International Journal of STD & AIDS

Female entertainment and sex workers (FESW) have high rates of alcohol and amphetamine-type stimulant (ATS) use, increasing risk for HIV/sexually transmitted infections (STI), and other negative outcomes. A prospective cohort of 1,198 FESW in a HIV/ATS use prevention intervention in Cambodia was assessed for alcohol and stimulant use disorders (AUD and SUD) using the Alcohol and Substance Use Involvement (ASSIST) scale. STI history was measured by self-report at baseline and at quarterly follow-up visits. Participants were asked if they had been diagnosed with an STI by a medical provider in the past 3 months. Marginal structural models were used to estimate joint effects of AUD and SUD on recent STI. At baseline, one-in-four screened AUD positive and 7% screened positive for SUD. At 18-months, 26% reported ≥1 recent STI. Accounting for time-varying and other known confounders, the adjusted odds ratio (AOR) for recent STI associated with AUD alone and SUD alone were 2.8 (95% CI:1.5–5.1) and 3.5 (95% CI:1.1–11.3), respectively. The AOR for joint effects of AUD and SUD was 5.7 (95% CI:2.2–15.2). AUD and SUD are independently and jointly associated with greater odds of STI among Cambodian FESW. Further research is critical for understanding how AUD and SUD potentiate biological and behavioural pathways that influence STI acquisition and to inform HIV risk-reduction interventions in FESW.

Illicit substance use poses a significant public health challenge in the United States. Certain populations are disproportionately impacted by substance use disorders. Men who have sex with men (MSM) have been shown to be three to four times more likely to report substance use compared to the general population. MSM also make up a disproportionate number of new cases of STIs. The impact of substance use disorders on STI and HIV infection risk has been well documented among this vulnerable population. Understanding the intersection of substance use and sexual risk is important to design effective interventions to reduce substance use and risk of STIs. However, little is known about the relationship between venues used to arrange sexual encounters including hook-up apps and substance use. This study describes the demographics and social network characteristics of MSM who presented to an STI clinic in Rhode Island including reported substance use and the primary hook-up venues used for meeting sexual partners. The results show that individuals using online venues to meet sexual partners were more likely to report substance use, indicating the possible utility of interventions using social media to address the unique vulnerability of STI and HIV infection for substance using MSM.

This study describes long-term viral load (VL) trajectories and their predictors among women living with HIV (WLWH), using data from Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA), an open prospective cohort study with linkages to the HIV/AIDS Drug Treatment Program. Using Latent Class Growth Analysis (LCGA) on a sample of 153 WLWH (1088 observations), three distinct trajectories of detectable VL (≥50 copies/ml) were identified: ‘sustained low probability of detectable VL’, characterized by high probability of long-term VL undetectability (51% of participants); ‘high probability of delayed viral undetectability’, characterized by a high probability VL detectability at baseline that decreases over time (43% of participants); and ‘high probability of detectable VL’, characterized by a high probability of long-term VL detectability (7% of participants). In multivariable analysis, incarceration (adjusted odds ratio (AOR) = 3.24; 95%CI:1.34–7.82), younger age (AOR = 0.96; 95%CI:0.92–1.00), and lower CD4 count (AOR = 0.82; 95%CI:0.72–0.93) were associated with ‘high probability of delayed viral undetectability’ compared to ‘sustained low probability of detectable VL.’ This study reveals the dynamic and heterogeneous nature of WLWH’s long-term VL patterns, and highlights the need for early engagement in HIV care among young WLWH and programs to mitigate the destabilizing impact of incarceration on WLWH’s HIV treatment outcomes.

