From the Division of Infectious Diseases.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA.
Sex Transm Dis. 2019 Nov;46(11):737-742. doi: 10.1097/OLQ.0000000000001056.
Gay, bisexual, and transgender youth and homeless youth are at high risk for sexually transmitted infections (STIs). However, little recent data exist describing STI positivity by anatomical site among those groups. We determined the positivity of Chlamydia trachomatis (CT) infection, Neisseria gonorrhoeae (NG) infection, and syphilis antibody reactivity among lesbian, gay, bisexual, transgender, and homeless youth.
We recruited 1,264 adolescents with high risk behavior aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, community health centers, and using social media and online dating apps in Los Angeles, California and New Orleans, Louisiana from May 2017 to February 2019. Participants received point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and syphilis antibody testing. We calculated STI positivity by anatomical site and compared positivity by participant subgroups based on human immunodeficiency virus (HIV) status, sex assigned at birth, and gender identity.
CT and NG positivity and syphilis antibody reactivity was higher among HIV-infected adolescent men who have sex with men (MSM) than HIV-uninfected adolescent MSM (40.2% vs. 19%, P < 0.05), particularly CT or NG rectal infection (28% vs. 12.3%, P < 0.05). Of participants with positive CT or NG infections, 65% had extragenital-only infections, 20% had both extragenital and urogenital infections, and 15% had urogenital-only infections.
Sexually transmitted infection positivity was high, particularly among transgender women and MSM. The high proportion of rectal and pharyngeal infections highlights the importance of both urogenital and extragenital STI screening. More accessible STI testing is necessary for high-risk adolescent populations.
男同性恋、双性恋和跨性别青年以及无家可归的青年感染性传播感染（STI）的风险较高。然而，最近很少有数据描述这些群体中按解剖部位划分的 STI 阳性率。我们确定了女同性恋、男同性恋、双性恋、跨性别和无家可归青年的沙眼衣原体（CT）感染、淋病奈瑟菌（NG）感染和梅毒抗体反应的阳性率。
我们于 2017 年 5 月至 2019 年 2 月期间，在加利福尼亚州洛杉矶和路易斯安那州新奥尔良的无家可归者收容所、男女同性恋、双性恋和跨性别组织、社区卫生中心以及通过社交媒体和在线约会应用程序，招募了 1264 名年龄在 12 至 24 岁之间、有高危行为的青少年。参与者接受了即时护理咽、直肠和尿道/阴道 CT 和 NG 检测以及梅毒抗体检测。我们按解剖部位计算了 STI 阳性率，并根据人类免疫缺陷病毒（HIV）状况、出生时的性别分配和性别认同，比较了不同参与者亚组的阳性率。
与未感染 HIV 的青少年男男性行为者（MSM）相比，感染 HIV 的青少年 MSM 的 CT 和 NG 阳性率和梅毒抗体反应率更高（40.2% 比 19%，P < 0.05），尤其是 CT 或 NG 直肠感染（28% 比 12.3%，P < 0.05）。在有 CT 或 NG 阳性感染的参与者中，65% 有外生殖器感染，20% 有外生殖器和泌尿生殖器感染，15% 有泌尿生殖器感染。
性传播感染阳性率很高，尤其是在跨性别女性和 MSM 中。直肠和咽感染比例较高，突出了泌尿生殖系统和外生殖器性传播感染筛查的重要性。高危青少年人群需要更方便获得性传播感染检测。
