Current News about Sexually Transmitted Disease

Background The Gonococcal Isolate Surveillance Project (GISP) was established to monitor antimicrobial resistance (AR) in Neisseria gonorrhoeae in the United States. Isolates collected in GISP undergo antimicrobial susceptibility testing allowing for estimates of resistance, based on exceeding minimum inhibitory concentrations (MICs), to be calculated. Methods We estimated the annual number and proportion of gonococcal infections with antibiotic resistance or elevated MICs (AR/eMICs) against 6 antibiotics for men and women aged 15 to 39 years in the United States using male urethral specimens collected in GISP during 2008–2019. Although GISP only measured MICs for male gonococcal infections, this study estimated AR/eMICs in women using data from men with female sex partners. GISP data were weighted against national gonorrhea case report data based on 4 variables (age group, year of report, US Census region, and race/Hispanic ethnicity) to estimate annual, national proportions of gonococcal infections with AR/eMICs. These weighted proportions were then multiplied by national estimates of incident gonococcal infections to calculate the number of incident gonococcal infections with AR/eMICs nationally. Results Women had a higher estimated number of cases with AR/eMICs compared with men (440,900 vs. 387,200 in 2019), although the estimated percentage of gonococcal infections with AR/eMICs was lower in women (50.7% vs. 54.4% in 2019). Elevated MICs to ceftriaxone remained below 1% throughout the study period. Conclusions Our analysis indicates that there are more women with AR/eMICs gonorrhea than men. Although the proportion of cases that are resistant to any one antimicrobial is increasing, eMICs to ceftriaxone remains low. 12/24/2024 01:00 AM
 

Background Neisseria gonorrhoeae is one of the recognized global antimicrobial resistance priorities. Extended-spectrum cephalosporins, the last remaining reliable antimicrobial, increasingly fail to clear N. gonorrhoeae infections, especially pharyngeal gonorrhea, leading to limited future treatment options. Methods We conducted a systematic review and meta-analysis of gonococcal treatment failures and compared the minimum inhibitory concentrations (MICs) of isolates from pharyngeal and extra-pharyngeal anatomical sites (PROSPERO registration: CRD42020189101). Results The overall pooled mean MIC for cefixime was 0.17 mg/L (95% confidence interval [CI], 0.07–0.41 mg/L), and that for ceftriaxone was 0.10 mg/L (95% CI, 0.05–0.22 mg/L). For cefixime, the mean MIC estimates for pharyngeal and extrapharyngeal treatment failures were 0.05 mg/L (95% CI, 0.02–0.14 mg/L) and 0.29 mg/L (95% CI, 0.11–0.81 mg/L), and those for ceftriaxone were 0.09 mg/L (95% CI, 0.03–0.22 mg/L) and 0.14 mg/L (95% CI, 0.03–0.73 mg/L), respectively. The pooled mean MICs for pharyngeal isolates are below the phenotypic European Committee on Antimicrobial Susceptibility Testing resistance breakpoint for both antimicrobials (>0.125 mg/L). Conclusions Our findings underscore the need to review the current resistance breakpoints used for pharyngeal infection, to establish international standards for MIC testing, and to advance efforts of the World Health Organization's global action plan to control the spread and impact of antimicrobial resistance in N. gonorrhoeae. Ongoing susceptibility testing of gonococcal isolates and surveillance of treatment failures are central to informing appropriate public health responses. 12/14/2024 01:00 AM
 

Millions of people in the United States are affected by sexually transmitted infections (STIs) every year, with profound consequences for the individual, their community, and society at large. In this review, we aim to summarize the epidemiology of 4 STIs: Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus, and to highlight the consequences of those infections among individuals and the healthcare system. Untreated N. gonorrhoeae, C. trachomatis, T. pallidum, or herpes simplex virus infection can result in female infertility, stillbirth, premature birth, and low birth weight. As many as 10% of incident HIV infections among men who have sex with men in the United States have been attributed to either N. gonorrhoeae or C. trachomatis infection. In 1 year in the United States, incident C. trachomatis infection resulted in $824 million lifetime medical costs and a loss of 1,541 lifetime quality-adjusted life years (QALYs) among men and 111,872 among women, while incident N. gonorrhoeae infection led to $323 million in lifetime medical costs, and a loss of 386 QALYs among women and 12,112 among men. Incident T. pallidum infection in 1 year resulted in $206 million in medical costs and a loss of 13,349 QALYs among both men and women, while genital herpes led to $107 million in medical costs and a loss of 33,100 QALYs. STI-attributable infertility alone resulted in more than $135 million in direct medical costs. Cumulatively, STIs lead to substantial financial costs to individuals and the health system, as well as long-term reductions in quality of life. 12/23/2024 01:00 AM
 

