Maternal Complications during Pregnancy and Risk Factors for Stunting.

Background: Stunting can be prevented by early detection when the mother is pregnant. Early detection can be carried out by looking for risk factors of stunting during pregnancy so that interventions can be early detected. This study aims to assess complications during pregnancy (disease and infection) and risk factors associated with stunting. Materials and Methods: The type of research was observational analytic with a case-control design on 450 mothers who were selected with simple random sampling (150 mothers who have stunting babies aged 0-2 months and 300 mothers who have not stunting babies aged 0-2 months in Malang Regency, Indonesia. This study used secondary data by looking at medical records, namely, laboratory examinations in the mother's book and cohort records at the public health center. This study was conducted from December 2021 to August 2022. Bivariate analysis with Chi-square and multivariate logistic regression was carried out to determine the variables that most influenced the incidence of stunting. Results: The results of multivariate analysis with logistic regression of maternal complications during pregnancy, which are a risk as a factor causing stunting, are Sexually Transmitted Infections (STIs) (Odds Ratio [OR]: 6.36; 95% Confidence Interval [CI]: 2.97-13.62), coronavirus disease 2019 (COVID-19) accompanied by pneumonia (OR: 5.12; 95% CI: 1.87-14.052), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 4.63; 95% CI: 1.10-19.59), hepatitis B (OR: 3.97; 95% CI: 1.253-12.565), pre-eclampsia (OR: 3.88; 95% CI: 1.81-8.30), and heart disease (OR: 3.373; 95% CI: 0.99-11.40). Conclusions: After recognizing the maternal factors that cause stunting, intervention should immediately be carried out on pregnant women with diseases (pre-eclampsia and heart disease) and infections (STI, COVID-19 + pneumonia, HIV/AIDS, and hepatitis B) to prevent stunting early.

Kaposi disease revealing HIV treatment breach: A report of two cases.

Key Clinical Message: The purpose of this article is to highlight that oral Kaposi's disease can be indicative of a high viral load of HIV, either in the case of primary infection or therapeutic failure. Abstract: We report two cases of Kaposi Disease associated with HIV. The first case was a 30-year-old patient who unaware of her HIV-positive status, and who was diagnosed with AIDS stage because of the biopsy revealed a gingival location of Kaposi disease. The second case was a 34-year-old patient who was referred to our department with a history of palatal lesion and claimed at first having no previous known medical conditions although his overall health condition seemed deteriorated. Our clinical examination was evocative of Kaposi Disease, which was confirmed by an emergency blood assessment and histological examination. Our diagnosis led us to disclose the HIV-positive status of the patient and identify a progression to the AIDS stage, which allowed us to reintroduce the patient in the hospital framework. This case emphasizes the role of the oral surgeon as a key actor thanks to their knowledge of the clinical buccal manifestations of sexually transmitted infections (STI), in an era of resurgence of those conditions in vulnerable key populations.

Community Pharmacy Chlamydia and Gonorrhea Test-To-Treat Program: Development of an Implementation Toolkit.

BACKGROUND: Sexually transmitted infection (STI) surveillance showed more than 2.5 million cases of chlamydia, gonorrhea, and syphilis nationally in the United States in 2022. Individuals often seek out non-emergency medical care at pharmacies. This makes community pharmacies well-positioned to address rising STI rates by offering services to screen and treat common STIs. A local health department, an independent pharmacy, and a school of pharmacy in Pennsylvania partnered to implement a test-to-treat service for chlamydia and gonorrhea within a pharmacy. This pilot program utilized: (1) patient self-collected test kits for chlamydia and gonorrhea screening and; (2) standing orders for treatment at the pharmacy. One goal of this pilot was to develop resources others can use to implement similar pharmacy-based chlamydia and gonorrhea testing and treatment services. OBJECTIVE: Develop an expert-informed implementation toolkit for a chlamydia and gonorrhea test-to-treat program at a community pharmacy. METHODS: The "How to Build an Implementation Toolkit from Start to Finish" framework from the University of California at Berkeley was used to design the initial toolkit outline. Toolkit content was triangulated from three sources: (1) comprehensive literature review; (2) pilot program implementation team meetings; and (3) feedback from public health and other experts. Pilot program partners met regularly to review and edit the toolkit. The draft toolkit was then reviewed by outside experts and potential end-users . RESULTS: An 11-item toolkit was developed. Toolkit contents were reviewed by 11 outside experts and potential end-users. Toolkit resources included STI training resources for pharmacy teams, testing and treatment standing orders, pharmacy treatment screening form, marketing strategies, patient education materials, sample workflow, essential supply list, and other key resources. CONCLUSION: Pharmacies may need additional resources for STI testing and treatment program implementation. Toolkit resources developed from this pilot program may help pharmacies overcome implementation barriers for similar programs.

