Search Results (265)

Mpox has become a significant health concern since the global outbreak that began in 2022. The aim of this study is to present the epidemiological situation of Mpox in Romania during 2022–2023 and to describe a severe case of Mpox in a patient who survived despite multiple co-pathologies. Forty-seven confirmed cases were reported at the national level, all in men, in 2022. The median age was 33 years. Twenty-six cases involved men who have sex with men (MSM), and twenty-three tested positive for HIV. We also describe a severe case involving a 34-year-old bisexual male with newly diagnosed AIDS who developed severe Mpox with persistent necrotic skin lesions, respiratory involvement, and multiple opportunistic infections: tuberculosis, pneumocystis pneumonia, syphilis, and oral candidiasis. The patient presented with fever, night sweats, weight loss, and dyspnea, with a single ulcerative facial lesion that later disseminated. Mpox infection was confirmed through PCR from skin lesion, serum, saliva, urine, rectal, nasal, and pharyngeal swab samples, with high viral loads persisting despite prolonged Tecovirimat therapy. The patient developed immune reconstitution inflammatory syndrome following the initiation of antiretroviral therapy. This case emphasizes the challenges of treating Mpox in immunocompromised patients. Full article

HIV disproportionately affects key populations (MSM, transgender people, sex workers and psychoactive substance users), who face greater social vulnerability and limited healthcare access. This study aimed at analyzing sexual orientation and gender identity and their association with sexual practices, sexually transmitted infections and psychoactive substance use among PrEP users. Method: A cross-sectional study was conducted between January 2018 and June 2021 with 736 Brazilian PrEP users from a health service in São Paulo. Sociodemographic data, sexual behaviors, STI history (past 3 months) and psychoactive substances use (past 3 months) were extracted from clinical records. The associations were analyzed using binomial logistic regression (p < 0.05). Results: Most of the participants were cisgender men (93.4%) and homosexual (84.8%), with a mean age of 34.9 years old. Condomless sex was reported by 98.5%, and 18.4% had some recent sexually transmitted infection, mainly syphilis. Psychoactive substance use was reported by 55.4%, especially marijuana, club drugs, erectile stimulants and poppers. Transgender and cisgender women were more likely to report sex work and crack use. Homosexual and bisexual participants had higher odds of using erectile stimulants. Conclusions: The study reveals key links between gender, sexual orientation and risk behaviors, highlighting the need for inclusive, targeted prevention. Full article

Neisseria gonorrhoeae, the causative agent of gonorrhea, represents a major public health concern due to its increasing antimicrobial resistance. While often asymptomatic—particularly in extragenital infections—untreated cases can lead to severe complications and further transmission. Despite global efforts to monitor antimicrobial resistance, data on the molecular determinants underlying decreased susceptibility in N. gonorrhoeae remain scarce in Peru. This study aimed to detect mutations in the penA and 23S rRNA genes, which confer decreased susceptibility to cephalosporins and azithromycin resistance. We extracted DNA from 124 N. gonorrhoeae-positive clinical rectal specimens collected in Aptima Combo 2 transport tubes from MSM patients. These DNA samples were then screened using the Mismatch Amplification Mutation Assay-based real-time PCR (MAMA-qPCR) to identify mutations in the 23S rRNA and penA genes. Each sample underwent separate reactions to detect A2059G and C2611T mutations in the 23S rRNA gene, and 86 of these samples were further tested in individual qPCR assays for the penA D345 deletion (D345del) or G545S mutations. Sanger sequencing was performed on all DNA samples positive for 23S rRNA mutations by MAMA-qPCR assay, and on 27 DNA samples that yielded sufficient penA amplicons for additional sequencing. Using the MAMA-qPCR assay for the 23S rRNA gene, 64 of 124 samples amplified in the A2059G reaction: 2 (3.1%) carried the mutation, and 62 were classified as wild type. In the C2611T reaction, 42 of 124 samples amplified, and none of them carried the mutation. Using the MAMA-qPCR assay for the penA gene, we only analyzed 86 samples, as the remaining 38 samples had insufficient DNA yield. A total of 44 of the 86 samples amplified in the D345del reaction: 5 (11.4%) carried the D345del, and 39 were classified as wild type. In the G545S reaction, 4 (6.4%) carried the mutation, and 58 were classified as wild type. Finally, sequencing of the penA gene in the 27 samples revealed mutations related to decreased susceptibility to cephalosporins. This study identified genetic mutations conferring resistance to azithromycin and decreased susceptibility to cephalosporins, providing an overview of the circulating mutations conferring resistance in N. gonorrhoeae strains in Peru. Full article

Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global epidemiological trends of syphilis from 2015 to 2025, with a focus on surveillance gaps, regional disparities, and structural determinants. Methods: A broad narrative approach was used to collect and analyze epidemiological data from 2015 to 2025. The literature was retrieved from databases (PubMed, Scopus) and official reports from the WHO, CDC, and ECDC. Included materials span observational studies, surveillance reports, and modeling data relevant to global trends and public health responses. Results: Globally, syphilis incidence has increased, with notable surges in North America, Europe, and Asia. MSM remain disproportionately affected, while congenital syphilis is resurging even in high-income countries. Low- and middle-income countries report persistent burdens, especially among women of reproductive age, often exacerbated by limited screening and surveillance infrastructure. The COVID-19 pandemic disrupted syphilis-related services and further exacerbated underreporting, hindering timely detection and response efforts. Surveillance systems vary widely in their completeness and quality, which significantly hinders global data comparability and coordinated public health responses. Conclusions: Despite its curability, syphilis continues to spread due to fragmented prevention strategies, inequities in access to care, and insufficient surveillance. Strengthening diagnostic access, integrating prevention efforts into broader health systems, and addressing social determinants are essential. Improved surveillance, equitable access, and innovation—including diagnostics and potential vaccine research—are critical to controlling the global syphilis epidemic. Full article

Dating applications (DAs) are widely used to establish social and sexual connections among men who have sex with men (MSM), particularly in urban areas. In this study, we aimed to examine the associations between DA use and mental health among Thai MSM. An online cross-sectional survey was completed by 442 MSM residing in Bangkok and urban municipalities across all regions of Thailand. Psychological distress (PD) and probable depression were assessed using the General Health Questionnaire (GHQ-12) and the Patient Health Questionnaire (PHQ-9), respectively. Of the participants, 62.7% were current users, with 33.2% experiencing PD and 33.9% having depression. A logistic regression analysis showed that PD was significantly associated with late-night use (AOR = 2.02, 95% CI: 1.08–3.78), matching failure (AOR = 1.95, 95% CI: 1.12–3.38), rejection (AOR = 2.07, 95% CI: 1.18–3.62), and ghosting (AOR = 1.78, 95% CI: 1.02–3.11). Simultaneously, depression was significantly associated with using DAs with the motivation of hooking up (AOR = 2.27, 95% CI: 1.05–4.93), privacy violations (AOR = 2.76, 95% CI: 1.42–5.38), unsolicited sexual images (AOR = 2.04, 95% CI: 1.11–3.74), physical assault (AOR = 2.97, 95% CI: 1.57–5.61), harassment (AOR = 2.54, 95% CI: 1.37–4.70), scams (AOR = 2.59, 95% CI: 1.41–4.77), and extreme disappointment from DA use (AOR = 5.98, 95% CI: 1.84–19.41). These findings highlight how DA usage patterns and negative experiences may contribute to the poorer mental health among MSM in urban areas. Full article

The Undetectable = Untransmittable (U=U) message is a cornerstone of HIV-related public health communication, yet global levels of awareness and acceptance remain unclear across key populations. This study aimed to assess the global prevalence of awareness and acceptance of the U=U message among men who have sex with men (MSM), people living with HIV (PLWH), healthcare professionals, and the general population. A systematic review and meta-analysis was conducted using data from PubMed, Embase, and Google Scholar without language restrictions through 31 October 2023. Eligible studies included prospective cohort studies, randomized clinical trials, and cross-sectional studies reporting numerical data on U=U awareness and acceptance. From 1171 screened records, 43 studies were included. Data were analyzed using a random effects model. The findings showed that U=U awareness was high among PLWH, moderate among MSM and healthcare professionals, and low in the general population. Complete acceptance of U=U was low in MSM and the general population, and moderate in PLWH and healthcare professionals. Any acceptance was moderate among MSM and the general population, and high among PLWH and healthcare professionals. These results highlight the need for targeted education strategies to enhance understanding and reduce HIV-related stigma, particularly in populations with lower awareness and acceptance. Full article

