Summer heat: a cross-sectional analysis of seasonal differences in sexual behaviour and sexually transmissible diseases in Melbourne, Australia

Seasonality of syphilis in males through the 2011 to 2019 mandatory surveillance period: A cross-sectional study in South Korea

Although the effects of seasonality on syphilis have been discussed previously, no previous study has evaluated the seasonality of syphilis incidence by sex and age group. We examined the seasonality of syphilis incidence by sex and age group in Korea from 2011 to 2019. The incidence of syphilis was calculated on the basis of Korea Diseases Control and Prevention Agency data, and an autoregressive integrated moving average (ARIMA) model and seasonal and trend decomposition using Loess were used to analyze the seasonality of the incidence in relation to epidemiological factors. The annual age-standardized incidence rates of primary, secondary, and congenital syphilis were 21.1, 8.8, and 64.0 cases/million persons, respectively, from 2011 to 2019. The highest incidence rates for primary and secondary syphilis were observed among those aged 20 to 29, 13 to 19, and 30 to 49 years, but not among the lower age groups. In analyses based on the ARIMA model, all univariate time series showed the highest goodness-of-fit results with ARIMA for primary syphilis (1,1,2), secondary syphilis (1,1,1), and congenital syphilis (0,1,2) (2,0,0) models. This study suggests that the incidence of secondary syphilis shows a summer seasonality for males and the highest incidence rate in the 20 to 29-year age group for both males and females in Korea. Public health action is needed to prevent an increase in syphilis incidence associated with sex, age group, and seasonal patterns.

Studying the seasonality of conceptions among five distinct population subgroups in mainland Greece: a story of similarities and variability

The paper studies seasonality of conceptions among five distinct population subgroups of mainland Greece for the period 1951-2002. The populations explored include those residing in Metsovo, Dion, Organi, Kehros, as well as a "General" Sample consisting of persons located in various areas of continental Greece. The populations under investigation present diverse characteristics regarding religion, cultural background, socio-economic status etc. Records of births were derived from the Vital Registration System of the respective municipalities and communities of the populations under research were constructed. The date of child conception was estimated as the recorded date of birth minus 260 days.The analysis focuses, among others, on the construction of seasonal indices, applying a variant ratio to moving averages method which reveal, in relative terms, the seasonality of the phenomenon. Subsequently, these ratios are considered as the dependent variable in regression models while months, expressed in terms of dummy variables, are introduced as predictors. Four main sub-periods are considered; 1951-64, 1965-80, 1981-92 and 1992-2002. The findings show that the extent of seasonality differs between periods as well as between the five population subgroups though the phenomenon becomes less prominent over time in all cases. There is a tendency of an increased number of conceptions among mountainous populations during summer, irrespective of religion or socio-economic status, possibly partly due to environmental factors (i.e. seasonal workload, domestic organisation of extended families, etc). Nevertheless, the mountainous populations differ regarding the intensity and duration of this phenomenon. By contrast, in Dion, a lowland Christian Orthodox population, conceptions increase after Easter and remain elevated until June.

Epidemiological Overview of Urogenital Gonorrhea in Mexico (2003-2020)

In Mexico, urogenital gonorrhea (UG) is one of the main sexually transmitted diseases notifiable by health systems around the world. Epidemiological data on sexually transmitted infections (STIs) in Mexico indicated that UG was "under control" until 2017. However, international epidemiological reports indicate the increase in incidence due to several factors, including an increase during the first year of the COVID-19 pandemic. These factors suggest that this phenomenon may occur in developing countries, including Mexico. Therefore, the aim of this study was to analyze national surveillance data on UG from 2003-2019 and the first year of the COVID-19 pandemic. An epidemiological study of cases and incidence of UG (2003-2020) was performed in the annual reports issued by the General Directorate Epidemiology in Mexico. Cases and incidence were classified and analyzed by year, sex, age group, and seasons (by temperature). Distribution of UG was carried out using heat maps for the whole country. Ultimately, a seasonal and correlation analysis was performed for UG cases versus temperature. The results showed that the distribution of cases and incidence by sex showed that there was no variation over 14 years. From 2016 onward, a significant increase in UG was observed before the pandemic. During the first year of the pandemic, a significant increase was observed in females aged 24-44 years. A heterogeneous distribution of UG was identified; however, border states were ranked among the top states with elevated incidences and cases. Lastly, the occurrence of UG was associated with temperature, related to summer. The information presented is intended to be useful to promote prevention and to contribute to visualize the distribution of UG over the last 18 years for decision making, and to show one of the consequences of the collapse of epidemiological surveillance of UG during the first year of the COVID-19 pandemic.

