ObjectivesThis study investigated the acceptability by gay men, bisexual men and other men who have sex with men (GBMSM) of French public health information and prevention measures implemented during the 2022 Mpox outbreak.MethodsANRS-MPX-SHS "Mpox: perception of risks, health measures and vaccination" is a cross-sectional survey conducted in GBMSM between July and September 2022. Online questionnaires collected information about Mpox-related awareness, perceptions and prevention behaviours. Multiple correspondence analysis identified participant profiles according to their level of acceptability of the information and prevention measures implemented during the 2022 outbreak. The study outcome was a variable grouping participants into three profiles: ‘strong endorsers’, ‘uninformed hesitant endorsers’ and ‘indifferent objectors’. Multinomial logistic regression was used to estimate factors associated with each profile.ResultsOf the 5688 participants, 5320 (93.5%) had available data for the outcome. The latter were mostly cisgender men (98%), aged between 35 and 54 years (54.5%), with tertiary education (82%); 44% were living in the Greater Paris region. Strong endorsers, uninformed hesitant endorsers and indifferent objectors accounted for 77.8%, 14.4% and 7.8% of the sample, respectively. Participants with tertiary education, those who had sex exclusively with men, those taking pre-exposure prophylaxis (ie, HIV-negative participants), HIV-positive participants and individuals living in the Greater Paris region, were all less likely to be uninformed hesitant endorsers or indifferent objectors. Participants with no lifetime HIV/sexually transmitted infection (STI) screening and those with infrequent screening were, respectively, more likely to belong to these two profiles.ConclusionsParticipants’ acceptability of the information and prevention measures implemented during the 2022 Mpox outbreak in France depended on the perceived capability of public health authorities to effectively diversify information targets, representations and communication channels. In order to prevent the transmission of Mpox (and other STIs) in the general population in future outbreaks, information and measures adopted must take into account the needs, perceptions and experiences of persons never or not regularly screened for HIV/STIs.

BackgroundClinical guidelines for sexually transmissible enteric infections can provide a framework for testing, management, antimicrobial stewardship and public health control. This review aimed to evaluate the currently available clinical guidelines and to highlight any areas for improvement.MethodA comprehensive online search for clinical guidelines was performed and reported using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, followed by evaluation using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool by three independent reviewers. An AGREE II domain score of >60% is the threshold for sufficient quality, and each guideline was rated high, average or low based on the domain percentages (five domains scoring >60%=high, 3–4 domains scoring >60%=average and ≤2 domains scoring>60%=low). Two authors developed a bespoke quality framework for sexually transmissible enteric infection guidelines and this was used to evaluate each guideline.ResultsSix clinical guidelines were identified from the UK (British Association for Sexual Health and HIV (UK-BASHH)), USA (Centers for Disease Control and Prevention (USA-CDC)), Europe (International Union against Sexually Transmitted Infections (Europe-IUSTI)), Canada-government, Brazil-government and Australia (Australasia Society for HIV, Viral Hepatitis, and Sexual Health Medicine (Australia-ASHM)). The overall AGREE II score was 56% (IQR 43–67) (domain 1 (scope and purpose) 67% (IQR=42–67), domain 2 (stakeholder involvement) 46% (IQR 34–62), domain 3 (rigour of development) 42% (IQR 22–49), domain 4 (clarity of presentation) 80% (IQR 57–89), domain 5 (applicability) 23% (IQR 11–30) and domain 6 (editorial independence) 67% (IQR 56–84)). The median global scores (out of 7) and rating (low, medium and high) were UK-BASHH (5/7, high), USA-CDC (5/7, average), Europe-IUSTI (4/7, average), Canada government (4/7, low), Brazil government (3/7, low) and Australia-ASHM (1/7, low). All six guidelines recommended testing using molecular platforms: UK-BASHH, USA-CDC and Europe-IUSTI recommended offering sexual health interventions and STI testing; the UK-BASHH and Australia-ASHM did not recommend empirical antimicrobials, and the Europe-IUSTI and Brazil government guidelines made specific antimicrobial recommendations, including macrolides, quinolones and cephalosporins.ConclusionFuture clinical guidelines for sexually transmissible enteric infections require consistency and to improve their applicability, rigour of development, stakeholder involvement and recommendations for sexual health interventions, sexually transmitted infection testing, partner notification, handwashing and food handlers’ advice and antimicrobial treatment.

