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Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities experience significant health disparities related to sexual health, including sexually transmitted infections (STIs). Improved access to culturally congruent primary care and sexual health services, including HIV/STI prevention and care, are needed. We describe how we developed a new community-based LGBTQ+ primary care clinic and implemented safety-net sexual health and STI screening and care services in Providence, Rhode Island., Methods: Open Door Health in Providence, Rhode Island, was started in 2020 to improve access to HIV/STI care and prevention services, primary care, and gender- affirming care for the LGBTQ+ community. We reviewed demographics and behaviors of patients presenting for STI screening services from February 2021 to October 2023 at the clinic. Bivariate and multivariate analyses were used to evaluate demographics and behaviors among patients testing positive for HIV and other STIs., Results: A total of N=1,633 people presented for STI screening. Of these, 56% were 30 years or younger, 65% identified as male, 24% as female, and 9% as non-binary or gender diverse. Forty-three percent were MSM, 19% were Black/African American (B/AA), and 22% were Hispanic/Latino (H/L). Seventy-one percent reported two or more partners in the last three months. The prevalence of STIs was 22.3% (4.4% syphilis, 7.5% gonorrhea, and 9.7% chlamydia). Those who tested positive for an STI were more likely to be B/AA (23.3% of B/AA individuals versus 15.9% of White, p<0.05), H/L (23.1% versus 17.4%, p<0.05), and MSM (25% versus 16.9%, p<0.05)., Conclusion: Open Door Health provides important safety-net STI services for the LGBTQ+ community. Individuals presenting for services had a high prevalence of HIV/STIs. Improved approaches are needed for HIV/STI care and prevention in this group, including among B/AA and H/L communities.

The adolescent care provider has a unique opportunity to provide young patients with appropriate counseling about sexual health and prevention of pregnancy and sexually transmitted infections. To provide high-quality sexual and reproductive health care for the adolescent, providers must be familiar with the breadth of contraceptive options and their characteristics. The purpose of this review is to discuss recent developments in contraception and to review commonly used contraceptive methods as they apply to adolescents., Competing Interests: Disclosure The authors have no conflicts of interest or funding sources to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Adolescence is a natural time for sexual exploration; developmentally-appropriate sexual education is essential to promote healthy behaviors and prevent long-term morbidity. Adolescents may confide in their primary care clinicians, who are responsible for providing information and access to evidence-based care including family planning, contraception, and abortion. Clinicians are essential in sexually transmitted infection prevention, screening, treatment, risk mitigation, and harm reduction for sexually active adolescents. Clinics should pay special attention to electronic medical record settings and insurance procedures to prevent unexpected lapses in confidentiality., Competing Interests: Disclosures The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Though men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STIs), factors that impact STI testing adherence among non-single MSM remain under-explored. While being in a relationship per se does not necessarily increase one's risk for STIs, certain behavioral risks and demographic factors may impact STI testing adherence. Through a sample of 296 non-single MSM located in the United States, we examined key behavioral and demographic factors and their associations with adherence to CDC's STI testing guidelines. Overall, the results showed inconsistent STI testing adherence rates among divergent subgroups of higher-risk non-single MSM. First, non-single MSM who take PrEP were more likely to adhere to STI testing and showed significantly higher adherence rates than those who do not take PrEP, but adherence rates were not related to nor significantly different than those who reported extra-relational sex or condomless anal sex. Further, STI testing adherence was positively associated with having a shorter relationship length, identifying as non-White, and living in an LGBTQ+-friendly neighborhood. Practical implications and recommendations for clinical practices, persuasive messages, and promotion strategies are discussed., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Despite national testing guidelines, rates of testing for HIV, sexually transmitted infections (STIs), and hepatitis C remain lower than recommended for men who have sex with men in the United States. To help address this, the TakeMeHome (TMH) program was started in March 2020 by Building Healthy Online Communities, a consortium of public health organizations and dating apps, to work with health departments to increase access to HIV testing for men who have sex with men on dating apps., Methods: Users of participating dating apps were sent messages about opportunities for testing with self-collected specimens through TMH. Program users were eligible to receive test kits if they lived in a participating zip code and were aged at least 18 years. Users who were interested in testing could order kits to be mailed to them for laboratory-based testing of HIV, hepatitis C, chlamydia, gonorrhea, and/or syphilis, depending on risk and availability in their zip code. Orders were sent via application programming interface to Molecular Testing Labs for fulfillment; kits were provided at no cost to the program user. Within approximately 24 hours of order receipt, Molecular Testing Labs mailed program users a kit with required collection supplies, directions, and a link to a video instruction for self-collection. Program users received an automated email after testing was complete with a link to access results through their online account. Individuals with positive results on any of the relevant tests were directed to additional information and to local providers for linkage to additional testing or treatment, depending on local protocols., Results: The positivity rate of specimens processed through TMH was 1.4% for HIV, 0.6% for hepatitis C, and 2.9% for all STIs combined. The per-person positivity rate was 15.3% across all STIs., Conclusions: The TMH program demonstrates that self-collected laboratory-processed testing is feasible and effective at identifying new HIV and STI cases., Competing Interests: Conflict of Interest and Sources of Funding: This work was supported by funding from Gilead Sciences Foundation (Hecht). Facente reports receipt of consulting fees from Gilead Sciences. Sullivan reports receiving grant funding from Gilead Sciences, grant and consulting fees from Merck, and salary support from ViiV Healthcare. The other authors have no potential conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)

Background: Sexually transmitted infections (STI) are a global concern. In Italy, despite the presence of publicly funded STI diagnostic centers, limited attention has been given to the knowledge of these services among the adult population. This study primarily aimed to evaluate Italian adults' knowledge about STI and dedicated health care centers. Secondarily, it explored condom usage behaviors., Methods: Conducted nationwide, this cross-sectional study used an online questionnaire. The primary outcomes included knowledge of dedicated STI centers and scores on the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ); secondary outcomes included inconsistent condom usage rates during various forms of intercourse., Results: With a participant count of 1036, results indicated that only 36% were aware of dedicated STI centers. The median STD-KQ score was 11 (interquartile range, 6-15). Multivariable regression models unveiled factors significantly associated with knowledge. Lesbian, gay, bisexual, transsexual, and queer (LGBTQ) individuals, health care workers, and those with higher STD-KQ scores exhibited greater STI centers' awareness. Better STD-KQ scores correlated with higher education levels, substance use, past STI diagnosis, and health care employment. Around 80% of the sample reported inconsistent condom use during different forms of intercourse. Although enhanced knowledge correlated with increased condom use, certain groups exhibited discrepancies between knowledge of STI and actual condom use., Conclusions: These findings emphasize the need for targeted awareness campaigns to enhance accessibility to STI centers, underscoring the necessity for multifaceted interventions beyond information dissemination to address suboptimal condom usage. In providing insights into STI knowledge and behaviors among Italian adults, this research informs interventions and policy adjustments to combat STI., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

Background: Human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) can cause severe and fatal complications; knowledge about these diseases is essential for promoting safe sex practices and modifying behaviours that are harmful to one's health. This study investigates Syrian people's understanding, attitudes, and behaviors towards HIV/AIDS and STIs, aiming to identify factors promoting safe sex practices and modifying harmful behaviors., Methods: This online cross-sectional study was conducted in Syria between 3 September and 23 November 2022, involving all 18+ individuals. The questionnaire was adapted from a previous study containing 74 questions from five sections: socio-demographic information, knowledge and practice regarding STIs, knowledge and practice regarding HIV/AIDS, attitude towards HIV/AIDS, and attitude regarding STIs and analyzed using descriptive and multivariate logistic regression., Results: The study involved 1073 participants mostly aged between 18-30, with 55.3% females. Over half had good awareness of STIs and HIV/AIDS, with 55% and 63% respectively. Specifically, the overall knowledge level of STI type, signs/symptoms, risks of transmission, preventive methods, and complications for untreated STIs were (45.7%), (52.9%), (58.1%), (66.1%), and (59.6%), respectively. Medical field respondents had higher knowledge of HIV (P-value < 0.05, OR = 2)., Conclusion: Our results show that Syrian people have a knowledge level of STIs and HIV was moderate. However, the attitude toward STIs was negative, as less than half of the participants had a good attitude. It is essential to solve these knowledge gaps, especially in low-income countries such as Syria.

