A Comparison of Syphilis Partner Notification Outcomes by Reported Use of Internet-based Apps to Meet Sex Partners in North Carolina, 2013-2016

Digital interventions for STI and HIV partner notification: a scoping review

BACKGROUND

Partner notification (PN) is key to the control of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital interventions have been used to facilitate PN. A scoping review was conducted to describe the interventions used, user preferences and acceptability of digital PN interventions from patient and partner perspectives.

METHODS

A systematic literature search was conducted of eight databases for articles published in English, available online with digital PN outcome data. Articles were assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative data were synthesised and analysed using thematic analysis.

RESULTS

Twenty-six articles met the eligibility criteria. Articles were heterogeneous in quality and design, with the majority using quantitative methods. Nine articles focused solely on bacterial STIs (five on syphilis; four on chlamydia), one on HIV, two on syphilis and HIV, and 14 included multiple STIs, of which 13 included HIV. There has been a shift over time from digital PN interventions solely focusing on notifying partners, to interventions including elements of partner management, such as facilitation of partner testing and treatment, or sharing of STI test results (between index patients and tested sex partners). Main outcomes measured were number of partners notified (13 articles), partner testing/consultation (eight articles) and treatment (five articles). Relationship type and STI type appeared to affect digital PN preferences for index patients with digital methods preferred for casual rather than established partner types. Generally, partners preferred face-to-face PN.

CONCLUSION

Digital PN to date mainly focuses on notifying partners rather than comprehensive partner management. Despite an overall preference for face-to-face PN with partners, digital PN could play a useful role in improving outcomes for certain partner types and infections. Further research needs to understand the impact of digital PN interventions on specific PN outcomes, their effectiveness for different infections and include health economic evaluations.

Effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced college males in China: evidence from an institutional-based cross-sectional study (Preprint)

Background

As a young subgroup, college students have become the main users of mobile social networks. Considering that people can indiscriminately access explicit sexual content on the internet, coupled with the increase of HIV infections in male college students, the role of the internet in meeting sexual partners and its correlation to risky sexual behavior has become an important topic.

Objective

The aim of this study is to explore the effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced male college students.

Methods

An institution-based cross-sectional study design was used to collect data through a paper-based questionnaire administered to male college students recruited from colleges and gay organizations in Hangzhou, Zhejiang Province, China. A total of 1045 sexually experienced male students were incorporated in our analysis, with the following information collected: sociodemographic characteristics, sexual intercourse–related behaviors, and sexually transmitted disease (STD) knowledge. Mann-Whitney U and Kruskal-Wallis tests were used to examine differences regarding basic characteristics and sexual risk behaviors between male college students who meet sexual partners via the internet and those who do not. Sequential logistic regression models were employed to examine the influence of meeting sexual partners via the internet on risky sexual behaviors after controlling for other factors.

Results

The mean age of the sexually experienced male students was 21.6 (SD 2.0) years. The likelihood of risky sexual behavior was varied, yet it was the highest for those who aim to meet paid sexual partners (145/192, 75.5% to 19/22, 86.4%), followed by those seeking partners for love or romance (258/435, 59.3%). Compared to non-internet partner seekers, internet partner seekers tended to have more casual intercourse (292/542, 53.9% versus 51/503, 10.1%), paid intercourse (32/542, 5.9% versus 12/503, 2.4%), and intercourse with same-sex partners (349/542, 64.4% versus 41/503, 8.2%); they were also more likely to use psychoactive drugs (125/349, 35.8% versus 5/41, 12.2%) and have more than 2 partners. With the increase of HIV and STD knowledge, the probability of having unprotected intercourse decreased for non-internet partner seekers. However, it increased for internet partner seekers with a rising HIV knowledge score. Sequential logistic regression showed that meeting sexual partners on the internet was statistically associated with sexual risk behaviors with multiple sexual partners (odds ratio 4.434; P<.001).

Conclusions

Meeting sexual partners via the internet is a common behavior among sexually experienced male college students, and those who meet partners on the internet exhibited higher levels of risky sexual behaviors although they had sufficient HIV and STD knowledge; this is especially true for students who aimed to find partners for sexual intercourse. Thus, more attention should be paid to young adults to address the risky sexual behaviors that may contribute to STD spread among this population.

