health is important to improve detection, facilitate treatment, and reduce transmission.

BackgroundCore groups, characterized by high levels of sexual activity and disease prevalence, are critical to the transmission dynamics of sexually transmitted infections (STIs) like gonorrhea. Understanding core group dynamics is essential for developing targeted interventions and understanding their potential effect on outcomes for gonorrhea. We assessed core group composition among gonorrhea cases in Guilford County, North Carolina, where gonorrhea rates are elevated, and antimicrobial resistance is a growing concern. MethodsWe used Neisseria gonorrhoeae surveillance data collected in both public health clinics and emergency departments in Guilford County to characterize core groups. Data including demographics, behavioral risks, and longitudinal gonorrhea test results, were reviewed for specimens submitted for gonorrhea testing. Statistical analyses, including descriptive statistics and univariate logistic regression, were performed to assess factors influencing core group membership within three subpopulations: teens, adult men who have sex with men (MSM), and adult heterosexuals. ResultsThe study included 25,520 patients, with 1,718 (6.7%) classified as part of the core group. The core group accounted for 68% of all gonorrhea cases, with subgroups such as teen, adult MSM, and adult heterosexual core groups contributing disproportionately to their respective gonorrhea cases (66%, 79%, and 67%, respectively). Demographic and behavioral risk factors are explored and factors increasing odds ratios of core group inclusion are identified among the general population as well as three subpopulations: teens, adult MSM, and adult heterosexual core groups. Notable risk factors for gonorrhea core group inclusion across all subgroups include increased number of sexual partners, drug use, and HIV status. Notably, there is variation in some risk factors among subpopulations including race/ethnicity and sex while traveling internationally. DiscussionAmong other factors, variations in public health policies and population level behavioral norms change the way gonorrhea spreads through a population. We report gonorrhea core group composition for a region with high gonorrhea rates. In particular, we discuss the role of teenagers in gonorrhea transmission dynamics, a typically under reported group. Understanding population specific dynamics is essential for formulating effective and targeted interventions.

BackgroundHigh rates of repeat infections post-treatment are reported in women infected with Trichomonas vaginalis (TV). Determining the origin of repeat infections is generally limited to clinical queries of adherence to treatment and sexual exposure. The purpose of this study was to add micro-satellite (MS) genotype data to classification criteria for origin of repeat TV infection, and examine if the addition of TV genotype changes classification as treatment failure, re-infection, or new infection MethodsWomen were enrolled at clinics in Birmingham, AL; Jackson, MS; and New Orleans, LA as part of a randomized clinical trial comparing single-dose (2 g) and multi-dose (500 mg twice daily x 7 days) metronidazole (MTZ) treatment regimens. Participants provided vaginal swabs and completed a behavioral audio-computer assisted self-interview (ACASI). TV specimens were genotyped at 11 microsatellite (MS) loci. Women with repeat TV infections at TOC, were classified as treatment failure, re-infection or new infections using behavioral and genotype data; classifications were compared. ResultsData were available for 45 women. Genotype concordance was defined as <4 MS loci different and genotype discordance was defined as [&ge;] 4 MS loci different. Clinical criteria vs. genotype-informed criteria classifications were treatment failure (66.7% vs 64.4%) re-infection (26.7% vs. 17.8%) and new infections (6.7% vs. 17.8%) respectively; Bowkers test of symmetry had X2=16.00 p=0.0011, indicating differences in results. ConclusionsThe majority of women, using either criteria, were classified as treatment failure. Clinical assessment may overestimate reinfections and underestimate new infections. Patient counseling should be adapted accordingly. SummaryTo more precisely determine the origin of repeat Trichomonas vaginalis infection, we compared genotype microsatellite size polymorphism data to clinical criteria and found that clinical data overestimated reinfection and underestimated new infections. Patient counselling should consider new partners.