Linking identified MPOX cases to care is essential for MPOX control. This study aims to investigate the intentions of healthcare seeking and self-isolation for MPOX among men who have sex with men (MSM) in China. A cross-sectional online survey was conducted in early August 2023 in China. Respondents were recruited by community-based organizations (CBOs), collecting information on demographics, health status, behavioural and psychological characteristics. Univariate and multivariate logistic regression analyses were performed to examine the predictors of intentions to seek healthcare and self-isolate for MPOX within the MSM population. A total of 7725 participants were recruited, with a median age of 30 years. 92.21% of the participants would seek healthcare for MPOX-like symptoms, but only 52.50% intended to self-isolate if diagnosed. Intentions to seek healthcare were lower among those with MPOX-like symptoms in the past 3 months (standardized prevalence ratio (SPRs) = 0.82, 95% CI: 0.74-0.89) and the willingness to self-isolate was reduced among those diagnosed with MPOX in the past 3 months (SPRs = 0.65, 95% CI: 0.48-0.87). Participants free of sexually transmitted infections (STIs) and those aware of their HIV status were more likely to seek healthcare and self-isolate than those with STIs or unaware of their HIV status. Regular followers of MPOX information and those perceiving a low risk of infection were more inclined to take preventive measures. These findings highlight the need for targeted MPOX prevention strategies for high-risk groups and the importance of addressing barriers in infectious disease prevention response.

Background: The COVID-19 pandemic and subsequent multinational mpox outbreak significantly disrupted sexual health care delivery, particularly impacting men who have sex with men (MSM). This study investigated these public health emergencies in relation to perceptions, attitudes, and sexual practices among MSM affiliated with a collective sex venue (CSV)., Methods: Electronic surveys were sent to clientele of a high-volume CSV between June 2021 and November 2022 across 3 time periods defined as pre-Omicron, post-Omicron, and mpox. Data collection encompassed sociodemographics, health care access, sexually transmitted infection/HIV status, COVID-19 testing, and sexual behaviors. Multivariable regression analyses identified factors associated with self-reported COVID-19 testing and positivity, and mpox exposure., Results: Among 1135 responses, demographics were largely cisgender MSM and predominantly White. Increased self-reported COVID-19 positivity was associated with having more sex partners and frequenting bathhouses for meeting sex partners. Confidence in COVID-19 mitigation strategies decreased post-Omicron. Factors linked to mpox exposure included younger age, increased sex partners, sexually transmitted infection positivity, and lower confidence in mitigation strategies., Discussion: These findings underscore the intersectionality between sexual behaviors and public health responses to COVID-19 and mpox among MSM communities affiliated with a CSV. Decreased confidence in mitigation strategies and changes in sexual behaviors during public health emergencies underscore the need for targeted interventions and messaging. Collaboration between health departments and CSVs can facilitate responses to current and future public health threats and interventions., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

Background: Sexual protective behaviors, such as consistent condom use and intention, are important preventative measures against the transmission of HIV/AIDS and sexually transmitted infections. Current sexual health research has yet to explore the interaction between contextual factors, such as gendered racial microaggressions, and the role of personal factors (i.e., body appreciation) on Black women's sexual risk and protective behaviors in the United States. Guided by objectification theory, we hypothesized that sexually objectifying gendered racial microaggressions moderated the body appreciation and condom use behaviors relationship. Participants: The current study consisted of 114 Black emerging adult women in the southern United States. Results: Results showed significant interactions between the frequency of sexually objectifying gendered racial microaggressions and body appreciation on consistent condom use and condom use intention. Conclusion: Overall, these findings suggested the need for sexual health researchers and interventionists to further explore the influence of gendered racial microaggressions and body appreciation on condom use behaviors.

STD-associated questions and symptoms are submitted frequently to general practitioners and STD outpatient-clinics. In this teaching article we address several important clinical questions regarding epidemiology, risk assessment, testing policy, diagnostics and prevention. STD's form a separate category of infectious diseases because of the role of sexuality. Good communication about sexual behavior is indispensable for an adequate diagnosis. We discuss the recognition of extragenital manifestations of STD, which requires alertness. Estimating the STD-risk based on sexual behaviour is essential for testing policy. Persons at high risk are tested for gonorrhoea, syphilis, hiv and hepatitis B. In other cases testing is based on symptoms and complaints. HIV and syphilis are serious std's. Early detection followed by treatment is important in preventing health damage and preventing further spread. Hiv-indicator-conditions are useful alarm-signs for this purpose. PrEP can help not to acquire hiv and increases sexual health. It can be prescribed by gp's and public health clinicians. But condom-use remains crucial in prevention.

