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Anal cancer screening is discussed. Anal cancer disproportionately affects people living with HIV Anal cancer is caused mainly by human papillomavirus (HPV), most commonly HPV-16. It occurs in 1-2 per 100 000 people in the general population, increases with older age, and is rare in those younger than 35 years. Rates are highest in HIV-positive men who have sex with men (MSM), occurring in 85 per 100 000 people. Screening should be done annually in high-risk people, using digital anorectal examination, anal cytology (Pap test), and HPV testing (if available). Annual screening should start at age 35 years in the highest risk group, HIV positive MSM and transgender women. Other high-risk groups have different age-based screening recommendations.

The 2 most frequent reportable bacterial sexually transmitted infections (STIs) worldwide and in Canada are those caused by Chlamydia trachomatis and Neisseria gonorrhoeae. Rates of both infections have been increasing over the last decade despite public health efforts aimed at prevention, testing and treatment. In 2019, 139,389 cases of chlamydia and 35,443 cases of gonorrhea were reported in Canada, an increase of 33.1% and 181.7%, respectively, since 2010. These increases may reflect improved diagnostics, increased screening and contact tracing or a true increase in incidence. Here, Van Ommen et al discuss the management of chlamydia and gonorrhea in primary care as health care providers work collectively toward the goal of decreasing the frequency of these infections and reducing associated morbidity through appropriate treatment.

Men who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection. Currently, the nonavalent HPV vaccine provides coverage against nine HPV genotypes, including seven HR-HPV genotypes. Here, we characterize anal HR-HPV genotype distribution and associated risk factors in MSM from Toronto, Canada recruited between September 2010 and June 2012. Wilcoxon–Mann–Whitney test was used for continuous variables, Chi-square test was performed for categorical variables, and a multivariable model using logistic regression was created to assess for correlates of anal HR-HPV infection. A total of 442 MSM were recruited, with a median age of 45 (IQR 38–50) and an overall HPV prevalence of 82%. The prevalence of any HR-HPV infection was 65.3% and 50.7% in the HIV-positive and HIV-negative MSM, respectively. No participant tested positive for all genotypes covered by the nonavalent vaccine. HIV status (aOR 1.806; 95% CI 1.159–2.816), smoking (aOR 2.176; 95% CI 1.285–3.685) and the number of lifetime sexual partners (aOR 2.466; 95% CI 1.092–5.567) were independent risk factors for anal HR-HPV infection. Our findings will be useful to inform HPV vaccine rollout and HPV prevention strategies in Canadian MSM.

Eckbo et al discuss five things to know about lymphogranuloma venereum (LGV). LGV is an aggressive, sexually transmitted infection caused by specific strains of Chlamydia trachomatis. Though LGV can be asymptomatic, the most common presentation is proctitis syndrome, whereby direct anal inoculation results in painful hemorrhagic proctitis, often mimicking inflammatory bowel disease. Swabs should be inserted 2 to 3 cm into the anal canal; alternatively, swabs can be collected by direct visualization during anoscopy. Lymph node aspirates and swabs of suspicious genital lesions can also be sent for NAAT. Canadian guidelines recommend oral doxycycline (100 mg, twice a day) for 21 days as first-line treatment.

Background. The importance of human immunodeficiency virus (HIV) blip magnitude on virologic rebound has been raised in clinical guidelines relating to viral load assays. Methods. Antiretroviral-naive individuals initiating combination antiretroviral therapy (cART) after 1 January 2000 and achieving virologic suppression were studied. Negative binomial models were used to identify blip correlates. Recurrent event models were used to determine the association between blips and rebound by incorporating multiple periods of virologic suppression per individual. Results. 3550 participants (82% male; median age, 40 years) were included. In a multivariable negative binomial regression model, the Amplicor assay was associated with a lower blip rate than branched DNA (rate ratio, 0.69; P < .01), controlling for age, sex, region, baseline HIV-1 RNA and CD4 count, AIDS-defining illnesses, year of cART initiation, cART type, and HIV-1 RNA testing frequency. In a multivariable recurrent event model controlling for age, sex, intravenous drug use, cART start year, cART type, assay type, and HIV-1 RNA testing frequency, blips of 500—999 copies/mL were associated with virologic rebound (hazard ratio, 2.70; P = .002), whereas blips of 50—499 were not. Conclusions. HIV-1 RNA assay was an important determinant of blip rates and should be considered in clinical guidelines. Blips ≥500 copies/mL were associated with increased rebound risk.

Doxycycline pre-exposure prophylaxis (doxyPrEP) has shown potential in preventing bacterial sexually transmitted infections, but the impact on the microbiome is unknown. This study assessed rectal microbiome changes over 48 weeks in 41 participants on HIV PrEP (tenofovir disoproxil fumarate/emtricitabine) enrolled in an open-label, randomized pilot trial comparing immediate (100 mg PO daily started immediately and continued to week 48) versus deferred doxyPrEP (100 mg PO daily starting at week 24, continued to week 48) in HIV-negative gay and bisexual men (Clinical Trial #: NCT02844634). Primary study outcomes included feasibility, adherence, and tolerability of the dual PrEP regimen, while exploratory outcomes included rectal microbiome changes. We performed 16S rRNA sequencing from participants that collected baseline, week 24, and week 48 samples. Microbial composition did not significantly change over time in either study arm as measured by individual taxa levels, or alpha and beta diversity at the genus level. A slight decrease ( < 10%) in alpha diversity was observed at the phylum level in the immediate arm, but not the deferred arm. This study shows doxyPrEP use results in minimal compositional changes in the microbiome over 12 months. Further research is needed to explore the impact of doxycycline for STI prevention on microbiome function and antimicrobial resistance. Here, the authors study the impact of doxycycline pre-exposure prophylaxis (doxyPrEP) on the microbiome of men who have sex with men on HIV PrEP, showing that doxyPrEP use results in minimal compositional changes in the microbiome over 12 months.

