Venereology

Background: Hepatitis C virus (HCV) infection presents a significant public health challenge globally, particularly in high-burden countries like Nigeria, where an estimated 2.4 million individuals are living with HCV. HCV self-testing (HCVST) can potentially bridge the significant diagnosis gap and help individuals to determine their HCV status in the privacy of their homes. It offers a solution to overcome barriers related to stigma and limited access to healthcare. In Nigeria, Self-testing for hepatitis C has only been implemented in a pilot research context. This study aimed to assess stakeholder and community awareness and perceptions of HCVST in Nigeria. The findings will provide insights that could inform effective policies and future scale-up programs for HCV control. Methods: A cross-sectional descriptive study was conducted using an online social media survey administered through SurveyMonkey. The survey was disseminated across social media platforms and groups between October–November 2023. Participants included Nigerians (both health professionals and non-health professionals) aged 18 years or older residing in any of the 36 states and the Federal Capital Territory (FCT). Data collected include sociodemographic characteristics, awareness and perceptions of HCVST, and perceived benefits and barriers. Results: Of 321 respondents, 94% perceived HCVST as highly important. While 77% of respondents knew about HIVST, only 58% had prior knowledge of HCVST. The analysis also showed that healthcare workers had greater awareness of HIV self-testing (82.3%) compared to non-healthcare workers (50.0%). Most respondents (88%) were highly likely to recommend HCVST and perceived it as a cost-effective alternative to traditional testing. Key perceived benefits included increased disease detection and control (67%), improved access to testing (21%), and reduced stigma (11%). In the unadjusted model, geographical zone (Southern Nigeria: cOR = 0.49, 95% CI: 0.30–0.77, p = 0.002), work experience (more than 20 years: cOR = 2.79, 95% CI: 1.11–8.07, p = 0.039), and prior awareness of HIV self-testing (cOR = 5.24, 95% CI: 3.00–9.43, p < 0.001) were significant predictors of HCVST awareness. However, in the adjusted model, only prior awareness of HIV self-testing remained significant (aOR = 4.77, 95% CI: 2.62–8.94, p < 0.001). Conclusions: The strong support for HCVST among stakeholders in Nigeria highlights its potential to enhance HCV control, especially within the broader context of infectious diseases like STIs. The greater awareness of HIV self-testing among healthcare workers compared to non-healthcare workers indicates the need for targeted awareness campaigns for non-healthcare populations. Addressing these awareness gaps, leveraging lessons from HIVST, and using existing infrastructure will be crucial. Prioritizing public education, outreach, and effective linkage to care will drive the impact of HCVST in achieving HCV elimination goals and position it as a model for expanding similar STI interventions in Nigeria. Full article

Extensive research on tuberculosis (TB) and HIV co-infection reveals the diverse prevalence and co-epidemic patterns across populations, necessitating tailored public health strategies. Co-infection is bidirectional; individuals with HIV are more susceptible to TB, and vice versa. Antiretroviral therapy (ART) and antituberculosis treatment (ATT) are critical for managing these conditions, but pose risks due to drug–pathogen and drug–drug interactions, potentially leading to immune reconstitution inflammatory syndrome (IRIS) in patients with HIV/AIDS. IRIS, often triggered by highly active antiretroviral therapy (HAART), can exacerbate HIV progression, increase drug resistance, and deteriorate patients’ quality of life. Approximately one-third of the global population with HIV is also infected with TB, with extensive drug-resistant (XDR) and multidrug-resistant (MDR) strains posing significant challenges. Latent TB infection (LTBI) further complicates the scenario, as it can progress to active TB, particularly in individuals with both conditions. The global and Indian mortality rates for TB-HIV co-infection remain high, emphasizing the need for new strategies. Additionally, unreported cases and inadequate post-treatment monitoring contribute to the high mortality rate, particularly among patients with LTBI. The complexity of managing HIV-TB co-infection, especially with LTBI, underscores the urgency of addressing these challenges to improve the outcomes for the affected populations. Full article