ObjectivesWe determined the frequency of sexually transmitted infection (STI) testing among people accessing sexual health services (SHS) in England. MethodsWe assessed STI testing frequency in face-to-face and online SHSs in England using data from the GUMCAD STI surveillance system. We quantified different combinations of tests (e.g. single chlamydia test or full STI screen), number of tests completed in 2024 and test positivity by sociodemographic and behavioural characteristics, as well as clinical setting and outcomes. ResultsOverall, there were 2,222,028 attendances at SHS in England in 2024 that involved tests for chlamydia, gonorrhoea, syphilis and/or HIV. Most of these attendances involved tests for all four of these STIs. Most people accessing SHS in England tested once (80.1%), and a small minority (1.9%) tested at least quarterly (4+ times). Some groups had a comparably larger proportion of quarterly testers; these included gay, bisexual, and other men who have sex with men (GBMSM) (6.7%), London residents (3.6%), online testers (2.5%), people using HIV-PrEP (13%), and people with 5+ partners in the previous 3 months (10.6%). Only 10.5% of GBMSM reporting higher-risk sexual behaviours tested quarterly despite recommendations for quarterly testing in this group. ConclusionsThe majority of those who tested for STIs in England in 2024 only tested once. The minority who tested at least quarterly had a higher proportion of GBMSM, people using HIV-PrEP, London residents and people reporting higher risk behaviours. Quarterly testing often appears to be aligned with current testing recommendations in England; however, we also observed that only a low proportion of behaviourally high-risk GBMSM and HIV-PrEP users are meeting these recommendations. It is important to acknowledge groups with lower or higher testing frequency when developing interventions and updating guidelines related to STI testing. WHAT IS ALREADY KNOWN ON THIS TOPICThe effectiveness of asymptomatic testing for chlamydia and gonorrhoea in gay, bisexual and other men who have sex with men (GBMSM), and the potential impact of the consequent increased antibiotic use on rising antimicrobial resistance and individual harm has recently been questioned. Testing and treatment remains a key pillar of STI prevention and management; despite this, there is limited evidence of STI testing frequency within sexual services (SHS) on a national level. WHAT THIS STUDY ADDSThis analysis shows that the majority of people attending SHSs in England in 2024 tested once, and only a small proportion of behaviourally high-risk people tested frequently. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYAwareness of groups that are behaviourally high risk but testing infrequently is important to guide interventions and messaging regarding STI testing. The low levels of frequent testing, even among those who would be recommended quarterly testing under UK guidelines, provides important context for wider discussion around asymptomatic STI screening.

ObjectivesMany countries recommend 3-monthly chlamydia/gonorrhoea screening for men-who-have-sex-with-men (MSM). New evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydia screening on population prevalence, coupled with concerns about overburdened health services and antimicrobial resistance (from over-treatment), calls into question current approaches to asymptomatic screening. We explored sexual health professionals/experts arguments in favour/against reducing asymptomatic screening using Polis (www.Pol.is), an online, crowdsourcing tool for understanding what large groups think. MethodsRecruited via global peak bodies/networks, 99 sexual health professionals/experts (43.4.% clinicians, 35.4% researchers) primarily from Oceania (41.4%), UK/Europe (29.4%) and North America (22.2%) submitted 83 statements in favour/against reduced screening for men-who-have-sex-with-men (e.g. Bisexual men who dont test regularly risk putting women at risk). Participants voted on submitted statements (agree/disagree/pass). We considered statements with [&ge;]80 agreement as strong support, 70-79% moderate support, [&le;]69% mixed support. We used content analysis to group clusters of related statements, and examined associations between participant demographics and votes for/against. ResultsThere was mixed support for statements on :1) the impact of screening in reducing prevalence; 2) whether asymptomatic infections pose clinical harm/necessitate treatment; and risk of antimicrobial resistance. Statements advocating for 6-monthly screening received moderate support, with arguments centering on resource use. Participants strongly supported the need for community engagement and maintaining frequent HIV/syphilis screening. UK/Europe participants were more likely to favour reduced chlamydia/gonorrhoea screening. ConclusionsWhile there were mixed opinions about relative utility, risks, and harms of reducing chlamydia/gonorrhoea screening for MSM, arguments relating to resource use may provide common ground for policy changes.

