Embedding a novel screening programme for sexually transmitted infections (chlamydia and gonorrhoea) within an ambulatory emergency surgical assessment unit: an observational cohort study.

BACKGROUND: A number of females with pelvic inflammatory disease will present to general surgical services with non-specific abdominal pain. Screening for sexually transmitted infections (STI) as an underlying cause is not routinely offered. We therefore established an STI screening programme for young females presenting to a same day emergency ambulatory surgical clinic as part of the diagnostic pathway. Data outlining the incidence and prevalence of STIs as the underlying cause of lower abdominal pain were collected. METHODS: We conducted an observational cohort study. Self-collected vulvovaginal swabs for chlamydia and gonorrhoea were offered as part of a standardised diagnostic pathway for all females meeting inclusion criteria presenting with abdominal pain. Positive results were referred to our local sexual health team for treatment and contact tracing. RESULTS: The cohort comprised 297 eligible patients; 259 participated, 20 patients declined testing and 18 samples were rejected as inadequate in the laboratory. 5.4% of swab results were positive (2 gonorrhoea and 12 chlamydia). All patients with positive swabs had presented with lower abdominal pain and of these only 21% had a documented sexual history. CONCLUSION: Undiagnosed STIs are prevalent, with significant fertility and public health risks. Young females seeking medical assessment for abdominal pain provide an opportunistic screening cohort with a likely subset of patients presenting with abdominal pain as a direct result of an STI. Our results demonstrate a high incidence of positive tests, suggesting further training of surgeons to include a sexual history in assessment of females with abdominal pain is vital.

Policy, practice, and prediction: model-based approaches to evaluating N. gonorrhoeae antibiotic susceptibility test uptake in Australia.

BACKGROUND: Antimicrobial resistance (AMR) represents a significant threat to global health with Neisseria gonorrhoea emerging as a key pathogen of concern. In Australia, the Australian Gonococcal Surveillance Program (AGSP) plays a critical role in monitoring resistance patterns. However, antibiotic susceptibility test (AST) uptake - a crucial component for effective resistance surveillance - remains to be a limiting factor. The study aims to model the processes involved in generating AST tests for N. gonorrhoea isolates within the Australian healthcare system and assess the potential impact of systematic and policy-level changes. METHODS: Two models were developed. The first model was a mathematical stochastic health systems model (SHSM) and a Bayesian Belief Network (BBN) to simulate the clinician-patient dynamics influencing AST initiation. Key variables were identified through systematic literature review to inform the construction of both models. Scenario analyses were conducted with the modification of model parameters. RESULTS: The SHSM and BBN highlighted clinician education and the use of clinical support tools as effective strategies to improve AST. Scenario analysis further identified adherence to guidelines and changes in patient-level factors, such as persistence of symptoms and high-risk behaviours, as significant determinants. Both models supported the notion of mandated testing to achieve higher AST initiation rates but with considerations necessary regarding practicality, laboratory constraints, and culture failure rate. CONCLUSION: The study fundamentally demonstrates a novel approach to conceptualising the patient-clinician dynamic within AMR testing utilising a model-based approach. It suggests targeted interventions to educational, support tools, and legislative framework as feasible strategies to improve AST initiation rates. However, the research fundamentally highlights substantial research gaps in the underlying understanding of AMR.

Inequalities in sexual and reproductive outcomes among women aged 16-24 in England (2012-2019).

BACKGROUND: Women aged 16-24 in England have a high burden of sexual and reproductive morbidity, with particularly poor outcomes among people living in more deprived areas (including racially minoritised populations). This analysis used national data to examine the disparities within sexual and reproductive outcomes among this population and to assess whether the patterns of inequality were consistent across all outcomes. METHODS: Within this ecological study, univariable and multivariable Poisson regression analyses of neighbourhood-level data from national data sets were carried out to investigate the relationships of deprivation and ethnicity with each of six dependent variables: gonorrhoea and chlamydia testing rates, gonorrhoea and chlamydia test positivity rates, and abortion and repeat abortion rates. RESULTS: When comparing Index of Multiple Deprivation (IMD) decile 1 (most deprived) and IMD decile 10 (least deprived), chlamydia (RR 0.65) and gonorrhoea (0.79) testing rates, chlamydia (0.70) and gonorrhoea (0.34) positivity rates, abortion rates (0.45) and repeat abortion rates (0.72) were consistently lower in IMD decile 10 (least deprived). Similarly, chlamydia (RR 1.24) and gonorrhoea positivity rates (1.92) and repeat abortion rates (1.31) were higher among black women than white women. Results were similar when both ethnicity and deprivation were incorporated into multivariable analyses. CONCLUSION: We found similar patterns of outcome inequality across a range of sexual and reproductive outcomes, despite multiple differences in the drivers of each outcome. Our analysis suggests that there are broad structural causes of inequality across sexual and reproductive health that particularly impact the health of deprived and black populations.