Background: Across sub-Saharan Africa, adolescents face the triple tragedy: unintended pregnancies, unsafe abortion, and sexually transmitted infections including HIV due to various reasons, among them, poor parent-adolescent communication on sexual and reproductive health. Effective interventions such as improving parent‒adolescent communication has been recognized as a protective factor for adolescent sexual and reproductive health outcomes. Research shows that parent-adolescent communication is associated with reduced adolescent engagement in risky sexual behaviours, including early sexual initiation, lower rates of teenage pregnancy, sexually transmitted infections, and increased self-efficacy in decision making. Despite the potential role of parent-adolescent communication in promoting optimal adolescent sexual and reproductive health, limited research evidence exists on interventions to improve parent-adolescent communication on sexual and reproductive health in sub-Saharan African countries. The aim of this systematic review is to assess the role of parent-adolescent communication intervention programs in improving sexual and reproductive health outcomes., Methods: We will pool evidence from published literature from January 1990 up to and including February 2024 from multiple databases: PubMed, Web of Science, Scopus, African Journals Online, JSTOR, Directory of Open Access Journals, and Google Scholar. Articles published in the English language will be included. Two reviewers will conduct screening for titles, abstracts, and full texts, while a third reviewer will arbitrate in cases of lack of concurrence. Experimental, quasi-experimental and observational study designs will be included.. A data extraction tool based on Microsoft Excel will be used to extract data items from different studies. We will focus on the following outcomes: initiation of sexual activity, use of condoms and contraceptives, reduced risky sexual behaviours such as unprotected sex, and lower rates of teenage pregnancy. When feasible, articles will be combined for statistical meta-analysis. Effect sizes, either reported as weighted mean differences for continuous data or as odds ratios for binary data, will be presented as proportions with 95% confidence intervals. We will use the random effects model to meta-analyse the include studies as we expect considerable variability across study designs. This will provide an average effect size that accounts for variability of results within studies. Sensitivity analysis will also be conducted to assess the robustness of the findings or conclusions of the meta-analysis. The review findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines., Discussion: This review provides insights into parent-based intervention programs that have been implemented in sub-Saharan African countries to improve adolescent sexual and reproductive health via promotion of parent-adolescent sexuality communication. The findings will guide further research on this issue as well as inform policy makers on which interventions have a potential effect in improving adolescent sexual and reproductive health. Protocol Registration Number: CRD42024525191 (PROSPERO), Date of registration: 27/03/2024., Competing Interests: Declarations. Ethics approval and consent to participate: No ethical review or consent to participate is required for this systematic review, as it does not involve primary data collection. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Early detection and treatment of HIV and sexually transmitted infections (STIs) are crucial for effective control. We previously developed MySTIRisk, an artificial intelligence-based risk tool that predicts the risk of HIV and STIs. We examined the attributes that encourage potential users to use it., Methods: Between January and March 2024, we sent text message invitations to the Melbourne Sexual Health Centre (MSHC) attendees to participate in an online survey. We also advertised the survey on social media, the clinic's website, and posters in affiliated general practice clinics. This anonymous survey used a discrete choice experiment (DCE) to examine which MySTIRisk attributes would encourage potential users. We analysed the data using random parameters logit (RPL) and latent class analysis (LCA) models., Results: The median age of 415 participants was 31 years (interquartile range, 26-38 years), with a minority of participants identifying as straight or heterosexual (31.8%, n = 132). The choice to use MySTIRisk was most influenced by two attributes: cost and accuracy, followed by the availability of a pathology request form, level of anonymity, speed of receiving results, and whether the tool was a web or mobile application. LCA revealed two classes: "The Precisionists" (66.0% of respondents), who demanded high accuracy and "The Economists" (34.0% of respondents), who prioritised low cost. Simulations predicted a high uptake (97.7%) for a tool designed with the most preferred attribute levels, contrasting with lower uptake (22.3%) for the least preferred design., Conclusions: Participants were more likely to use MySTIRisk if it was free, highly accurate, and could send pathology request forms. Tailoring the tool to distinct user segments could enhance its uptake and effectiveness in promoting early detection and prevention of HIV and STIs., Competing Interests: Declarations. Ethics approval and consent to participate: This study received ethical approval from the Alfred Hospital Ethics Committee in Melbourne, Australia (project number: 637/23). All research procedures adhered to the committee's ethical standards and regulations. All participants provided informed consent at the start of the online survey. Participants could proceed with the survey only if they provided their consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Specific to sexual health, individuals in need of information may be adolescents who have limited ability to formally access healthcare. These digital natives may turn to ChatGPT to address their concerns on sexually transmitted infections (STI). We sought to evaluate the veracity of ChatGPT's responses to commonly asked questions on STIs., Methods: We instructed ChatGPT (GPT 3.5) to answer STI questions from three domains, namely, (1) general risk factors for STIs, (2) access to care and diagnosis of STIs and (3) management of STIs and postexposure prophylaxis. The responses were recorded and checked against the US Centers for Disease Control and Prevention STI Treatment Guidelines 2021., Results: Overall, the responses were concise and accurate. In terms of prevention, ChatGPT could also recommend measures like safe sex practices and human papillomavirus vaccination. However, it failed to recommend HIV pre-exposure prophylaxis. When an individual expressed a symptom that could potentially represent STI (eg, dyspareunia) ChatGPT appropriately provided reassurance that other possibilities exist, but advocated for testing. In terms of treatment, ChatGPT consistently communicated the importance of partner testing and follow-up testing, but at times, failed to highlight the importance of testing for other STIs. Overall, the advice given was not tailored to the specific individual's circumstances., Conclusions: ChatGPT can provide helpful information regarding STIs, but the advice lacks specificity and requires a human physician to fine-tune. Its ubiquity may make it a useful adjunct to sexual health clinics, to improve knowledge and access to care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Human Papillomavirus (HPV) infection poses a significant health risk, particularly for high-risk groups such as men who have sex with men (MSM), people living with HIV (PLHIV), and transgender individuals. Despite the availability of effective vaccines, uptake among these groups remains suboptimal due to various social and behavioral barriers (BeSD). A cross-sectional survey was conducted at the Sexually Transmitted Infections (STIs) clinic in Bologna, Italy, from 8 April to 12 April 2024 using a paper questionnaire, investigating HPV vaccine uptake and BeSD factors influencing vaccination decisions. Statistical analyses included descriptive statistics and multivariate logistic regression. Among the 236 respondents, PLHIV and transgender individuals demonstrated lower uptake rates (60.0% and 15.6%) if compared to women under 30 years old (72.7%). Concern about HPV infection varied significantly across groups, with MSM showing the highest worry (48.7%). Perceptions of vaccine safety and access were mixed, influencing vaccination decisions. Multivariate analysis indicated that age inversely correlated with infection worry (OR: 0.94, 95% CI: 0.91-0.98), while being a woman under 30 (OR: 164.0, 95% CI: 17.2-1560.18) or MSM (OR: 3.53, 95% CI: 1.37-9.11) was positively associated with vaccine uptake. The study identifies disparities in HPV vaccine uptake among STI clinic users in Bologna, Italy, emphasizing the need for targeted public health campaigns. These campaigns could engage STI clinics and address awareness, safety perceptions, and access barriers to enhance vaccination coverage among sexual and gender minorities., Competing Interests: The authors declare no conflicts of interest.

Background: International migrants are vulnerable to sexually transmitted infections, and their flow may accelerate the related virus (e.g., HIV, HCV, and syphilis) transmission. When international migrants enter a new environment, there will be a process of adaptation in all areas of life, and social integration plays an important role in international migrants' daily life., Objective: This study aimed to explore the influence of social integration on the risky sexual behaviors of international migrants in China and provided evidence both for healthcare intervention and global health development., Methods: A cross-sectional survey was conducted between January and September 2021 among international migrants who lived in China by snowball sampling method. Descriptive statistics were used to analyze the basic characteristics and risky sexual behaviors of international migrants. Multivariable logistic regression analyses were used to identify the influencing factors of risky sexual behaviors., Results: In total, 1433 international migrants were incorporated into the study. There were 23.10% (331) participants who considered their Chinese fluent, and 34.40% (493) considered it hard. The average number of Chinese friends they frequently interact with was (5.45 ± 2.16), and 77.60% (1112) of international migrants often attend activities held by Chinese people with 84.86% (1216) having a Chinese name. The probability of engaging in risky sexual behaviors was higher among people with lower Chinese or English level. Moreover, participants with fewer Chinese friends frequently interacted with had more unprotected sexual behaviors. People who did not often attend activities held by Chinese people had more multiple sexual partners (AOR 1.441; 95%CI 1.019,2.039) and unprotected sexual behaviors (AOR 1.523; 95%CI 1.006,2.306)., Conclusions: Social integration was related to the prevalence of risky sexual behaviors among international migrants. Improving Chinese level, increasing social interaction with locals as well as maintaining a healthy lifestyle may help decrease risky sexual behaviors. Therefore, more attention should be paid to social integration among international migrants, helping them integrate into local society, and promote their health condition to effectively address the health challenges faced by them in a globalized world., Competing Interests: Declarations Ethics approval and consent to participate The study protocol and consent procedure were approved by Ethics Review Committee, School of Public Health, Zhejiang university. The informed consent was obtained from all subjects and/or their legal guardian(s). The confidentiality of individuals was properly protected in the management of investigation and the processing of data. Consent for publication All authors have agreed with the content and approved the submission of the manuscript. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Adolescent risky sexual behaviors in Nigeria pose significant public health challenges, including unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs). Understanding the determinants of these behaviors in urban and rural contexts is crucial for effective intervention development., Objective: This study explored the determinants of risky sexual behaviors and access to adolescent reproductive health services (ARHS) among in-school adolescents in Enugu State, Nigeria., Methods: A descriptive cross-sectional design with mixed methods was utilized, involving 880 adolescents aged 10-19 years from eight schools (four urban, four rural) for quantitative analysis and 80 adolescents for qualitative analysis. Data were gathered through self-administered questionnaires and focus group discussions (FGDs). Statistical analyses included descriptive statistics, chi-square tests, and logistic regression with a significance level of p<0.05., Results: Among respondents, 420 (47.7%) reported being sexually active, with similar figures in urban (212; 48.2%) and rural (208; 47.3%) areas. The mean age for the sexual debut was identical across groups: 14.62 years (SD 1.768). The majority (85.5%) had multiple sexual partners. Condom use was low in both groups: 18.9% in urban and 9.6% in rural areas. Almost half of both groups (46.2% urban, 49.0% rural) never used condoms. Substance use was strongly associated with risky sexual practices, particularly alcohol, followed by marijuana and cigarettes. Notably, 86% of adolescents who used substances before sex did not use condoms, and 47% reported forced sex. Key determinants of risky behavior included poverty, peer pressure, and poor parental supervision. Access to ARHS was limited, with concerns about stigma and confidentiality; 57.7% lacked access, with rural adolescents facing poorer access (66.3%) than their urban counterparts (47.5%)., Conclusion: The study underscores the need for increased awareness, parental involvement, and targeted interventions to improve ARHS access and reduce risky sexual behaviors among adolescents in Enugu State., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Background: In western Kenya, menstrual hygiene management (MHM) is a pervasive problem. Challenges are compounded for economically constrained women who continue to engage in sex during menses and resort to practices such as vaginal insertion of tissue and cotton to maintain dryness during sex. These practices can be harmful to the vaginal microbiome (VMB) and can lead to high rates of sexually transmitted infections (STIs) and HIV. This study will evaluate whether menstrual cups that can be worn during intercourse may be beneficial to the VMB and help prevent Bacterial vaginosis (BV) and STI acquisition among these economically vulnerable women., Methods: In this single-arm trial among economically vulnerable women in semi-urban western Kenya, we will evaluate the preliminary efficacy of menstrual cups on non-optimal VMB, BV, and STIs, and investigate safety, acceptability, and implementation needs. Through peer referral we aim to recruit 402 menstruating women aged 15-35 who exchange sex for money or basic needs. Women who are pregnant, have delivered in the past six months, or use an intrauterine device (IUD) will not be eligible. Participants will be seen every six months for 24 months and be asked about their sexual and MHM practices, with samples collected to assess BV and VMB. At baseline, 12-, and 24-month visits, additional samples will be collected to measure HIV and STIs (C. trachomatis, N. gonorrhoeae, and T. vaginalis). HSV-2 status will be assessed at baseline. Intervention provision will consist of one reusable disc-shaped menstrual cup per participant and a group-based training within four weeks of the 12-month visit, followed by monthly telephone surveys for the first three months to assess cup use, adverse events, and provide any assistance. Primary analyses of preliminary efficacy will compare probabilities of optimal VMB, BV, and STIs in the pre-intervention period to the post-intervention period. Primary safety analyses will compare occurrence of menstrual toxic shock syndrome and cervicovaginal laceration., Discussion: If demonstrated safe and effective, this multipurpose reproductive health intervention will offer a dignified solution for the menstrual hygiene needs of women who engage in sex for livelihood and reduce their occurrence of non-optimal VMB, BV, and STIs., Trial Registration: Clinicaltrials.gov NCT05666778 (28th December, 2022); Pan African Clinical Trials Registry 202,305,912,778,108 (25th May, 2023)., (© 2024. The Author(s).)