RationaleThe first key step in contact tracing for sexually transmitted infections (STIs) is to notify recent exposed sex partners. Gay and bisexual men and other men who have sex with men (GBMSM) bear a high burden of STIs and one-off partners contribute disproportionately to community transmission, posing a particular challenge to contact tracing. Here we explore and theorise the barriers and facilitators of GBMSM telling their one-off sexual partners about their exposure to STIs. DesignUsing focus groups with diverse GBMSM from Leeds, Glasgow, London and on-line (n=28) we used a multi-level approach to intervention development to enhance contact tracing. This framework included initial stakeholder engagement; deductive thematic analysis to identify key barriers and facilitators to contact tracing with one-off partners; the use of the theoretical domains framework (TDF) to theorise these barriers and facilitators and subsequently the use of the behaviour change wheel (BCW), incorporating the behaviour change technique taxonomy (BCTT), to suggest intervention content to enhance the key step of notifying partners; and final stakeholder input to ensure this content was fit for purpose and satisfied the APEASE criteria. ResultsIn relation to the TDF, the barriers and facilitators primarily related to beliefs about consequences. Having used the BCW and further stakeholder engagement, our final intervention recommendations related to focussed efforts to change the culture and corresponding norms and social practice of notifying sex partners about the risk of infection in GBMSM communities. This could usefully be achieved through dedicated community engagement and partnership work, through focussed mass and social media interventions twinned with focussed peer-led work to normalise and destigmatise contact tracing. ConclusionThrough systematically working with key stakeholders, GBMSM communities and using a range of tools from the behavioural sciences, we have developed a suite of evidence-based and theoretically informed intervention content which, if developed further, could enhance GBMSMs willingness to notify sex partners about their risk of infection.

ObjectivesSexual decision-making and STI prevention are influenced not only by individuals characteristics, but also those of their partners and their relationship with each other. To inform tailored STI prevention and better understand STI transmission dynamics, this study aimed to understand the characteristics of sexual partners and partnerships among UK GBMSM, for whom there has been limited information beyond partner numbers. MethodsWorking with community-based organisations, we co-designed a sexual partnerships module for the UKs annual online cross-sectional community-based RiiSH GBMSM survey, undertaken November-December 2023. We collected data about [&le;]3 most recent male sex partners since August 2023 and analysed variations in relative demographic characteristics (age, ethnicity), sexual behaviours (sexual practices, condom use, HIV-PrEP use) and communication (talking about sexual health, sharing HIV status) by partner type. ResultsAltogether 1106 participants described 2342 partners: 12%, 20%, 11% and 57% reporting 0, 1, 2 and 3 partners, respectively, of varying combinations. Casual partner types were most commonly reported (43%) vs. one-time (36%), established (14%) and uncertain relationships defined (7%). Concurrency was common with the mean number of ongoing partnerships >1 (1.23, 95%CI:1.17-1.30). Age-mixing varied by partner type, from median 2 (established partners) to 10 (one-time partners) years difference. Sexual health communication differed by partner type. While highest among established partners, it was twice as common to be unaware of one-time partners HIV status and not to have discussed sexual health (both 68%) vs. among casual partners (30% and 28%, respectively). Condom use was low across all partnership types, though HIV-PrEP was used in 49% of one-time partnerships involving condomless anal intercourse. DiscussionGBMSM in the UK have diverse types of male sexual partners and partnerships, which vary in their demographic mixing, sexual behaviour and sexual health communication. STI prevention and sexual wellbeing programmes targeting GBMSM should consider partnership and partner type. Key messagesO_ST_ABSWhat is already knownC_ST_ABSSexual behaviours vary across individuals and also partnership types. Understanding the timing, behaviours and characteristics of partnerships, and therefore the sexual contact network, may inform STI prevention efforts. What this study addsThis study of GBMSM from a large, UK-wide community sample show their sexual partnerships are diverse in their behaviour, characteristics and communication, varying both between and within individuals. What are the implicationsFurther research and practice should consider partnership type when designing and delivering STI prevention interventions to maximise their effectiveness among GBMSM and potentially more broadly.