The impact of COVID-19 lockdown on cases and deaths of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C in China: an interrupted time series analysis

BACKGROUND

China has implemented nationwide lockdown to contain COVID-19 from an early stage. Previous studies of the impact of COVID-19 on sexually transmitted diseases (STDs) and diseases caused by blood-borne viruses (BBVs) in China have yielded widely disparate results, and study on deaths attributable to STDs and BBVs are scarce.

OBJECTIVE

We aimed to elucidate the impact of COVID-19 lockdown on the cases, deaths, and case-fatality ratios of STDs and BBVs.

METHODS

We extracted the monthly cases and deaths data for AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C between January 2015 and December 2021 from the notifiable disease reporting database on the official website of the National Health Commission of China. We used descriptive statistics to summarize the number of cases and deaths, and calculated incidence and case-fatality ratios before and after implementing nationwide lockdown (January 2020). We used negative binominal segmented regression models to estimate the immediate and long-term impacts of lockdown on cases, deaths, and case-fatality ratios in January 2020 and December 2021, respectively.

RESULTS

A total of 14,800,330 cases and 127,030 deaths of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C were reported from January 2015 to December 2021, with an incidence of 149.11/100,000 before lockdown and 151.41/100,000 after lockdown , and a case-fatality ratio of 8.21/1000 before lockdown and 9.50/1000 after lockdown . In the negative binominal model, AIDS cases (-23.4%; 0.766, 0.626-0.939) and deaths (-23.9%; 0.761, 0.647-0.896), gonorrhea cases (-34.3%; 0.657, 0.524-0.823), syphilis cases (-15.4%; 0.846, 0.763-0.937), hepatitis B cases (-17.5%; 0.825, 0.726-0.937) and hepatitis C cases (-19.6%; 0.804, 0.693-0.933) showed significant decreases in January 2020. Gonorrhea, syphilis and hepatitis C showed small increases in the number of deaths or case-fatality ratios in January 2020. By December 2021, the cases, deaths, and case-fatality ratios for each disease had either reached or remained below expected levels.

CONCLUSIONS

COVID-19 lockdown may have contributed to fewer reported cases of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C, and more reported deaths or case-fatality ratios of gonorrhea, syphilis and hepatitis C in China.

CLINICALTRIAL

Effect of temperature on Escherichia coli bloodstream infection in a nationwide population-based study of incidence and resistance

BACKGROUND

The incidence of Escherichia coli bloodstream infections (BSI) is high and increasing. We aimed to describe the effect of season and temperature on the incidence of E. coli BSI and antibiotic-resistant E. coli BSI and to determine differences by place of BSI onset.

METHODS

All E. coli BSI in adult Israeli residents between January 1, 2018 and December 19, 2019 were included. We used the national database of mandatory BSI reports and outdoor temperature data. Monthly incidence and resistance were studied using multivariable negative binomial regressions with season (July-October vs. other) and temperature as covariates.

RESULTS

We included 10,583 events, 9012 (85%) community onset (CO) and 1571 (15%) hospital onset (HO). For CO events, for each average monthly temperature increase of 5.5 °C, the monthly number of events increased by 6.2% (95% CI 1.6-11.1%, p = 0.008) and the monthly number of multidrug-resistant events increased by 4.9% (95% CI 0.3-9.7%, p = 0.04). The effect of season was not significant. For HO events, incidence of BSI and resistant BSI were not associated with temperature or season.

CONCLUSION

Temperature increases the incidence of CO E. coli BSI and CO antibiotic-resistant E. coli BSI. Global warming threatens to increase the incidence of E. coli BSI.

Seasonal Patterns and Trends in Dermatoses in Poland

Background: The amount of data available online is constantly increasing, including search behavior and tracking trends in domains such as Google. Analyzing the data helps to predict patient needs and epidemiological events more accurately. Our study aimed to identify dermatology-related terms that occur seasonally and any search anomalies during the SARS-CoV-2 pandemic. Methods: The data were gathered using Google Trends, with 69 entries between January-2010 and December-2020 analyzed. We conducted the Seasonal Mann–Kendal Test to determine the strength of trends. The month with the highest seasonal component (RSV) and the lowest seasonal component (RSV) was indicated for every keyword. Groups of keywords occurring together regularly at specific periods of the year were shown. Results: We found that some topics were seasonally searched in winter (e.g., herpes, scabies, candida) and others in summer (e.g., erythema, warts, urticaria). Conclusions: Interestingly, downward trends in searches on sexually transmitted diseases in comparison with increased infection rates reported officially show a strong need for improved sexual education in Poland. There were no significant differences in trends for coronavirus-related cutaneous symptoms during 2020. We have shown that the seasonality of dermatologically related terms searched in Poland via Google did not differ significantly during SARS-CoV-2 pandemic.

