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Research news in clinical context
  1. Drieda Zaçe1,
  2. Marina Daskalopoulou2,
  3. Weiming Tang3
  1. 1 Infectious Disease Unit, Department of System Medicine, University of Rome Tor Vergata, 00133, Roma, Italy
  2. 2 Institute for Global Health, University College London, London, UK
  3. 3 Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Drieda Zaçe, Infectious Disease Unit, Department of System Medicine, University of Rome Tor Vergata, Roma, Italy; driedazace{at}

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Strategies for evaluating penicillin allergy in STI services

Over-reporting of penicillin or beta-lactam allergy often complicates STI management. In this trial, participants at low risk of allergy identified through a questionnaire were randomised to either (1) penicillin skin testing (PST), followed (if negative) by challenge with full-dose (250 mg) oral amoxicillin (PST arm, n=102), or (2) graded oral challenge (GOC), starting with 25 mg and following (if no reactions) with a full dose (GOC arm, n=104). In the PST arm, 99/102 (97%) participants proceeded to oral challenge and 96/99 (97%) had no reaction. In the GOC arm, 99/104 (95%) participants proceeded to full-dose challenge and 95/99 (96%) had no reaction. In each arm, three and four participants, respectively, experienced mild allergic reactions. Both PST and GOC procedures are effective in identifying patients who are not truly allergic to penicillin.

Lillis RA, Barbee LA, McNeil CJ, et al. Randomized multicenter trial for the validation of an easy to administer algorithm to define penicillin allergy status in sexually transmitted infection clinic outpatients. Clin Infect Dis. Published online February 7, 2024. doi:10.1093/cid/ciae064

Myocardial disease in women living with HIV

This cohort study from the USA employed cardiac magnetic resonance (CMR) to evaluate myocardial disease in women with (n=261, mean age 54 years) and without (n=101, mean age 52 years) HIV. Analysing three primary CMR parameters—myocardial native T1 (reflecting fibroinflammation), extracellular volume fraction (reflecting fibrosis) and triglyceride content (marker of steatosis)—revealed that women with HIV had higher myocardial fibroinflammation, particularly those with viraemia or a low current or nadir CD4 count. The study underscores the importance of optimising HIV control, and addressing traditional risk factors, to prevent cardiovascular diseases in women living with HIV.

Kato Y, Ambale-Venkatesh B, Naveed M, et al. HIV, HIV-specific factors and myocardial disease in women. Clin Infect Dis. Published online February 13, 2024. doi:10.1093/cid/ciae077

A novel point-of-care battery-powered test for gonorrhoea to inform management in resource-limited settings

In resource-limited settings, syndromic management of STIs is frequently used in symptomatic individuals, which may lead to inappropriate antibiotic use. A cross-sectional study in primary healthcare facilities in South Africa evaluated the diagnostic performance of a novel lateral flow assay to detect Neisseria gonorrhoeae (NG-LFA) surface-exposed antigens at point of care. The test consists of a battery-powered handheld electronic fluorescence reader that provides an automated qualitative result (positive, negative or invalid). Participants included 200 males with urethral discharge and 200 females with vaginal discharge. Among males, NG-LFA applied to urine samples demonstrated 96.1% sensitivity and 97.2% specificity relative to molecular tests. Among females, NG-LFA applied to vaginal swabs showed 91.7% sensitivity and 96.3% specificity. The novel NG-LFA offers promise to optimise treatment in settings without direct access to laboratory testing.

Peters RPH, Klausner JD, Mazzola L, et al. Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: a cross-sectional performance evaluation. Lancet. 2024;403 (10427):657–664. doi:10.1016/S0140-6736(23)02240-7

Mortality among adults living with HIV in Europe and North America between 1996 and 2020

Using data from 17 European and North American cohorts, this study analysed longitudinal trends in causes of death among 189 301 individuals on antiretroviral therapy. There were 16 832 documented deaths over 1 519 200 person-years. The most common causes of death were AIDS (25%), non-AIDS malignancy (14%) and cardiovascular disease (8%). Between 1996–1999 and 2016–2020, all-cause death rates decreased from 16.8 to 7.9 per 1000 person-years, with a significant decline in AIDS-related mortality and a concomitant increase in deaths due to non-AIDS cancers. There were differences among subgroups, with more pronounced reductions among men who have sex with men and less favourable trends among men and women who acquired HIV through injecting drug use. The findings highlight the need for targeted interventions and policies to address specific mortality risks affecting different populations.

Trickey A, McGinnis K, Gill MJ, et al. Longitudinal trends in causes of death among adults with HIV on antiretroviral therapy in Europe and North America from 1996 to 2020: a collaboration of cohort studies. Lancet HIV. 2024;11(3):e176-e185. Doi:10.1016/S2352-3018(23)00272-2

STI Editor’s Choice: Digital vending machines dispensing HIV and STI test kits in public settings—acceptable and effective

In 2022–2023, seven digital vending machines distributing free rapid HIV self-tests and STI self-sampling kits were installed in community centres, General Practitioner surgeries, saunas and universities across southwest England. Over 12 months, 2356 kits were dispensed, with STI self-sampling kits being the most popular (74%). Most users were aged 16–35 years (78%) and 56% identified as male. Importantly, based on a questionnaire’s answers, most had never previously tested or had not tested in the last 12 months for HIV or STI. Offering convenience, instant access and confidentiality, the machines can reach populations less engaged with sexual health services. However, only 51% of dispensed STI kits were returned and users often expressed concerns about privacy and safety when accessing the vending machines.

Gobin M, Dhillon S, Kesten JM, et al. Acceptability of digital vending machines to access STI and HIV tests in two UK cities. Sex Transm Infect. 2024;100(2):91–97. Published 2024 Feb 19. doi:10.1136/sextrans-2023–0 55 969

Missed opportunities for anorectal gonorrhoea testing in women not reporting anal sex

Anorectal testing for gonorrhoea is advised in women who report anal sex or anorectal symptoms. This retrospective analysis of 329 869 consultations with cisgender women who have sex with men undergoing testing for gonorrhoea in the Netherlands (2016–2021) identified 117 693 women who were tested both urogenitally and anorectally. Among 43 757 women without reported recent anal sex, 781 (2%) tested positive for gonorrhoea, with over 70% testing positive at the anorectal site. Findings were similar in women who reported recent anal sex. Independent predictors of anorectal gonorrhoea in these two groups were concurrent urogenital gonorrhoea and anorectal chlamydia. The association between urogenital and anorectal infections suggests autoinoculation from the genital to the anorectal site. However, approximately 20% of women had an infection solely at the anorectal site, without a concurrent urogenital infection, indicating that anorectal testing on indication only could miss anorectal infections.

Visser M, Hoebe CJPA, Wolffs PFG, Heijne JCM. Anorectal Neisseria gonorrhoeae infections in women with and without reported anal sex and sex workers in sexual health centres in the Netherlands: a retrospective cohort study. Lancet Microbe. Published online February 12, 2024. doi:10.1016/S2666-5247(23)00376-2

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  • Handling editor Anna Maria Geretti

  • Contributors All authors contributed to the selection of articles and to the writing of summaries. DZ submitted the final version to the journal.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.