Intersection of Syphilis and HIV Networks to Identify Opportunities to Enhance HIV Prevention

BACKGROUND

HIV and syphilis infection continue at disproportionate rates among minority men who have sex with men (MSM) in the United States. The integration of HIV genetic clustering with partner services can provide important insight into local epidemic trends to guide interventions and control efforts.

METHODS

We evaluated contact networks of index persons defined as minority men and transgender women diagnosed with early syphilis and/or HIV infection between 2018-2020 in two North Carolina regions. HIV clusters were constructed from pol sequences collected through statewide surveillance. A combined "HIV-risk" network, which included persons with any links (genetic or sexual contact) to HIV-positive persons, was evaluated by component size, demographic factors, and HIV viral suppression.

RESULTS

In total, 1,289 index persons were identified and 55% named 1,153 contacts. Most index persons were Black (88%) and young (median age 30 years); 70% had early syphilis and 43% had prevalent HIV infection. Most people with HIV (65%) appeared in an HIV cluster. The combined HIV-risk network (1,590 contact network and 1,500 cluster members) included 287 distinct components; however, 1,586 (51%) were in a single component. Fifty-five percent of network members with HIV had no evidence of viral suppression. Overall, fewer index persons needed to be interviewed to identify one HIV-positive member without viral suppression (1.3 versus 4.0 for contact tracing).

CONCLUSIONS

Integration of HIV clusters and viral loads illuminate networks with high HIV prevalence, indicating recent and ongoing transmission. Interventions intensified towards these networks may efficiently reach persons for HIV prevention and care re-engagement.

Unnamed Partners From Syphilis Partner Services Interviews, 7 Jurisdictions

BACKGROUND

Reducing transmission depends on the percentage of infected partners treated; if many are missed, impact on transmission will be low. Traditional partner services metrics evaluate the number of partners found and treated. We estimated the proportion of partners of syphilis patients not locatable for intervention.

METHODS

We reviewed records of early syphilis cases (primary, secondary, early latent) reported in 2015 to 2017 in 7 jurisdictions (Florida, Louisiana, Michigan, North Carolina, Virginia, New York City, and San Francisco). Among interviewed syphilis patients, we determined the proportion who reported named partners (with locating information), reported unnamed partners (no locating information), and did not report partners. For patients with no reported partners, we estimated their range of unreported partners to be between one and the average number of partners for patients who reported partners.

RESULTS

Among 29,719 syphilis patients, 23,613 (80%) were interviewed and 18,581 (63%) reported 84,224 sex partners (average, 4.5; 20,853 [25%] named and 63,371 [75%] unnamed). An estimated 11,138 to 54,521 partners were unreported. Thus, 74,509 to 117,892 (of 95,362-138,745) partners were not reached by partner services (78%-85%). Among interviewed patients, 71% reported ≥1 unnamed partner or reported no partners; this proportion was higher for men who reported sex with men (75%) compared with men who reported sex with women only (65%) and women (44%).

CONCLUSIONS

Approximately 80% of sex partners were either unnamed or unreported. Partner services may be less successful at interrupting transmission in networks for men who reported sex with men where a higher proportion of partners are unnamed or unreported.

Patient Perception of Mobile Phone Apps for the Care and Prevention of Sexually Transmitted Diseases: Cross-Sectional Study

Background

In the emerging era of digitalization and electronic health, various health-related apps have been launched, including apps for sexually transmitted diseases. Until now, little has been known about how patients perceive the value of such apps.

Objective

To investigate patient’s attitudes and awareness toward sexually transmitted disease–related apps in an outpatient sexually transmitted disease clinic setting.

Methods

A cross-sectional study was conducted at a dermatovenereological outpatient unit between April and July 2019. Patients completed a self-administered questionnaire on their perceptions of the popularity and usefulness of sexually transmitted disease–related apps. Descriptive analysis was performed with expression of categorical variables as frequencies and percentages. For continuous variables, the median, range, and interquartile range were indicated. Contingency tables and chi-square tests were used to investigate associations between sociodemographic data and items of the questionnaire.

