Sexually transmitted diseases最新文献

{"title":"Optimizing HIV Partner Services for Gay, Bisexual, and Other Men Who Have Sex With Men Previously Diagnosed With HIV: A Modeling Study.","authors":"Udodirim N Onwubiko, Adrien Le Guillou, Cynthia Lyles, Kevin M Maloney, Kevin P Delaney, Samuel M Jenness","doi":"10.1097/OLQ.0000000000002167","DOIUrl":"10.1097/OLQ.0000000000002167","url":null,"abstract":"<p><strong>Background: </strong>HIV Partner Services (HIV-PS) is a vital strategy for identifying and linking individuals to treatment and prevention; however, its population-level impact has been limited. This study investigated the potential impact of expanding HIV-PS to include previously diagnosed individuals and a broader sexual partner network in reducing HIV incidence among gay, bisexual, and other men who have sex with men (GBMSM).</p><p><strong>Methods: </strong>Stochastic network models were used to simulate HIV and bacterial sexually transmitted infection transmission within male same-sex partnerships in Atlanta. Two primary interventions were examined: prioritizing people with previously diagnosed HIV who were out-of-care (PWDH-OOC) in routine HIV-PS and expanding partner elicitation to include partners of HIV-positive partners of index cases. We quantified how modifications to HIV-PS cascade steps under these interventions would impact HIV incidence among GBMSM.</p><p><strong>Results: </strong>Expanded partner elicitation modestly increased the pool of partners eligible for linkage to transmission-disrupting services, with minimal impact on HIV incidence. In contrast, including PWDH-OOC led to a 10-fold increase in both index-case and partner pools. However, substantial reductions in HIV incidence required enhancements to other HIV-PS steps, particularly in partner identification and antiretroviral therapy (ART) reengagement for PWDH-OOC. Prioritizing ART reengagement for PWDH-OOC, alongside optimized HIV-PS, resulted in up to 63% of HIV infections being averted.</p><p><strong>Conclusions: </strong>Our study highlights the potential of strategic improvements to HIV-PS for accelerating HIV incidence reduction among GBMSM. Synergistic optimization of HIV-PS, along with prioritizing ART reengagement for previously diagnosed individuals, will be essential for achieving substantial reductions in HIV incidence.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":"495-502"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting Pre-Exposure Prophylaxis to Gay, Bisexual, and Other Men Who Have Sex With Men in the US Deep South: A Qualitative Exploration of Promotion Perceptions and Preferences.","authors":"Ronnie M Gravett, Joseph D Tucker, Lynn T Matthews, Barbara Van Der Pol, Greer McCollum, Jason J Ong, Jeanne Marrazzo, Latesha Elopre","doi":"10.1097/OLQ.0000000000002146","DOIUrl":"10.1097/OLQ.0000000000002146","url":null,"abstract":"<p><strong>Background: </strong>Effective HIV pre-exposure prophylaxis (PrEP) promotion is critical to mitigate PrEP disparities, yet there are gaps in understanding how gay, bisexual, and other men who have sex with men respond to and prefer PrEP promotion. The Deep South of the United States, a region with high HIV rates and low PrEP uptake, has unique contextual factors that stifle effective PrEP provision and uptake, which could be overcome with effective PrEP promotional messaging.</p><p><strong>Methods: </strong>We conducted an exploratory qualitative study grounded in Andersen's Behavioral Model for Healthcare Utilization. We recruited HIV-negative gay, bisexual, and other men who have sex with men, aged 18 to 39 years, from social media, dating apps, and community outreach to complete semistructured interviews to explore perceptions of and preferences for PrEP promotion. Interview transcripts were inductively and deductively coded for thematic analysis.</p><p><strong>Results: </strong>Forty participants completed interviews (median age, 28 years; 68% Black; 48% current PrEP users). Three themes emerged: (1) the role of different identities with subthemes emphasizing diversity to reduce stigma and improve relatability; (2) interpersonal relationships, that is, friends, partners, and family, affect PrEP promotion; and (3) reduced emphasis on HIV risk in promotions.