Background Sexual health service engagement is important for the healthy sexual development of young people. Further, as later adolescence and early adulthood are critical periods for relationship development, sexual health needs may vary across this period and be associated with relationship status. Methods A total of 468 participants, aged 16-25years (mean age: 19.7years) and living in the United Kingdom, completed an anonymous, online survey about their sexual health service use. To explore how relationship status is associated with engagement for five different sexual health services, we conducted chi-squared and multivariable logistic regression analyses. Results In general, engagement with sexual health services was low: 28.2% reported accessing free condoms, 21.4% reported STI testing, and 9.4% had used relationship advice services. Among women only, 57.2% had accessed services to start the pill and 19.6% had done so for pregnancy testing. Among all participants, those in relationships were more likely to have accessed sexual health services for free condoms (aOR: 1.71, 95% CI: 1.13, 2.59). Among female participants, those in relationships were more likely to have accessed sexual health services to start the pill (aOR: 2.21, 95% CI: 1.45, 3.36) and for pregnancy testing (aOR: 3.86, 95% CI: 2.20, 6.78). There were no differences by relationship status for accessing sexual health services for STI testing or relationship advice. Conclusions Health care providers and relationship and sexual education providers should encourage all young people to engage with sexual health services, while also recognising that sexual health needs are likely to vary depending on relationship status.

Background Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n =18) and British Columbia (n =20), Canada, as part of a mixed-methods implementation science study (2020-2022). Over 3years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM.

Abstract: Sexually transmitted infection rates continue to rise in adolescents and young adults. Treatment of patients and their partners is vitally important to prevent reinfection and morbidity. Expedited partner therapy (EPT) is a legally available option for clinicians. EPT is endorsed by the Centers for Disease Control and Prevention and allows clinicians to prescribe medication for certain STIs for their patients' partner(s) without an evaluation of the partner(s). However, EPT is underutilized, and multisystem-level barriers exist to successful EPT exist. This article reviews the indications of EPT, common barriers to EPT and solutions to overcome these barriers, and practical considerations when prescribing EPT., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Doxycycline post-exposure prophylaxis (PEP) has been shown to be efficacious for the prevention of bacterial sexually transmitted infections, but resistance implications for Neisseria gonorrhoeae remain unknown. We aimed to use a mathematical model to investigate the anticipated impact of doxycycline PEP on the burden of gonorrhoea and antimicrobial resistance dynamics in men who have sex with men (MSM) in the USA., Methods: Using a deterministic compartmental model, characterising gonorrhoea transmission in a US MSM population comprising three sexual activity groups defined by annual partner turnover rates, we introduced doxycycline PEP at various uptake levels (10-90%) among those with high sexual activity. Infections were stratified by symptom status and resistance profile (ie, susceptible, ceftriaxone-resistant, tetracycline-resistant, or dual-resistant), with ceftriaxone the treatment for active infection. As resistance to tetracycline, not doxycycline, is monitored and reported nationally, we used this as a proxy for doxycycline PEP resistance. We compared the 20-year prevalence, incidence rates, and cumulative incidence of gonococcal infection, resistance dynamics (time to 5% prevalence of ceftriaxone resistance, 5% prevalence of dual resistance, and 84% prevalence of tetracycline resistance), and antibiotic consumption with baseline (ie, no doxycycline PEP)., Findings: Uptake of doxycycline PEP resulted in substantial reductions in the prevalence and incidence of gonorrhoea, but accelerated the spread of tetracycline resistance. The maximum reduction in prevalence over 20 years compared with no uptake ranged from 40·3% (IQR 15·3-83·4) with 10% doxycycline PEP uptake to 77·4% (68·4-84·9) with 90% uptake. Similarly, the maximum reduction in the incidence rate ranged from 38·6% (14·1-83·6) with 10% uptake to 77·6% (68·1-84·7) with 90% uptake. Cumulative gonococcal infections were reduced by a median of 14·5% (IQR 8·4-21·6) with 10% uptake and up to 46·2% (26·5-59·9) with 90% uptake after 5 years, and by 6·5% (3·4-13·0) with 10% uptake and 8·7% (4·3-36·2) with 90% uptake by 20 years. In almost all scenarios explored, doxycycline PEP lost clinical effectiveness (defined as 84% prevalence of tetracycline resistance) within the 20-year period, but its lifespan ranged from a median of 12·1 years (IQR 9·9-15·7) with 10% uptake to 1·6 years (1·3-1·9) with 90% uptake. Doxycycline PEP implementation had minimal impact on extending the clinical lifespan of ceftriaxone monotherapy (5·0 years [IQR 4·0-6·2]), with the median time to 5% prevalence of resistance ranging from 4·8 years (3·9-6·0) for 90% uptake to 5·0 years (4·1-6·2) for 10% uptake. Similarly, the median time to 5% prevalence of dual resistance to ceftriaxone and tetracycline ranged from 4·8 years (3·9-6·0) for 90% uptake to 5·8 years (4·8-7·4) for 10% uptake. Median decrease in ceftriaxone consumption for high doxycycline PEP uptake levels compared with baseline ranged from 41·7% (27·0-54·3) for 50% uptake to 50·2% (29·3-62·7) for 90% uptake at 5 years, but dropped to 11·8% (6·9-32·0) for 50% uptake and 12·1% (7·0-41·6) for 90% uptake after 20 years., Interpretation: Notwithstanding the clear benefits of doxycycline PEP for other sexually transmitted infections, for N gonorrhoeae, model findings suggest that doxycycline PEP is an effective but impermanent solution for reducing infection burden, given eventual selection for resistant strains. This finding presents a challenge for policy makers considering strategies for doxycycline PEP implementation and oversight: the need to balance the clear, short-term clinical benefits with the risk of harm via antimicrobial resistance., Funding: US Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases., Competing Interests: Declaration of interests YHG has received consulting fees from GSK outside the scope of this work. ER is an employee of Analysis Group, outside the scope of this work., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Black gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by HIV and STIs. Safe Spaces 4 Sexual Health (SS4SH), a community-informed, status-neutral HIV/STI testing intervention combines online outreach via geo-social networking apps and social media with mobile van testing. During 2018-2019, we recruited 25 participants for interviews about their perceptions of SS4SH compared to clinic-based testing. Participants were aged 21-65 years (mean 35); 22 (88%) identified as Black/African American; 20 (80%) identified as gay; and 10 (40%) were living with HIV. Interviews were transcribed, coded, and analyzed using a modified thematic constant comparative approach. Five themes emerged; two related to perceptions of online outreach materials (participants were drawn to eye-catching and to-the-point messages and desired more diversity and representation in messages), and three related to preference for the mobile van (participants found SS4SH provided more comfort, more privacy/confidentiality, and increased accessibility and efficiency). GBM is increasingly using geo-social networking apps to meet sexual partners, and tailored online outreach has the potential to reach historically underserved populations. SS4SH is a barrier-reducing strategy that may serve as an entry to a status-neutral approach to services and help reduce stigma and normalize accessing HIV services.