Ambient temperature and risk of urinary tract infection in California: A time-stratified case-crossover study using electronic health records

BACKGROUND

In the United States (US), urinary tract infections (UTI) lead to more than 10 million office visits each year. Temperature and season are potentially important risk factors for UTI, particularly in the context of climate change.

METHODS

We examined the relationship between ambient temperature and outpatient UTI diagnoses among patients followed from 2015 to 2017 in two California healthcare systems: Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. We identified UTI diagnoses in adult patients using diagnostic codes and laboratory records from electronic health records. We abstracted patient age, sex, season of diagnosis, and linked community-level Index of Concentration at the Extremes (ICE-I, a measure of wealth and poverty concentration) based on residential address. Daily county-level average ambient temperature was assembled from the Parameter-elevation Regressions on Independent Slopes Model (PRISM). We implemented distributed lag nonlinear models (DLNM) to assess the association between UTI and lagged daily temperatures. Main analyses were confined to women. In secondary analyses, we stratified by season, healthcare system, and community-level ICE-I.

RESULTS

We observed 787,186 UTI cases (89% among women). We observed a threshold association between ambient temperature and UTI among women: an increase in daily temperature from the 5th percentile (6.0 ˚C) to the mean (16.2 ˚C) was associated with a 3.2% (95% CI: 2.4, 3.9%) increase in same-day UTI diagnosis rate, whereas an increase from the mean to 95th percentile was associated with no change in UTI risk (0.0%, 95% CI: -0.7, 0.6%). In secondary analyses, we observed the clearest monotonic increase in the rate of UTI diagnosis with higher temperatures in the fall. Associations did not differ meaningfully by healthcare system or community-level ICE-I. Results were robust to alternate model specifications.

DISCUSSION

Increasing temperature was related to higher rate of outpatient UTI, particularly in the shoulder seasons (spring, autumn).

Incidence and duration of incident oropharyngeal gonorrhoea and chlamydia infections among men who have sex with men: prospective cohort study

Objectives

This prospective cohort study aimed to determine the natural history and incidence of oropharyngeal gonorrhoea and chlamydia among a cohort of men who have sex with men (MSM) over a 12-week period, and to examine risk factors associated with incident oropharyngeal infections.

Methods

MSM either aged ≥18 years and had a diagnosis of oropharyngeal gonorrhoea by nucleic acid amplification test (NAAT) in the past 3 months or aged 18–35 years who were HIV-negative taking pre-exposure prophylaxis (PrEP) were eligible for this study. Enrolled men were followed up for 12 weeks. Oropharyngeal swabs were collected at week 0 (baseline) and week 12 (end of study). Between these time points, weekly saliva specimens and the number of tongue kissing, penile–oral and insertive rimming partners were collected by post. Oropharyngeal swabs and saliva specimens were tested by NAAT for Neisseria gonorrhoeae and Chlamydia trachomatis. Poisson regression was performed to examine the risk factors (weekly number of partners) associated with incident oropharyngeal gonorrhoea.

Results

A total of 100 MSM were recruited. The incidence of oropharyngeal gonorrhoea and chlamydia was 62 (95% CI 37 to 105) and 9 (95% CI 2 to 35)/100 person-years, respectively. The median duration of incident oropharyngeal infection with gonorrhoea was 28 days (IQR=21–36, n=7). The incidence rate ratio (IRR) for oropharyngeal gonorrhoea increased with an increased number of kissing partners (IRR=1.08; 95% CI 1.03 to 1.12) an increased number of penile-oral sex partners (IRR=1.07, 95% CI 1.01 to 1.14) but not with an increased number of insertive rimming partners (IRR=1.11, 95% CI 0.96 to 1.29) or other demographic factors. The IRR and duration of incident oropharyngeal chlamydia were not calculated due to the small number of cases (n=2).

Conclusions

MSM have a high incidence of oropharyngeal gonorrhoea and the median duration of infection was less than 3 months.

Sexually Transmitted Infection Diagnoses and Access to a Sexual Health Service Before and After the National Lockdown for COVID-19 in Melbourne, Australia

Background

We aimed to examine the impact of lockdown on sexually transmitted infection (STI) diagnoses and access to a public sexual health service during the coronavirus disease 2019 (COVID-19) pandemic in Melbourne, Australia.