BackgroundChlamydia trachomatis is a highly prevalent sexually transmitted infection (STI) strongly associated with female infertility. Polymerase Chain Reaction (PCR) is considered the gold standard for diagnosis, utilizing primers designed to target either the ompA gene (encoding the major outer membrane protein) or the cryptic plasmid gene. MethodsThis cross-sectional study was conducted on infertile women attending the Infertility Clinic at Damascus University Obstetrics Hospital, Syria. A total of 160 cervical swab samples were analyzed from these women. Genomic DNA was extracted using a Qiagen kit, followed by PCR with primers targeting Chlamydia trachomatis major outer membrane protein gene (CTM -ompA-targeting) and cryptic plasmid (CTP -cryptic plasmid-targeting). FindingsPositivity rates were 51.3% for CTM and 31.9% for CTP. A statistically significant association was observed between C. trachomatis infection and monthly income (p= 0.039), as well as between it and education level (p= 0.001). Additionally, a significant association was found between C. trachomatis positivity and education level (p= 0.017). InterpretationThese findings underscore the significant burden of Chlamydia trachomatis in infertile Syrian women and highlight the diagnostic advantages of ompA-based PCR, suggesting socioeconomic factors influence infection prevalence.

IntroductionThe number of bacterial sexually transmitted infections diagnosed among men who have sex with men (MSM) continues to rise annually. Innovative public health interventions are needed to address this. Partner notification (PN), is important in reducing STI transmission by identifying, testing and treating the sex partners of people with STIs. Outcomes of PN in MSM are sub-optimal; some MSM with STIs report high numbers of "one-off" sex partners (where sex occurs on one occasion only) who appear to contribute disproportionately to community transmission but are poorly reached by current PN interventions. Aims/ObjectivesThis paper describes the protocol for development of a novel, co-produced, multi-level, PN intervention for MSM with "one-off" partners. The process described will ensure the intervention is evidence-based, theoretically informed and acceptable to users, service providers, commissioners and those with community interest. Methods and AnalysisOur three-phase approach draws on the revised Medical Research Council (MRC) guidance for developing and evaluating complex interventions. First, we combine evidence synthesis with stakeholder engagement to understand the barriers and enablers to PN to co-produce preliminary intervention ideas. Next, we further develop our intervention ideas and adapt our emerging programme theory by collecting detailed data through focus groups and interviews with purposively sampled stakeholders. Data analysis using the theoretical domains framework and the behaviour change wheel will detail the relationship between putative causal mechanisms and optimal intervention components involved in enhancing PN amongst MSM. Finally, we refine our programme theory, map and clarify our intervention and its intersecting components. We will share our intervention with a panel of expert clinicians, third sector organisations and a lay audience of MSM to detail a co-produced PN intervention. OutcomeCo-produced intervention and programme theory suitable for testing in a future feasibility study. Ethics and disseminationThis protocol received ethical approval from Glasgow Caledonian University HLS/NCH/19/059. Findings will be published with open access licenses. SUMMARYPartner notification for men who have sex with men is suboptimal this paper describes a protocol to develop a co-produced multi-level partner notification intervention.

