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Published in STI: men who have sex with men frequently receive antibiotics despite negative STI tests
The Sydney Sexual Health Centre guidelines indicate immediate presumptive antibiotic treatment for men who have sex with men (MSM) with anogenital symptoms, in addition to laboratory-based three-site molecular testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoea (GC). Across 1061 visits (January 2020 and December 2021), 42% of symptomatic MSM tested CT and GC negative, yet many received antibiotic treatment. A total of 187 courses of ceftriaxone were prescribed to patients who tested GC negative at all anatomical sites. Using microscopy at point of care, particularly in men with urethral symptoms, substantially reduced but did not eliminate prescribing of unnecessary ceftriaxone. The study highlights the need for rapid molecular point-of-care tests, to reduce unnecessary antibiotic use and decelerate the emergence of antibiotic resistance.
Wong A, Applegate T, Boettiger DC, et al. Unnecessary antibiotic use in MSM with anogenital symptoms attending a sexual health clinic: a retrospective analysis. Sexually Transmitted Infections. Published Online First: 13 June 2024. doi: 10.1136/sextrans-2024–0 56 120.
Mail order HIV self-tests reach priority populations and previously untested individuals across the USA
The Together Take Me Home programme offered free mail-order HIV self-testing kits through an online system, advertising through existing HIV prevention social marketing programmes and LGBTQ+dating apps. In the first year, 219 360 individuals received 443 813 tests. Most test recipients were young, cisgender men and black or Latino, with half living in high-incidence areas. A quarter had never previously taken an HIV test. According to 10-day and 60-day follow-up surveys (n=14 217), 88% of test recipients used a test themselves and 27% gave a test to someone else. The programme appeared to improve access to HIV testing among at-risk individuals, including first-time testers and acquaintances of test recipients. As downstream positive effects, some test recipients reported subsequent HIV/STI prevention behaviours.
Sanchez T, MacGowan RJ, Hecht J, et al. Findings from the First Year of a Federally Funded, Direct-to-Consumer HIV Self-Test Distribution Program—United States, March 2023–March 2024. Morbidity and Mortality Weekly Report. 2024;73(24):558–564.
GC is frequently resistant to cefixime in Melbourne
A study conducted in Melbourne, Australia between 2021 and 2022 assessed the prevalence of cefixime-resistant N. gonorrhoea among individuals attending a sexual health clinic. Among 1176 isolates tested, 6.3% exhibited resistance to cefixime, exceeding the 5% threshold recommended by the WHO for discontinuing cefixime. Cefixime resistance was highest among women (16.4%), followed by men who have sex with women (6.4%) and MSM (5.8%). Resistance to azithromycin was found in 4.9% of isolates, while no resistance to ceftriaxone was detected. The findings suggest that cefixime would have limited efficacy for treating gonorrhoea in Australia, highlighting the need for alternative treatment strategies and continued antimicrobial resistance surveillance.
Chow EP, Stevens K, DePetra V, et al. Prevalence of cefixime-resistant GC in Melbourne, Australia, 2021–2022. The Journal of Infectious Diseases. 2024;jiae313.
Which resistance threshold for empiric gonorrhoea treatment?
Researchers in the USA conducted a cost-effectiveness analysis to assess the optimal resistance threshold for switching empiric gonorrhoea treatment among MSM. Using a mathematical model, the study evaluated thresholds between 1% and 10% under scenarios of antibiotic availability and use of drug-susceptibility testing. Changing the switching threshold did not significantly impact the annual number of gonorrhoea cases, treatment failures, or overall costs. However, a low threshold of 1–2% (less than the current threshold) could enhance overall net health benefits if new antibiotics become available or drug-susceptibility testing is used to inform retreatment. The findings emphasise the importance of developing new antibiotics and adopting treatment strategies to manage antimicrobial resistance effectively.
Yin X, Li Y, Rönn MM, et al. Assessing thresholds of resistance prevalence at which empiric treatment of gonorrhoea should change among MSM in the US: A cost-effectiveness analysis. PLoS Medicine. 2024;21(7):e1004424. Published 2024 Jul 8. doi:10.1371/journal.pmed.1004424
Mycoplasma genitalium and pelvic inflammatory disease
The role of M. genitalium as an aetiological agent of PID has been debated. A systematic review with random-effects meta-analyses assessed both the association of M. genitalium with PID (10 studies; 7246 people) and the proportion of PID cases with nucleic acid detection of the organism (19 studies; 21 104 people). M. genitalium was significantly associated with PID (pooled OR 1.67, 95% CI 1.24 to 2.24). The pooled positivity of M. genitalium in PID cases was 10.3% (95% CI 5.6 to 16.0). The highest proportion M. genitalium in PID cases was found in studies from the Americas (15.4%) and African regions (12.6%). These data support testing for M. genitalium in all clinical presentations of PID.
Htaik K, Vodstrcil LA, Plummer EL, et al. Systematic review and meta-analysis of the association between M. genitalium and pelvic inflammatory disease (PID). Clinical Infectious Disease. Published online June 7, 2024. doi:10.1093/cid/ciae295.
STIs in transgender women with and without HIV in the Eastern and Southern USA
A community-based study enrolled 1018 transgender women (median age 31 years) across six US cities to estimate the prevalence of bacterial STIs among participants with (n=276, 27%) and without HIV. Participants completed a survey and underwent laboratory-based testing. Blood samples were tested for syphilis; self-collected anorectal, urine and vaginal samples, as appropriate, were tested for chlamydia and gonorrhoea. Overall, 16% had at least 1 STI, with a higher prevalence detected in participants living with HIV (32%) compared with those without HIV (11%). Chlamydia was found in 5% of participants, gonorrhoea in 2%, and syphilis in 11%. Disparities based on race were observed, with higher rates of STIs in Black and Hispanic participants. Tailored interventions are needed to address the unique sexual health needs of transgender women, particularly those living with HIV.
Brown EE, Patel EU, Poteat TC, et al. Prevalence of sexually transmitted infections among transgender women with and without HIV in the Eastern and Southern United States. The Journal of Infectious Diseases. 2024;229(6):1614–1627. doi:10.1093/infdis/jiad605.
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Footnotes
Handling editor Anna Maria Geretti
X @GvillaDr
Contributors Each author summarised two articles for this work. NAV is the guarantor of the work. All authors contributed equally to the completion of this work.
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.