Methods

The operating hours of Melbourne Sexual Health Centre (MSHC) remained the same during the lockdown. We examined the number of consultations and STIs at MSHC between January and June 2020 and stratified the data into prelockdown (February 3 to March 22), lockdown (March 23 to May 10), and postlockdown (May 11 to June 28), with 7 weeks in each period. Incidence rate ratios (IRRs) and their 95% confidence intervals (CI) were estimated using Poisson regression models.

Results

The total number of consultations dropped from 7818 in prelockdown to 4652 during lockdown (IRR, 0.60; 95% CI, 0.57-0.62) but increased to 5347 in the postlockdown period (IRR, 1.15; 95% CI, 1.11-1.20). There was a 68% reduction in asymptomatic screening during lockdown (IRR, 0.32; 95% CI, 0.30-0.35), but it gradually increased during the postlockdown period (IRR, 1.59; 95% CI, 1.46-1.74). Conditions with milder symptoms showed a marked reduction, including nongonococcal urethritis (IRR, 0.60; 95% CI, 0.51-0.72) and candidiasis (IRR, 0.61; 95% CI, 0.49-0.76), during lockdown compared with prelockdown. STIs with more marked symptoms did not change significantly, including pelvic inflammatory disease (IRR, 0.95; 95% CI, 0.61-1.47) and infectious syphilis (IRR, 1.14; 95% CI, 0.73-1.77). There was no significant change in STI diagnoses during postlockdown compared with lockdown.

Conclusions

The public appeared to be prioritizing their attendance for sexual health services based on the urgency of their clinical conditions. This suggests that the effectiveness of clinical services in detecting, treating, and preventing onward transmission of important symptomatic conditions is being mainly preserved despite large falls in absolute numbers of attendees.

Changing from Clinician-Collected to Self-Collected Throat Swabs for Oropharyngeal Gonorrhea and Chlamydia Screening among Men Who Have Sex with Men

The coronavirus disease 2019 (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was used primarily for genital and anorectal infections, with only limited studies on the performance of self-collection of oropharyngeal swabs for oropharyngeal STI detection. The Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhea and chlamydia screening on 16 March 2020 in order to reduce health care worker risk during the COVID-19 pandemic. We compared the proportions of valid and positive samples for gonorrhea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician collection period, between 20 January and 15 March 2020, and the self-collection period, between 16 March and 8 May 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for Neisseria gonorrhoeae was higher in the self-collection period (1.6% [24/1,497]) than in the clinician collection period (0.9% [23/2,600]) (P = 0.038), but the proportions did not differ for the detection of Chlamydia trachomatis The positivity rates of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio [PR], 1.07 [95% confidence interval {CI}, 0.85 to 1.34]) (P = 0.583) and oropharyngeal C. trachomatis (adjusted PR, 0.84 [95% CI, 0.51 to 1.39]) (P = 0.504) specimens did not differ between the two periods. Self-collected oropharyngeal swabs for the detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and, importantly, reduce health care worker exposure to respiratory infections.

The association between ambient temperature and clinical visits for inflammation-related diseases in rural areas in China

BACKGROUND

The association between temperature and mortality has been widely reported. However, it remains largely unclear whether inflammation-related diseases, caused by excessive or inappropriate inflammatory reaction, may be affected by ambient temperature, particularly in low-income areas.

OBJECTIVES

To explore the association between ambient temperature and clinical visits for inflammation-related diseases in rural villages in the Ningxia Hui Autonomous Region, China, during 2012─2015.

METHODS

Daily data on inflammation-related diseases and weather conditions were collected from 258 villages in Haiyuan (161 villages) and Yanchi (97 villages) counties during 2012─2015. A Quasi-Poisson regression with distributed lag non-linear model was used to examine the association between temperature and clinical visits for inflammation-related diseases. Stratified analyses were performed by types of diseases including arthritis, gastroenteritis, and gynecological inflammations.

RESULTS

During the study period, there were 724,788 and 288,965 clinical visits for inflammation-related diseases in Haiyuan and Yanchi, respectively. Both exposure to low (RR: 2.045, 95% CI: 1.690, 2.474) and high temperatures (RR: 1.244, 95% CI: 1.107, 1.399) were associated with increased risk of total inflammation-related visits in Haiyuan county. Low temperatures were associated with increased risks of all types of inflammation-related diseases in Yanchi county (RR: 4.344, 95% CI: 2.887, 6.535), while high temperatures only affected gastroenteritis (RR: 1.274, 95% CI: 1.040, 1.561). Moderate temperatures explained approximately 26% and 33% of clinical visits due to inflammation-related diseases in Haiyuan and Yanchi, respectively, with the burden attributable to cold exposure higher than hot exposure. The reference temperature values ranged from 17 to 19 in Haiyuan, and 12 to 14 in Yanchi for all types of clinical visits.