Mycoplasma genitalium retrospective audit of Northern Territory isolates from 2022.

Abstract: The Northern Territory (NT) has the highest rates of sexually transmitted infections (STI) in Australia; however, the local prevalence of Mycoplasma genitalium (M. genitalium) has not been previously determined. This study was designed to review M. genitalium detection, to determine the regional NT prevalence and macrolide resistance rates. In our study the NT background prevalence of M. genitalium is 13%, with the highest detection rates occurring in central Australia and in correctional facility inmates. Symptomatic patients attending sexual health clinics have a positivity rate of 12%, but very high macrolide resistance. The decision to screen for M. genitalium should be based on several factors, including the prevalence of the infection in the local population; the availability of effective treatments; and the potential benefits and risks of detection and therapy.

Association between different levels of suppressed viral load and the risk of sexual transmission of HIV among serodiscordant couples on antiretroviral therapy: a protocol for a two-step systematic review and individual participant data meta-analysis.

INTRODUCTION: HIV is a major global public health issue. The risk of sexual transmission of HIV in serodiscordant couples when the partner living with HIV maintains a suppressed viral load of <200 copies of HIV copies/mL has been found in systematic reviews to be negligible. A recent systematic review reported a similar risk of transmission for viral load<1000 copies/mL, but quantitative transmission risk estimates were not provided. Precise estimates of the risk of sexual transmission at sustained viral load levels between 200 copies/mL and 1000 copies/mL remain a significant gap in the literature. METHODS AND ANALYSIS: A systematic search of various electronic databases for the articles written in English or French will be conducted from January 2000 to October 2023, including MEDLINE, Embase, the Cochrane Central Register of Controlled Trials via Ovid and Scopus. The first step of a two-step meta-analysis will consist of a systematic review along with a meta-analysis, and the second step will use individual participant data for meta-analysis. Our primary outcome is the risk of sexual HIV transmission in serodiscordant couples where the partner living with HIV is on antiretroviral therapy. Our secondary outcome is the dose-response association between different levels of viral load and the risk of sexual HIV transmission. We will ascertain the risk of bias using the Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) and Quality in Prognostic Studies (QUIPS), the risk of publication bias using forest plots and Egger's test and heterogeneity using I2. A random effects model will estimate the pooled incidence of sexual HIV transmission, and multivariate logistic regression will be used to assess the viral load dose-response relationships. The Grading of Recommendations, Assessment, Development and Evaluation system will determine the certainty of evidence. ETHICS AND DISSEMINATION: The meta-analysis will be conducted using deidentified data. No human subjects will be involved in the research. Findings will be disseminated through peer-reviewed publications, presentations and conferences. PROSPERO REGISTRATION NUMBER: CRD42023476946.

A suitable and efficient optimization system for the culture of chlamydia trachomatis in adult inclusion conjunctivitis.