Digital technologies are reshaping health care, making digital health literacy (DHL) a critical competency for navigating online health information. Although widely conceived and measured as a unidimensional measure of DHL, the literature increasingly supports a multidimensional framing of the eHealth Literacy Scale (eHEALS). Studies propose alternative factor structures that can better inform population-level interventions, but these studies have not accounted for the ordinal nature of eHEALS response data. This study aimed to identify and validate an alternate multidimensional structure of eHEALS accounting for its ordinal response scale. Data were drawn from the 2022 GetCheckedOnline community survey of consenting English-speaking British Columbia residents aged ≥16 years who reported sexual activity in the past 12 months. Participants were recruited through geo-targeted digital advertisements, community outreach, and in-person recruitment at public events, and community locations. DHL was measured using eHEALS, with responses collected on a 5-point Likert scale. Descriptive statistics summarized eHEALS responses using means, medians, and IQRs. Exploratory and confirmatory factor analyses were used to assess the scale's structure using polychoric correlations and standard model fit indices. Reliability and validity were evaluated using polychoric ordinal alpha, average variance extracted, and composite reliability, with missing data addressed via multiple imputation. Overall, 1657 participants met inclusion criteria with a mean age of 33.0 (SD 11.77, 95% CI 32.4-33.6) years. Among these 47.3% (95% CI 44.9%-49.7%) identified as women, 30.4% (95% CI 28.1%-32.6%) identified as racialized minorities, 80.5% (95% CI 78.5%-82.3%) reported easy internet access, and 32.2% (95% CI 30.0%-34.5%) had a bachelor's degree or higher. Across eHEALS items, median scores were 4.0 (IQR 1.0-2.0) with excellent internal consistency (polychoric ordinal α=.92). Exploratory factor analysis supported a 3-factor solution explaining 65.7% of the variance, demonstrated through confirmatory factor analysis (χ² =71.7, P<.001, root-mean-square error of approximation=0.059, standardized root-mean-square residual=0.026, comparative fit index=0.969, Tucker-Lewis Index=0.948). The final model included Information Navigation (standardized loadings=0.765-0.917), Resource Appraisal (0.825-0.892), and Confidence in Use (0.803 for both items), with composite reliability (0.784-0.900), and average variance extracted (0.503-0.738) supporting construct validity. This study confirms a multidimensional structure of eHEALS, identifying Information Navigation, Resource Appraisal, and Confidence in Use as key dimensions of DHL. This revised model enhances measurement precision, enabling more accurate identification of populations with limited DHL and informing the development of targeted, equity-oriented interventions. Future research should aim to confirm this multidimensional structure in more diverse populations and explore how distinct DHL domains influence access to digital health services in various contexts. Additionally, ongoing scale development must adapt to account for the role of emerging technologies, including artificial intelligence and social media algorithms in health care.

IntroductionThe Quadrivalent human papillomavirus (HPV) Vaccine Evaluation Study with Addition of the Nonavalent Vaccine Study (QUEST-ADVANCE) aims to provide insight into the long-term immunogenicity and effectiveness of one, two and three HPV vaccine doses. Here, we describe the protocol for QUEST-ADVANCE.Methods and analysisQUEST-ADVANCE is an observational cohort study including males and females who are unvaccinated or vaccinated with the quadrivalent or nonavalent HPV vaccine in British Columbia, Canada. Female participants who are unvaccinated or vaccinated with 1–3 doses of the quadrivalent or nonavalent HPV vaccine at 9–14 years of age will be recruited approximately 5 or 12 years postvaccination eligibility. Male participants who are unvaccinated or vaccinated with 1 or 2 doses of the nonavalent HPV vaccine at 9–14 years of age will be recruited at approximately 5 years postvaccination eligibility. The study involves a maximum of four visits over a period of 4–5 years for female participants, and two visits over a 12-month period for male participants. At each visit, self-collected swabs (cervico-vaginal or penile) and questionnaire data will be collected. In each study group, a subset of participants will be invited to participate in a substudy evaluating the long-term humoral immunogenicity of the HPV vaccine. Additional blood samples will be collected from participants who are part of the immunogenicity substudy. The total required sample size is 7180 individuals. The primary objectives are (1) to examine vaccine effectiveness in males and females against prevalent genital HPV infections for one, two and three doses of the HPV vaccine compared with unvaccinated participants and (2) to evaluate if there is non-inferior immunogenicity as indicated by type-specific antibody response of one dose of the HPV vaccine in 20–27-year-old females vaccinated at 9–14 years of age compared with historical data of three doses of the HPV vaccine females vaccinated at 16–26 years of age up to 12 years postvaccination.Ethics and disseminationQUEST-ADVANCE was approved by the Research Ethics Board of the University of British Columbia/Children’s and Women’s Health Centre of British Columbia (H20-02111). Individual electronic informed consent or assent will be obtained from each participant before any study-specific procedures are undertaken. Results will be published in an international peer-reviewed journal and on the study website.