Background: Consistent use of sexually transmitted infection (STI) prevention methods is proven to decrease transmission of STIs. However, rates continue to rise within the United States, particularly among high-risk populations. Women experiencing homelessness may face barriers to access reproductive health care. This quality improvement initiative sought to examine perceived barriers to STI prevention and opportunities for expanding STI prevention services and education for women experiencing homelessness., Methods: Surveys were administered during a 1-day health event in August 2023 at a clinic that predominately serves persons experiencing homelessness in North Texas. Respondents included adult, nonpregnant, English-speaking individuals assigned female at birth with a history of homelessness. Demographic characteristics, sexual history, participants' knowledge of STIs, and perceived barriers to obtaining sexual health care were gathered. Participants had the opportunity to suggest methods for improving access to STI care., Results: Among participants (n = 36), more than half (59%) were tested for STIs within the past year. Most preferred condoms for STI prevention. The average knowledge score among questions about STI transmission and methods of prevention was 65%, with the lowest scores observed among trichomoniasis (39% correct), preexposure prophylaxis (31%), and dental dams (25%). Common barriers included cost (33%) and side effects (33%). One-third (36%) of participants reported no barriers to the use of prevention products., Conclusions: Findings highlight the need for educational opportunities among this population to increase knowledge of STI transmission and prevention. Patients may benefit from clinicians emphasizing education and increasing the visibility of services., Competing Interests: Conflict of Interest and Sources of Funding: The authors have no conflict of interest to disclose. E.L.T. is a past speaker for GSK and a consultant with Merck Pharmaceuticals for work unrelated to this article. The authors have no funding to disclose., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

Abstract: The San Francisco Department of Public Health was the first to issue guidance on the use of doxycycline for postexposure prophylaxis against sexually transmitted infections in at-risk populations. We investigated the association between the issuance of these guidelines and rates of male rectal chlamydia, male rectal gonorrhea, and adult male syphilis., Competing Interests: Conflict of Interest and Sources of Funding: This study was supported by a grant (R01 AI155217) from the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health. The authors have no financial disclosures or conflicts of interest to report., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)

Objectives: Mpox continues to spread in China, and stakeholders' experiences may help inform prevention and control strategies., Study Design: Qualitative study., Methods: A qualitative study across 14 Chinese cities recruited stakeholders from Centers for Disease Control and Prevention (CDCs), community-based organizations (CBOs), and hospitals involved in curbing mpox. Semi-structured interviews were conducted by telephone and analyzed using Colaizzi's phenomenological method., Results: 15 CBOs workers, 14 CDCs staff, and 13 healthcare workers were recruited. Three theme categories were identified: "Efforts to curb mpox epidemic", including CDCs' epidemic management and health education, hospitals' diagnosis, treatment, and care, CBOs' counseling, publicity, and referrals. "Challenges to curb mpox epidemic", including negative impacts of hospital-based quarantine, lack of specific antiviral drugs, gay identity disclosure concerns, psychological problems, contact tracing difficulties, and inadequate communication and collaboration. "Recommendations for curbing mpox epidemic", including prioritizing supervised home-based quarantine, incorporating HIV-related indicators into hospital quarantine criteria, reducing the cost of hospital quarantine, accelerating the development of vaccines and drugs, enhancing patient privacy protection, psychological training for stakeholders, establishing a task force that comprises personnel who are experienced in contact tracing and strengthening communication and collaboration., Conclusions: Effective control of mpox spread requires strengthening collaboration with CBOs and community healthcare centers (CHCs) and working out a flexible and contextualized mechanism. It also needs to reinforce patient privacy protection and integrate stigma reduction into strategies. Additionally, it is important to include HIV-related indicators in the quarantine evaluation and provide psychological training for stakeholders to help them manage their mental health and improve counseling skills., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa., Methods: A search for studies published in PubMed, Embase, and Psych Info by March 2023 was done. Studies involving EmA (18-25 years), conducted in Africa, and reporting 1 or more of 7 SBs were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socioecological model., Results: Overall, 143 studies were analyzed. Noncondom use had the highest pooled prevalence (47% [95% confidence interval {CI}, 42-51]), followed by study-defined SB (37% [95% CI, 25%-50%]) and concurrency (37% [95% CI, 21%-54%]), multiple sex partners (31% [95% CI, 25%-37%]), younger age at sexual debut (26% [95% CI, 20%-32%]), age-disparate relationships (24% [95% CI, 17%-32%]), and transactional sex (19% [95% CI, 13%-26%]). Heterogeneity was partially explained by sex, with female participants having higher pooled prevalence estimates compared with their male counterparts. In 4 of the 7 outcomes, alcohol/drug use was the most common risk factor., Conclusions: Sexual behavior was common among EmA and differentially higher in emerging female adults. Noncondom use had the highest pooled prevalence, which may contribute to the transmission of HIV and other sexually transmitted infections. Interventions targeting emerging female adults and alcohol/drug use may reduce SB, which may in turn mitigate transmission of HIV and other sexually transmitted infections among EmA in Africa., Competing Interests: Conflict of interest: None declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)

Background: Up until recently, monkeypox (mpox) was considered to be a rare zoonotic infection restricted to Central and West Africa. However, in July 2022, the World Health Organization declared mpox to be a public health emergency of international concern, after there were several outbreaks in non-endemic countries. This study assessed the information channels used by individuals accessing the "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" of Istituto Superiore di Sanità (National Institute of Health in Italy) with regard to mpox. We also evaluated their awareness, and knowledge about mpox focusing on transmission and prevention., Methods: This is a cross-sectional study conducted on "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" users, between January and April 2023. The target population was helpline users who were older than 18 years of age, and were phoning the service for the first time (i.e. who have not phoned in the last 12 months). Participants were interviewed using a questionnaire containing 19 questions filled by the interviewer. Collected data were analysed through descriptive statistics, and significance testing., Results: From January to April 2023, "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" received 2,389 phone calls, 216 of which participated in this study. Most of these were male (85.2%; n=186), single (79.2%; n=171) and in employment (72.2%; n=156). Awareness about mpox was high (71.3%; n=154), with the central and south/islands regional areas having the highest percentage of participants who heard about the virus (84.3%; n=43 vs 72.4%; n=42; p=0.078). Television was the most frequently mentioned source of information about mpox by participants (63%; n=97; p<0.001). This medium was also the most preferred source of information about mpox (39%; n=60; p=0.109). The majority of participants stated that they did not know what mpox is (67.6%; n=146), and less than half knew that it is preventable (42.4%; n=89). Of those who stated that mpox is a preventable illness, less than half knew about the existence of a vaccine (44.9%; n=40; p<0.001)., Conclusions: This study provides insights into the awareness, knowledge, prevention tools and information channels of individuals who contacted the "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse". Useful indications for defining future information campaigns were obtained.

