Misdiagnosis of Sexually Transmitted Diseases in Hong Kong Outpatient Private Healthcare

Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method;then the extracted DNA was tested using the DiagCor GenoFlowTM STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.

Socio-Demographic, Clinical, and Hygiene Profile of Syndromically Managed Sexually Transmitted Diseases: A Cross Sectional Study in a Tertiary Care Center in India

Background: Sexually transmitted diseases are one of the several major public health concerns, the burden of which is borne by low- and middle-income countries like India. Purpose: The purpose is to evaluate the relationship between menstrual and sanitary hygiene and sexually transmitted diseases (STD) based on syndromic diagnosis Methods: An out-patient department (OPD) based cross sectional survey to determine these associations, if any exist, which would help critically analyze syndromic management. STD was reported by the presence of vaginal/cervical/urethral discharge with or without irritation and itching, lower abdominal pain and ulcer. Results: The prevalence of STD was 66.84% with the most commonly reported symptoms being discharged (31.18%), followed by abdominal pain (17.92%) and itching/irritation (12.90%), with ulcer (4.83%) being the least reported symptom. Perimenopausal age ((AOR: 0.420 [CI: 0.189 - 0.915];p = 0.030), higher grades of education ((AOR: 0.228 [CI: 0.119 - 0.424];p < 0.001) for secondary), urban residency (AOR: 0.435 [CI: 0.686 - 2.733];p < 0.001), and contraception use (AOR: 0.531 [CI: 0.308 - 0.887];p = 0.018) were associated with lesser odds of presenting with an STD symptom. Belonging to a minority religious community (AOR: 7.20 [CI: 1.866 - 48.251];p < 0.012) or backward castes (AOR: 3.753 [CI: 1.587 - 10.144];p < 0.001), having similar illness (AOR: 4.205 [CI: 2.795 - 6.439];p < 0.001) or having an invasive gynecological procedure done in the past one year (AOR: 1.953 [CI: 1.184 - 3.295];p = 0.010) and washing the reusable sanitary material only with water (AOR: 4.900 [CI: 2.701 - 9.116];p < 0.001) as compared to washing it with water and soap, had a higher association with presenting with STD symptoms. Stratified analysis also showed that women presenting discharge (AOR: 2.049 [CI: 1.343 - 3.146] for vaginal and cervical;AOR: 1.426 [CI: 0.826 - 2.482] for urethral) were more likely to not have a toilet facility in an accessible condition. Women with sanitary napkin use had lesser odds (AOR: 0.780 [CI: 0.516 - 1.180];p = 0.293) of presentation for STD in OPD than women who used other material. Conclusion: To better manage the group of diseases that may present with symptoms of STD under syndromic approach, we propose interventions such as menstrual hygiene education and promotion of the use of sanitary napkins among women especially those belonging to lower socio-economic sections of the society.

The Educational System Against Sexually Transmitted Diseases:Optics in the Brazilian School Context

The aim of this study was to contribute to the teaching of sexually transmitted diseases(STDs)in high schools.The study was done from the research knowledge about STDs of 61 students from two schools of Rio Claro-SP,Brazil:A state and a private school,through a questionnaire(pre-test)and an interview with two biology professors,and each one from each school.The results indicated that,in general,the students in the private school had more knowledge about the subject.The public school students showed more problems with knowledge about the symptoms of STDs.In those two schools,the knowledge on the subject proved to be generic and superficial.According to the biology teachers,both of them teach about the content,and the teaching material contains themes of sexuality and STDs.From these results,an intervention was developed with students,using methods such as group dynamics and lecture dialogued lessons.After the intervention,there was an increase in the percentage of correct answers for the students of both schools(post-test)which shows that it was effective.We conclude that this work has achieved the objective of clarifying the theme to the students,but lack the schools a better dialogue with them for the planning of this content,since,although it is foreseen the your teaching,you're not going on an apprenticeship.

Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China:a multicentre cross-sectional survey

Background:Delayed or inappropriate treatment for sexually transmitted diseases(STDs)increases the risk of HIV acquisition and may cause other harmful outcomes.However,studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men(MSM)are scarce.This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM.Methods:During 2012-2013,a multicentre cross-sectional study was conducted in 7 Chinese cities.Participants completed an interview-questionnaire and gave venous blood samples,which were then tested for antibodies to HIV,syphilis,and herpes simplex virus-2(HSV-2).MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM.Results:Of the 4496 eligible MSM who completed this survey,24.4%(1096/4496)were categorized as suspected STD-infected MSM.35.7%(391/1096)of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months.Among MSM who did not attend STD clinics for treatment,the prevalence of syphilis and HSV-2 was significantly higher;the HIV prevalence and incidence within this subpopulation reached as high as 14.5%and 12.2/100 person-years,respectively.Multivariate logistic regression analysis indicated that having 7-12 years of education(vs.≤6 years;aOR,2.5;95%CI,1.0-6.1),≥13 years of education(vs.≤6 years:aOR,2.8;95%CI,1.2-7.0),monthly income>500 USD(vs.≤500 USD:aOR,1.5;95%CI,1.1-2.1),obvious STD-related symptoms within last 12 months(aOR,5.3;95%CI,3.7-7.5),being HIV infected(aOR,1.7;95%CI,1.1-2.6),currently syphilis infected(aOR,0.6;95%CI,0.4-0.9)and HSV-2 infected(aOR,0.6;95%CI,0.5-0.9)were independent correlates with seeking STD treatment in clinics among Chinese MSM.Conclusions:The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM.Models that prioritize better screening for and education about STDs should be urgently implemented,especially among low-income MSM.

Sexual Behavior and Awareness of Sexually Transmitted Diseases Among Street-Based Female Sex Workers in the Florence Area, Central Italy

Objective:Street-based female sex workers are more likely to practice unprotected sex with multiple partners increases their risk of infection with sexually transmitted diseases.This study was performed to evaluate the understanding of and risk factors for sexually transmitted diseases among street-based female sex workers.Methods:A survey consisted of a sociodemographic section and a health section was conducted from June to August in two consecutive years(2012-2013)using an anonymous questionnaire compiled by street-based female sex workers in the area of Florence(Central Italy).A descriptive analysis of sociodemographic,epidemiological,and anamnestic variables was performed using common methods for proportions;associations between variables were assessed using univariate and bivariate logistic regression.Results:Totally 122 street-based female sex workers(mean age,24.1 years;age range,17-45 years)were enrolled,and were from Europe(63.1%)(mainly from Romania[48.4%]and Albania[13.1%]),Africa(31.2%)(specifically Nigeria),and South America(5.7%).Of the 122 street-based female sex workers,63%were married/engaged and 37%were single.More than half had been living in Italy and Florence for more than 1 year;72.8%stated that they possessed a residence permit and the others were illegal migrants.Eighteen(15%)street-based female sex workers also worked in the industry in neighboring European countries.Their level of education was generally high:58.1%had completed secondary school(lower secondary school and upper secondary school).A total of 81.4%stated that they perceived an actual fear of contracting human immunodeficiency virus;in fact,43.3%had never been tested for any sexually transmitted diseases except for human immunodeficiency virus.Conclusion:Despite the long-time involvement of street-based female sex workers in the commercial sex industry,the large numbers of clients and a strong perception of concerns about sexually transmitted diseases.This study confirms a low rate of condom use and blood screening,and corresponding science education and health screening efforts need to be strengthened in this high risk population.

Arboviruses and Sexually Transmitted Infections in the Bioceanic Route: Health Indicators in a Municipality

Background: the physical integration of South America through a Bioceanic Corridor has been idealized for a long time by the countries that make up Mercosur. This integration will have impacts on the population residing in the cities where the route will be built. Among them, Porto Murtinho, southern Mato Grosso on the border with Paraguay, stands out, where a bridge will be built over the Paraguay River that will link these two countries. Methods: a retrospective, quantitative and cross-sectional study of a descriptive type of documentary approach that sought to analyze the prevalence of arboviruses, Sexually Transmitted Infections (STIs) and Diseases Related to Inadequate Environmental Sanitation (DRIES) notified and stored in the National System of Notifiable Diseases (SINAN). The sample consisted of new cases of these pathologies in the municipality of Porto Murtinho registered between January 2017 and December 2020. Results: there was an increase of 10% in the total number of diseases within this period. The number of dengue cases increased 36 times;the incidence of Syphilis, HIV and HPV decreased;and, finally, maintenance of cases of Gonorrhea, Leptospirosis, Yellow Fever, Zika, Chikungunya, Hepatitis A and B. Conclusions: actions are needed to prevent the increase of these pathologies together with the construction of the Bioceanic Route, thus avoiding damage population health and increased consumption of government resources.

