STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11

Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta-analysis

INTRODUCTION

Of 37.7 million people living with HIV in 2020, 6.1 million still do not know their HIV status. We synthesize evidence on concurrent HIV testing among people who tested for other sexually transmitted infections (STIs).

METHODS

We conducted a systematic review using five databases, HIV conferences and clinical trial registries. We included publications between 2010 and May 2021 that reported primary data on concurrent HIV/STI testing. We conducted a random-effects meta-analysis and meta-regression of the pooled proportion for concurrent HIV/STI testing.

RESULTS

We identified 96 eligible studies. Among those, 49 studies had relevant data for a meta-analysis. The remaining studies provided data on the acceptability, feasibility, barriers, facilitators, economic evaluation and social harms of concurrent HIV/STI testing. The pooled proportion of people tested for HIV among those attending an STI service (n = 18 studies) was 71.0% (95% confidence intervals: 61.0-80.1, I2 = 99.9%), people tested for HIV among those who were tested for STIs (n = 15) was 61.3% (53.9-68.4, I2 = 99.9%), people tested for HIV among those who were diagnosed with an STI (n = 13) was 35.3% (27.1-43.9, I2 = 99.9%) and people tested for HIV among those presenting with STI symptoms (n = 3) was 27.1% (20.5-34.3, I2 = 92.0%). The meta-regression analysis found that heterogeneity was driven mainly by identity as a sexual and gender minority, the latest year of study, country-income level and region of the world.

DISCUSSION

This review found poor concurrent HIV/STI testing among those already diagnosed with an STI (35.3%) or who had symptoms with STIs (27.1%). Additionally, concurrent HIV/STI testing among those tested for STIs varied significantly according to the testing location, country income level and region of the world. A few potential reasons for these observations include differences in national STI-related policies, lack of standard operation procedures, clinician-level factors, poor awareness and adherence to HIV indicator condition-guided HIV testing and stigma associated with HIV compared to other curable STIs.

CONCLUSIONS

Not testing for HIV among people using STI services presents a significant missed opportunity, particularly among those diagnosed with an STI. Stronger integration of HIV and STI services is urgently needed to improve prevention, early diagnosis and linkage to care services.

Prevalence and Determinants of Opportunistic Infections in HIV Patients: A Cross-Sectional Study in the City of Semarang

Background

Opportunistic infection (OI) is the most significant complication of the human immunodeficiency virus (HIV). Differences in the characteristics of HIV patients make the prevalence of Opportunistic infection different between regions. The study aimed to identify variables associated with OI incidence among HIV-infected patients in Semarang City, Indonesia.

Methods

This study uses secondary data sourced from special HIV surveillance for 2019–2021 with a cross-sectional method. 1362 HIV patients with variables health care facilities; year of diagnosis; area of residence; age; sex; pregnancy status; occupation; risk factors; risk group determined based on purposive sampling were included in the chi-square analysis and logistic regression.

Results

This study showed 12.3% (n=167) of HIV patients experienced OI, where OI was more common in HIV patients with risk groups of sex workers (28.70%), high-risk partners (18.60%), and Male Sex with Men (MSM) (15.40). The most common types of OI were tuberculosis infection (43%), candidiasis (21%), and diarrhea (9%). Age was the variable most associated with the incidence of OI (p-value 0.001).

Conclusions

Age groups 45–54 years and 55–64 years have the most influential association with Opportunistic infection incidence in HIV patients, so planning an appropriate intervention program for this subpopulation is necessary.

Uptake and correlates of chlamydia and gonorrhea testing among female sex workers in Southern China: a cross-sectional study

BACKGROUND

Female sex workers (FSW) are highly susceptible to chlamydia and gonorrhea infection. However, there is limited literature examining their testing uptake to date. This study aimed to assess the uptake and determinants of chlamydia and gonorrhea testing among FSW in Southern China.

METHODS

A cross-sectional study with convenience sampling was performed in five cities in Southern China. Data on socio-demographic characteristics, sexual behaviors, chlamydia and gonorrhea testing, and the utilization of health care services from participants were collected through face-to-face interviews. Univariate and multivariable logistic regressions were used to determine factors associated with chlamydia and gonorrhea testing, respectively.