</p><p><strong>Conclusions: </strong>To see behavior change for seeking PrEP knowledge and PrEP uptake, PrEP promotions must evolve to improve diversity to foster relatability and reduce stigma, harness social networks to efficiently transmit messaging, and tactfully discuss risk behaviors without compounding stigma.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":"488-494"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 3 Treatment Regimens for Latent Syphilis of Late or Unknown Duration Using Public Health Surveillance Data.","authors":"Travis J Hunt, Anna Berzkalns, Chase A Cannon, Tim W Menza, Julia C Dombrowski, Matthew R Golden","doi":"10.1097/OLQ.0000000000002148","DOIUrl":"10.1097/OLQ.0000000000002148","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Disease Control and Prevention recommends treating latent syphilis of late/unknown duration (LSUD) with 3 doses of intramuscular benzathine penicillin G (BPG) or 28 days of oral doxycycline. This recommendation lacks high-quality evidence.</p><p><strong>Methods: </strong>Using public health surveillance data from King County, Washington, we conducted a retrospective cohort study comparing rates of serological cure (≥2-titer reactive plasma reagin [RPR] decline) among persons with LSUD following receipt of 1 of 3 regimens: 1 dose of BPG, 3 doses of BPG, and 28 days of doxycycline. Subjects included persons diagnosed in 2007 to 2020 with an initial RPR ≥1:2 and follow-up RPR testing 1 to 36 months after treatment. We stratified initial RPRs into high and low titer (≥1:32, <1:32) and compared outcomes using Cox proportional hazards.</p><p><strong>Results: </strong>The study population included 761 persons with median time from treatment to last RPR/serological cure of 219 days (interquartile range, 114-488 days). Among high-titer persons, serological cure occurred in 36 of 41 (88%), 330 of 376 (88%), and 58 of 64 (88%) receiving single-dose BPG, 3-dose BPG, and doxycycline, respectively. Among low-titer persons, serological cure occurred in 4 of 13 (31%), 114 of 235 (49%), and 14 of 30 (47%) receiving single-dose BPG, 3-dose BPG, and doxycycline, respectively. Controlling for initial RPR, serological cure did not differ between high-titer persons receiving 1- and 3-dose BPG (adjusted hazard ratio, 0.89; 95% confidence interval, 0.63-1.26) or 1-dose BPG and 28 days of doxycycline (adjusted hazard ratio, 1.03; 95% confidence interval, 0.68-1.58).</p><p><strong>Conclusions: </strong>Serological outcomes in high-titer LSUD after 1 dose of BPG, 3 doses of BPG, and 28 days of doxycycline are similar.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":"457-461"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Design Process of a Digital Patient Decision Tool to Increase Sexually Transmitted Infection Testing in the Emergency Department.","authors":"Lauren S Chernick, Talia Adler, Jaciara N De Souza, Christina N Franqui, Lisa-Pierre Tchoungui, Anna Caselli, Ariel Tyndell, Renato Castilho, Marc A Probst, Delivette Castor, Jason Zucker","doi":"10.1097/OLQ.0000000000002166","DOIUrl":"10.1097/OLQ.0000000000002166","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults (AYA) frequently use the emergency department (ED) and admit to infrequent contraceptive use, increasing their risk of sexually transmitted infections (STIs). This study aimed to design STI Check in the Emergency Room (STIckER), a user-informed digital patient decision aid aiming to increase shared decision making around genitourinary and extragenital STIs testing among AYA ED patients.</p><p><strong>Methods: </strong>This 2-center study followed a multiphase approach. In phase 1, we defined our health condition, target audience, and health decision, and organized a multidisciplinary steering group. Through a series of design workshops, we created a low-fidelity prototype. In phase 2, we conducted semistructured interviews with AYA ED patients and ED health care providers to understand values and preferences around STI testing and decision-aid implementation. Interviews were recorded and analyzed using rapid qualitative analysis techniques. Data from interviews led to a final high-fidelity prototype.