RESUMO
BACKGROUND: There is limited information on rates of STIs in Jamaica due to syndromic management and limited aetiological surveillance. We examined the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) and characteristics associated with STIs among sexually active women who participated in a randomised trial of a progestin implant initiation in Jamaica (the Sino-Implant Study (SIS)). METHODS: SIS was a randomised trial conducted in Kingston, Jamaica, from 2012 to 2014 to evaluate whether initiation of the Sino-Implant (II) led to more unprotected sex among women ages 18-44â years. Data collected included self-reported demographic, sexual behaviour information; and vaginal swabs collected at baseline, 1-month and 3-month follow-up visits for a biomarker of recent semen exposure (prostate-specific antigen (PSA)) and for STIs. We examined associations between STIs and PSA, demographics, sexual behaviour and insertion of an implant, with a repeated-measures analysis using generalised estimating equations (SAS Institute, V.9.3). RESULTS: Remnant vaginal swabs from 254 of 414 study participants were tested for STIs. At baseline, 29% of participants tested for STIs (n=247) had laboratory-confirmed CT, 5% NG, 23% TV and 45% any STI. In a repeated-measures analysis adjusted for study arm (immediate vs delayed implant insertion), those with PSA detected did not have an increased prevalence of any STI (prevalence ratio (PR)=1.04 (95% CI 0.89 to 1.21)), whereas prevalence decreased for each 1-year increase in age (PR=0.98 (95% CI 0.97 to 0.99)). Immediate implant insertion was not associated with increases in any STI in subsequent visits (PR=1.09 (95% CI 0.94 to 1.27)). CONCLUSIONS: Although the prevalence of laboratory-confirmed STIs was high, the immediate initiation of a contraceptive implant was not associated with higher STI prevalence rates over 3â months. TRIAL REGISTRATION NUMBER: NCT01684358.
Assuntos
Comportamento Contraceptivo , Dispositivos Intrauterinos/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/transmissão , Sexo sem Proteção/estatística & dados numéricos , Adulto , Preservativos/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Jamaica/epidemiologia , Prevalência , Fatores de Risco , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/psicologia , Sexo sem Proteção/psicologiaRESUMO
INTRODUCTION: Previous studies found conflicting results regarding associations between urogenital Chlamydia trachomatis infections and ethnicity or urogenital symptoms among at-risk populations using either ompA-based genotyping or high-resolution multilocus sequence typing (MLST). This study applied high-resolution MLST on samples of individuals from a selected young urban screening population to assess the relationship of C. trachomatis strain types with ethnicity and self-reported urogenital symptoms. Demographic and sexual risk behaviour characteristics of the identified clusters were also analysed. METHODS: We selected C. trachomatis-positive samples from the Dutch Chlamydia Screening Implementation study among young individuals in Amsterdam, the Netherlands. All samples were typed using high-resolution MLST. Clusters were assigned using minimum spanning tree analysis and were combined with epidemiological data of the participants. RESULTS: We obtained full MLST data for C. trachomatis-positive samples from 439 participants and detected nine ompA genovars. MLST analysis identified 175 sequence types and six large clusters; in one cluster, participants with Surinamese/Antillean ethnicity were over-represented (58.8%) and this cluster predominantly consisted of genovar I. In addition, we found one cluster with an over-representation of participants with Dutch ethnicity (90.0%) and which solely consisted of genovar G. No association was observed between C. trachomatis clusters and urogenital symptoms. CONCLUSIONS: We found an association between urogenital C. trachomatis clusters and ethnicity among young screening participants in Amsterdam, the Netherlands. However, no association was found between C. trachomatis clusters and self-reported urogenital symptoms.
Assuntos
Infecções por Chlamydia/genética , Chlamydia trachomatis/genética , Busca de Comunicante/métodos , Emigrantes e Imigrantes/estatística & dados numéricos , Tipagem de Sequências Multilocus , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Análise por Conglomerados , Etnicidade , Feminino , Genótipo , Humanos , Masculino , Países Baixos/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Análise de Sequência de DNA , Suriname/epidemiologia , Sexo sem Proteção , População UrbanaRESUMO
OBJECTIVES: Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a risk-reduction strategy within female sex workers' (FSW) primary partnerships, we examined STI/HIV test result disclosure patterns between FSWs and their primary, non-commercial male partners in two Mexico-US border cities. METHODS: From 2010 to 2013, 335 participants (181 FSWs and 154 primary male partners) were followed for 24â months. At semiannual visits, participants were tested for STIs/HIV and reported on their disclosure of test results from the previous visit. Multilevel logistic regression was used to identify individual-level and partnership-level predictors of cumulative (1) non-disclosure of ≥1 STI test result and (2) non-disclosure of ≥1 HIV test result within couples during follow-up. RESULTS: Eighty-seven percent of participants reported disclosing all STI/HIV test results to their primary partners. Non-disclosure of ≥1 STI test result was more common among participants who reported an STI diagnosis as part of the study (adjusted OR=3.05, 95% CI 1.13 to 8.25), while non-disclosure of ≥1 HIV test result was more common among participants in longer-duration partnerships (AOR=1.15 per year, 95% CI 1.03 to 1.28). Drug use before/during sex within partnerships was associated with non-disclosure of both STI (AOR=5.06, 95% CI 1.64 to 15.62) and HIV (AOR=4.51, 95% CI: 1.32 to 15.39) test results. CONCLUSIONS: STI/HIV test result disclosure was highly prevalent within FSWs' primary partnerships, suggesting couples-based STI/HIV testing with facilitated disclosure may be feasible for these and potentially other high-risk, socially marginalised couples.