This study examines the trends, impacts, and challenges of HIV in Bangladesh from 2000 to 2024, with a focus on its epidemiology, demographic distribution, and socioeconomic determinants. Despite maintaining one of the lowest HIV prevalence rates globally (<0.1%), Bangladesh faces a concentrated epidemic among high-risk populations, including people who inject drugs (PWID), men who have sex with men (MSM), sex workers, transgender individuals, and migrant workers. Analysis reveals a steady increase in reported infections, attributed to enhanced diagnostic capacities and public awareness. The 25–49 year age group remains the most affected, accounting for over 65% of cases, underscoring the vulnerability of the economically active population. Gender disparities persist, with males representing the majority of infections but lower ART coverage among females and transgender individuals. While interventions such as PMTCT programs, ART expansion, and targeted awareness campaigns have contributed to improved outcomes, barriers such as stigma, healthcare inequities, and limited rural access hinder progress. The study also evaluates Bangladesh’s progress toward the 95-95-95 targets, highlighting significant strides in treatment and viral suppression but gaps in diagnosis. Future research must address behavioral trends, stigma reduction, and integration of HIV services for marginalized populations. This paper emphasizes the need for evidence-based strategies to ensure equitable healthcare delivery and sustainable progress in combating HIV. Full article

Background/Objectives: In addition to classical transmission routes, hepatitis A (HA) outbreaks were, for the first time, linked to sexual activity in the late 1970s, particularly among men who have sex with men (MSM). Since then, outbreaks have continued to emerge globally among adults engaging in high-risk sexual behaviors, reinforcing the ongoing public health significance of this transmission route. Although the COVID-19 pandemic temporarily reduced HA cases, outbreaks reemerged following the relaxation of pandemic measures. This study aims to report the HA outbreak registered at Romania’s tertiary infectious diseases hospital during the first half of 2022. Methods: We retrospectively analyzed all HA cases admitted to the National Institute for Infectious Diseases from 1 January to 1 August 2022. Results: Among 51 cases, eight children (under 14) were excluded from further analyses. Of the 43 remaining cases, 37 (86%) were male, with 20/37 (54.05%) identified as MSM. Twenty-two of the males (59.45%) were previously or concomitantly diagnosed with sexually transmitted diseases (STDs), notably syphilis and HIV. A marginal finding: 14 out of 29 patients screened for hepatitis E tested positive for IgM. The MSM patients exhibited significantly higher transaminase levels (ALT median level 3404 U/L [IQR 2608–5448] vs. 2066 U/L [IQR 1393–3682]) and more severe liver impairment (INR median level 1.37 [IQR 1.18–1.78] vs. 1.18 [IQR 1.11–1.43] compared to non-MSM patients. While direct bilirubin levels were higher in MSM (7.4 mg/dL vs. 5.5 mg/dL), the difference was not statistically significant. Conclusions: An HA outbreak occurred at the beginning of 2022 among Romanian young MSM, with a more severe acute liver injury. High-risk sexual practices may be a potential risk factor for severe HA. This emphasizes the need to screen for STDs in young males with HA and review vaccination policies for at-risk individuals. Full article

Background: Men who have sex with men (MSM) in Japan, and globally, face disparities in mental health and well-being, driven by stigma, exclusion, and minority stress. While social capital is known to enhance well-being, no previous research has examined the distinct roles of gay versus heterosexual social capital in relation to subjective happiness. Methods: We conducted a cross-sectional online survey of 1564 MSM in Greater Tokyo, using geosocial networking applications. Social capital was measured using an adapted Resource Generator to assess access to resources from MSM and heterosexual network members. Subjective happiness was assessed using the Japanese version of the Subjective Happiness Scale. Multivariable linear regression identified correlates of happiness. Results: Gay social capital was the strongest predictor of subjective happiness, exceeding the effects of self-rated health, education, employment, and age. High levels of heterosexual social capital were also associated with greater happiness but to a lesser extent. Unemployment, poor health, and attendance at gay cruising venues were negatively associated with happiness. Conclusions: These findings provide the first global evidence of the differential associations between gay and heterosexual social capital on subjective happiness. Community-based interventions that affirm identity and build peer connection may substantially improve well-being among MSM in Japan. Full article