This position statement is aimed at front-line clinical practitioners and public health authorities in WHO European Region providing services for people wishing to reduce their risk of acquiring sexually transmitted infections (STIs), including HIV., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In the 4 largest cities in the Netherlands, an estimated 400 people live with undiagnosed HIV, including 170 in Amsterdam. Amsterdam targets having zero new HIV infections in 2026. Undocumented migrants are disproportionately affected by HIV and often contract HIV after migration. Moreover, they often experience difficulties accessing health care. The aim of this study was to analyze the outcomes of an HIV/sexually transmitted infection testing program for undocumented migrants through community based testing., Methods: Between May 2021 and January 2022, data for this cross-sectional study were collected during outreach testing activities of the Amsterdam Center for Sexual Health of the Public Health Service, and the NGO Doctors of the World. Activities were organized in collaboration with migrant partner organizations. Participants were tested free-of-charge for HIV, syphilis, gonorrhea, chlamydia, and, if indicated, hepatitis B and C. Before testing, a health care provider-administered questionnaire was filled out., Results: A total of 126 people from 22 countries were tested for HIV during 28 outreach activities. Mean age was 37 (IQR 32-43). Forty-nine people (39%) were additionally tested, (through self-sampling) for chlamydia, gonorrhea and syphilis, 42 (33%) for Hepatitis B and 14 (11%) for Hepatitis C. We found zero new HIV infections and 5 positive chlamydia cases.Reaching 52 HIV first time testers and 19 first time testers since migration shows the importance of these activities. The number of participants tested were lower than initially expected due to lower attendance per testing day for various reasons., Conclusions: To increase the likelihood of reaching undocumented migrants for HIV/sexually transmitted infection testing and linkage to care, focus should be on on-site provider-initiated testing, e.g. during outreach health care activities, and on easy access to centers for sexual health. Collaboration between health care providers and community stakeholders is essential., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

Objective: To evaluate the prevalence and characteristics of concurrent bacterial sexually transmitted infections (bSTIs) among individuals with mpox., Design: Prospective cohort study of participants aged 18 years or older with confirmed mpox conducted in Rio de Janeiro, Brazil. This cross-sectional analysis includes only participants who underwent bSTI testing at baseline between June 2022 and January 2024., Methods: Participants were offered testing for chlamydia/gonorrhea (NAAT, anorectal swabs) and syphilis (active diagnosis if VDRL ≥ 1/8). Baseline prevalence of bSTIs was calculated, and participant characteristics were described based on concomitant bSTI diagnosis (yes/no). Chi-squared/Fisher's tests were used for qualitative variables, and the Wilcoxon rank-sum test for quantitative variables., Results: Out of 634 enrolled participants, 538 (84.9%) were tested for STIs and included in this analysis, mostly cisgender men, aged 30-39 years with postsecondary education. Overall prevalence of concomitant bSTI was 37.3%, mainly syphilis, followed by chlamydia and gonorrhea. Half of the participants were living with HIV, and one third was on HIV pre-exposure prophylaxis. Concomitant bSTI diagnosis at the time of mpox assessment was associated with being aged 30-39 years, self-identifying as cisgender men, having HIV-positive status, reporting proctitis symptoms and reporting any STI in the past 12 months., Conclusions: Our data reveals a notable prevalence of concomitant bSTIs among participants with confirmed mpox at a prominent infectious diseases' referral center in Rio de Janeiro, Brazil. These findings underscore the importance of integrating mpox into the differential diagnosis of anogenital manifestations and the promotion of combination prevention strategies within sexual healthcare services., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Trans and non-binary people are often discriminated against. Discrimination has a negative impact on health and may affect sexual health and behavior. We explored the relationship between discrimination based on gender identity and the perceived ability to make decisions about their sex life to feel as protected as desired from HIV and sexually transmitted infections (STI) among trans and non-binary people in Germany. Secondarily, we assessed whether feeling unable of making HIV/STI-protected sex decisions was associated with behaviors related to increased HIV/STI risk., Methods: We conducted a cross-sectional study using data from the Sexual Health and HIV/STI in Trans and Non-Binary Communities (TASG) survey conducted online between March-July 2022 among trans and/or non-binary people aged 18 years and older living in Germany. We described the prevalence of frequent discrimination based on gender identity. We calculated prevalence ratios (PR) with 95% confidence intervals (95% CI) for the associations between frequent experienced discrimination based on gender identity and feeling unable of making HIV/STI-protected sex decisions, and between feeling unable of making HIV/STI-protected sex decisions and behaviors related to increased HIV/STI risk., Results: Among 3077 participants, 22% reported frequent discrimination based on gender identity. Participants experiencing such discrimination reported 1.4 times more often to feel unable to make HIV/STI-protected sex decisions (PR 1.4, 95% CI 1.1-1.8). This perceived inability was associated with increased prevalence of sex under drug influence (PR 2.9, 95% CI 2.3-3.7) and condomless penetrative sex with multiple partners without PrEP (PR 2.0, 95% CI 1.4-2.9)., Conclusion: Feeling unable to make decisions to feel protected from HIV/STI among trans and non-binary people was associated with both frequent discrimination and behaviors that increase the HIV/STI risk. Strategies for empowering trans and non-binary people to assert their sexual decision-making needs should be explored., (© 2024. The Author(s).)

Objective: HIV can be effectively prevented by oral HIV pre-exposure prophylaxis (PrEP). When PrEP was introduced, there was apprehension that condom use would decrease and STIs would increase. The purpose of this study was to investigate sexual behaviour and STI incidence among PrEP users., Design: Prospective cohort study METHODS: The Amsterdam PrEP demonstration project (AMPrEP) provided oral PrEP to men who have sex with men (MSM) and transgender women from 2015 to 2020. Participants could choose between daily and event-driven PrEP. We tested for HIV and STIs at each quarterly study visit. We examined changes in numbers of sex partners and frequency of condomless anal sex with casual partners (CAS) with negative binomial regression. We examined HIV incidence, and changes in STI incidence using Poisson regression., Results: 367 participants (365 MSM) initiated PrEP, median duration of participation was 3.9 years (interquartile range[IQR]=3.4-4.0). Median number of sex partners per three months was 13 (IQR=6-26) and decreased with each additional year on PrEP (adjusted rate ratio[aRR]=0.86/year, 95%confidence interval[CI]=0.83-0.88). Frequency of CAS per three months was 10 (IQR=3-20.5) and also decreased (aRR=0.92/year, 95%CI=0.88-0.97). Incidence of any STI was 87/100PY (95%CI=82-92) and did not increase over time. Two HIV infections were diagnosed (incidence=0.2/100PY; 95%CI=0.0-0.6), both during the first year and among daily PrEP users., Conclusions: In this prospective cohort with an observation period of four years, we observed a low HIV incidence and a decrease in the number of sex partners and CAS over time. Although STI incidence was high, it did not increase.

Objectives: Sexually transmitted infections (STIs) have markedly increased over the last decade in Spain, calling for prevention and control innovative approaches. While there is evidence indicating the effectiveness of self-sampling for STI diagnosis, no kits for this purpose have been authorised in Spain., Methods: A prospective single-blind cross-sectional study carried out between November and December 2022 in an STI clinic in Madrid, Spain, to determine the validity, feasibility and acceptability of self-sampling kits used by non-healthcare professionals from vagina, pharynx, rectum and urethra to diagnose Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Self-samples were compared with samples collected by healthcare professional (HC samples) and analysed by PCR. Frequency of CT and NG diagnosis by sample type was compared using McNemar's test for paired data. Sensitivity and specificity of self-samples for CT and NG diagnosis were also calculated., Results: 306 self-samples from 51 participants were analysed. 80% were men with median age of 33 (IQR: 28-38) years. Self-samples and HC samples showed no significant statistical differences in CT and NG diagnosis. Self-samples had a sensitivity of 81% for CT and 93% for NG, with a specificity of 97% for CT and 95% for NG. More than 90% of participants had no difficulty understanding the kit instructions and 71% expressed high levels of satisfaction with the self-sampling kit., Conclusion: Self-sampling kits for CT and NG diagnosis can be safely and effectively used by non-healthcare professionals in Spain. National strategies for STI prevention and control should prioritise self-sampling strategies., Competing Interests: Competing interests: This study is the result of an agreement between the Spanish Ministry of Health of Spain, the City Council of Madrid and Deltalab Group. Deltalab Group was responsible for the development and provision of the self-sampling kits used in this study., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of this research was to examine the effect of teach-back method-based training provided to reproductive-age women to protect them from sexually transmitted diseases (STDs) on their protective behaviors. Sexually transmitted diseases cause significant health problems for many women every year. The transmission of sexually transmitted diseases can be prevented through health education, which is among the preventive health services. Nurses are the leading health educators. Nurses should learn new education systems and models and use them in their practice. This study has a randomized controlled design. The teach-back method and face-to-face training were provided to women of reproductive age experimentally for protection from sexually transmitted diseases. In this research, the teach-back method in which there were 42 participants in each group, an identifying information form for women in three groups who were provided face-to-face training and not trained, the Behavioral Scale for Protection from Sexually Transmitted Diseases were applied pre-training, fifteen days and three months after the training. Participants' socio-demographic data in the intervention and control groups were compared. The mean age of the teach-back group had been 30.64 ± 5.73, the average age of the face-to-face group had been 29.83 ± 5.49, and the mean age of the non-trained group had been 28.16 ± 5.09. These groups had displayed similar characteristics. The mean score of the Behavioral Scale for Protection from Sexually Transmitted Diseases was found to be 75.57 ± 12.78 pre-training, 82.54 ± 9.59 fifteen days after the training and 81.85 ± 9.28 three months after the training in women who were trained with the teach-back method; 76.92 ± 10.03 pre-training, 80.78 ± 8.72 fifteen days after the training and 80.21 ± 8.77 three months after the training in women who received face-to-face training, while it was found in women who did not receive face-to-face training to be 75.73 ± 6.14 pre-training, 75.61 ± 6.01 fifteen days after the training and 75.54 ± 6.09 three months after the training and there was a statistically significant relationship between them (F = 6.736; p < 0.001). As a result of the research, it was found that the training provided to women with the teach-back method had a positive effect on women's behaviors and was more effective than face-to-face training., (© 2024. The Author(s).)