The prevalence of transfusion-transmissible infections (TTIs) among blood donors is critical for ensuring blood safety. Aim: To provide an updated assessment of TTIs at a tertiary care hospital in Mexico over a ten-year period. We conducted a retrospective cross-sectional study. Blood samples were analyzed from potential donors at tertiary care hospital between 2012 and 2022. Donors completed a questionnaire and were screened for HIV, syphilis, hepatitis B, and hepatitis C using nucleic acid testing and serological tests. Prevalence and trends were estimated. Among the 117,756 donors analyzed, 0.48% were positive for syphilis, with a significant annual decrease of −5.9% (p < 0.001), although notable fluctuations occurred, including a peak in 2021. HIV showed a significant annual increase of 9.8% (p = 0.029), with a peak in approximately 2019–2020. Hepatitis C maintained a stable trend, with a slight annual decrease of −5.6% (p = 0.170). Hepatitis B consistently decreased, with an annual decrease of −11.3% (p = 0.06). This study highlights the importance of continuous monitoring and screening of blood donors to ensure blood safety. These findings underscore the need for localized public health interventions, particularly to address the increasing incidence of HIV. Further research should focus on enhancing donor screening practices and public health strategies to reduce the prevalence of TTIs. Full article

Background: The sexual transmissibility of enteric pathogens, including Salmonella spp., has been described in men who have sex with men (MSM). However, the factors seen in MSM with Salmonella spp. are poorly understood. Method: We aimed to systematically review the literature to explore any factors seen in MSM with Salmonella spp. (MSM). We searched six databases—Medline, PubMed, CINAHL, Embase, Emcare, and Global Health—in April 2024 for manuscripts which contained primary peer-reviewed data in English and the measurement of any risk factors observed in MSM with Salmonella spp. This review was registered on PROSPERO (CRD42023472864). Results: Eleven manuscripts were included in the final review and highlighted demographic (living with HIV), behavioural (oral–anal sex, receptive and penetrative anal sex, hand licking to stimulate their partner, group sex, non-condom use), and biological (co-infection with CMV, Mycobacterium avium complex, Strongyloides stercoralis, Blastocystis hominis, Klebsiella spp. Herpes simplex virus, Cytomegalovirus, Cryptosporidium, Histoplasmosis, Shigella spp.; previous infection with Treponema pallidum, Neisseria gonorhoeae, Chlamydia trachomatis and hepatitis B; and antimicrobial treatment failure) factors seen in MSM with Salmonella spp. Conclusion: Despite a limited number of manuscripts and individuals, this review highlighted some potential demographic, behavioural, and biological factors implicated in the transmission of Salmonella spp. in MSM. These data will provide insights for future guidelines, public health control strategies, and research. Full article

Background: Condoms have proven to be an effective contraceptive barrier method of family planning and have played a vital role in preventing sexually transmitted diseases including HIV. However, existing evidence shows that utilization of condoms remains low, especially among youth and adolescents. We aimed to determine the condom use rate and associated factors among the students of Gulu University in Uganda. Methods: A cross-sectional study was conducted among undergraduate students of Gulu University between June and December 2023. The students were accessed from their respective faculties and chosen using a simple random sampling method. Data were collected using a pretested self-administered structured questionnaire. Condom use was defined as use of either male or female condom in any sexual encounter within the previous six months. Results: A total of 404 participants, with a median age of 23 years (interquartile range (21.5–24) years) were enrolled in this study, 54.2% (n = 219) of whom were men. The response rate of the respondents was 94.1%. Overall, 81.4% (n = 329) of the participants were in senior classes (year 2, 3, 4, and 5), and 18.6% (n = 75) were in their first year of study. The condom use rate was 53.7% (n = 217). Condom use rate was 50.2% (n = 109) among male and 49.8% (n = 108) among female students. Sex (men) (aPR = 0.82, 95% CI = 0.71, 0.95, p = 0.01), nature of sexual relationship (married) (aPR = 1.4, 95% CI = 1.07, 1.85, p < 0.015), place of HIV testing (University health unit) (aPR =1.22, 95% CI = 1.06, 1.41, p = 0.005), and having sex in the absence of condoms (aPR = 1.22, 95% CI = 1.01, 1.46, p = 0.021) were significantly associated with consistent condom use. Conclusions: Just over half of undergraduate students of Gulu University used condoms in their sexual encounters in the past six months. There should be heightened campaigns on condom use to prevent unintended pregnancies and sexually transmitted infections. Full article