Assuntos
Busca de Comunicante/estatística & dados numéricos , Profissionais do Sexo , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: Cervical cancer is caused by carcinogenic human papillomavirus (HPV) infections. Prior to the introduction of HPV vaccination in Suriname, we performed a cross-sectional study to estimate the prevalence of and determinants for genital carcinogenic HPV infections. METHODS: Women were recruited at a family planning (FP) clinic and a sexually transmitted infections (STI) clinic. Vaginal swabs were used for HPV genotyping by the SPF10 PCR-DEIA-LiPA25 system. Logistic regression was used to identify determinants for carcinogenic HPV infection. RESULTS: The prevalence of any HPV was 54.2% and of carcinogenic HPV was 27.9% among 813 women attending the FP clinic. Among the 188 women attending the STI clinic, the prevalence of any HPV (76.1%) and of carcinogenic HPV (40.4%) was significantly higher. HPV52 was the most prevalent genotype in both clinics. The prevalence of HPV16 and/or 18 was 6.4% in the FP clinic and 12.2% in the STI clinic. The following determinants were independently associated with carcinogenic HPV infection among women visiting the FP clinic: ≥2 recent partners (OR 1.53; 95% CI 1.13 to 2.06), Chlamydia trachomatis co-infection (OR 1.89; 95% CI 1.32 to 2.70), disassortative ethnic sexual mixing (OR 1.50; 95% CI 1.13 to 1.99) and ethnic group (OR 1.90; 95% CI 1.27 to 2.85 for Creole and OR 1.67; 95% CI 1.06 to 2.62 for mixed ethnicity, both compared with Hindustani). No independent determinants were found among women visiting the STI clinic. CONCLUSIONS: Carcinogenic HPV is highly prevalent among women in Suriname, and not equally distributed among ethnic groups. These data provide a baseline to assess possible shifts in the prevalence of HPV genotypes following vaccination.
Assuntos
Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Adulto , Estudos Transversais , Etnicidade , Feminino , Genótipo , Técnicas de Genotipagem , Humanos , Papillomaviridae/genética , Fatores de Risco , Suriname/epidemiologia , Adulto JovemRESUMO
Las clamidias son los patógenos más importantes en las enfermedades de transmisión sexual en todo el mundo. Sólo para Estados Unidos se estima que ocurren más de 4 millones de infecciones clamidiales por año. En Costa Rica pocos estudios de la infección por Chlamydia trachomatis (CT) han sido publicados por la falta de introducción de pruebas sensibles y específicas para su tamizaje y diagnóstico. Este estudio pretende determinar la presencia de la infección por CT en un grupo de mujeres trabajadoras de sexo (MTS) para demostrar la necesidad de diagnóstico y tomar las medidas adecuadas de prevención y control. En un estudio descriptivo transversal prospectivo, un total de 457 MTS fueron analizadas, se obtuvieron muestras de endocervical y orina, así como datos epidemiológicos. La prueba de PCR Roche Diagnostic fue usada para detectar la infección por C. Trachomatis. Se determina un 14.7 por ciento de prevalencia de infección afectando principalmente a los grupos etarios de 16 a 34 años así, como su relación con comportamientos de riesgo tales como, edad temprana de inicio de relaciones sexuales (10 a 19 años), baja escolaridad (66 por ciento primaria o menos), múltiples compañeros sexuales (50.7 por ciento de 11 a 50 por semana), no uso del preservativo (43.8 por ciento). No se encontró relación entre la infección por CT y el diagnóstico clínico sintomatológico lo que evidencia la necesidad de la implementación de un método de diagnóstico como las pruebas de amplificación nucleica de gran sensibilidad y especificidad como, su aplicación en diferentes tipos de muestras: endocervicales, uretrales, orina que permitan la detección y prevención de la infección, para brindar los tratamientos oportunos y la disminución de la morbilidad y la transmisión.
The Chlamydia are the most important pathogens in the sexual transmission diseases over the world. An estimated of 4 million Chlamydia infection occurs annually in the United States. In Costa Rica, few studies of the Chlamydia trachomatis (CT) infection have been published because of the lack of sensitive and specific testing introduction methods for screening and diagnostic. This study tries to determine the presence of the infection by CT in a group of women sex workers (WSW) to demonstrate that we must implemented the diagnostic and take the measures from prevention and control. In one descriptive, prospective and transversal study, a total of 457 WSW were analyzed. Endocervicales, urine samples and epidemiological data were obtained from the study. C. Trachomatis infection was detected with the PCR Roche Diagnostic Test. In this study a 14.7% of prevalence is determined, affecting mainly groups of people from 16 to 34 years old. Besides, a connection with early sexual intercourse (10 to 19 years), low schooling (primary 66% or less), multiple sexual partners (50.7% from 11 to 50 per week), non use of condom (43.8%) was found. In the study there was not relation between infection by CT and the clinical diagnostic symptoms that demonstrates the necessity of the implementation of a diagnostic method, like nucleic acid amplifi cation tests, for the great sensitivity and specifi city, and its application in different specimens: urethral, endocervicales, urine that allow the detection and prevention of the infection, to offer the proper treatments and the reduction of the morbidity and the transmission.