Henry M. Jackson Foundation

Kenyan guidelines recommend syndromic management for sexually transmitted infections (STIs), which may miss many infections. We used nucleic acid amplification testing to screen for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at 3 anatomic sites among adolescents and adults with behavioral risk factors in Western Kenya. From December 2021 to April 2023, we enrolled participants without HIV who were aged 14 to 55 years and reported a recent history of an STI, transactional sex, condomless sex with multiple partners, injection drug use, and/or anal sex with male partners. Urine, oropharyngeal swabs, and anorectal swabs were tested using Xpert CT/NG (Cepheid). Multivariable robust Poisson regression models were used to estimate prevalence ratios and 95% confidence intervals for factors potentially associated with the prevalence of both STIs combined. Among 405 participants tested for CT/NG at enrollment, 324 (80.0%) were females, and 324 (80.0%) were aged 14 to 24 years. CT and/or NG was diagnosed in 143 participants (35.3%), including CT in 111 (27.4%) and NG in 76 (18.8%). Infections were most prevalent at the urogenital site, with 124 (30.6%) participants diagnosed with urogenital CT and/or NG. Anorectal CT/NG was observed in 117 (28.9%) and oropharyngeal CT/NG in 14 (3.5%). Females had higher prevalences than males of both urogenital (33.6% vs. 18.5%, P = 0.012) and anorectal CT/NG (31.8% vs. 17.3%, P = 0.015). A theoretical screening approach that only tested for urogenital infections would have missed 18.0% of CT cases and 18.4% of NG cases. In multivariable analyses, there were no statistically significant associations between sociodemographic variables and CT/NG prevalence. Urogenital and anorectal CT/NG infections were common in 2 communities in Western Kenya with behavioral vulnerability but difficult to predict based on sociodemographic variables. Nucleic acid amplification testing-based urogenital and anorectal screening of sexually active adolescents and young adults could reduce CT/NG burden in this population.

Infection-related movement disorders (IRMD) represent an important group of secondary movement disorders whose prevalence, patterns, treatment and outcomes remain poorly understood. To survey members of the International Parkinson and Movement Disorder Society regarding prevailing practices in IRMD. A cross-sectional online survey was conducted. Of 95 responses received, 75 (78.9%) were from the Asia-Oceania (AO) region and were further analyzed. The highest number of responses was from India (67/75, 89.3%). The most frequent phenotypes included ataxia (64, 85.3%), chorea (49, 65.3%), myoclonus (55, 73.3%) and parkinsonism (43, 57.3%). Tuberculosis-related (61, 81.3%), subacute sclerosing panencephalitis (50, 66.7%), and dengue-related movement disorders (49, 65.3%) were most frequent. Variable outcomes were observed by 46 (61.3%) respondents and 66 (88%) indicated that up to 50% of patients experienced persistence of IRMD. This survey provides critical insights into prevailing practices in the field of IRMD from the AO region.

Understanding the drivers of seasonal disease outbreaks remains a fundamental challenge in disease ecology. Periodic outbreaks can be driven by several seasonally varying factors, including pulses of susceptible individuals through births, changes in host behaviour and social aggregation and variation in host immunity. However, when these potential drivers overlap temporally, isolating their relative contributions to outbreak patterns becomes challenging. We studied Hendra virus, a zoonotic pathogen with seasonal spillovers from bats to horses and humans. Multiple seasonal factors have been hypothesized to drive Hendra virus transmission, including food shortages, birth pulses and changes in host aggregation, but their temporal overlap has made identifying primary drivers difficult. We conducted a 4-year longitudinal study of Pteropus bats to test whether seasonal birth pulses and the resulting influx of susceptible juveniles drive Hendra virus transmission. Using a Bayesian ageing model, we aged sexually immature bats and placed them into birth cohorts. We used our age predictions to model how viral shedding and antibody responses changed as bats aged. We tracked Bartonella spp. Infection-a bacterial pathogen requiring close contact for transmission-as an indicator of transmission opportunities within each cohort for comparison. We found no evidence that seasonal birth pulses of immunologically naïve juveniles drove Hendra virus transmission. Two out of three cohorts showed substantially reduced maternal antibody transfer compared to the 2018 cohort, with seroprevalence near zero at our earliest sampling timepoints and showed no clear evidence of synchronized seroconversion. Furthermore, Bartonella infection rates were consistent across cohorts, indicating that opportunities for pathogen transmission remained consistent across cohorts despite varying viral shedding patterns. Our findings demonstrate that birth pulses alone cannot explain observed patterns of Hendra virus outbreaks. These results highlight the importance of using multiple lines of evidence to evaluate competing mechanisms underlying seasonal disease dynamics, particularly when potential drivers coincide temporally.