The prevalence of Chlamydia trachomatis infection in the genitourinary tract is increasing, with an annual rise of 9 million cases. Individuals afflicted with these infections are at a heightened risk of developing adult inclusive conjunctivitis (AIC), which is commonly recognized as the ocular manifestation of this sexually transmitted infection. Despite its significant clinical implications, the lack of distinctive symptoms and the overlap with other ocular conditions often lead to underdiagnosis or misdiagnosis of AIC associated with C. trachomatis infection. Here, we established six distinct C. trachomatis culture cell lines, specifically highlighting the MA104 N*V cell line that exhibited diminished expression of IRF3 and STAT1, resulting in reduced interferons. Infected MA104 N*V cells displayed the highest count of intracytoplasmic inclusions detected through immunofluorescence staining, peaking at 48 hours post-infection. Subsequently, MA104 N*V cells were employed for clinical screening in adult patients diagnosed with AIC. Among the evaluated cohort of 20 patients, qPCR testing revealed positive results in seven individuals, indicating the presence of C. trachomatis infection. Furthermore, the MA104 N*V cell cultures derived from these infected patients demonstrated successful cultivation and replication of the pathogen, confirming its viability and infectivity. Molecular genotyping identified four distinct urogenital serovars, with serovar D being the most prevalent (4/7), followed by E (1/7), F (1/7), and Ia (1/7). This novel cellular model contributes to studies on C. trachomatis pathogenesis, molecular mechanisms, and host-pathogen interactions both in vitro and in vivo. It also aids in acquiring clinically relevant strains critical for advancing diagnostics, treatments, and vaccines against C. trachomatis.

Risk factors for treatment non-completion among patients with syphilis.

Background: With recent increases in syphilis, there is growing interest in expanding screening; however, treatment rates have historically been low. Objectives: This study examines demographic and clinical factors that may contribute to non-completion of syphilis treatment. Design: This is a retrospective comparative cohort study of all patients with syphilis from January through November 2018 at an urban, tertiary care hospital. Methods: Demographics and clinical information were extracted from the electronic medical record. Descriptive statistics and odds ratios (ORs) were calculated. Results: Of 171 patients with syphilis, 89 (52.0%) completed treatment. Patients ages 40-49 were least likely to complete treatment (OR 0.14; 95% CI 0.03-0.72, p = 0.02) compared to those ages 18-24. Non-heterosexual patients were significantly more likely to complete treatment (OR 3.60; 95% CI 1.13-11.49, p = 0.03) compared to heterosexual patients. Patients diagnosed in the emergency department completed treatment at the lowest rate. Conclusion: A major gap in syphilis treatment still exists, which must be addressed to achieve optimal impact from syphilis screening programs.

Demographic and clinical factors associated with risk for not completing treatment among patients with syphilis Rates of syphilis, a common sexually transmitted infection, have been steadily increasing in the United States, now at their highest in decades. Left untreated, syphilis can lead to major health complications, and in pregnant women can cause abnormalities in newborn babies or stillbirth. To address this epidemic, screening programs are being developed to diagnose syphilis in vulnerable populations. However, screening without treatment is not an effective strategy, and historically syphilis treatment rates have been low. This is most likely because the treatment can require a lengthy antibiotic course and often several office visits. In this study, we looked back at the patients diagnosed with syphilis at our hospital for 11 months in 2018 to understand factors that might be associated with a risk of not completing treatment. In this sample, only slightly more than half of patients with syphilis completed treatment. We found that younger patients, patients who didn't identify as heterosexual, and patients with private insurance were all more likely to complete syphilis treatment. We also found that patients diagnosed in the emergency department completed treatment at the lowest rates. These findings suggest some areas where new strategies can be developed to help support patients with syphilis to get treated. Only with sufficient treatment of patients with syphilis can we make progress on the growing syphilis epidemic.

Canadian Health Research Funding Patterns for Sexual and Gender Minority Populations Reflect Exclusion of Women.

Purpose: We explored the funding areas of Two-Spirit, lesbian, gay, bisexual, transgender (trans), queer or questioning, and intersex individuals (2S/LGBTQI)-specific health research funded by the Canadian Institutes of Health Research (CIHR) mentioned in the grant abstracts. Methods: We analyzed the publicly available database of grant abstracts funded by CIHR from 2009-2020 to examine what types of 2S/LGBTQI-specific health outcomes would be studied and in what populations. Results: We found that 58% of awarded grant abstracts mentioned studying sexually transmitted diseases, the majority of which was on human immunodeficiency virus. Of the funded 2S/LGBTQI grant abstracts that specified the gender of the population to be studied (n=23), less then 9% mentioned studying cisgender women. Almost 40% mentioned including trans women/girls, and 30% mentioned including trans men/boys. None of the studies examined mentioned work with the Two-Spirit community. Conclusion: These results reflect larger social and health inequities that require structural level changes in research to support the 2S/LGBTQI community.