Some syphilis patients do not exhibit an appropriate serological response after treatment despite the absence of any clinical evidence of treatment failure or reinfection. This condition is called “serofast syphilis” or “serological non-response syphilis.” This study explored the incidence of asymptomatic neurosyphilis (ANS) and related factors in 324 asymptomatic patients with serological non-response syphilis. We analyzed descriptive statistics stratified by the presence of asymptomatic neurosyphilis for the basic characteristics of samples. Bivariate analysis was conducted to assess correlations between outcomes and potential predictors. Variables significant in the bivariate analysis (p<0.1) were entered into multivariable logistic regression models. All p-values were two-sided with a significance threshold of p<0.05. The results indicated that 89 of 324 patients had ANS (incidence of 27.5%), and the greatest risk factors were a < fourfold decrease in serum rapid plasma reagin (RPR) titers after treatment and current serum RPR titers >1:32. Our findings suggest that ANS is common among syphilis patients, and patients with a fourfold decrease in serum RPR titers after treatment and current serum RPR titers >1:32 are more likely to develop ANS.

Intimate partner violence (IPV) and sexually transmitted infections (STIs) are significant public health problems worldwide. However, most research on this association and risk of STIs has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Thailand. We aimed to examine prevalence of IPV and identify factors associated with STIs among Thai women. Participants were patients aged 15–49 years attending two gynecology clinics at a university hospital in Bangkok, Thailand. Data were collected through an anonymous structured questionnaire, including sociodemographic characteristics, IPV, childhood abuse (CA), sexual risk behaviors, alcohol use, depressive symptoms, and self-reported STI diagnosis. Multivariate logistic regression analyses were used to examine factors associated with STI diagnosis. Among 400 participants, 84 (21%) had ever experienced at least one type of IPV in the past year. IPV, CA, age at first sex, multiple sexual partners, and alcohol use were significantly associated with STI-positive. Women who reported IPV (OR = 2.65, 95% CI = 1.11–6.28), experienced CA (OR = 5.59, 95% CI = 1.08–28.99), and had multiple sexual partners (OR = 1.39, 95% CI = 1.08–1.79) were significantly more likely to have an STI. Incorporation of IPV screening into general STIs screening is needed for this population to prevent and decrease IPV and STI consequences. Further research is also needed to understand the pathways linking IPV and STI risk to optimize the design of effective prevention interventions.

In 2019 the British Association for Sexual Health and HIV (BASHH) guidelines for the management of gonorrhoea were updated. Epidemiological treatment was reserved for sexual contacts presenting within 14 days of exposure only. The aim of this evaluation was to review the potential implications of the new guidelines on the management of gonorrhoea contacts. For this retrospective service evaluation, all gonorrhoea contacts presenting to two UK sexual health services in 2018 were identified using the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) code Partner notification: gonorrhoea contact (PNG). Demographics, clinical characteristics and outcome data were collected from the electronic patient records. The 2019 guidelines were retrospectively applied to evaluate impact. For 436 patients seen as gonorrhoea contacts, gonorrhoea prevalence was 36% (159/436), and chlamydia prevalence 19% (83/429). Gonorrhoea prevalence varied with sexual risk: women 57% (61/107), heterosexual men 20% (28/143), men who have sex with men (MSM) 38% (69/183, p < .001); and with time since exposure: prevalence 43% (114/267) in those presenting within 14 days, 28% (42/149) after 14 days (p = .003). Epidemiological treatment of contacts presenting within 14 days would result in the treatment of 73% (114/156) of confirmed cases, with 37% (153/416) contacts unnecessarily treated. The BASHH gonorrhoea guideline changes represent an opportunity to improve antibiotic stewardship by reducing unnecessary treatment of gonorrhoea negative contacts.