Background: For a variety of reasons related to biology, behaviour, and environment, a subset of a population known as female sex workers (FSWs) or female transactional sex workers is at increased risk of health, depression, social stigma and access to timely and quality healthcare when needed. In low- and middle-income countries (LMICs), there was lack of understanding regarding the experiences and healthcare utilisation and behaviours, the health burden among them, their experiences, and how they access health care. Using Anderson's behavioural model of health service utilisation as a framework, this review aimed to explore the experiences of, and healthcare seeking behaviours of female sex workers in low-and middle-income countries., Methods: Six relevant databases such as PubMed, Embase, Global Health, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed research articles published between January 1990 and December 2023 that discussed female transactional sex work in low- and middle-income countries. Subject terms such as: low-and middle- incomes, sex workers (female and male), sexually transmitted infections (STIs) in the sex work industry, prostitution, commercial sex, and health-seeking behaviour were used for the databases search. Out of 6,135 articles that were retrieved for the study, 26 met the inclusion criteria. Of the total number of studies, four were reviews, eight were quantitative studies, six were qualitative studies, and two utilised mixed methods., Findings: Results from a thematic analysis of studies that combined quantitative and qualitative methods yielded six overarching themes.The study found that women engaged in sex work for different reasons - to fend for themselves (i.e., livelihood), self-employment and others do it for pleasure. However, force sex or unprotected which can lead to sexually transmitted infections, sexual abuse, job insecurity, were critical risks factors in engaging in sex work. These factors make them vulnerable to predators and health risks. It was found that sex workers were aware of the importance of seeking healthcare, and do make the efforts, however, crucial factors such as difficulty accessing healthcare and maltreatment by healthcare providers and social stigma disincentivises FSW health-seeking behaviours. Sexual workers reported discomfort disclosing their occupations because of the stigma and discrimination which further affects their regular health examinations and obtaining medically approved condoms from healthcare facilities., Conclusion: Complex challenges rooted in economic vulnerability, social marginalisation, and limited access to healthcare afflict female sex workers in LMICs. The maltreatment and stigma can potentially affect LMICs from achieving using health facility care, with potential implications on achieving the universal health coverage goals. Comprehensive, rights-based strategies that address structural injustices and empower these women to live healthier, more secure lives are necessary to address their special needs., (© 2024. The Author(s).)

The prevention and control of human immunodeficiency virus and sexually transmitted infections (HIV/STI) face challenges worldwide, especially in China. Prediction tools, which analyze medical data and information to make future predictions, were once mainly used in HIV/STI research to help make diagnostic or prognostic decisions, has have now extended to the public as a freely accessible tool. This article provides an overview of the different roles of prediction tools in preventing and controlling HIV/STI from the perspectives of individuals, healthcare providers, and policymakers. For individuals, prediction tools serve as a risk assessment solution that assess their risk and consciously improve risk reception or change risky behaviors. For researchers, prediction tools are powerful for assisting in identifying risk factors and predicting patients' infection risk, which can inform timely and accurate intervention planning in the future. In order to achieve the best performance, current research increasingly underscores the necessity of considering multiple levels of information, such as socio-behavioral data, in developing a robust prediction tool. In addition, it is also crucial to conduct trials in clinical settings to validate the effectiveness of prediction tools. Many studies only use theoretical parameters such as model accuracy to estimate its predictive. If these improvements are made, the application of prediction tools could be a potentially inspiring solution in the prevention and control of HIV/STI, and an opportunity for achieving the World Health Organization's agenda to end the HIV/STI epidemic by 2030., (© 2024. The Author(s).)

Background: Peer-delivered HIV self-testing (HIVST) and sexually transmitted infection self-sampling (STISS) may promote adherence to oral pre-exposure prophylaxis (PrEP), but no studies have analyzed this approach among transgender women (TGW) in sub-Saharan Africa., Setting: The Peer study was a cluster randomized trial in Uganda (October 2020-July 2022; NCT04328025)., Methods: Ten TGW peer groups, each with 1 TGW peer and 8 TGW, were randomized 1:1 to receive quarterly in-clinic HIV testing with PrEP refills as standard-of-care (SOC) or SOC plus monthly peer delivery of oral-fluid HIVST, STISS, and PrEP refills (intervention). Participants were followed for 12 months. The primary outcome was PrEP adherence., Results: We screened 85 TGW and enrolled 82 (41 per arm). The median age was 22 years (interquartile range [IQR] 20-24). Twelve-month retention was 88% (72/82). At the 3, 6, 9, and 12-month clinic visits, 10%, 5%, 5%, and 0% of TGW in the intervention arm had TFV-DP levels ≥700 fmol/punch, versus 7%, 15%, 7%, and 2% in the SOC arm, respectively (P = 0.18). At all visits, any detectable TFV-DP levels were significantly higher in SOC than the peer delivery group (P < 0.04). PrEP adherence was associated with sex work (incidence rate ratio 6.93; 95% CI: 2.33 to 20.60) and >10 years of schooling (incidence rate ratio 2.35; 95% CI: 1.14 to 4.84). There was a strong correlation between tenofovir detection in dried blood spots and urine (P < 0.001). No HIV seroconversions occurred., Conclusions: Peer-delivered HIVST and STISS did not increase low levels of oral PrEP adherence among TGW in Uganda. Long-acting PrEP formulations should be considered for this population., Competing Interests: The research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Grant Number R34MH121084 to A.M. A.M. received research funding outside the submitted work from Gilead Sciences, Inc. J.E.H. is a consultant for Merck. None of the remaining authors declared any conflict of interest. The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Competing Interests: We declare no competing interests.

CHOICES-TEEN is a bundled intervention aimed at reducing the risks of unintended pregnancy, sexually transmitted infections, and alcohol- and tobacco-exposed pregnancies for adolescent girls involved in the juvenile justice system. We examined youths' ( N = 22) elicited pros and cons concerning alcohol, tobacco, condom, and contraception use to inform future iterations of CHOICES-TEEN and other prevention programming during a one-arm pilot study. Content analysis was used to identify recurring themes elicited and recorded during a decisional balance exercise with a counselor. The most recurrent pros and cons were factors that directly affected these adolescents, with more immediate consequences. The results provide insight into motivations for engaging in substance use and risky sexual behaviors for these youth, as well as barriers to change.