Sexually transmitted diseases and HIV co-infection among adult male patients in the 2022 monkeypox outbreak: a systematic review and meta-analysis.

This meta-analysis estimates sexually transmitted disease (STI) and HIV rates in male monkeypox patients during the 2022 outbreak. The study examines contextual factors that increase monkeypox risk. A systematic review of PubMed/Medline, Scopus, and Google Scholar was conducted to find observational studies on monkeypox patients' demographics and medical characteristics from the 2022 outbreak. This review's meta-analysis followed the System for the Unified Management, Assessment, and Review of Information - Joanna Briggs Institute (SUMARI JBI) guidelines. All HIV and STI prevalence data for male monkeypox patients was exported into the SUMARI JBI. For point prevalence of HIV and STIs, we used the Freeman-Tukey-type arcsine square root transformation to stabilize raw proportion variances. A fixed-effects model weighted and pooled all estimates by inverse variance. We then used a random model to account for sampling variation and reported fixed-effect model effect size heterogeneity across studies. Study heterogeneity was measured using the I2 test statistic and P-values. I2 test results were interpreted as low (25%), moderate (50%), and high (75%). Six Spanish and English studies qualified. These studies included 541 male monkeypox patients, 214 of whom had HIV and 255 with other STIs. HIV prevalence was estimated at 40% (95% CI = 0.31%, 0.50%; ᵡ2=15) and STIs at 43% (95% CI = 25%, 61%; ᵡ2=118). Overall, analyses showed moderate to high heterogeneity. Four in ten male monkeypox patients in 2022 had HIV or other STIs. To prevent HIV and other STIs, public health measures should target male and female monkeypox patients.

Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link.

BACKGROUND: Mobile Link is a mobile phone-based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. OBJECTIVE: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. METHODS: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link's messaging and outreach services to 70% of female entertainment workers in 5 years. RESULTS: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval -0.088 to 0.126) DALYs averted, Mobile Link's cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. CONCLUSIONS: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842.

Is doxycycline post-exposure prophylaxis being utilised in Germany? Insights from an online survey among German men who have sex with men.

PURPOSE: Doxycycline post-exposure prophylaxis (Doxy-PEP) reduces the likelihood of Chlamydia and early syphilis by approximately two-thirds. Currently, data on the frequency of Doxy-PEP use in men who have sex with men (MSM) are limited. This study aimed to assess knowledge, attitude towards, and frequency of Doxy-PEP use among MSM in Germany. METHODS: We conducted a national online survey in Germany from summer to fall 2023, recruiting MSM and transgender women. Participants were invited to complete the online survey through social media, online dating platforms, and print media advertisements with active recruitment and poster advertising in private practices, tertiary outpatient clinics, and MSM community events in Germany. RESULTS: In total, 438 participants completed the survey and were included in the analysis, and 285 (65.1%) were living with the human immunodeficiency virus (HIV) or taking HIV-pre-exposure prophylaxis (PrEP). Overall, 170 participants (38.8%) had heard of Doxy-PEP, and 275 (62.8%) would consider taking it, but only 32 (7.3%) reported having ever taken Doxy-PEP. The most common reason for a negative attitude towards Doxy-PEP were apprehension about insufficient detailed information, and concerns about antibiotic resistance. Doxy-PEP users were more likely to be on HIV-PrEP, had a higher self-reported risk of bacterial sexually transmitted infections (STIs), and often had a history of bacterial STIs. CONCLUSION: The study demonstrated high awareness and strong interest in Doxy-PEP among MSM in Germany, most of whom were living with HIV or taking HIV-PrEP; however, the actual usage of Doxy-PEP remains low in the summer and fall of 2023.

HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform.

Background: Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China. Objective: This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China. Methods: We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence. Results: A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95% CI 1.22-9.64) in the past 6 months. Conclusions: This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS.

Genitourinary infection and gastroschisis: A systematic review and meta-analysis.

BACKGROUND: Gastroschisis is a congenital anomaly of the umbilical ring with increasing prevalence, especially amongst younger mothers. There is increasing evidence that exposure to genitourinary infections (GUTI) may play an important role in the etiology of gastroschisis. This systematic review and meta-analysis aimed to identify, appraise, and summarize the literature on exposure to GUTI and gastroschisis. METHODS: Six electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library electronic databases, and Prospero) were searched using a comprehensive search strategy. Citations and cited articles for all included studies were searched. Peer-reviewed, quantitative studies reporting an association of urinary tract infections (UTI) and/or sexually transmitted infections (STI) with gastroschisis were included. Prospero registration CRD42022377420. RESULTS: A total of 2392 papers were identified via the searches of which 15 met our inclusion criteria and were included after title and abstract and full text screening. The study period for included studies ranged from 1995 to 2016, most were from the USA. Four studies considering exposure to STIs and five to UTIs were eligible to progress to meta-analysis. Meta-analysis identified a significantly increased risk of gastroschisis in association with periconceptional exposure to UTI [OR 1.54 (95% CI 1.29, 1.8)], STI [OR 1.4 (95% CI 1.01, 1.79)]. CONCLUSIONS: Periconceptional exposure to GUTI is associated with an increased risk of gastroschisis. The prevention and timely treatment of GUTI amongst women of childbearing age may help to reduce the occurrence of gastroschisis.

Sexual health services for adolescents on Reunion Island: results from a descriptive interview-based study.

OBJECTIVES: To describe the experiences of sexual health services available for adolescents aged 15-19 years on Reunion Island. DESIGN: A qualitative descriptive study was conducted from 3 December 2022 to 24 October 2023. Data were analysed using the phenomenological interpretative method. SETTING: Centre Hospitalier Universitaire of Reunion Island. PARTICIPANTS: 15 participants were recruited through convenience sampling, but 3 of them did not attend the interviews. INTERVENTIONS: Face-to-face or videoconferencing open-ended individual interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: Barriers and facilitators to access sexual health services, relationship between adolescents and healthcare professionals when using these services and suggestions made by adolescents for improving access to care and quality of care. RESULTS: In total, 12 adolescents were included with most being female (11 with a mean age of 18 years). Most interviewees were in a relationship, lived in urban areas and had sexual intercourse (nine, respectively). Participants attended high school, university and preparatory college (four, respectively). Most interviews were face to face (11). The mean duration of the interviews was 32 min. Two themes revealing the experiences of sexual health services emerged. Participants described maintaining sexual health as a difficult journey in their quest for information about sexual health and the available services provided. Participants demonstrated that they had the ability to cope with the consequences of unprotected sex. CONCLUSIONS: To date, sexual health services available on Reunion Island may not meet the needs of adolescents. Implementation of a strategy aimed at providing young people with skills, addressing their needs and working with them in a collaborative manner may be necessary. Appropriate teaching methods and the training of healthcare professionals should also be considered.

Utility, acceptability and applicability of a nucleic acid amplification test in comparison with a syndromic approach in the management of sexually transmitted diseases at Mulago National Referral Hospital in Uganda (ASTRHA): protocol for an open-label, randomised controlled trial.

