Determinants of Syphilis and Trichomonas Infections among Women Attending Selected Health Facilities in Kigali, Rwanda

Background: Syphilis and Trichomonas are among more than 30 known Sexually Transmitted Infections (STIs). They make part of the four (4) most prevalent treatable STIs globally, together with Chlamydia and gonorrhea. They are associated with lifelong health problems, especially among women and their babies, including but not limited to exacerbation of HIV acquisition risks, preterm labor, birth defects, and deaths. This study was conducted to determine the prevalence and determinants of Syphilis and Trichomonas infections among women attending selected Health Facilities (HFs) in Kigali, Rwanda. Methods: This study was a cross-sectional survey that collected data from 174 women who attended eight (8) HFs in Kigali, Rwanda from October 7 to December 6, 2019, for Outpatient Diagnosis (OPD) services. The HFs were purposefully selected while women participants were recruited using a systematic random sampling strategy. Vaginal swabs were microscopically examined for the presence of Trichomonas vaginalis and Syphilis was diagnosed using FaStep Syphilis Rapid tests to detect IgG and IgM specific to Treponema pallidum. The questionnaire captured information on the socio-demographic characteristics and sexual behaviors of the participants. Fisher exact test, Phi, and logistic regression were the main statistical analysis of the study. Results: This study recruited 174 women; aged between 17 and 49 years old, with a mean age of 29 years. The findings show that 12% (21 out of 174) of the women had either Syphilis (9.8%) or Trichomonas (2.3%), but none had both. Syphilis infections significantly affected women living in slums (40%, p=0.001), with a history of STI before (15.2%, p=0.028), not always using a condom (14.9%, p=0.014), and self-reporting to have had one lifetime sex partner (23.5%, p= 0.002). Living in slums, not always using a condom, and self-report of one lifetime sex partner uniquely increase the risks of getting syphilis up to 6.305, 5.53, and 5.81 times compared to their counterparts who are not, respectively. Trichomonas infection was significantly high (p <0.01) among women in economic category one (18.2%, p=0.029), self-reporting to lack transport (13.6%, p <0.001) and health cover (12.5%, p <0.001) as barriers of not attending a health facility while they are sick. Lacking transport means and health cover uniquely exacerbate the risks of Trichomonas infection up to 36.7 and 22.32 times, respectively. Conclusion: This study concludes that Syphilis and trichomonas infections are still major public health problems among women attending health facilities in Kigali, Rwanda. Therefore, there is still a need to enhance health promotion programs to improve healthcare-seeking behaviors and empower women to negotiate safe sexual activities.

HIV Transmission Potential and Sex Partner Concurrency: Evidence for Racial Disparities in HIV Risk Among Gay and Bisexual Men (MSM)

We determined whether racial disparities in HIV infection among gay and bisexual men (MSM) may be partially explained by racial differences in the HIV transmission potential (i.e. mixing of people living with HIV and people not living with HIV or of unknown HIV serostatus) and density (i.e. sex partner concurrency) of sexual networks. Data included a behavioral survey, testing for HIV, and an egocentric sexual network survey. Mixed effects logistic regressions were used for hypothesis testing. Black (vs. non-Black) MSM were more likely to not know their partner’s HIV serostatus (21.8% vs. 9.6%). Similar proportions reported sex partner concurrency (67.1% vs. 68.0%). In adjusted analyses, among Black MSM, sex partner concurrency significantly increased the odds of an HIV transmission potential partnership (TPP), and this association was not significant among non-Black indexes. The association between an HIV TPP and sex partner concurrency may help explain persistent racial disparities in HIV prevalence.