RESULTS

Overall, 1207 FSWs were recruited, with the mean age of 30.7 ± 6.8 years and an average number of clients of 7.0 (4.0-10.0) per week. 65.4% participants constantly used condoms with clients during the past month. Only 7.5 and 10.4% had been tested for chlamydia and gonorrhea in the last year, respectively. Multivariable analysis indicated that FSW who worked at low tiers (adjusted Odds Ratio (aOR) = 2.36, 95%CI:1.23-10.14), had more clients in the last month (aOR = 1.03, 95%CI:1.01-1.05), used condoms consistently (aOR = 1.79, 95%CI:1.12-2.86), had STD symptoms (aOR = 4.09,95%CI:2.62-6.40), had been tested for HIV (aOR = 5.16, 95%CI:3.21-8.30) or syphilis (aOR = 6.90, 95%CI:4.21-11.22) in the last year were more likely to have chlamydia testing. In addition, FSW who had more clients in the past month (aOR = 1.02,95%CI:1.00-1.04), had STD symptoms (aOR = 3.33, 95%CI:2.03-5.46), had been tested for HIV (aOR = 3.94, 95%CI:2.34-6.65) and syphilis (aOR = 3.27, 95%CI:1.96-5.46) in the last year were more likely to have gonorrhea testing.

CONCLUSIONS

The testing rates of chlamydia and gonorrhea are low among Chinese FSW. Integrating chlamydia and gonorrhea testing into HIV testing promotion programs may help bridge the gap among FSW.

Prevalence of Opportunistic Infections and Associated Factors in HIV-Infected Men Who Have Sex With Men on Antiretroviral Therapy in Bach Mai Hospital, Hanoi, Vietnam: A Case-Control Study

OBJECTIVE

To investigate the distribution of opportunistic infections (OIs) and factors associated with acquiring OIs in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in comparison to those of heterosexual patients.

METHOD

A cross-sectional study was conducted on 82 HIV-infected MSM and 120 HIV-infected heterosexual men in Bach Mai Hospital, Hanoi, Vietnam. Demographical characteristics and clinical data were collected and analyzed using appropriate statistics (Mann-Whitney, Chi-square, Fisher's exact test, and logistic regression).

RESULTS

The prevalence of OIs among MSM and heterosexual patients were 63.4% and 81.7%, respectively. The most frequent OI in the MSM group was human papilloma virus (HPV) (11%), followed by hepatitis B virus (8.5%), mycobacterium tuberculosis (7.3%), and Talaromycosis (2.4%).

CONCLUSIONS

Multivariate logistic regression analysis showed that buying sex (odds ratio (OR) = 4, 95% confidence interval (CI): 1.13-14.25) and injecting drugs (OR = 13.05, 95% CI: 2.39-71.21) were associated with increased odds of having OIs in heterosexual patients while increasing age (OR = 1.1, 95% CI: 1.01-1.24) was correlated to increased odd of acquiring OIs in the MSM group. HIV-infected MSM accumulates OIs with increasing age, while heterosexual individuals increase opportunistic infections by buying sex or injecting drugs.

Gender differences in risk taking behaviors for Chlamydia trachomatis

Chlamydia trachomatis (CT) is a global problem. We compared the risk taking behaviors for CT infection between men and women. Adults (2299 females, 5559 males) were administered the Risk Behavior Assessment. In women, CT was associated with candidiasis, in men with gonorrhea, genital warts, and syphilis. Risk factors for both genders were trading sex for money, use of marijuana for women, and use of Ecstasy and Viagra for men. Those with CT had higher risk perception for HIV infection and were more likely to obtain HIV testing. Patient teaching and concurrent testing for HIV and CT are imperative.

Sexually transmissible infections among female sex workers in Amsterdam between 2011 and 2016: does risk vary by work location?

Background Female sex workers (FSW) are at risk for sexually transmissible infections (STI). This study aimed to investigate whether the risk for chlamydia and gonorrhoea differs by work location among FSW in Amsterdam. Additionally, trends in STI positivity rates between 2011 and 2016 were assessed.