</p><p><strong>Results: </strong>Interviews with 19 AYA ED patients suggested interest in participating in the decision for STI testing and have emotions about getting results. Interviews with 15 ED health care providers highlighted that shared decision making matches clinical practice, interventions should not increase cognitive load, and sexual health interventions are more complex when parents are involved. Both groups were receptive to nonjudgmental sexual health interventions that promote privacy and eliminate testing stigma.</p><p><strong>Conclusion: </strong>The STIckER decision aid was designed using an iterative process that involved user testing and integrating feedback, leading to a digital tool that could promote equitable STI testing built specifically for the complex ED setting.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":"462-469"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmet Need for Human Papillomavirus Vaccination Among Men Who Have Sex With Men Living With and Without Human Immunodeficiency Virus, San Francisco, 2023.","authors":"Paloma L Ramirez, Antonio A M Moscatelli, Bow Suprasert, Moranda Tate, Erin C Wilson, Willi McFarland","doi":"10.1097/OLQ.0000000000002177","DOIUrl":"10.1097/OLQ.0000000000002177","url":null,"abstract":"<p><strong>Background: </strong>Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection and resulting anal cancer. Guidelines for HPV vaccination for MSM older than 26 years recommend shared clinical decision making. Our objectives were to measure history of HPV vaccination and identify disparities in vaccination in a community-recruited sample of MSM in 2023 in San Francisco.</p><p><strong>Methods: </strong>Data originated from National HIV Behavioral Surveillance. Time-location sampling recruited participants through outreach at venues where MSM congregate during randomly selected times. Face-to-face interviews collected demographics, risk and preventive behaviors, access to health care, and HIV status. Multivariable logistic regression analysis assessed factors associated with HPV vaccination.</p><p><strong>Results: </strong>Among 497 MSM respondents, 44.9% reported HPV vaccination. Human papillomavirus vaccination was more likely for MSM aged 18 to 29 years versus older (adjusted odds ratio [AOR], 4.84; 95% confidence interval [CI], 2.37-9.87), having a college degree versus less education (AOR, 1.74; 95% CI, 1.18-2.57), seeing a health care provider in the last 12 months (AOR, 3.60; 95% CI, 1.62-8.01), and diagnosed with an sexually transmitted disease (AOR, 1.97; 95% CI, 1.30-2.99). Among MSM not living with HIV, using preexposure prophylaxis in the last 12 months had an increased odds of HPV vaccination (AOR, 4.53; 95% CI, 2.69-7.63).</p><p><strong>Conclusions: </strong>Less than half of MSM in San Francisco reported HPV vaccination. We recommend health care providers verify vaccination history and more routinely offer HPV vaccine to unvaccinated MSM at any age. Men who have sex with men living with HIV should consider HPV vaccination given confirmed safety, strong immune response, and some data on efficacy, even while awaiting further clinical studies.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":"482-487"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistence of genetically related Neisseria gonorrhoeae strains causing Disseminated Gonococcal Infection (DGI) cases in southwestern Michigan during 2019 to 2023.","authors":"Sandeep J Joseph, Laura A S Quilter, Brian H Raphael, John C Cartee, Katherine Hebrank, Kim M Gernert, Matthew W Schmerer, Alison D Ridpath, Elizabeth Burgess, Leslie Dybas, Heather M Blankenship, Kelly Jones, James B Kent, Stephen Dietrich, Kyle T Bernstein, Ellen N Kersh","doi":"10.1097/OLQ.0000000000002211","DOIUrl":"https://doi.org/10.1097/OLQ.0000000000002211","url":null,"abstract":"<p><strong>Background: </strong>Disseminated gonococcal infection (DGI) is a rare complication of Neisseria gonorrhoeae (Ng) infection, historically affecting 0.5-3% of individuals. In 2019, a DGI genomic cluster associated with the ST-7822 strain was identified in southwest Michigan. This study retrospectively assessed the persistence of this strain.