Background: Gay, bisexual, and other men who have sex with men (GBMSM) face a disproportionate burden of sexually transmitted infections and are eligible for targeted vaccinations for hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV) and mpox. This study examines the sociodemographic characteristics, sexual behaviours, and sexual healthcare service (SHS) use associated with vaccination uptake., Methods: We undertook analyses of RiiSH-Mpox - an online, community-based survey with GBMSM recruited via social media and dating apps. We calculated vaccination uptake (≥1 dose) among eligible GBMSM. Bivariate and multivariable logistic regression was performed to identify factors independently associated with vaccination uptake among eligible participants., Results: Reported uptake in eligible GBMSM was around two-thirds for each of the vaccinations considered: mpox 69% (95% confidence interval (CI): 66%-72%), HAV 68% (CI:65%-70%), HBV 72% (CI:69%-74%) and HPV 65% (CI:61%-68%). Vaccination course completion (receiving all recommended doses) ranged from 75% (HBV) to 89% (HAV) among eligible GBMSM. Individuals who represented missed opportunities for vaccination ranged from 22 to 30% of eligible SHS attendees. Younger participants, individuals identifying as bisexual, reporting lower educational qualifications, or being unemployed reported lower uptake across multiple GBMSM-selective vaccinations. Individuals who reported greater levels of sexual behaviour and recent SHS use were more likely to report vaccinations., Conclusion: Eligible participants reported high uptake of vaccinations; however, uptake was lower amongst young GBMSM and self-identifying bisexual men. Awareness of groups with lower vaccination uptake will help inform practice, delivery strategies and health promotion, to improve the reach and impact of vaccinations amongst GBMSM., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: DLW was supported by Balvi Filantropic Fund, Barry Satz and Ronald Satz Memorial Fund and Chulalongkorn University (Second Century Fund- C2F Postdoctoral Fellowship), University of Western Australia (Overseas Research Experience Fellowship) and Yamagata Prefectural Central Hospital, Yamagata, Japan (Clinical Residency Fellowship). CM was supported by the Centre of Excellence in Mathematics, Ministry of Higher Education, Science, Research and Innovation, Thailand, Center of Excellence on Medical Biotechnology, and Thailand Center of Excellence in Physics. AKi is a Rothwell Family Fellow. The funder(s) had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. All other authors declare no competing interests. The data supporting the findings of this study are available within this paper and its additional information. All genome sequences and associated metadata in this study are published in GISAID's EpiCoV database under the mpox category (accession numbers are given in the appendix). The institutional review board at Yamagata Prefectural Central Hospital, Yamagata, Japan, waived ethical approval for this work as it determined that our project is exempt under the type of environmental surveillance study. We, the authors of this paper, embrace inclusive, diverse, and equitable conduct of research. Our team comprises individuals who self-identify as underrepresented ethnic minorities, gender minorities, members of the LGBTQIA+ community, and individuals living with disabilities. We actively promote gender balance in our reference list while maintaining scientific relevance. We thank all the volunteers, entertainment venue staff, and sanitary workers who kindly supported the sample collection. Also, thanks to the United States Centers for Disease Control and Prevention (CDC) Thailand for technical support and the previous Chargé d'Affaires of the United States of America to Thailand (U.S. Embassy & Consulate in Thailand) for facilitating collaboration with the CDC and Armed Forces Research Institute of Medical Sciences. We also thank the LGBTQIA+ community in Indonesia, Madagascar, Myanmar, Thailand, Papua New Guinea, Mozambique, Pakistan, Viet Nam, Sri Lanka, India, Philippines, Cambodia, Laos, Timor-Leste, Nepal, Maldives for generously supporting sample collection, TEDxChiangMai team for facilitating a platform for collaboration, and marginalised, vulnerable indigenous communities in Indonesia, Madagascar, Myanmar, Thailand, Papua New Guinea, Mozambique, Pakistan, Viet Nam, Sri Lanka, India, the Philippines, Cambodia, Laos, Timor-Leste, Nepal, and the Maldives for supporting sample collection. Special thanks to Nuttawut Kietchaiyakorn for helping with the illustrations. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps.

Competing Interests: Conflict of Interest and Sources of Funding: The authors declare no conflicts of interest. Support for this work comes from funding provided to C.E.C. from the National Institute of Allergy and Infectious Diseases (R37AI051334 and U19AI144133) and Open Philanthropy, and a Developmental Research Project Award from U19AI144133 awarded to M.C.G.

Purpose of Review: There are high rates of sexually transmitted infections (STIs) worldwide. Adolescents and young adults (AYA) ages 15-24 years remain one of the populations that is most vulnerable to STIs. The goal of this review is to summarize recent international updates in adolescent STI screening and treatment., Recent Findings: Normalizing sexual history taking and STI testing, and advocating for adolescents to receive comprehensive sexuality education improves stigma surrounding sexual health. The global rise in syphilis is pervasive and includes high rates of infection among AYA and women of reproductive age - universal screening may be indicated depending on local epidemiology. Gonococcal antimicrobial resistance remains a significant public health concern worldwide, thus judicious use of antimicrobials and reporting cases of resistance is crucial. Sexual health services are increasingly using virtual platforms, which may be an effective strategy for STI testing and treatment among AYA., Summary: Specific areas of focus to address the STI epidemic among AYA include reducing stigma surrounding sexual health, screening, and treatment of STIs, especially with the global rise in syphilis and high rates of gonorrhea resistance, in addition to increased use of telehealth services as effective education and intervention strategies., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Human immunodeficiency virus pre-exposure prophylaxis (PrEP) is considered as an effective protection against a human immunodeficiency virus (HIV) infection. However, it is still unclear, how PrEP use is associated with the incidence of sexually transmitted infections (STI) other than HIV. PrEP became reimbursable in Germany from September 1, 2019 for persons with statutory health insurance (SHI). With the EvE-PrEP study, the Federal Ministry of Health commissioned the evaluation of the effects of the new reimbursement situation in Germany. In the presented module of the EvE-PrEP study, routine data from three large German SHI funds were analyzed in anonymized form for the period January 1, 2019 to March 31, 2020. Data were analyzed regarding: Characteristics and adherence of PrEP users, treatment success of PrEP, and changes in STI incidence rates before and since PrEP use. The cooperating SHI funds collectively covered about 52% of the overall population in Germany in 2019. A total of 7102 persons with PrEP use were included into the analysis. These were predominantly male (99%), on average 37.4 years old and a high proportion of persons lived in large cities. The average quotient of PrEP daily defined doses and assumed days on PrEP was 87%. The average STI rates normalized per 100 person-years at individual level pre PrEP did not statistically significant differ compared to since PrEP (chlamydia: 17.5 vs. 17.6, gonococcal infection: 29.1 vs. 30.7, and syphilis: 14.6 vs.13.6). A large data set was used to evaluate the introduction of PrEP as a SHI benefit in Germany. A potentially suspected increase in bacterial STI incidence rates was not found. A rather high average adherence rate was observed. The very high proportion of men and people from the largest German cities among PrEP users is striking. These results could indicate barriers to PrEP access for people at risk of HIV, especially if they are women or people living in less urban areas., (© 2024. The Author(s).)

Introduction: Male contraception includes various methods designed to prevent pregnancy by focusing on the male's role in reproduction., Results: Behavioral methods, such as withdrawal and periodic abstinence, offer non-invasive alternatives that require self-control and precise timing to avoid depositing sperm in the female reproductive tract during fertile periods. However, these methods generally have low effectiveness and rely heavily on user adherence and experience. The male condom, a barrier method, provides both contraception and protection against sexually transmitted infections. Its effectiveness relies on correct and consistent use., Discussion: Access to comprehensive sexual education and medical counseling is essential to dispel the stigma surrounding contraceptive use and correct misconceptions, ensuring proper usage and ultimately contributing to better reproductive health outcomes., (© 2024 American Society of Andrology and European Academy of Andrology.)

Background: Healthcare workers have a fundamental role in providing care and education on sexually transmitted infections (STIs). However, their knowledge is often worryingly limited. This study aimed to assess the real knowledge and attitude regarding STIs among healthcare workers of the IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Methods: The recruited subjects were asked to complete a 31-item questionnaire, divided into 3 sections: socio-demographic context, knowledge about STIs, and personal sexual behavior., Results: We enrolled 140 subjects, employed as nurses (52.9%), physicians (12.9%), laboratory technicians (7.1%), or other workers (27.1%). Despite the generalized erroneous belief of having a good level of knowledge on the matter, only one-third of the subjects could correctly identify STIs among a list of diseases, and less than one-third correctly recognize all possible ways of transmission. Human immunodeficiency virus (HIV) was the most frequently recognized STI (97%), but only 39.2% of healthcare workers were correctly informed about the body fluids that can transmit the virus. Most participants (93.5%) correctly identified condoms as effective in preventing STIs but did not indicate complete abstinence as the only way to guarantee protection against STIs. Most participants were informed on the oncogenic potential of human papillomavirus (HPV) infections (82%), the usefulness of the Pap test (85.7%), and the existence of vaccines against some STIs (63.5%)., Conclusions: Overall, healthcare workers have limited knowledge about STIs. Creating specific educational programs aimed at healthcare providers should become a priority.