Abstarct Chlamydia trachomatis (CT) is a sexually transmitted infection (STI). In 2020, an estimated 128.5 million new CT infections were reported among adults worldwide. The global prevalence was 4.0% in women and 2.5% in men. Young adults are the most frequently infected. This bacterial STI is often asymptomatic but can lead to serious complications, particularly in pregnant women. The objective of this study was to determine the prevalence and sociodemographic profile of CT infection in pregnant women living in resource-limited settings. Methods We conducted a cross-sectional study between June 2023 and december 2023 in a maternity ward located west of Kinshasa in an impoverished area with a low-income population. During the study period, we collected 239 cervical swab samples from pregnant women. CT DNA was extracted using the QIAamp DNA Mini Kit. Molecular diagnosis was performed by amplification of a 201 bp fragment of bacterial 16S rDNA from the cryptic plasmid. Results The age group most affected by CT in our cohort was 25 to 35 years (65.83%); married women were more represented than single women (83.22% versus 16.77%). The incidence of CT infection was 18%. The most common vaginal symptoms associated with the infection were vaginal itching and abnormal vaginal discharge, while the most common hypogastric symptom was chronic pelvic pain. Prematurity and spontaneous abortions were the most frequently observed pregnancy complications. Conclusion Chlamydia trachomatis (CT) infection is common among pregnant women living in poverty in Kinshasa. The infection particularly affects the most sexually active age group. It is associated with vaginal and hypogastric symptoms, as well as complications related to the progression of the pregnancy.

ObjectivesAntimicrobial resistance of Mycoplasma genitalium (MG) is a growing concern worldwide. Because reliable data on the burden of resistant MG in Belgium are missing, an additional prospective surveillance program was implemented in 2022 to estimate the real burden of resistant MG in Belgium. MethodsBelgian laboratories (n=21) provided frozen remnants of MG positive samples to the National Reference Centre of Sexually Transmitted Infections from July to November 2022. The presence of macrolide and fluoroquinolones resistance associated mutations (RAMs) was assessed using Sanger sequencing of the 23SrRNA and parC gene. Differences in resistance patterns were correlated with surveillance methodology, socio-demographic and behavioral variables via Fishers exact test and logistic regression analysis. ResultsSequencing for both macrolide and fluoroquinolone RAMs was successful for 232/244 MG positive samples. Over half of the samples were resistant to macrolides (55.2%). All MG in samples from men who have sex with men (MSM) (24/24) were resistant to macrolides. The presence of fluoroquinolone RAMs was estimated to be 26% and did not differ with socio-demographic and sexual behaviour characteristics. ConclusionsGiven the considerable cost of macrolide resistance testing, our data suggest that the use of macrolide resistance testing in MSM does not seem justified in Belgium. However, the lower prevalence of macrolide resistance in other population groups, combined with further emergence of fluoroquinolone resistance provides evidence for macrolide resistance testing in these groups. Continued surveillance of resistance in MG in all groups will be crucial to guide national testing- and treatment strategies.

BackgroundIn the US, sexually transmitted infections (STI) are reported for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) but not Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG). TV and MG surveillance data in the US remains inadequate. We evaluated the performance of the fully automated, multi-plex PCR-based Alinity m STI assay, to simultaneously detect CT, NG, TV, and MG, at a large Veterans Affairs hospital system. Methods260 urine, urogenital, and extragenital clinical specimens were tested with the Alinity m STI assay and the results were compared to those from the Abbott RealTime CT/NG assay in our lab and TV and MG assays run at an external reference laboratory. ResultsAlinity m STI assay results for urine specimens had an overall percent agreement (OPA) with the RealTime comparator assay of 187/187 (100.0%) for CT and 186/187 (99.5%) for NG. For 20 rectal specimens, the OPA for CT was 95% and for NG was 100%; for 13 oral specimens, OPA was 100% for CT and 92.3% for NG. Of the urine specimens sent for TV and MG testing, 100% agreement was observed between the Alinity m STI assay and TV (n=104) and MG (n=30) comparator assay results. ConclusionsThe Alinity m STI assay is an easy-to-use, sensitive and specific assay that allows high-throughput testing for common and undertested STI pathogens to facilitate surveillance efforts. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIMycoplasma genitalium and Trichomonas vaginalis are sexually transmitted infections, however, global prevalence data vary between geographical regions, as these sexually transmitted infections are not included in routine screening. C_LI What this study addsO_LIThis study aimed at assessing Trichomonas and Mycoplasma prevalence and association with a positive Chlamydia and/or Gonorrhoeae result. C_LI How this study might affect research, practice, or policyO_LIIncluding Mycoplasma genitalium and Trichomonas vaginalis testing in a routine screening STI diagnostic algorithm, with cost-effective and accurate multiplex assays can improve diagnosis to initiation of appropriate treatment. C_LI

