Effect of screening young men for <i>Chlamydia trachomatis</i> on the rates among women: a network modelling study for high-prevalence communities

Qu, Zhuolin; Azizi, Asma; Schmidt, Norine; Craig-Kuhn, Megan Clare; Stoecker, Charles; Hyman, James M.; Kissinger, Patricia

doi:10.1136/bmjopen-2020-040789

Cited by 10 publications

(17 citation statements)

References 19 publications

(9 reference statements)

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“…For example, incorporating sexual pleasure or security considerations within programming may have a positive impact on condom use, which has direct implications for reductions in STIs [ 35 ]. Moreover, the screening and testing of some high-risk populations, including men, transgender female sex workers, bisexual people, and other men who have sex with men are important regardless of self-reported sites of potential exposure [ 36 , 37 ]. For bisexual people and men who have sex with men, the need for systematic multisite screening, regardless of symptoms, is also crucial [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

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Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 Global Burden of Disease Study

Yan

Jing

et al. 2022

BMC Infect Dis

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Background World Health Organization announced its goal of ending sexually transmitted infection (STI) epidemics by 2030. To provide a reference for tailored prevention strategies, we analyzed trends and differences in STIs by geographical regions and age groups from 1990 to 2019. Methods Annual number of new infections and age-standardized incidence rates (ASRs) of syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes were recorded from the 2019 Global Burden of Disease study. We quantified the temporal trends of STIs by calculating changes in new infections and estimated annual percentage changes (EAPCs) of ASR. Results The ASRs of syphilis, chlamydia, trichomoniasis, and genital herpes increased by 1.70% (95% confidence interval [CI], 1.62–1.78%), 0.29% (95% CI 0.04–0.54%), 0.27% (95% CI 0.03–0.52%), and 0.40% (95% CI 0.36–0.44%) per year from 2010 to 2019 worldwide, respectively, while that of gonorrhea did not. The American regions had the greatest increase in ASR for syphilis (tropical Latin America: EAPC, 5.72; 95% CI 5.11–6.33), chlamydia (high-income North America: EAPC, 1.23; 95% CI 0.73–1.73), and gonorrhea (high-income North America: EAPC, 0.77; 95% CI 0.12–1.41). Additionally, southern sub-Saharan Africa and East Asia had the greatest increase in ASR for trichomoniasis (EAPC, 0.88; 95% CI 0.57–1.20) and genital herpes (EAPC, 1.44; 95% CI 0.83–2.06), respectively. In the most recent years, the population with the greatest incidence of syphilis tended to be younger globally (25–29 years in 2010 vs. 20–24 years in 2019) but older in North Africa and Middle East (20–24 year vs. 25–29 years); with chlamydia tended to be older in southern sub-Saharan Africa (25–29 years vs. 30–34 years) but younger in Australasia (40–44 years vs. 25–29 years); with genital herpes tended to be older in high-income North America (20–24 years vs. 25–29 years) and South Asia (25–29 years vs. 30–34 years). Conclusions Syphilis, chlamydia, trichomoniasis, and genital herpes showed a trend of increasing ASR from 2010 to 2019. The differences in trends by geographical regions and age groups point to the need for more targeted prevention strategies in key regions and populations.

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Section: Discussionmentioning

confidence: 99%

“…For bisexual people and men who have sex with men, the need for systematic multisite screening, regardless of symptoms, is also crucial [ 38 ]. Therefore, when resources are sufficient, monitoring work should be carried out among different populations according to location [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 Global Burden of Disease Study

Yan

Jing

et al. 2022

BMC Infect Dis

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“…27 With half of respondents reporting physical sex during this time, and 67.9% of men reporting vaginal sex not always using a condom, there is still a large portion of the population at risk for contracting a STI that needs access to sexual health services. With the recent modeling study showing screening asymptomatic men prevents Ct in both men and women in a high prevalence population, 28 it is necessary to ensure these services are available.…”

Section: Discussionmentioning

confidence: 99%

Changes in Sexual Behavior Related to the COVID-19 Stay-at-Home Orders Among Young Black Men Who Have Sex With Women in New Orleans, LA

Craig-Kuhn¹,

Schmidt²,

Scott³

et al. 2021

Sexual Trans Dis

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Background: COVID-19 stay-at-home orders enacted in New Orleans, LA on March 16, 2020, may have caused changes in the way young men interacted with sex partners.Methods: An online substudy was conducted (May 21, 2020 to June 9, 2020) among Black men who have sex with women, 18 years and older, and who had previously enrolled in the parent study Check It (May 17, 2017 to March 6, 2020) to assess changes in sexual behavior during the stay-at-home orders.Results: Among 111 participants, from enrollment in Check It to during stay-at-home orders, recent vaginal sex declined from 96.4% to 47.8% (P < 0.0001), reports of multiple female sex partners declined from 45.0% to 14.4% (P < 0.0001), and sexual abstinence increased from 3.6% to 38.7% (P < 0.0001). Among those who did have vaginal sex, condomless sex rates did not change between enrollment in Check It and the substudy (64.5% vs 67.9%, P = 0.68). During stay-at-home orders oral sex, virtual sex, and pornography viewing were 40.5%, 42.3%, and 76.6%, respectively. Some (17.1%) acquired a new sex partner during stay-at-home orders, and 44.1% left their home to meet a partner for sex. Only 27.9% had seen information about safe sex during the pandemic. Income was diminished for 62.2% and 23.4% moved away from New Orleans when stay-at-home orders were enacted.

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“…Women Mathematical models confirm that widescale testing of asymptomatic women should be effective to reduce the duration of infectiousness [55] and CT prevalence [56][57][58]. However, pragmatic studies indicate that it might be difficult to achieve a reduction in prevalence and in complications.…”

Section: Test Implementation In 'Real-life' Does Not Achieve the Desi...mentioning

confidence: 99%

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

et al. 2022

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Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation.

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Effect of screening young men for Chlamydia trachomatis on the rates among women: a network modelling study for high-prevalence communities

Cited by 10 publications

References 19 publications

Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 Global Burden of Disease Study

Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 Global Burden of Disease Study

Changes in Sexual Behavior Related to the COVID-19 Stay-at-Home Orders Among Young Black Men Who Have Sex With Women in New Orleans, LA

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

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