The age of patients living with human immunodeficiency virus (HIV) is increasing and the greatest proportion of aged HIV patients occurred in Western and Central Europe and North America (WCENA). In aged HIV patients in WCENA, older MSM is the main population. The aim of our study was to evaluate the HIV prevalence in older MSM in WCENA. A meta-analysis was conducted. We searched Medline, Embase, PsycINFO, Web of Science, Cochrane library, Ageline databases, and government websites. Studies that estimated HIV prevalence in older MSM in WCENA were selected. The pooled HIV prevalence and odds ratio (OR) of the risk of living with HIV in older MSM were calculated. In total of 23000 records were initially records were identified and 12 records were included. The total sample size of older MSM was 6118. The pooled HIV prevalence in older MSM in WCENA was 26% (95% CI 18%–33%), which was much higher than that in younger MSM (18%, 95% CI 14%–21%). Notably, the HIV prevalence in older MSM has been continuously increasing in the past two decades in WCENA, raising from 16% to 33%. The pooled OR for older MSM to be living with HIV was 1.68 compared to younger MSM. The HIV prevalence in older MSM in WCENA is disproportionately high, with a continuously increasing trend in the past two decades. Older MSM also carry significantly higher risk of living with HIV than younger MSM.

Data regarding disclosure of HIV status to sexual partners among perinatally acquired HIV-infected (PHIV) youth are limited, particularly from Asian countries. This cross-sectional study assessed the patterns of, attitudes about, and factors associated with HIV disclosure to sexual partners among PHIV youth aged 15–24 years who attended a pediatric HIV clinic in Thailand. Participants were interviewed using a semi-structured questionnaire designed to elicit demographic and sexual behavior information. Those who had sexual partners were queried about their relationship and HIV status disclosure. Reasons to disclose or not to disclose were assessed accordingly. Among the 51 (44.4%) youth who had sexual partners, 55.8% had steady partners, 45.1% did not always use condoms, and 41.2% disclosed their HIV status. Reasons to disclose included trust and concern about the risk of infection to their partners. Reasons not to disclose included fear of rejection and stigmatization, and not knowing how to disclose. Most youth reported a need for disclosure-related guidance. Knowing their sexual partner’s HIV status was the only independent factor associated with disclosure (aOR 14.6; 95% CI 2.8–75.4). This study demonstrates a high rate of unsafe sex and a low rate of partner disclosure in PHIV youth, and highlights the need for a comprehensive guideline for HIV disclosure to sexual partners.

This study aimed to evaluate unprotected receptive anal sex intercourse (URAI) rates and vulnerabilities to HIV infection among men who have sex with men (MSM) that use geosocial networking dating apps in Brazil. An online, analytical, cross-sectional study was carried out with 2,250 MSM. The analyzed variables were grouped according to domains of vulnerability and analyzed by bi and multivariate statistics to calculate the Adjusted Odds Ratios (aOR). The prevalence of self-reported HIV was 7.1%; and of URAI, 23.4%. The studied variables that increased the chances of engaging in URAI were: identifying as homosexual (aOR = 8.30; 95%CI = 5.68:12.04), pansexual (aOR = 5.01; 95%CI = 2.04:12.38), or bisexual (aOR = 3.14; 95%CI = 2.03:4.80), using apps for obtaining sex (aOR = 1.3; 95%CI = 1.0:1.5), engaging in group sex (aOR = 1.6; 95%CI = 1.3:2.0), and reporting chemsex (aOR = 1.5; 95%CI = 1.1:2.0). Self-reported positive HIV status was associated with: less than a minimum wage income (aOR = 1.78; 95%CI = 1.22:2.58), lower education (aOR = 1.86; 95%CI = 1.31 CI; 2,64), not knowing the partner’s HIV status (aOR = 1.84; 95%CI = 1.06:3.19), practicing group sex (aOR = 1.67; 95%CI = 1.04; 2.68), and chemsex (aOR = 2.03; 95%CI =1.06:3.19). The applications interaction is shaped by their own users to better meet their desires and needs. However, this behavior exposes individuals to HIV vulnerabilities.

A 20-year-old young woman with cauliflower-shaped lesions on her vulva was misdiagnosed as condyloma acuminatum. Further evaluation revealed positive serological tests for syphilis. On histological examination, and numerous plasma cells were seen to infiltrate the dermis heavily. The cauliflower-shaped lesions on vulva completely disappeared after benzathine penicillin treatment. Cauliflower-shaped lesions are a rare manifestation of secondary syphilis.