Results

A total of 226 patients were surveyed (heterosexual: 137/193, 71.0%; homosexual: 44/193, 22.8%; bisexual: 12/193, 6.2%); 11.9% (27/225) had previously used health-related apps. Nearly half of the patients (97/214, 45.3%) specifically considered sexually transmitted disease–related apps useful, 47.8% (100/209) voted that they could supplement or support the consultation of a physician. Interestingly, only 35.1% (74/211) preferred a printed patient brochure on sexually transmitted diseases over downloading and using an app, but 64.0% (134/209) would download a sexually transmitted disease–related app recommended by their physician. General information regarding sexually transmitted diseases (93/167, 55.7%), evaluation of skin diseases based on photos or videos (78/167, 53.3%), information on the prevention of sexually transmitted diseases (76/167, 45.5%), mediation of nearby contact points or test sites (74/167, 44.3%), anonymous medical advice (69/167, 41.3%), and calculation of the risk of having a sexually transmitted disease (63/167, 37.3%) were rated as the most important features. Men were more likely than women to find sexually transmitted disease–related apps useful in general (P=.04; χ²=6.28) and to pay for such apps (P=.01; χ²=9.19). Patients aged <40 years would rather download an app recommended by their physician (P=.03; χ²=7.23), whereas patients aged >40 years preferred reading a patient brochure on sexually transmitted diseases (P=.02; χ²=8.14).

Conclusions

This study demonstrated high general interest in the use of sexually transmitted disease–related apps in this sample of dermatovenereological outpatients. In particular, young age and male sex were significantly associated with a positive perception, underlining the high potential of apps in the prevention and early recognition of sexually transmitted diseases in this group. Future studies are warranted to validate these findings in other populations.

Syphilis testing among spouses of patients with syphilis in Japan: an epidemiological study using an administrative claims database

The number of syphilis cases reported in Japan, transmitted mainly by heterosexual contact, has been increasing since 2014. However, Japan has not introduced partner services programmes, and it remains unclear whether contacts of patients with syphilis undergo testing. This study aimed to estimate the proportion of spouses of patients with syphilis who underwent syphilis testing. We retrospectively identified patients who had recently started syphilis treatment as well as their spouses from a Japanese claims database for employee health insurance plans, collected between 2010 and 2017. Spousal syphilis testing was defined as either a nontreponemal or treponemal test within three months after the index patient started treatment. We determined the proportion of spousal syphilis testing and analysed its associations with patient and spouse characteristics, and year of syphilis treatment. Of the 217 patients who were identified to have started syphilis treatment, 29 (13.3%) spouses underwent syphilis testing: 23/182 (12.6%) among wives, and 6/35 (17.1%) among husbands, of male and female index patients, respectively. Among wives aged <45 years, the proportion tested declined over time. Despite the rise in syphilis incidence, the proportion of spouses tested, including women of reproductive age, declined. In Japan, partner services programmes need to be implemented to control sexually transmitted infections.

Analysis of the prevalence of STIs in Russia according to the federal laboratory network

Background. The incidence rate of sexually transmitted infections (STIs) in different countries has attracted the attention of specialists from all over the world. The official rates of STI incidence in Russia are significantly lower than those in the United States. Objective. To assess the prevalence of STIs among patients in a network of federal laboratories. Methods. The prevalence analysis of Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Neisseria gonorrhoeae, human papillomavirus (HPV) types 16, 18 and herpes simplex virus (HSV) types 1, 2 was performed on the basis of anonymous data from 40 521 patients examined for sexually transmitted pathogens by real-time polymerase chain reaction (PCR). The studied biomaterial was delivered from 656 laboratory departments located in 284 settlements of all federal districts of the Russian Federation from January 2017 to June 2019. Results. One and more of the eight pathogens were detected in 13.8% of patients, two or more pathogens simultaneously were detected in 1.4% of patients. The prevalence of viral infections was: 5.6% in HPV type 16, 1.8% in HPV type 18, 0.5% in HSV-1, and 1.6% in HSV-2. The highest percentage of patients in whom at least one infection was detected was in the age groups under 17 years (27.9%) and 1825 years (19.8%). The distribution by gender in the groups varied, inversely: women predominated in the group under 17 years old (69%), men predominated in the group over 46 years old (71%). The prevalence of pathogenic bacteria was: C. trachomatis 3.8%, M. genitalium 1.5%, N. gonorrhoeae 0.5%, T. vaginalis 0.3%. Discussion. The official incidence of STIs in Russia is significantly lower than that in the United States, which, in our opinion, may indicate not the stable situation in our country infection-wise, but inefficiency of registering STIs in Russia. Conclusion. The data from the federal network of laboratories indicate a high prevalence of STIs in the Russian Federation. The existing STIs accounting system requires modernization. Introduction of the state national program for the Diagnosis, Treatment, and Prevention of STIs can be useful to reduce the spread of infections, improve the reproductive health of the population, and reduce the incidence of reproductive cancer.