ObjectivesDoxycycline prophylaxis shows promise for bacterial sexually transmitted infection (STI) prevention, but data primarily come from high-income countries. This study assessed awareness, willingness and factors associated with willingness to use doxycycline for bacterial STI prevention among men who have sex with men (MSM) using HIV pre-exposure prophylaxis (HIV-PrEP) in Vietnam.MethodsBetween 25 January and 4 February 2024, a cross-sectional study recruited males aged ≥18 years who reported having sex with men in the past 12 months from 11 HIV-PrEP clinics in Hanoi and Ho Chi Minh City. Self-administered surveys were conducted, and multivariable logistic regression was applied to identify factors associated with willingness to use doxycycline prophylaxis.ResultsAmong 350 participants, the median age was 25 (IQR 21–30), and 10.6% self-reported a bacterial STI diagnosis in the past 12 months. In the previous 6 months, the median number of sex partners was 2 (IQR 1–4), 53.1% reported condomless anal sex. Awareness of doxycycline was low (20.2%; 65/322); however, 75.4% (264/350) expressed willingness to use it, with 63.6% (168/264) preferring doxyPrEP. Participants who disclosed HIV-PrEP use to all sex partners (adjusted OR (aOR) 4.17; 95% CI 1.84, 9.46) and those with higher perceived STI risk (aOR 1.12; 95% CI 1.03, 1.22) were more likely to report willingness to use doxycycline prophylaxis. Concerns about daily medication (aOR 0.43; 95% CI 0.24, 0.81) and fear of judgement from peers (aOR 0.41; 95% CI 0.21, 0.81) were associated with lower willingness.ConclusionsKnowledge of doxycycline prophylaxis among MSM on HIV-PrEP in Vietnam was low. However, most expressed willingness to use it, with two-thirds preferring doxyPrEP. Findings highlight the need to disseminate information on doxycycline prophylaxis for bacterial STI prevention, monitoring the usage and evaluating comparative effectiveness of doxyPEP and doxyPrEP to guide implementation efforts in Vietnam.

Syphilis is a re-emerging disease, and suspicion of syphilis infection should be considered in all cases with atypical skin manifestations, mainly when there is a history of unprotected sexual intercourse. Here, we describe a case of secondary syphilis in a woman aged 42 years, who presented with an atypical, painful and itchy skin rash with vegetative cerebriform lesions, which resolved after the administration of penicillin. Multiplex PCR targeting Treponema pallidum on vaginal and lesion swabs, along with syphilis serology, confirmed the diagnosis.

ObjectivesIn sub-Saharan Africa, approximately 86% of HIV infections in adolescents aged 15–19 years occur among girls. Their heightened susceptibility is likely influenced by converging sociobehavioural and biological factors, although the relative contributions remain unclear. To address this, we compared known and hypothesised risk factors for HIV between cisgender adolescent girls and adult women in South Africa and evaluated the relationships between these factors and sexually transmitted infection (STI) status.MethodsThis cross-sectional observational study included adolescent (n=305; 14–19 years) and adult females (n=114; 25–35 years) in two South African provinces (Western Cape (WC), KwaZulu-Natal (KZN)). Demographic and sociobehavioural data were collected by questionnaire. Colposcopy was conducted to identify cervicovaginal abnormalities, and tests for bacterial vaginosis (BV), Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were performed.ResultsAdults reported higher risk sexual behaviour than adolescents across multiple variables, although adolescents were more likely to have STIs than adults (62.8% vs 34.0%, respectively, p=0.0010 for WC; 42.5% vs 16.4%, respectively, p=0.0002 for KZN). Adolescents did, however, report earlier sexual debut (16 years old vs 17 years old, p<0.0001 for both sites) and KZN adolescents were more likely to use intravaginal sexual enhancers than adults (34.6% vs 20.6%, respectively, p=0.0417). Numbers of sexual partners (β-coefficient: 0.34, SE: 0.12, p=0.0054) and sex acts within the previous 3 months (β-coefficient: 0.25, SE: 0.09, p=0.0062) were associated with STIs in adolescents and trended to significance for adults. Intravaginal sexual enhancer use (KZN only; β-coefficient: 0.95, SE: 0.38, p=0.0118) and biological risk factors, including BV Nugent score (β-coefficient: 0.09, SE: 0.04, p=0.0257) and signs of cervicovaginal injury/inflammation (β-coefficient: 1.07, SE: 0.45, p=0.0171), were associated with STIs in adolescents but not adults.ConclusionsRisk factors for STIs including HIV may differ between age groups of girls and women, and mitigation interventions may need to be tailored accordingly.