University of São Paulo (USP), Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
BMC Infect Dis. 2024 Feb 26;24(1):260. doi: 10.1186/s12879-024-09144-z.
BACKGROUND: The presence of untreated sexually transmitted infections (STIs) significantly increases the chance of acquiring HIV. In Brazil, testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among Pre-Exposure Prophylaxis (PrEP) users is insufficient, and syndromic treatment is a priority in clinical practice. Multi-site testing for CT/NG improves thescreening of asymptomatic cases and ensures timely treatment. Therefore, it is essential for HIV prevention. This study aims to test the importance of two-site testing for better screening of these pathogens and to determine whether the presence of symptoms is an indicator of CT/NG infection. METHODS: This is a cross-sectional study carried out in four public infectious diseases clinics in São Paulo State, Brazil between January of 2022 and March of 2023. All participants had an anal swab and a first-pass or mid-stream urine collected for CT/NG analysis by Polymerase chain reaction (PCR). Data about sociodemographic, sexual behavioural and clinical aspects were collected. Pathway analysis was used to examine the direct and indirect relationships between variables according to the theoretical model. RESULTS: We screened 171 PrEP users which had two samples collected, resulting in 342 samples. Comparing the anatomic sites, the urine samples showed lower sensitivity for CT and NG than anal samples. Gonorrhoea was directly linked to lower age (β= -0.161, p = 0.001). Time of PrEP use was directly associated with CT infection (β = 0.202; p = 0.042) and inversely associated with dysuria (β= -0.121, p = 0.009). Lower occurrence of yellow-green secretion was linked to detection of CT (β= -0.089, p = 0.005) and NG (β= -0.048, p = 0.002) infections. Foul-smelling discharge was directly associated with CT (β = 0.275, p = 0.004) and NG (β = 0.295, p = 0.037) infection. CONCLUSION: The symptoms are a bad indicator of CT and NG infection, and the screening must be done in more than one site since most of the positive results would be missed if only urines were tested. In the case of testing only one anatomical site, specifically the urethra, the CT/NG incidence and prevalence would be underestimated. The two-sites testing improves detection rates of CT/NG, and PrEP follow-up benefits people offering STI testing.
背景：未经治疗的性传播感染（STIs）显著增加了获得 HIV 的机会。在巴西，对暴露前预防（PrEP）使用者中的沙眼衣原体（CT）和淋病奈瑟菌（NG）进行检测的情况不足，临床实践中优先进行症状性治疗。CT/NG 联合检测可提高无症状病例的筛查率，并确保及时治疗。因此，这对于 HIV 预防至关重要。本研究旨在检验双部位检测对更好地筛查这些病原体的重要性，并确定症状是否是 CT/NG 感染的指标。
方法：这是一项在巴西圣保罗州的四家公立传染病诊所进行的横断面研究，时间为 2022 年 1 月至 2023 年 3 月。所有参与者均采集肛拭子和首段或中段尿液，通过聚合酶链反应（PCR）分析 CT/NG。收集社会人口统计学、性行为和临床方面的数据。路径分析用于根据理论模型检验变量之间的直接和间接关系。
结果：我们筛查了 171 名 PrEP 使用者，他们采集了两个样本，共采集了 342 个样本。比较解剖部位，尿液样本对 CT 和 NG 的敏感性低于肛门样本。淋病与较低的年龄直接相关（β=-0.161，p=0.001）。PrEP 使用时间与 CT 感染直接相关（β=0.202；p=0.042），与尿痛呈负相关（β=-0.121，p=0.009）。黄绿色分泌物减少与 CT（β=-0.089，p=0.005）和 NG（β=-0.048，p=0.002）感染有关。恶臭分泌物与 CT（β=0.275，p=0.004）和 NG（β=0.295，p=0.037）感染直接相关。
结论：症状是 CT 和 NG 感染的不良指标，必须在多个部位进行筛查，因为如果仅检测尿液，大多数阳性结果将被遗漏。如果仅检测一个解剖部位，特别是尿道，则 CT/NG 的发病率和患病率将被低估。双部位检测可提高 CT/NG 的检出率，PrEP 随访使 STI 检测受益于人们。
Epidemiol Serv Saude. 2021-3-15
Sex Transm Infect. 2020-5-13
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