Living with chronic health conditions such as HIV has implications for health-related quality of life (HRQoL) and improving the HRQoL of people living with HIV (PLWH) is becoming increasingly important for researchers, policymakers, and health practitioners. However, there is limited research on factors that help to explain HRQoL among persons with HIV in sub-Saharan Africa. We examined the contributions of emotion regulation and self-compassion in the HRQoL of 187 PLWH (56.1% female) drawn from the HIV clinic in a specialist hospital in southeast Nigeria. They completed the Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18), Self-compassion Scale, and Patient-Reported Outcome Quality of Life-HIV (PROQOL-HIV). While controlling for participants’ demographic variables, the regression results showed that self-compassion was positively associated with HRQoL. Higher difficulties in emotion regulation were not associated with HRQoL in the presence of self-compassion. The findings extend the outcomes of previous research in other parts of the world and support the notion that enhancing self-compassion interventions may shore up the HRQoL of people living with chronic health conditions. HRQoL interventions that embody culturally informed self-compassion strategies and developmental level approach are needed for the health system in sub-Saharan Africa. Full article

Gardnerella vaginalis is a Gram-variable bacillus capable of causing bacterial vaginosis, a condition prevalent in reproductive-age women, this bacterium is present in almost 100% of cases and is also considered a gateway to various sexually transmitted infections. This organism exhibits high pathogenicity linked to virulence and resistance genes acquired throughout evolution, showcasing elevated resistance to a broad spectrum of drug classes. This study conducted comparative genomic analyses to identify these genes and correlate their presence with positive Darwinian selection. Additionally, new drug targets were selected through docking and molecular modeling, guided by the heightened antimicrobial resistance exhibited by this microbial species. The available genomes of G. vaginalis were analyzed, and the orthologous genes were delineated and positively selected, whereby 29 groups were found. Of these genes, one of great importance was predicted, Mef(A), which is related to resistance to the macrolide group of antibiotics, which are one of the main choices for the treatment of sexually transmitted infections. Additionally, two potential protein candidates were selected as drug targets. These proteins were linked with a natural compound each and are considered good potential drug targets. The analyses in this study contribute to analyzing the evolution of the species and how resistance genes are related to their permanence as a potential pathogen. Full article

Trichomonas vaginalis infection represents the most prevalent non-viral, curable parasitic sexually transmitted infection (STI) worldwide. The demand for precise and cost-effective point-of-care (POC) tests is paramount in the pursuit of STI epidemic control, ensuring expeditious patient diagnosis and therapeutic interventions. In the present study, we searched academic databases, including PubMed (US National Library of Medicine and the National Institutes of Health), Scopus, and Web of Science, employing the following keywords: “Trichomonas vaginalis”, “diagnosis”, “point-of-care tests”, and “rapid diagnosis”, to provide information about the development and effectiveness of POC tests to identify T. vaginalis. Present assays for T. vaginalis exhibit suboptimal performance, and the integration of advanced technologies, notably nanotechnologies, emerges as a formidable instrumentality for augmenting diagnostic precision while curtailing expenditure. In this review, we provide an encompassing survey of cutting-edge POC tests for T. vaginalis diagnosis and offer an outlook on future prospects in this domain. Full article