Vaccination May Be Economically and Epidemiologically Advantageous Over Frequent Screening for Gonorrhea Prevention.

BACKGROUND: Gonorrhea's rapid development of antimicrobial resistance underscores the importance of new prevention modalities. Recent evidence suggests that a serogroup B meningococcal vaccine may be partially effective against gonococcal infection. However, the viability of vaccination and the role it should play in gonorrhea prevention are an open question. METHODS: We modeled the transmission of gonorrhea over a 10-year period in a heterosexual population to find optimal patterns of year-over-year investment of a fixed budget in vaccination and screening programs. Each year, resources could be allocated to vaccinating people or enrolling them in a quarterly screening program. Stratifying by mode (vaccination vs. screening), sex (male vs. female), and enrollment venue (background screening vs. symptomatic visit), we consider 8 different ways of controlling gonorrhea. We then found the year-over-year pattern of investment among those 8 controls that most reduced the incidence of gonorrhea under different assumptions. A compartmental transmission model was parameterized from existing literature in the US context. RESULTS: Vaccinating men with recent symptomatic infection, which selected for higher sexual activity, was optimal for population-level gonorrhea control. Given a prevention budget of $3 per capita, 9.5% of infections could be averted ($299 per infection averted), decreasing gonorrhea sequelae and associated antimicrobial use by similar percentages. These results were consistent across sensitivity analyses that increased the budget, prioritized incidence or prevalence reductions in women, or lowered screening costs. Under a scenario where only screening was implemented, just 5.5% of infections were averted. CONCLUSIONS: A currently available vaccine, although only modestly effective, may be superior to frequent testing for population-level gonorrhea control.

Electronic Partner Notification for Sexually Transmitted Infections: A Qualitative Assessment of Patient, Clinical Staff, and State Field Epidemiologist Perspectives.

In Massachusetts (MA), partner notification is routinely offered for new HIV and infectious syphilis cases, but there are no formal partner notification services for gonorrhea and chlamydia. Electronic partner notification (ePN), which allows patients to anonymously notify their partners of sexually transmitted infection exposure, could fill this gap. We evaluated the acceptability of and ideal characteristics for a statewide ePN service in MA. We performed semistructured interviews with patients at a Boston area sexual health clinic and conducted focus groups with clinicians and Massachusetts Department of Public Health Field Epidemiologists (FEs). We developed a codebook and thematically analyzed interview and focus group data; 25% of interviews were double coded. We identified six main themes from our data: (1) partner notification is a relational process and (2) partner notification is situation dependent. There are three pairs of challenges and core values for an effective ePN system: (3) stigmatization versus inclusivity, (4) trust versus mistrust, and (5) privacy versus helpful information sharing. Therefore, (6) a statewide ePN platform must be customizable at each possible step. Although ePN was acceptable across all three groups, the likelihood of individual use was grounded in a patient's sociocultural context, interpersonal relationships, trust in the platform and health authorities, desire to avoid stigmatization, and privacy needs. These factors are best accommodated by a platform that adapts to users' preferences and needs. ePN presents an opportunity to link partners at risk for gonorrhea or chlamydia to clinical care that is complementary to the more labor-intensive FE role.

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19.

INTRODUCTION: Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic. METHODS: This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023. RESULTS: The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to prep-andemic levels (-3.6 pp in the late-pandemic period, p<0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p<0.001), controlling for sex, age, insurance type and clinic characteristics. CONCLUSIONS: Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.

An Interactive Modeling Tool for Projecting the Health and Direct Medical Cost Impact of Changes in the Sexually Transmitted Diseases Prevention Program Budgets.

CONTEXT: Estimating the return on investment for public health services, tailored to the state level, is critical for demonstrating their value and making resource allocation decisions. However, many health departments have limited staff capacity and expertise to conduct economic analyses in-house. PROGRAM: We developed a user-friendly, interactive Excel-based spreadsheet model that health departments can use to estimate the impact of increases or decreases in sexually transmitted infection (STI) prevention funding on the incidence and direct medical costs of chlamydia, gonorrhea, syphilis, and STI-attributable HIV infections. Users tailor results to their jurisdictions by entering the size of their population served; the number of annual STI diagnoses; their prior annual funding amount; and their anticipated new funding amount. The interface was developed using human-centered design principles, including focus groups with 15 model users to collect feedback on an earlier model version and a usability study on the prototype with 6 model users to finalize the interface. IMPLEMENTATION: The STI Prevention Allocation Consequences Estimator ("SPACE Monkey 2.0") model will be publicly available as a free downloadable tool. EVALUATION: In the usability testing of the prototype, participants provided overall positive feedback. They appreciated the clear interpretations, outcomes expressed as direct medical costs, functionalities to interact with the output and copy charts into external applications, visualization designs, and accessible information about the model's assumptions and limitations. Participants provided positive responses to a 10-item usability evaluation survey regarding their experiences with the prototype. DISCUSSION: Modeling tools that synthesize literature-based estimates and are developed with human-centered design principles have the potential to make evidence-based estimates of budget changes widely accessible to health departments.