</p><p><strong>Methods: </strong>Ninety Ng isolates from disseminated sites of infection from Michigan (2019-2023) were sequenced; antimicrobial susceptibility testing (AST) was performed. Phylogenetic analysis was performed to assess genetic relatedness. Data from 370 ST-7822 urogenital and extragenital gonococcal infection (UGI) isolates were included in the phylogenetic analysis. The porB1A allele, a marker associated with DGI, and antimicrobial resistance markers were also analyzed.</p><p><strong>Results: </strong>Phylogenetic analysis identified seven DGI clades, with clade 7 (n = 26) containing the 2019 cluster (n = 11). Clade 7 isolates (mean SNP difference: 32) formed two sub-clusters from a single ancestor between 2019-2023 and clustered with local UGI isolates. All clade 7 DGI isolates and 82.7% of ST-7822 UGI isolates carried the porB1A allele. Among DGI isolates with AST data (n = 21), all were susceptible to ceftriaxone; no mosaic penA alleles were identified.</p><p><strong>Conclusions: </strong>The persistence of clade 7 associated with the 2019 Michigan DGI cluster suggests ongoing regional transmission of the ST-7822 strain type that has a high proportion with porB1A allele, which has been associated with invasive infection. The genetic similarity between DGI and UGI isolates suggests that DGI strains are not genetically distinct but derived from circulating strains causing mucosal infections. Continued genomic surveillance is essential to understand virulence factors contributing to disseminated infections.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Clinical Outcome Measures in a Therapeutic Trial for Late Latent Syphilis.","authors":"Khalil G Ghanem, Matthew Hamill","doi":"10.1097/OLQ.0000000000002225","DOIUrl":"https://doi.org/10.1097/OLQ.0000000000002225","url":null,"abstract":"","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study design matters: Using a rigorous analytic design to examine the association between rectal douching and incident rectal gonorrhea and chlamydia.","authors":"Emma Chrznowski, Lindley A Barbee, Lisa E Manhart, Christine M Khosropour","doi":"10.1097/OLQ.0000000000002226","DOIUrl":"https://doi.org/10.1097/OLQ.0000000000002226","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have identified an association between rectal douching and prevalent rectal Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), but few studies have examined associations with incident infections.</p><p><strong>Methods: </strong>We used data from ExGen, a 48-week cohort study conducted in Seattle, Washington, 2016-2018. Each week, participants completed a survey and self-collected rectal specimens, which were tested for CT/GC at the end of the study. Our primary analysis was a case-crossover analysis. We identified individuals with incident rectal GC or CT and included 1 case-week (the first week of the incident rectal infection) and 2 randomly-selected control-weeks (weeks where the participant tested negative for rectal GC/CT). We used multivariate conditional logistic regression to estimate the association between douching and rectal GC/CT. In an exploratory analysis, we created a \"synthetic\" cross-sectional study of the longitudinal data to mirror the design of other studies.</p><p><strong>Results: </strong>There were 140 individuals in ExGen. Our case-crossover sample comprised 17 GC case-weeks and 34 matched GC control-weeks, and 22 CT case-weeks and 44 matched CT control-weeks. Participants reported douching during 64.7% of GC case-weeks and 70.6% control-weeks (aOR = 0.47; 95% CI = 0.07-3.10). Douching was reported at a similar frequency among CT case-weeks (45.5%) versus control weeks (47.7%) (aOR = 1.16; 95% CI = 0.26-5.07). In our exploratory synthetic cross-sectional study, rectal douching was significantly associated with rectal GC but not CT.</p><p><strong>Conclusion: </strong>Douching was not associated with rectal GC/CT in this methodologically-rigorous analysis. A better understanding of the mechanisms of douching products and impact of long-term use may be warranted.