Introduction: The development of antiretroviral therapy (ART) has immensely improved the quality of life of people living with HIV/AIDS. Despite such a change, concerns continue to persist regarding the safety of the latest drugs added to the regimens. This study aims to evaluate the incidence of type 2 diabetes mellitus (T2DM) and weight gain in individuals receiving antiretroviral therapy containing dolutegravir at a general hospital in Addis Ababa, Ethiopia. Methods: A retrospective cohort study was conducted at RDDMH from 1 February to 30 March 2022. The study included PLHIV who had dolutegravir substituted into their combined regimen in November 2019. Collected data underwent cleaning, entry, and analysis using Statistical Package for Social Sciences (SPSS) v. 26.0 and R programing. Descriptive statistics were employed for univariate and bivariate analysis. The Kaplan–Meier model in R was used to illustrate the hazard function. A significance level of p < 0.05 and a 95% confidence interval were employed for statistical reporting. Results: The study followed 185 PLHIV who were on ART who either substituted their previous regimens or initiated a new dolutegravir-based regimen for 12 months. Most were females (59.5%), aged over 38 years (57.5%), married (50.8%), and had lived with HIV for 7 or more years (51.9%). The incidence proportion of T2DM in this sample was 7.0% (95% CI: 3.8–10.3). The age category (X²(1, N = 185) = 12.29, p < 0.001) exhibited a statistically significant relationship with the incidence of T2DM. The cumulative rate of T2DM in the age group over 38 years was approximately 15.4%. The pairwise Wilcoxon signed rank test revealed statistically significant differences in BMI scores between time points. Conclusion: This study observed a noteworthy incidence of T2DM among PLHIV receiving a dolutegravir-based first-line ART. Healthcare providers should prioritize early follow-up and management options for PLHIV who are on dolutegravir-based ART regimens. Full article

Congenital syphilis, a preventable and deadly disease, has witnessed an alarming resurgence in the US in recent years, posing a vital public health challenge. Historically, effective prevention and treatment strategies led to a decline in congenital syphilis, and some believed that it could be eradicated. However, inadequate prenatal care, limited access to healthcare services, and gaps in syphilis screening programs have led to a resurgence of congenital syphilis. In this narrative review, we aim to highlight the key factors contributing to the reemergence of congenital syphilis and its implications on maternal and child health. Full article

The burden of morbidity and mortality caused by sexually transmitted infections (STIs) has serious consequences on the quality of life of populations. Nowadays, despite numerous prevention campaigns, sexually transmitted infections have been on the rise in France for several years. It remains important to transmit the right information in order to better educate and support patients. Where then remains the problem, and how can we improve the involvement and awareness of the general population regarding the risks of these STIs? It is imperative to work upstream on the training of health professionals and students because they are the first interlocutors and the only ones to transmit the knowledge acquired during their initial training to the individuals concerned. The objective of this work is to identify the areas where health professionals and students do not yet have all the notions acquired via a multiple-choice questionnaire on the different STIs and their major characteristics. These results will contribute to the implementation of additional training at the Health Centers in France. Full article

Background: This study seeks to understand the empirical nature of macro-financial factors associated with the worsening of HIV infections and the risks that need to be carefully monitored for a sustainable improvement in HIV outcomes as developing countries seek to achieve the United Nations 95-95-95 targets. Methods: The author used a panel VAR model to study the long-term endogenous relationships between percentage changes in the annual spot price of the most traded commodities, GDP per capita, health spending, and the HIV infection rate of developing countries. Results: The author discovered that shocks of global commodity prices negatively impact GDP per capita, real government health spending, and real private health spending. These shocks have adverse spillover effects characterized by worsening HIV infections. The reactions from price shocks suggest that GDP per capita contract immediately when a commodity price shock hits developing economies. Real government health spending and real private health spending also contract instantly. HIV infections begin worsening three years after the shock in the energy and precious metal blocks of countries. HIV infections also begin to worsen two years after shocks in the agricultural block of counties. These impacts are statistically significant and can potentially reverse the positive HIV infection gains achieved in the previous years. Emergency funds, insurance schemes, and international aid for HIV need to discharge more funds to counter these shocks. Conclusions: There is a significant risk of reversing HIV infection outcomes arising from commodity price shocks. Funding agencies must protect HIV prevention services from global macro-economic shocks as countries move closer to the United Nations 95-95-95 targets. Full article

Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world. The estimated global prevalence in 2016 was 156 million adults aged 15–49. However, these data are underestimated, since the most used diagnostic method is the wet mount, which has low sensitivity, the information regarding the estimated duration of infection is limited and there is evidence of undiagnosed asymptomatic cases in both sexes. Currently 80% of cases—including both sexes—are asymptomatic, which makes the disease silent and chronic in course, leading to complications. The aim of this review was to discuss the diagnostic methods for T. vaginalis detection that are currently available and applicable in the clinical laboratory routine. Overall, nucleic acid amplification techniques are the best option for T. vaginalis detection, with higher sensitivity and specificity than other tests. Although these techniques present higher cost, their implementation should be supported to ensure correct trichomoniasis diagnosis and treatment beyond contributing to questions on epidemiology and control. Full article