Background Most Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) infections in men who have sex with men (MSM) are diagnosed at extragenital sites. However, testing at these sites is often lacking. The purpose of this study was to determine if a standardized questionnaire administered by physicians and clinical assistants improves documentation of sex activity and increases extragenital testing and diagnoses of GC and CT among MSM. Methods A standardized sexual history questionnaire was implemented on 11/1/2022. Electronic medical records of 664 MSM with human immunodeficiency virus, including 1064 encounters, were reviewed to compare preimplementation and postimplementation sexual history documentation, adequacy of documentation, extragenital GC and CT testing, and GC and CT diagnoses. Analysis included χ2 and exact tests and logistic regression adjusting for physician cluster effects. Results The standardized questionnaire was used by 53.7% of physicians and 85.9% of coordinators. Documentation of whether sexual activity occurred increased from 79.3% (95% confidence interval [CI], 0.758–0.828) in the preintervention pre-COVID-19 period to 95.2% (95% CI, 0.925–0.970) in the postintervention period with an adjusted odds ratio of 4.7 (95% CI, 2.7–8.8). Specific questions about anal and oral sex increased from 42.0% to 88.1% (P < 0.001) and 23.7% to 88.7% (P < 0.001), respectively. Anal and pharyngeal testing increased from 14.4% to 20.2% (P = 0.040) and 17.2% to 23.3% (P = 0.045), respectively. Conclusions This study demonstrates that using a standardized questionnaire during clinical encounters can improve documentation of sexual activity and testing for GC and CT at extragenital sites. 12/14/2024 01:00 AM
 

Background Syphilis cases continue to climb in the United States, with a 159% increase among women between 2018 and 2022. Congenital syphilis (CS) cases continued along the same trajectory, with a 183% increase over the same time frame. Adherence to the screening guidelines may assist in reducing this trend. Our analysis aimed to determine the proportion of commercially insured women receiving syphilis screening during pregnancy. Materials and Methods We analyzed the 2022 Merative MarketScan Database containing commercially insured medical claims to determine syphilis screening rates among insured pregnant women aged 18 to 49 years, insured for 8 months before childbirth. Screening events were classified into 3 categories: first (1–13 weeks), second (14–27 weeks), and third (28+ weeks). Percentages and odds ratios were calculated for pregnancy categories by age category, trimester, Centers for Medicare & Medicaid Services regions, employment, and type of health insurance. Results Of the 170,005 pregnant women in the sample, 79.6% were screened for syphilis at least once, and 95.1% resided in a state requiring syphilis testing during pregnancy. The highest percentage of pregnant women was screened during the third trimester, and the majority of those screened received at least 2 tests during pregnancy. Women in states with laws had 14% greater odds for receiving any screening during pregnancy. Discussion Despite Centers for Disease Control and Prevention syphilis screening recommendations, only 79.6% received screening among this insured population. Effective communication on the importance of syphilis screening for all medical providers and their patients may increase the screening rates and decrease the incidence of CS. 03/04/2025 01:00 AM
 

Background The COVID-19 pandemic affected sexually transmitted infection (STI) testing and diagnosis rates in the United States, but these patterns have not been well characterized among people with HIV. Methods We analyzed medical records data of HIV Outpatient Study (HOPS) participants seen for HIV care from January 2019 to March 2021, with ≥1 CD4+ cell count and viral load test results recorded. We used Poisson regression models to estimate rate ratio (RR) and 95% confidence interval (CI) to compare STI testing and diagnoses rates on/after versus before March 1, 2020 (early COVID-19 pandemic [pandemic] vs. prepandemic). Results Of 2311 eligible patients, STI tests (STI cases, primarily defined as test results that were positive) were as follows during the analysis time frame: 4991 gonorrhea (157), 4978 chlamydia (135), and 4216 syphilis (114). Comparing pandemic versus prepandemic periods, STI testing RRs were 0.78 for both gonorrhea (95% CI, 0.73–0.82) and chlamydia (95% CI, 0.73–0.83), and 0.93 for syphilis (95% CI, 0.88–0.99); diagnosis rates were not statistically different. Multivariable models showed reduced testing for gonorrhea (adjusted RR, 0.79; 95% CI, 0.72–0.87) and chlamydia (adjusted RR, 0.78; 95% CI, 0.71–0.86) for men who have sex with men, but not for other HIV transmission groups. Conclusions The fallout of the COVID-19 pandemic on sexual health may not be seen for some time. Despite reduced STI testing, rates of STI diagnoses did not decrease. It will take a return to more routine screening and improved access to sexual health care to uncover the true impact of undetected or untreated STIs. 03/24/2025 01:00 AM
 