ObjectivesChemsex is the use of select psychoactive drugs to enhance sexual experiences and has been described among gay, bisexual, and other men who have sex with men (GBMSM). We aimed to characterise sexual risk, wellbeing and health-seeking behaviours among GBMSM and gender-diverse people reporting chemsex-associated drug use. MethodsWe analysed data from Reducing inequalities in Sexual Health (RiiSH), an online community survey of 2,758 UK-resident men and gender-diverse people having sex with men undertaken in November-December 2024. We compared those reporting chemsex-associated drug use with those who did not, assessing sociodemographic characteristics, well-being, sexual risk behaviours and sexual health service (SHS) engagement. ResultsOverall, 8% (218/2,758) reported chemsex-associated drug use in the last year. A higher proportion of participants reporting chemsex-associated drug use in the last year also reported a composite measure of sexual risk based on self-reported behaviours in the previous 3-4 months (e.g. prior bacterial STI diagnosis, [&ge;]5 male condomless anal sex partners) compared to those who did not (85% vs 61%, p<0.001). They also more frequently reported attending a SHS in the last year (81% vs 57%, p<0.001). Those reporting chemsex-associated drug use also more frequently reported a long-term limiting mental health condition (36% vs 24%, p<0.001) and poorer personal wellbeing (e.g. reporting low life satisfaction 36% vs 20%, p<0.001). ConclusionWhile a minority of participants in this national, community-based sample reported chemsex-associated drug use, this group had higher sexual risk and poorer indicators of wellbeing. Many participants also attended SHS, reinforcing the key supporting role of SHS for referral pathways to harm reduction support for those experiencing problematic drug use.

OBJECTIVEClinical trials have shown that doxycycline as post-exposure prophylaxis after sexual contact (doxy-PEP) prevents sexually transmitted bacterial infections (STI). We investigated current awareness about informal use of antibiotics as pre- and post-exposure prophylaxis to prevent STI (STI-PrEP/PEP) among men who have sex with men (MSM). In addition, we investigated psychosocial determinants of its use. METHODSData were collected in the Amsterdam Cohort Study among MSM, the Netherlands, between October 2021 and October 2022. In an online questionnaire, we assessed socio-demographics, sexual behavior, bacterial STI diagnoses, STI-PrEP/PEP awareness, perceived effectiveness of, and beliefs and attitudes towards STI-PrEP/PEP, and intention to use it. STI-PrEP/PEP users were described and (ordinal) logistic regression analysis was conducted to identify factors associated with STI-PrEP/PEP awareness (yes/no) and intention to use STI-PrEP/PEP (7-point Likert scale). RESULTSAmong 593 MSM with median age 46 years (IQR 36-53), 102 (17.2%) were aware of STI-PrEP/PEP and 15 (2.5%) had ever used it. STI-PrEP/PEP awareness was associated with living with HIV, HIV-PrEP use in the preceding 6 months, and sexualized drug use with casual partner(s). Median intention to use STI-PrEP-PEP was 3 (IQR 2-4). Higher intention to use STI-PrEP/PEP was associated with HIV-PrEP use, sexual contact with casual partners, being worried to get an STI, self-protection as reason to use it, the intention to reduce STI testing and sexual experimenting. Stigmatizing beliefs regarding STI-PrEP/PEP users were associated with lower use intentions. CONCLUSIONPreventive use of antibiotics for STI prevention is limited among MSM in the Netherlands in 2021/2022. Some men have a high intention for future use. Self-protection and a wish for sexual experimenting are amongst the intrinsic motivators for higher intention to use STI-PrEP/PEP. More studies on the safe use of STI-PrEP/PEP are required as well as a strategy to educate those who have already adopted STI-PrEP/PEP or have a high intention to do so, and their healthcare providers.