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doxycycline post-exposure prophylaxis is effective and highly acceptable in an urban public sexually transmitted disease clinic: Philadelphia, 2019-2023.","authors":"Felicia M T Lewis, Anna B Cope, Kelly Clark, Robbie Madera, Lenore Asbel, Daniel R Newman, Nicole L Davis","doi":"10.1097/OLQ.0000000000002224","DOIUrl":"10.1097/OLQ.0000000000002224","url":null,"abstract":"<p><strong>Background: </strong>We sought to determine real-world effectiveness of doxycycline post-exposure prophylaxis (doxy PEP) in reducing sexually transmitted infections (STI) among men who have sex with men attending an HIV pre-exposure prophylaxis (HIV PrEP) clinic in Philadelphia.</p><p><strong>Methods: </strong>Data from eligible HIV PrEP patients who did and did not receive doxy PEP from September 1, 2019-December 31, 2023 were analyzed. We used a cohort study design and Cox models to estimate associations between doxy PEP receipt and incident gonorrhea (GC), chlamydia (CT), and/or syphilis. We also used a crossover design and Poisson models to estimate incidence rate ratios (IRR) for any STI and each STI separately among individuals in the year before and after doxy PEP initiation.</p><p><strong>Results: </strong>Among the 508 eligible men, most were young men of color and 416 (82%) opted to receive doxy PEP. Receiving doxy PEP was associated with a reduction in any incident STI (hazard ratio [HR] 0.61, 95% confidence interval 0.40-0.93) and any incident CT (HR 0.40, 95% CI 0.21-0.78). Participants experienced a 62% relative reduction in STI rates while taking doxy PEP (IRR 0.38 (95% CI 0.29-0.50), including a reduction in CT (IRR 0.28, 95% CI 0.20-0.39) and GC (IRR 0.49, 95% CI 0.37-0.65).</p><p><strong>Conclusions: </strong>We observed a significant reduction in any STI and CT in both analytic arms, suggesting that doxy PEP is effective in real-world settings. Enhancing doxy PEP implementation would likely reduce community STI transmission.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth-friendly sexual health services and peer support for improved sexual and reproductive health outcomes among adolescents and young adults in South Africa: results of a factorial randomized controlled trial.","authors":"Jana Jarolimova, Jacob Busang, Natsayi Chimbindi, Nonhlanhla Okesola, Theresa Smit, Guy Harling, Nuala McGrath, Andrew Copas, Janet Seeley, Kathy Baisley, Maryam Shahmanesh","doi":"10.1097/OLQ.0000000000002203","DOIUrl":"10.1097/OLQ.0000000000002203","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults in South Africa have high burdens of STIs and unintended pregnancy. We evaluated the impact of peer support and/or expanded sexual and reproductive health (SRH) services on STIs, contraception, and pregnancy in rural KwaZulu-Natal, South Africa.</p><p><strong>Methods: </strong>We analyzed secondary outcomes from a 2x2 factorial randomized controlled trial conducted March 2020-August 2022 among 16-29-year-olds, comparing: 1) enhanced Standard of Care (SoC): access to mobile youth-friendly HIV prevention(AYFS); 2) SRH: self-collected STI testing and referral to AYFS with expanded SRH services; 3) Peer-support: peer navigator facilitation of AYFS attendance; 4) SRH + peer-support. At 12 months all participants were offered STI testing; female participants self-reported contraceptive use and pregnancy.</p><p><strong>Results: </strong>Among 1743 trial participants (51% female), 927 (53%) had 12-month STI results; 209 (22.5%) tested positive: 163 (17.6%) chlamydia, 54 (5.8%) gonorrhea, 44 (4.8%) trichomoniasis. STI prevalence was somewhat lower among those exposed to peer-support (aOR adjusted for sex, age, location: 0.77, 95%CI 0.56-1.06) or SRH (aOR 0.74, 0.56-1.06) and, compared to SoC, was reduced in those exposed to both (aOR 0.59, 0.38-0.94). In SRH arms, 64/469 (13.6%) had a new STI at 12 months, with no difference by peer-support (p = 0.97). Among females, 336/634 (53.0%) reported using contraception and 47/667 (7.1%) pregnancy, with little difference by study arm.</p><p><strong>Conclusions: </strong>Peer support and STI testing with expanded SRH each had no more than small effects on STIs, contraception, or pregnancy. Combined or more intensive interventions, e.g., repeat screening, enhanced partner notification, and deeper understanding of structural drivers, are needed.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}