Despite the availability of pre-exposure prophylaxis (PrEP) in the United Kingdom (UK), uptake among men who have sex with men (MSM) remains inconsistent, signalling a persistent ‘PrEP Gap’. Empirical studies show the important role of psychosocial factors (e.g., stigma, identity, trust in science, and sexual behaviours) in PrEP acceptability and uptake. This study aimed to identify subgroups of MSM in the UK based on psychosocial predictors of PrEP acceptability. A cross-sectional survey of MSM (N = 500) was conducted between June and September 2023. Participants completed validated measures assessing identity resilience, internalised homonegativity, LGBTQ+ connectedness, trust in science, NHS perceptions, HIV stigma, PrEP self-efficacy, condom self-efficacy, sociosexual orientation, perceived HIV risk, and PrEP acceptability. Latent Profile Analysis (LPA) was used to identify distinct subgroups based on these psychosocial dimensions. Four psychosocial profiles were defined: (1) PrEP Ambivalent (15%); (2) PrEP Accepting (36.2%); (3) PrEP Hesitant (37%); and (4) PrEP Rejecting (11.8%). These profiles provide evidence for varied combinations of personal and structural factors influencing PrEP acceptability. PrEP acceptability among MSM in the UK is shaped by distinct psychosocial configurations, influenced by identity, stigma, trust, and perceived risk. These findings highlight the need for differentiated and targeted interventions for enhancing PrEP acceptability based on psychosocial profile. Audience segmentation strategies offer a promising pathway to bridge the awareness-to-engagement gap and address the nuanced barriers facing diverse subgroups within the MSM community. Full article

The COVID-19 pandemic triggered a public health crisis that significantly impacted sexually transmitted infections (STIs), particularly syphilis. However, data on syphilis incidence during the pandemic remains inconsistent globally. Key groups affected include women of reproductive age, pregnant women, individuals living with HIV, and men who have sex with men (MSM). This paper reviews available literature from databases such as PubMed, Scopus, and Google Scholar to analyse the pandemic’s influence on congenital and gestational syphilis, focusing on high-risk populations. We discuss the pandemic’s impact on the incidence of gestational and congenital syphilis, including changes in screening and treatment protocols. Additionally, we examine alterations in syphilis prevalence and testing among people living with HIV and MSM, including implications observed in blood donors. The findings underscore the consequences of impaired STI diagnostics for public health. We emphasise the need for uninterrupted access to diagnostics and treatment during public health crises. To prevent rising syphilis rates post-pandemic, it is crucial to implement robust education and accessible testing measures. Full article

By 2022, Bulgaria’s National Reference Laboratory had confirmed 4024 HIV cases. We analyzed 132 pol gene sequences to characterize the molecular epidemiology of HIV-1 subtypes A1, A6, and A7 (2001–2022). A1 accounted for 50.0% (66/132) of cases, increasing after 2014, with peaks in 2019 and 2022. A6 comprised 48.5% (64/132), dominating from 2005 to 2014 before stabilizing. A7 was rare (1.5%, 2/132), detected in 2003 and 2011. Transmission patterns varied: A1 was linked to men who have sex with men (MSM) (62.1%), while A6 was primarily heterosexual (HET) (82.8%) with a balanced gender distribution (56.3% male, 43.8% female). Resistance mutations were identified in 29.6% of cases, with A6 showing higher rates of nucleoside reverse transcriptase inhibitor (NRTI) (20.3%) and non-nucleoside reverse transcriptase inhibitor (NNRTI) (7.8%) resistance than A1. Phylogenetic analysis revealed that 13 Bulgarian sequences (9.8%) were involved in transmission clusters, including 10 (7.6%) from sub-subtype A1 and 3 (2.3%) from sub-subtype A6, highlighting distinct genetic diversity and transmission patterns. Despite significant migration from Ukraine in 2022, A6 prevalence remained unchanged, suggesting localized transmission dynamics. These findings highlight a shifting HIV-1 sub-subtype distribution in Bulgaria and emphasize the need for targeted prevention, diagnosis, and treatment strategies tailored to the evolving molecular landscape. Full article

Syphilis is a re-emerging sexually transmitted disease caused by Treponema pallidum subsp. pallidum (TPA). It especially affects vulnerable populations such as men who have sex with men (MSM) and people living with HIV. Despite being treatable with benzathine penicillin G, a substantial increase in TPA resistance to azithromycin has been reported in many countries. The objective of this study was to detect the resistance of T. pallidum (TPA) to macrolides in blood samples from men who have sex with men and people living with HIV using molecular methods in a cross-sectional study. The detection of both TPA and the resistance to azithromycin was achieved through molecular methodologies (nested PCR), which were applied to blood samples of people with asymptomatic syphilis. We report the first data on the molecular prevalence of TPA and the first identification of genetic resistance to azithromycin (punctual mutation A2058G) in Mexico. Resistance testing for syphilis is not routinely performed in Mexico, but azithromycin continues to be prescribed despite syphilis being treatable with benzathine penicillin G. Therefore, the surveillance of cases of syphilis treatment failure, especially in vulnerable populations, which are the population group that maintains the active transmission of TPA, is recommended. Full article