INTRODUCTION: Sexually transmitted diseases (STDs) are a major cause of long-term disability. Urethral discharge syndrome (UDS), abnormal vaginal discharge (AVD) and genital ulcer disease (GUD) are very common in low-income and middle-income countries (LMICs), where, due to lack of resources, these infections are managed according to a syndromic approach. Although microbiological diagnosis using nuclear acid amplification tests (NAAT) is already a standard to prescribe targeted treatments in industrialised countries, no randomised clinical trials have been conducted to evaluate clinical usefulness and acceptability of NAAT in comparison with syndromic approach in LMICs. The results of this study could inform diagnostic guidelines since they may suggest an update of the current recommendation if microbiological diagnosis using NAAT in the management of STD is demonstrated to be both useful and acceptable in an LMIC context. METHODS AND ANALYSIS: The primary objective of this randomised, open-label trial is to evaluate the clinical usefulness of a NAAT and its acceptability in comparison with a clinical syndromic approach and to explore whether this test could replace the syndromic approach in the management of STDs at a national referral hospital in Uganda. 220 patients presenting to the STD clinic at Mulago Hospital in Kampala, Uganda with AVD, UDS or GUD will be randomised to either standard of care (syndromic management) or NAAT-based treatment with a 1:1 ratio. All the patients will be asked to return after 2 or 3 weeks for a control visit. Primary outcome will be therapeutic appropriateness. ETHICS AND DISSEMINATION: This trial was approved by the Mulago Hospital Research and Ethical Committee (MHREC2023-97) and the Uganda National Council for Science and Technology (HS31000ES). Patients will give informed consent to participate before taking part in the study. Results will be published in peer-reviewed journals in open-access formats and data made available in anonymised form. TRIAL REGISTRATION NUMBER: NCT05994495.

Qualitative evaluation of digital vending machines to improve access to STI and HIV testing in South West England: using a Person-Based Approach.

OBJECTIVES: To report the development, implementation, acceptability and feasibility of vending machines offering HIV and sexually transmitted infection (STI) testing kits. DESIGN: A qualitative study using the Person-Based Approach with patient and public involvement workshops and stakeholder involvement and interviews with machine users, sexual health service (SHS) staff, venue staff and local authority sexual health commissioners. Transcripts were analysed thematically. SETTING: Bristol, North Somerset and South Gloucestershire (BNSSG). PARTICIPANTS: 15 machine users, 5 SHS staff, 3 venue staff and 3 local authority commissioners. INTERVENTION: Four vending machines dispensing free HIV self-testing and STI self-sampling kits in publicly accessible venues across BNSSG were introduced to increase access to testing for groups at higher risk of HIV and STI infection who are less likely to access SHS clinic testing services (young people, people from black communities, and gay, bisexual and other men who have sex with men). RESULTS: Machine users reported the service was convenient, easy to use and accessible; however, concerns regarding privacy related to machine placement within the venues and issues of maintenance were raised. Promotional material was inclusive and informative; however, awareness of the service through the promotional campaign was limited. Vending machines were acceptable to venue staff once clear processes for their management were agreed with the SHS. SHS staff identified challenges with the implementation of the service related to the limited involvement of the whole SHS team in the planning and development. CONCLUSIONS: The codeveloped vending machine service was acceptable, addressing some barriers to testing. Resources and protected staff time are needed to support greater involvement of the whole SHS team and service providers in venues. Adopting a similarly robust coproduction approach to the implementation of the machines could avoid the challenges reported. The placement of the machines to assure users privacy and repeated, targeted promotion could encourage service use among target groups.

Update on Squamous Cell Carcinoma of the Nail Unit: An Human Papillomavirus-Associated Condition.

Background: Squamous cell carcinoma (SCC) and SCC in situ (Bowen's disease) are the most common malignancies of the nail unit. They are frequently seen in men over 50 and most commonly affect the fingers. The role of high-risk human papillomavirus (HPV) infection has been identified as a key contributor to the development of nail unit SCC. Summary: In this review, we aimed to summarize the current state of our understanding of how HPV contributes to nail unit SCC, the role of genitodigital transmission of HPV, and the clinical features of HPV-associated nail unit SCC. We also review current advances in the treatment of nail unit SCC, with a focus on the potential role of HPV vaccination in the treatment and prevention of nail unit SCC. Key Messages: Nail unit SCC should be recognized as an HPV-associated disease. HPV vaccination may represent a non-surgical modality for the management of these challenging malignancies in the appropriate clinical setting.

Development of a risk prediction score for screening for HBV, HCV and HIV among migrants in France: results from a multicentre observational study (STRADA study).