Accelerated partner therapy contact tracing for people with chlamydia: The LUSTRUM cluster cross-over randomised controlled trial

Objective: To assess accelerated partner therapy (APT) as a contact tracing intervention for people with chlamydia. Design: Cross-over cluster-randomised controlled trial. Setting: 17 sexual health clinics (clusters) in the United Kingdom, 2018-2019. Participants: Heterosexual people aged over 16 years with a positive Chlamydia trachomatis test result and/or clinical diagnosis of pelvic inflammatory disease, cervicitis, non-gonococcal urethritis or epididymo-orchitis, and reporting one or more contactable sexual partner in the past six months, and their sexual partners. Interventions: Clusters were assigned by random permutation to either (a) usual care: health care professional advises the index patient to tell their sex partner(s) to attend clinic for sexually transmitted infection (STI) screening and treatment, or (b) usual care plus the offer of APT: healthcare professional assesses sex partner(s) by telephone, then sends or gives the index patient antibiotics and STI self-sampling kits for their sex partner(s). After a two-week washout period, clinics crossed over to the opposite exposure. Each period lasted 6 months. Main outcome measures: The primary outcome was the proportion of index patients with a positive C. trachomatis test 12-24 weeks after treatment. Secondary outcomes included proportions and types of sex partners treated. Analysis: Intention-to-treat, fitting random effects logistic regression models. Results: All clinics completed both periods. Overall, 1536 and 1724 recruited index patients provided data in intervention and control phases respectively. In total, 4807 sex partners were reported, of whom 1636 (34%) were committed/established partners. Overall, 293/1536 (19.1%) of index patients chose APT for a total of 305 partners, of whom 248 accepted. In intervention and control phases, 666 (43%) and 800 (46%) of index patients were tested for C. trachomatis at 12-24 weeks; 31 (4.7%) and 53 (6.6%) were positive, adjusted odds ratio (aOR) 0.66 (95% CI 0.41 to 1.04, p=0.07). Among index patients with treatment status recorded, the proportion with ≥1 sex partner treated was 775 (88.0%) in the intervention and 760 (84.6%) in the control phase, aOR 1.27 (95% CI 0.96 to 1.68, p=0.10). Seven adverse events of low severity were recorded. Conclusions: APT can be safely offered as a contact tracing option for people with C. trachomatis and might reduce the risk of repeat infection. Future research should find ways to increase uptake and develop alternative interventions for one-off partners.

Male genital allergy with penile oedema and severe aseptic urethritis, due to vulvovaginal candidiasis, simulating sexually transmitted infection

Sexually transmitted diseases (STDs) are frequently encountered and more than 1 million are acquired daily. Genital allergy (GA), on the other hand, is another uncommon cause of sexually transmitted disorders that should be considered if no infection is identified or genital soreness persists or worsens with antimicrobial therapy. In this case report; we present a patient, with severe GA (type I hypersensitivity reaction) to vulvovaginal candidiasis in his sex partner. He was initially misdiagnosed as STD as he presented with severe penile and urethral oedema culminating in hematuria and bladder neck obstruction due to severe urethral oedema. Our systematic approach in diagnosis and hence treatment of the patient and his sex partner is outlined. Keywords: Candidiasis, genital allergy, penile oedema, STD, urethritis.

Comment on “Large-scale GWAS reveals insights into the genetic architecture of same-sex sexual behavior”

The phenotypic measures used by Ganna et al. (Research Articles, 30 August 2019, p. 882) lump together predominantly heterosexual, bisexual, and homosexual individuals, including those who have experimented with a same-sex partner only once. This may have resulted in misleading associations to personality traits unrelated to understood categories of human sexuality. Scientific studies of human sexuality should use validated and reliable measures of sexual behaviors, attractions, and identities that capture the full spectrum of complexity.

Response to Comment on “Large-scale GWAS reveals insights into the genetic architecture of same-sex sexual behavior”

Hamer et al. argue that the variable “ever versus never had a same-sex partner” does not capture the complexity of human sexuality. We agree and said so in our paper. But Hamer et al. neglect to mention that we also reported follow-up analyses showing substantial overlap of the genetic influences on our main variable and on more nuanced measures of sexual behavior, attraction, and identity.