Epidemiología de la gonorrea con relación a las minorías étnicas / Epidemiology of gonorrhoea in relation to ethnic minorities

Dynamically changing demographic, economic and cultural forces underlie the behaviours that directly determine the spread of sexually transmitted diseases. The incidence of sexually transmitted diseases is on the rise even in countries with strong economic and social welfare and health care infrastructures. The incidence of disease differs between ethnic groups exhibiting different social and cultural behaviour. Several studies have looked into the role of different risk factors in the transmission of gonorrhoea in different countries. This review covers the incidence of gonorrhoea in different countries and populations, and explores the interaction between different risk factors.

Las fuerzas, demográficas, culturales y económicas ­dinámicamente cambiantes­ subyacen a las conductas sexuales que determinan directamente la diseminación de las enfermedades de transmisión sexual (ETS). La incidencia de ETS se encuentra en aumento, aun en los países con beneficios sociales y económicos sólidos e infraestructura de servicios de salud. La incidencia de las enfermedades difiere entre los grupos étnicos que muestran conductas sociales y culturales diferentes. Diversos estudios investigaron el papel de diferentes factores de riesgo en la transmisión de la gonorrea en distintos países. Esta reseña analiza la incidencia de gonorrea en diferentes países y poblaciones y la interacción entre los diversos factores de riesgo.

Descripción geográfica de los casos de sífilis y gonorrea notificados en el Servicio de salud de Valdivia / Geographical description of the notificated cases of syphilis and gonorrhea in health service of Valdivia

Se realizó un estudio descriptivo del total de casos de sífilis (231) y gonorrea (261) notificados en las 12 comunas de la provincia de Valdivia (Servicio de salud Valdivia), comparándolas entre sí. Se observó grandes divergencias en las notificaciones de casos según comunas. Se concluyó que para evaluar la real magnitud de las ETS en las diferentes comunas es necesaria la precisión pormenorizada de la notificación de casos

Situación epidemiológica de las ETS en los Servicios de Salud de la VIII Región / Epidemiological status of STD: National Health Services in the Chilean VIII Region

Se describe la situación epidemiológica de las enfermedades de transmisión sexual en los servicios de salud de la VIII región, comparándolos con lo que se observa en el resto del país. Se concluye que hay una subnotificación de los casos de sífilis y gonorrea. Los factores responsables serían: a) actualmente la frecuencia de consultas por ETS ha disminuído, b) existe una menor demanda del test VDRL, c) Test de mayor sensibilidad prácticamente no son realizados. Estas limitaciones son más frecuentes en los servicios de Talcahuano y Ñuble. Las tendencias observadas coinciden con las nacionales en una reducción de la incidencia de sífilis y en un ascenso o meseta en las cifras de gonorrea. Es necesario hacer notar que ambas enfermedades aumentan en los adolescentes

Enfermedades de transmisión sexual en una regional del servicio de salud de Bogotá / Sexually-transmitted diseases in a regional health service of Bogota

En 1981, en una seccional del servicio de salud de Bogotá que presta atención a grupos desvalidos de población se investigó la eficiencia con que se llevó a cabo el control epidemiológico de las enfermedades de transmisión sexual durante el período 1976-1980. Para tal fin se aplicó una encuesta a miembros del equipo de salud y pacientes de siete de los ocho centros de salud con que cuenta la regional. Se comprobó que entre 1978 y 1980 disminuyeron las tasas de incidencia de sífilis y blenorragia, si bien en 1980 la de sífilis experimentó un ligero aumento. La tasa de blenorragia descendió de 8,5 en 1977 a 2,5 por 10 000 habitantes en 1980. La frecuencia de sífilis fue mayor en los grupos de edad de 15 a 44 años y de menores de un año; no obstante, en 1980 la enfermedad se incrementó en el primer grupo y desapareció en el segundo. Las encuestas, que se aplicaron a los médicos directores de los centros, ginecoobstetras, enfermeras jefas, auxiliares de enfermería, analistas y promotoras de salud demostraron que, por lo general, el personal de salud no ejecutaba programas de control de enfermedades de transmisión sexual y no existía uniformidad de criterios para el diagnóstico clínico y serológico de las enfermedades. Por último, la búsqueda activa de personas infectadas y el uso de la información en relación con el registro de casos, la notificación pertinente, la condensación y el análisis estadístico de los datos, así como la divulgación de información sobre enfermedades de transmisión sexual eran deficientes