Background and Objectives: Sexualized substance use (SSU) and chemsex have garnered increasing attention in public health research, particularly among men who have sex with men (MSM). However, the prevalence and implications of these behaviors in the general population and among women remain underexplored. This systematic review and meta-analysis aimed to synthesize existing evidence on the prevalence of SSU and chemsex in the general population, with a specific focus on women. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, ProQuest, Scopus, Web of Science, Cochrane, and PsycINFO were searched for studies published before 18 February 2025. The keywords included “chemsex”, “sexualized substance use”, “prevalence”, and “women”. Studies were included if they reported prevalence data on SSU or chemsex in the general population or among women. The exclusion criteria included studies focused exclusively on MSM, adolescents, or specific drug toxicity. The pooled prevalence estimates were presented using forest plots, and the heterogeneity was assessed using I² statistics in RStudio (version 4.3.2). Results: The findings reveal that SSU and chemsex are significant phenomena, with pooled prevalences of 19.92% in the general population and 15.61% among women. The higher prevalence of SSU (29.40%) compared with chemsex (12.66%) in the general population suggests that substance use during sex is a broader behavioral pattern. Among women, the prevalence of chemsex was notably lower (3.50%) than SSU (25.78%). Conclusions: This study underscores that SSU and chemsex are significant public health concerns extending beyond the MSM community. The findings highlight the need for inclusive public health strategies that address these behaviors across the general population. Future research should focus on standardizing definitions, exploring contextual factors, and developing targeted interventions to mitigate associated risks, such as sexually transmitted infections, substance dependency, and mental health disorders. Full article

Several studies conducted worldwide have reported on the effectiveness of consistent condom use with lubricants in preventing HIV transmission and acquisition; however, men who have sex with men (MSM) in Ghana continue to be disproportionately affected by the HIV burden. They are stigmatized, discriminated against, and criminalized, leading to social isolation, reduced access to health care, and inadequate targeted interventions. The dissemination of HIV prevention tools such as condoms and lubricants is also mainly focused on the general population, and this approach overlooks the specific needs and vulnerabilities of MSM. This study aimed to determine the prevalence and associated factors of consistent condom use with lubricants among MSM in Ghana. We analyzed cross-sectional data from the Ghana Men’s Study II dataset involving 4095 MSM aged 18 years and above. De-identified data were imported into STATA (College Station, TX, USA, software version 17) for data analysis. Descriptive analysis was performed to describe relevant characteristics of the study population. Multivariable logistic regression analysis was performed for significant variables in bivariate analysis to determine the associated factors of consistent condom use with lubricants. All the statistical analyses were performed at a 95% confidence interval, with significant differences at p < 0.05. The prevalence of consistent condom use with lubricants during penetrative anal sex was highest with male partners (44.9%), followed by female partners (40.0%), and all sexual partners (38.9%), respectively. In multivariable logistic regression analysis, having a senior high school education (AOR: 1.76; 95% CI: 0.88–3.12, p = 0.039), tertiary education or higher (AOR: 2.24; 95% CI: 0.86–3.23, p = 0.041), being an insertive sex partner (AOR: 1.26; 95% CI: 1.02–1.56, p = 0.029), being a sex worker (AOR: 1.41; 95% CI: 1.00–1.98, p = 0.048), buying sex from other males (AOR: 1.32; 95% CI: 1.03–1.70, p = 0.027), being a light drinker (AOR: 0.54; 95% CI: 0.42–0.68, p < 0.001), being a moderate drinker (AOR: 0.48; 95% CI: 0.30–0.78, p = 0.003), and possessing good HIV knowledge (AOR: 1.79; 95% CI: 1.46–2.20, p < 0.001) had higher odds of consistent condom use with lubricants. Being Islamic (AOR: 0.65; 95% CI: 0.49–0.87, p = 0.004), having a low income (AOR: 0.57; 95% CI: 0.42–0.77, p < 0.001), and easy access (AOR: 0.52; 95% CI: 0.37–0.72, p < 0.001) to condoms were positively associated with consistent condom use. This study found a low prevalence of consistent condom use with lubricants among the MSM population in Ghana. The study also found a range of socio-demographic, behavioral, and structural factors associated with consistent condom use with lubricants. This calls for very specific and unique public health interventions, such as developing a predictive model to identify and mitigate barriers to consistent condom use with lubricants. Full article