The Arg753Gln polymorphism in Toll-like receptor 2 has been associated with an increased risk of bacterial infections as well as with protection from the late stages of Lyme disease and the acquisition of syphilis. In this study, we determined the presence of this polymorphism in samples collected from men having sex with men/men with women in the Amsterdam Cohort Studies. The presence of the polymorphism was determined by nested PCR, followed by Sanger sequencing. A set of 90 syphilis-seronegative individuals was compared to 95 syphilis-diagnosed participants. A polymorphism allele frequency of 3.9% was found in the control group and 2.63% in the syphilis case group, respectively. None of the individuals showed a homozygous Arg753Gln polymorphism. The number of self-reported sexual contacts was higher in the group of syphilis patients compared to the control group (p = 0.0063). Moreover, in the syphilis case group (n = 49), participants heterozygous for the TLR2-Arg753Gln reported higher numbers of sexual contacts (p = 0.037) compared to wild-type homozygotes. Our findings suggest a possible protective effect of TLR2-Arg753Gln in the acquisition of syphilis. In addition, the determination of the number of self-reported sexual contacts can be used in an evaluation of the protective effect of polymorphism in a population with a low prevalence of it. Full article

Women living in the semi-arid region of Caatinga in the northeast of Brazil report the use of plant mixtures to treat diseases in the genitourinary tract. Plant extracts were obtained from barks to simulate traditional use. The anti-trichomonads activity as well as the cytotoxic effect of plant extracts were tested. Herein, we confirmed this traditional knowledge by testing plants aqueous extracts against Trichomonas vaginalis and Tritrichomonas foetus, the etiologic agents of human and bovine trichomoniasis. All plant extracts were active individually against at least one trichomonads species except for Prosopis juliflora and Amburana cearensis. Cedrela sp. was the most active against both trichomonads species. Finally, a mixture of plants used in traditional medicine was evaluated for activity. A mixture containing extracts of the plants Ximenia americana, Anadenanthera colubrina var. cebil, Myracrodruon urundeuva, Sideroxylon obtusifolium, and Amburana cearensis was active against the two trichomonads. This finding confirms the traditional practice by women living in the Caatinga region of using a mixture of plants during sitz baths to treat vaginal infections. Altogether, these results highlight the ethnopharmacological use of Cedrela sp. and of the plant mixture for the treatment of venereal diseases by Caatinga residents. Full article

Background: Since the implementation of pre-exposure prophylaxis (PrEP) in HIV prevention, a significant increase in the prevalence of other sexually transmitted infections (STIs) has been reported, especially among men who have sex with men (MSM). Doxycycline is being examined as a potential pharmacological agent in preventing these infections. This review aims to summarize available data on the effectiveness and potential side effects of doxycycline for the prevention of bacterial STIs. Methods: We reviewed the National Library of Medicine and the National Center of Biotechnology Information in order to find clinical trials and relevant observational studies regarding doxycycline usage in STI prophylaxis. Results: Doxycycline prophylaxis reduced the risk of acquiring chlamydia, syphilis, and, in a majority of the trials, the risk of gonorrhea. The clinical trials on doxycycline STI prophylaxis were underpowered to determine if doxycycline promotes the selection of resistance in Neisseria gonorrhoeae and Chlamydia trachomatis. Additionally, no serious side effects of this preventive measure have been reported. None of the studies aimed to compare the efficacy of post- and pre-exposure prophylaxis of STDs with doxycycline. Conclusions: The preliminary results regarding STI prophylaxis with doxycycline seem to be promising. Further research is needed to determine the potential risk of doxycycline prophylactic prescription. Full article