Sexual commitment in Plasmodium parasites is essential for malaria transmission, yet the signaling events initiating sexual conversion in only a subpopulation of parasites remain unclear. We discovered a single valine(V2163) to leucine(L2163) mutation in a transcription factor required for P. falciparum gametocytogenesis (AP2-G) that abrogates sexual differentiation. AP2-G.L2163 does not bind the ap2-g consensus motif, GnGTAC, or stimulate gene transcription, including autoregulation. The GDV1-dependent expression of AP2-G.L2163 demonstrates GDV1's critical role in the initial activation of the silent ap2-g locus in the absence of functional AP2-G. While AP2-G.V2163 is required for MSRP1 expression, providing a marker that discriminates early from late sexually committed schizonts. Together this work demonstrates that V2163 in AP2-G plays a critical role in DNA binding, highlighting the functional importance of this specific region for malaria transmission as well as the key role of GDV1 in the initial activation of ap2-g expression and induction of sexual differentiation.

Background: The post-acute sequelae of SARS-CoV-2 infection represent a growing public health concern. While associations between COVID-19 and metabolic disorders have been reported, less is known about this risk in young, healthy populations. This study aimed to quantify the risk of developing new-onset metabolic disorders following SARS-CoV-2 infection among U.S. active-duty service members. Methods: We conducted a propensity score-matched cohort study using U.S. Military Health System data between July 2020 and June 2021 of active-duty service members (ADSM) aged 18 to 65 years old. COVID-19 infections were identified through ICD-10 codes or laboratory results. A 1:2 matched cohort compared 103,789 COVID-19 exposed individuals with 207,578 controls. Outcomes included incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension (HTN), hyperlipidemia (HLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic syndrome (MetS) within one year. Cox proportional hazards models calculated adjusted hazard ratios (aHR) while controlling for obesity and overweight status. Results: The median age for both those with and without COVID-19 infection was 26 years (interquartile range 22–33 years), with males comprising the majority of participants (81.1% male, 18.9% female). COVID-19 infection was associated with significantly increased hazards for incident HTN (aHR 1.09; 95% CI, 1.01–1.18), HLD (aHR 1.30; 95% CI, 1.10–1.54), and MASLD (aHR 1.36; 95% CI, 1.15–1.60). However, no significant increased risk was observed for T2DM or MetS. Conclusions: COVID-19 infection was associated with significantly increased risk of developing HTN, HLD, and MASLD, highlighting important long-term metabolic consequences in a young, healthy population.

Prevention and appropriate management of musculoskeletal (MSK) conditions is a key contributor to a healthy and well population. Physical therapists (PTs) and athletic trainers (ATs) are allied health professionals at the forefront of prevention and management of MSK conditions, working in wide-ranging healthcare settings, from outpatient clinics, with specialized populations (e.g., athletes), within schools, and in industrial settings and public health. PTs and ATs receive extensive education in evidence-based practice for the prevention and treatment of common MSK conditions, but little to no formal education in dissemination and implementation (D&I) science. This curricular omission may contribute to persistent challenges and gaps in the real-world translation of injury prevention and rehabilitation research into sustainable and effective PT and AT practice. Here the authors, five MSK injury prevention and management researchers and clinicians with experience or expertise in D&I science, present a brief background on the emergence of D&I in the MSK literature, and outline short- and longer-term goals for the integration of D&I into PT and AT education and training, setting forth a vision for the prominence of D&I in the PT/AT professions.

Pre-exposure prophylaxis (PrEP) has shifted the paradigm of condom use and perceived risks for HIV and sexually transmitted infections (STIs) among men who have sex with men (MSM). We identified factors associated with inconsistent condom use and reasons for non-use among German MSM, with and without HIV, from two clinics in Germany between 2018 and 2024. Participants completed a questionnaire by computer-assisted self-interview every 6 months for up to 24 months. Multivariable robust Poisson regression models were fitted to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for the associations between factors of interest and inconsistent condom use and reasons for non-use. Inconsistent condom use was reported by 81% and 66% of 122 MSM during insertive and receptive anal sex, respectively. Inconsistent condom use was associated with (aPR [95% CI]) age >30 years (insertive: 31-40, 1.34 [1.13, 1.59]; ≥41, 1.27 [1.02, 1.58]), living without HIV (insertive: 1.28 [1.11, 1.47]; receptive: 1.32 [1.17, 1.49]), sex under the influence of drugs (insertive: 1.20 [1.04, 1.38]; receptive: 1.16 [1.03, 1.31]), and not worrying about STIs (insertive: 1.20 [1.06, 1.36]). Living with HIV, preference for condomless sex, and partner's HIV suppression were the most frequent reasons for non-use among participants with HIV. Using PrEP, preference for condomless sex, and partner's HIV status were the most frequent reasons for non-use among participants without HIV. Novel interventions tailored to specific high-risk subgroups, adjusted to address reasons for non-use, and adapted to mitigate risk compensation among MSM using PrEP are needed.