CONCLUSIONS

Our findings add additional evidence for the adverse effect of suboptimal ambient temperature and provide useful information for public health programs targeting people living in rural villages.

Seasonal variations in kissing and sexual activities among men who have sex with men in Melbourne, Australia: implications for seasonal sexually transmissible infection preventions and interventions

Background Previous studies have shown that there is a peak in sexually transmissible infection (STI) cases and sexual activities around summer, but there has been no study examining whether kissing also follows a similar seasonal pattern. The aim of this study was to examine the seasonal patterns of kissing and sex partners among gay, bisexual and other men who have sex with men (MSM).

METHODS

A short cross-sectional study was conducted among MSM attending the Melbourne Sexual Health Centre between March 2016 and February 2017. Participants were asked to report the number of kissing-only, sex-only and kissing-with-sex male partners in the last 3 months. The mean number of male partners was calculated and stratified by Australia's seasons. The seasonal trend in the number of partners was assessed by negative binomial regression models.

RESULTS

In total, 4391 MSM were included in the analysis. The number of kissing-only and sex-only partners increased significantly from autumn to summer among MSM in Melbourne (Ptrend <0.001). MSM reported the highest number of male partners for kissing-only (mean: 4.91; 95% confidence intervals (CI): 4.78-5.04) and sex-only (mean: 1.91; 95% CI: 1.83-1.99) around summer compared with other seasons. However, the number of kissing-with-sex partners remained stable across seasons.

CONCLUSIONS

The study data suggest that there is a peak in kissing-only and sex-only partners among MSM around summer and holiday seasons.

Seasonal variation in gonorrhoea incidence among men who have sex with men

Background After reviewing urethral gonorrhoea cases among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) in Adelaide, Australia, we noticed peaks of gonorrhoea among MSM occurred predominantly in the first quarter of the year (January-March). The aim of this study was to formally test this hypothesis against data from a similar period at three sexual health services, one each in Adelaide, Melbourne and Sydney.

METHODS

This study was a retrospective analysis of computerised records at the three Australian sexual health services. Potential risk factors for urethral gonorrhoea among MSM were also reviewed at the SASSH.

RESULTS

More peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney and in the second and fourth quarter in Melbourne. Factors independently associated with urethral gonorrhoea at the SASSH were being a young MSM, especially those aged 25-29 (odds ratio (OR) 2.66, 95% confidence interval (CI): 2.00-3.54), having more than one sexual partner (OR 1.71, 95% CI: 1.43-2.04), having had sex interstate and overseas (OR 1.52, 95% CI: 1.06-2.17), and presenting in the first quarter (OR 1.30, 95% CI: 1.10-1.55).

CONCLUSION

Our data suggest that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services over the year and for the timing of health promotion activities.

Increased Detection of Pharyngeal and Rectal Gonorrhea in Men Who Have Sex With Men After Transition From Culture To Nucleic Acid Amplification Testing

BACKGROUND

This before-and-after study measured the impact of a change in testing methods from culture to nucleic acid amplification testing (NAAT) on the detection of pharyngeal and rectal gonorrhea in men who have sex with men (MSM) on a sexual health service level, including the effect on subgroups anticipated to have higher rates of gonorrhea.

METHODS

In March 2015, Melbourne Sexual Health Centre changed its laboratory method for gonococcal testing from culture to NAAT using the Aptima Combo 2 and Aptima GC tests. We compared the proportion of tests positive for rectal and pharyngeal gonorrhea in MSM using culture in 2014 with those using NAAT in 2015.

RESULTS

The proportion of tests positive for rectal gonorrhea by NAAT was double that obtained by culture (8% vs 3.9%; prevalence ratio [PR], 2.0; 95% confidence interval [CI], 1.8-2.4) and 5-fold for pharyngeal gonorrhea (8.3% vs 1.6%; PR, 5.2; 95% CI, 4.2-6.4). Similar increases in test positivity were observed in human immunodeficiency virus (HIV)-positive and HIV-negative men. By NAAT, test positivity for rectal gonorrhea was higher in HIV-positive compared with HIV-negative men (15.4% vs 7.3%; PR, 2.1; 95% CI, 1.7-2.6). Culture and NAAT had similar test positivity for rectal gonorrhea among men who reported contact with gonorrhea (24.9% vs 25.3%, PR 1.0, 95% CI 0.8-1.4) and men who presented with symptoms of proctitis (22.2% vs 27.9%, PR 1.3, 95% CI 0.8-2.0).

CONCLUSIONS

A switch from culture to Aptima Combo 2 testing for extragenital gonorrhea in MSM increased detection and was most marked for pharyngeal infections.