Oropharyngeal cancers (OPCa) caused by HPV have emerged as one of the leading causes of malignancies caused by HPV infection. They are also significantly more likely to occur in males and in people with a history of oral sex with multiple partners. Gay and bisexual men are disproportionately affected by HPV-positive oropharyngeal cancers. We studied 1699 gay and bisexual men on 2 major dating sites in the US to assess their knowledge about HPV-related OPCa, attitudes toward screening for it, beliefs about oropharyngeal cancer screening based on the Health Belief Model, and attitudes toward possible screening approaches for OPCa. Knowledge on a 12-item scale was low, with a median of 5 items correct: 72% knew of the benefits of HPV vaccination. Significant predictors of needing OPCa screening included perception of risk for OPCa, seeing it as severe, having lower barriers, fewer reasons to avoid screening, higher knowledge, and being HPV vaccinated were significant predictors, explaining half the total variance. Most participants would accept routine, virtual/online doctor or dental appointments, and over half would accept an in-person screening. Nearly two-thirds stated that they would accept getting checked for OPCa if they could do self-screening at home, and half were prepared to use an online screening tool or app, where they could take an “oral selfie” and send it to a healthcare provider for examination. One-third stated that they would trust the results of a home screening completed by themselves and posted to a website equally as cancer screening completed online by a healthcare provider. Data indicate that despite low OPCA knowledge levels, the risk of HPV-associated OPCa was known. Being at personal risk and having knowledge of disease severity had 70% of the sample thinking about, or preparing to get, screening. Self-screening by a smartphone “oral selfie” transmitted to a screening website was acceptable to many gay and bisexual men, and online screening by a doctor or dentist was acceptable to most. OPCa screening in this population using electronic technology, together with the increasing incidence of HPV-associated OPCa in gay and bisexual men, brings together an opportunity to detect OPCa early. Full article

Sexually transmitted infections (STIs) constitute a major public health issue in the United States. North Carolina (NC) in the southeastern U.S. ranks among the highest in STI incidence. We aimed to describe the incidence rates and identify potential risk factors of STIs in NC. The STI data reported by the NC Department of Health and Human Services for 2018 were compiled for chlamydia, gonorrhea, syphilis, and HIV infections for all 100 NC counties. Linear regression modeling was used to assess the association of STIs with predefined county-level variables. The mean STI incidence rates per 100,000 persons were highest for chlamydia (592.43 ± 30.02), followed by gonorrhea (212.06 ± 13.75), HIV (12.66 ± 0.947), and syphilis (3.33 ± 0.439). For chlamydia, higher risk was significantly associated with income (β = −0.008, SE = 0.003; p = 0.006), education (some college; β = 10.02, SE = 3.15, p = 0.002), race (Black; β = 12.17, SE = 1.57, p < 0.0001), and number of truck stops (β = 20.20, SE = 6.75, p = 0.004). The same variables, except for education, were associated with higher gonorrhea risk. Only race (being Black) was significantly associated with higher syphilis risk. Racial disparities in STI burden were significant, with race (being Black) constituting a risk factor for all four STIs. Interventions targeted to identified risk factors may help to reduce the STI burden in NC. Full article

Background: Human cytomegalovirus (HCMV) is an important pathogen in immunocompromised individuals where it causes end organ diseases leading to increased morbidity and mortality. The aim of this study was to determine the prevalence of HCMV infection and its associated risk factors among HIV patients in Edo State, Nigeria. Methods: A total of 150 HIV patients consisting of 80 males and 70 females were enrolled for this study. About 4 mL of venous blood was aseptically collected from each participant by venipuncture and was centrifuged to obtain serum. The serum was screened by ELISA for HCMV IgG and IgM antibodies. Results: The results obtained were analyzed using SPSS version 20 for data analysis. An overall prevalence of 32.7% for HCMV IgM antibodies was recorded among the HIV patients. Males had a higher prevalence of 55.1% HCMV IgM antibodies than their female counterparts with 44.9% HCMV IgM antibodies. HCMV was more prevalent among the age group <19 years (51.0%), followed by the age group 20–39 years (30.6%), while the age groups >60 years, and 40–59 years recorded a prevalence of 12.2% and 6.1%, respectively. Conclusions: The co-occurrence of HCMV IgG and IgM antibodies, religion and location significantly influenced the acquisition of HCMV infection among HIV patients. Integrating HIV prevention by spreading awareness and early diagnosis of HCMV is key to reducing complications from these viral infections in HIV disease patients. Full article