METHODS

This was a retrospective analysis of routinely collected clinical data during STI consultations of FSW by the Prostitution and Healthcare Centre (P&G292). Work location was categorised as window prostitution, escorts/homeworkers, clubs/brothels/private houses/massage salons and other.

RESULTS

In total, 7558 STI consultations of 2529 FSW in the period 2011-16 were included. Positivity rates for chlamydia and gonorrhoea were 6.6% and 2.0%, respectively. Infectious hepatitis B virus, syphilis and HIV were diagnosed in <0.2% of consultations. Positivity rates of chlamydia and rectal gonorrhoea differed significantly by work location (P < 0.001). Genital and rectal chlamydia and rectal gonorrhoea were significantly less likely among women working in window prostitution, except for the other-group. Risk factors for STI did not vary by work location. Among women working in window prostitution, positivity rates for oropharyngeal and genital chlamydia and genital gonorrhoea were significantly decreasing between 2011 and 2016 (P trend <0.05).

CONCLUSIONS

The higher STI positivity among escorts/homeworkers and FSW in clubs/brothels/private houses/massage salons emphasises the need for extra attention to improve condom use and STI testing in this group. Factors associated with STI did not vary by work location, thus interventions, including those used by P&G292, to reduce STI risk, can be used for women at all work locations.

Linked factors to access to sexual health checkups of female sex workers in the metropolitan region of Chile

OBJECTIVES

To describe and compare the profile of female sex workers (FSWs) that access or do not access sexual health checkups (SHC). The research question was what are the factors linked to access to SHC for FSWs in the metropolitan region (RM) of Chile?

METHODS

A cross-sectional study was conducted in the RM with FSWs over the age of 18. A sample of 370 FSWs was selected by using the time-location sampling method in closed venues and at street-level locations. A survey was applied, validated, and included clinical-epidemiological, behavioral and socio-demographic variables.

RESULTS

38.6% (n = 140) of FSWs that answered the question never used SHC and 37.6% (n = 84) received checkups in a specialized health center for FSWs. FSWs with no SHC were younger, prone to have more group sex, preferably with occasional or no stable partner, and did not know where to get an HIV test.

CONCLUSIONS

FSWs have had uncertain access to sexual health controls. FSWs with no SHC and young FSWs presented higher-risk behaviors.

An Update on the Global Epidemiology of Syphilis

PURPOSE OF REVIEW

Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income counties.

RECENT FINDINGS

World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries, however outbreaks among select populations need to be adequately addressed.

SUMMARY

Continued vigilance and investment is needed to address syphilis worldwide. The epidemiology of syphilis differs in high-income and low- and middle-income counties.

Trichomonas vaginalis is very rare among women with vaginal discharge in Podlaskie province, Poland

Trichomonas vaginalis is the most common curable sexually transmitted pathogen globally. However, in the European Union (EU), trichomoniasis appears to be a rare condition. The aim of this study was to examine the prevalence of T. vaginalis among females attending an STI centre in Bialystok, Poland, using the highly sensitive and specific APTIMA T. vaginalis assay. Consecutive females, referred by gynaecologists mainly because of abnormal vaginal discharge, were diagnosed using wet mount microscopy, culture and APTIMA T. vaginalis assay. Among 272 women studied, 82% were pre- and 18% postmenopausal. The average age was 36.0 ± 13.9 (range: 18-86) years. Abnormal discharge (alone or accompanied by itch or vulvovaginal burning) was the most frequent complain in both groups (66.2% and 48.0%). Erythema and discharge were the most frequent abnormal signs (58.6% and 56.0%). Not a single T. vaginalis-positive sample was detected using wet mount microscopy, culture or APTIMA T. vaginalis assay. Despite using the highly sensitive APTIMA T. vaginalis assay for detection, the pathogen could not be identified in females in the studied setting, similar to results from other EU settings. The need for general screening using NAAT for this pathogen while diagnosing vulvovaginal symptoms in females in Poland appears to be low.