OBJECTIVES: Migrants from high HIV, hepatitis B virus (HBV) or hepatitis C virus (HCV) endemicity regions have a great burden of these infections and related diseases in the host countries. This study aimed to assess the predictive capacity of the Test Rapide d'Orientation Diagnostique (TROD) Screen questionnaire for HIV, HBV and HCV infections among migrants arriving in France. DESIGN: An observational and multicentre study was conducted among migrants. A self-questionnaire on demographic characteristics, personal medical history and sexual behaviours was completed. SETTING: The study was conducted in the centres of the French Office for Immigration and Integration (OFII). PARTICIPANTS: Convenience sampling was used to select and recruit adult migrants between January 2017 and March 2020. OUTCOME MEASURES: Participants were tested for HIV, HBV and HCV with rapid tests. For each infection, the test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy. RESULTS: Among 21 133 regular migrants seen in OFII centres, 15 343 were included in the study. The participants' mean age was 35.6 years (SD±11.1). The prevalence (95% CI) of HBV, HCV and HIV was 2.0% (1.8% to 2.2%), 0.3% (0.2% to 0.4%) and 0.3% (0.2% to 0.4%), respectively. Based on the sensitivity-specificity curve analysis, the cut-off points (95% CI) chosen for the risk score were: 2.5 (2.5 to 7.5) for HBV infection in men; 6.5 (0.5 to 6.5) for HBV infection in women; 9.5 (9.5 to 12.5) for HCV infection; and 10.5 (10.0 to 18.5) for HIV infection. Test performance was highest for HIV (AUC=82.15% (95% CI 74.54% to 87.99%)), followed by that for HBV in men (AUC=79.22%, (95% CI 76.18% to 82.26%)), for HBV in women (AUC=78.83 (95% CI 74.54% to 82.10%)) and that for HCV (AUC=75.95% (95% CI 68.58% to 83.32%)). CONCLUSION: The TROD screen questionnaire showed good overall performance for predicting HIV, HBV and HCV infections among migrants in OFII centres. It could be used to optimise screening for these infections and to propose rapid screening tests to those who are at high risk. TRIAL REGISTRATION NUMBER: NCT02959684.

Fitz-Hugh-Curtis Syndrome in a Male Patient.

We report the case of a 38-year-old Middle Eastern man with intractable right upper quadrant (RUQ) abdominal pain and several emergency department visits during the last seven years, with extensive and repeated radiologic and endoscopic workups proven negative for biliary or upper gastrointestinal disease. He presented to our outpatient surgical clinic in March 2023 complaining of worsening RUQ and epigastric pain and was scheduled for a robotic cholecystectomy for presumed biliary dyskinesia following a repeat cholescintigraphy (hepatobiliary iminodiacetic acid) scan. During a cholecystectomy, extensive bilobar perihepatic adhesions were found, indicative of Fitz-Hugh-Curtis syndrome (FHCS). A thorough lysis of adhesions was performed along with a wedge liver biopsy, with subsequent histological examination showing chronic cholecystitis, perihepatic mesothelial fibrosis with mild subcapsular hepatic steatosis, and no evidence of liver fibrosis. The patient was examined in the clinic two weeks after surgery with complete resolution of symptoms. This case highlights the importance of considering FHCS in the differential diagnosis of male patients presenting with refractory RUQ abdominal pain despite a negative workup. Early recognition and prompt treatment can prevent unnecessary extensive, repeat testing and delays in intervention in these patients.

Current recommendations for vaccines for patients planning pregnancy: a committee opinion.

Encounters for infertility care are opportunities to assess and update immunization status. Individuals of reproductive age are often unaware of their need for immunization, their immunization status, and the potentially severe consequences of preventable disease on pregnancy outcome. The purpose of this American Society for Reproductive Medicine (ASRM) Practice Committee document is to summarize current recommendations regarding vaccinations for individuals of reproductive age. This document replaces the ASRM Practice Committee document titled "Vaccination guidelines for female infertility patients," last published in 2018 (Fertil Steril 2018;110:838-41).