Introduction Understanding levels of human immunodeficiency virus (HIV) testing among populations at risk for acquisition is essential to meeting the goal of the United Nations that 95% of individuals living with HIV know their status. This study assessed HIV testing prevalence among men who had sex with men (MSM), characteristics of MSM who have never tested for HIV, and missed testing opportunities in Hanoi, Vietnam. Methods We measured the prevalence of never testing for HIV and missed opportunities for testing in the baseline data of a cohort study of MSM recruited in 2017 to 2019 in Hanoi. Logistic regression analysis characterized MSM who had never tested before cohort participation. Results Of 1893 MSM enrolled in the cohort, 39.4% had never previously tested for HIV. Men who had sex with men with children (adjusted odds ratio, 1.75; 95% confidence interval, 1.09–2.82) and those who did not know or remember having a male partner living with HIV (adjusted odds ratio, 1.41; 95% confidence interval, 1.07–1.84) were more likely to have never tested. Older age, university education, higher income, and having a male partner living with HIV were associated with a lower likelihood of never having been tested. The most common missed testing opportunities to test MSM who had never been tested were when receiving free condoms from health educators (35.3%), testing for other sexually transmitted infections (STIs) (23.3%), reporting their MSM status to health care workers (16.4%), and receiving an STI diagnosis (13.0%). The most common barriers identified by MSM who had never tested were fear of seeking health care due to their sexual orientation (82.7%) and having been refused health care due to their sexual orientation (76.2%). Conclusions Facilitating provider-initiated HIV testing in STI clinics and other health care services, community-based testing, and HIV self-test kits should enhance HIV testing options for young MSM, especially those with lower education and income. 12/18/2024 01:00 AM
 

Background The etiology of nongonococcal urethritis (NGU) is incompletely understood. We sought to determine if genitourinary bacterial diversity or specific taxa were associated with incident NGU. Methods From August 2014 to July 2018, men who have sex with women attending a sexual health clinic were clinically evaluated, including Mycoplasma genitalium (MG) and Chlamydia trachomatis (CT) testing, at enrollment and 6 monthly visits. New cases of NGU (≥5 polymorphonuclear leukocytes per high-power field in urethral exudates plus either symptoms or visible discharge) and their visit preceding NGU diagnosis were matched 1:1 to 2 sequential visits without NGU (controls). We determined associations with incident NGU and applied broad-range 16S rRNA gene polymerase chain reaction and sequencing to urine samples from each visit. We used conditional logistic regression to evaluate the association of Shannon Diversity Index, species richness, Haemophilus influenzae, Fannyhessea vaginae, Lactobacillus iners, and Streptococcus mitis group with incident non-CT–non-MG-NGU (NCNM-NGU). Results Of 62 matched case-control pairs, median age was 32 years. Higher Shannon Diversity Index the previous month was associated with higher odds of incident NCNM-NGU (adjusted odds ratio [aOR], 2.8 per unit increase; 95% confidence interval [CI], 1.03–7.47), as was F. vaginae at NGU diagnosis (aOR, 5.1; 95% CI, 1.28–20.15), F. vaginae acquisition (aOR, 13.8; 95% CI, 1.96–97.33), and consistent carriage of F. vaginae (aOR, 16.1; 95% CI, 1.66–156.29). Odds of NCNM-NGU were higher when L. iners cleared between visits (aOR, 18.0; 95% CI, 1.08–299.24). Neither the H. influenzae nor S. mitis group was associated with incident NCNM-NGU. Conclusions F. vaginae acquisition/detection and L. iners clearance were associated with urethritis. This merits investigation in larger longitudinal studies using species-specific detection methods. 12/24/2024 01:00 AM