A Survey of Digital Content Required for STD Prevention Education Taught by School Nurses

Purpose: In recent years, there has been concern in Japan about the increase in STDs among adolescents aged 15 - 19. In order to prevent STDs and guide adolescents toward desirable sexual behavior, this study’s goal was to examine the actual state of STD prevention education taught by school nurses as part of the school curriculum, as well as the kinds of digital content they wish to have for teaching on the subject. Method: An anonymous, self-administered questionnaire was distributed by email and leaflet. Targeting the 100 valid responses received from the surveyed school nurses, descriptive statistics were made for each survey item and comparisons were made between the early- and mid-career groups based on years of experience. Results: 70.0% of respondents reported teaching about STDs in Health & Physical Education classes. School nurses in the early-career group used ready-made materials, while the mid-career group used both ready-made and self-made materials. 95% of respondents reported that they had little or no knowledge of STDs, while 84% reported that they were “good” or “fairly good” at teaching classes on sexuality. Both groups reported difficulty with the topics of “phimosis” and “nocturnal emissions” in the physiological category, “sexual behavior” in the “sex-adjacent” category, and “sexual and reproductive issues” in the psychosocial category. Respondents expressed a need for digital content covering the topics of “sexual violence”, “sexual abuse”, “sexually transmitted diseases”, and “how to turn down sex”. The mid-career group desired digital content for more items than the early-career group, with significant differences in the pathogens involved in sexually transmitted diseases and sex-adjacent items. 32.0% of respondents answered that they had done self-study for sex education classes in the past three years, and both groups desired self-study on “sexually transmitted diseases”, with the mid-career group significantly higher than the early-career group on “cervical cancer & HPV”, “emergency contraceptives”, and “media literacy”. Conclusion: Health & Physical Education is the main subject that covers STDs, and pre-existing materials are commonly used. It is expected that this is due to nurses’ busy schedules and the fact that only one school nurse is assigned to each school. The data collected suggested that nurse teachers want categorized digital content that can be used in the classes they are responsible for, rather than educational content on topics they are not comfortable with. In addition, given the changing environment surrounding sex, it was clear that they wish to understand the realities and needs of the high school students they teach, and desire self-study opportunities to improve their teaching methods.

An edge-based model for non-Markovian sexually transmitted infections in coupled network

In this paper,allowing for general transmission and recovery times distributions,we proposed an edge-based age-structured-like compartmental model for STIs(EBACMS)in a coupled nctwork.We considered sexual transmissions between men with also heterosexual contacts.Mathematically,we gave the general approach of proving the nonnegativity of solutions for the system coupling ordinary and partial differen-tial equations,which can be applied to all edge-based compartment models.We then analyzed the epidemic threshold Ro with different distributions which couples the thresholds of the single-layer and bipartite networks in the percolation theory.We also studied the global stability of disease-free equilibrium with R0<1 and the final epidemic size F(the proportion of the population experiencing infection during the epidemic)with R0>1.In addition,numerical simulations indicated that given a fixed exponential transmission distribution,a higher variance(with same mean)in general recovery distribution gives smaller R0 and F.Sensitivity analysis on Ro and F in terms of the parameters illustrated that male-to-male transmission routes have a greater impact on Rg and F than the heterosexual transmission routes for the Markovian transmission process and arbitrary recovery process.The results provide a good theoretical guideline to consider the distributions of real-world STIs.

Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium;collected 33 isolates during three years from 2017 to 2020;used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group;while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%;finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone;especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance;for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance;in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance;in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.