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      Prevalence and Risk Factors for Rectal and Urethral Sexually Transmitted Infections From Self-Collected Samples Among Young Men Who Have Sex With Men Participating in the Keep It Up! 2.0 Randomized Controlled Trial :

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d7447252e144">Background</h5> <p id="P1">Despite recommendations that sexually active men who have sex with men be regularly tested for sexually transmitted infections (STIs) and that testing reflect anatomical sites of potential exposure, regular testing is not widely performed, especially for rectal STIs. As such, little is known about the prevalence of rectal and urethral STIs among young men who have sex with men (YMSM). </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d7447252e149">Methods</h5> <p id="P2">The current study examined the prevalence and risk factors for rectal and urethral chlamydia and gonorrhea in a sample of 1,113 YMSM ages 18 to 29 (mean: 24.07 years). Before participating in a randomized controlled trial for an online HIV prevention program (Keep It Up! 2.0), participants completed self-report measures and self-collected urine and rectal samples. Participants mailed samples to a laboratory for nucleic acid amplification testing. Viability of self-collected samples was examined as a potential method to increase STI screening for MSM without access to STI testing clinics. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d7447252e154">Results</h5> <p id="P3">Results indicated that 15.1% of participants tested positive for an STI, 13.0% for a rectal STI, 3.4% for a urethral STI, and 1.2% for both rectal and urethral STIs. Rectal chlamydia was significantly more common (8.8%) than rectal gonorrhea (5.0%). Rectal STIs were higher among Black YMSM compared to White YMSM. Additionally, rectal STIs were positively associated with condomless receptive anal sex with casual partners. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d7447252e159">Conclusions</h5> <p id="P4">Findings call attention to the need for healthcare providers to test YMSM for rectal STIs. This study also demonstrates the viability of including self-collected samples for STI testing in an eHealth program. </p> </div>

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          Most cited references17

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          Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections.

          It is uncertain which methods for the diagnosis of rectal gonococcal and chlamydial infection are optimal. This study evaluated the performance of culture and nucleic acid amplification tests (NAATs) for rectal chlamydial and gonococcal diagnosis. From July 2003 until February 2007, 441 rectal test sets were collected from individuals attending a sexually transmitted disease clinic and three HIV clinics who gave a history of anal intercourse or were women at high risk for Neisseria gonorrhoeae or Chlamydia trachomatis infections. Rectal swab specimens were tested using culture and commercial NAATs employing transcription-mediated amplification (TMA), strand displacement amplification (SDA), and PCR amplification. Test performance was evaluated using a rotating standard by which patients were classified as infected if either two or three comparator tests were positive. Test sensitivities for the detection of N. gonorrhoeae ranged from 66.7% to 71.9% for culture to 100% for TMA. Specificities were 99.7% to 100% for culture and greater than 95.5% for all three NAATs. Test sensitivities for C. trachomatis ranged from 36.1% to 45.7% for culture and among NAATS from 91.4% to 95.8% for PCR to 100% for TMA. Specificities of the NAATs ranged from 95.6% to 98.5% (two-of-three standard) and from 88.8% to 91.8% (three-of-three standard). Over 60% and 80% of gonococcal and chlamydial infections, respectively, among men who have sex with men and over 20% of chlamydial infections in women would have been missed if the rectal site had not been tested. Currently available NAATs are more sensitive for the detection of chlamydial and gonococcal infection at the rectal site than is culture.
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            Methods for the design and analysis of relationship and partner effects on sexual health.

            Sexual intercourse involves two people and many aspects of sexual health are influenced by, if not dependent on, interpersonal processes. Yet, the majority of sexual health research involves the study of individuals. The collection and analysis of dyadic data present additional complexities compared to the study of individuals. The aim of this article was to describe methods for the study of dyadic processes related to sexual health. One-sided designs, including the PLM, involve a single individual reporting on the characteristics of multiple romantic or sexual relationships and the associations of these factors with sexual health outcomes are then estimated. This approach has been used to study how relationship factors, such as if the relationship is serious or casual, are associated with engagement in HIV risk behaviors. Such data can be collected cross-sectionally, longitudinally or through the use of diaries. Two-sided designs, including the actor-partner interdependence model, are used when data are obtained from both members of the dyad. The goal of such approaches is to disentangle intra- and inter-personal effects on outcomes (e.g., the ages of an individual and his partner may influence sexual frequency). In distinguishable datasets, there is some variable that allows the analyst to differentiate between partners within dyads, such as HIV status in a serodiscordant couple. When analyzing data from these dyads, effects can be assigned to specific types of partners. In exchangeable dyadic datasets, no variable is present that distinguishes between couple members across all dyads. Extensions of these approaches are described.
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              Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study.

              The prevalence of gonorrhea of the pharynx among select samples of men who have sex with men (MSM) ranges from 9% to 15%. To our knowledge, there have been no longitudinal studies in a prospective MSM cohort to estimate pharyngeal gonorrhea incidence or predictors of infection. We examined the prevalence, incidence, and sociodemographic and behavioral predictors of pharyngeal gonorrhea in a cohort of sexually active, human immunodeficiency virus-negative MSM. We conducted a prospective study of pharyngeal gonorrhea among MSM who were enrolled in a behavioral intervention study to prevent human immunodeficiency virus infection (Project EXPLORE). Participants were enrolled in this ancillary study from March 2001 through July 2003. At baseline and every 6 months thereafter until 31 July 2003, participants were tested for pharyngeal gonorrhea and were administered a questionnaire regarding their oral sex practices. Rectal and urethral gonorrhea testing were also performed. Prevalence of pharyngeal gonorrhea was 5.5% (136 cases diagnosed from 2475 tests). The incidence rate was 11.2 cases per 100 person-years. Pharyngeal gonorrhea was positively associated with younger age and the number of insertive oral sex partners in the past 3 months. Ejaculation did not increase the risk of pharyngeal gonorrhea. Gonorrhea of the pharynx was asymptomatic in 92% of cases. The pharynx is a common, asymptomatic reservoir for gonorrhea in sexually active MSM.
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                Author and article information

                Journal
                Sexually Transmitted Diseases
                Sexually Transmitted Diseases
                Ovid Technologies (Wolters Kluwer Health)
                0148-5717
                2017
                August 2017
                : 44
                : 8
                : 483-488
                Article
                10.1097/OLQ.0000000000000636
                5821498
                28703727
                b2a09c9e-4661-45cd-982a-015da78c65e7
                © 2017
                History

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