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BackgroundBacterial vaginosis associated bacteria (BVAB) have been detected among cisgender men who have sex with women (MSW) and may be associated with clinical syndromes in men. We evaluated the frequency and correlates of three BVAB in MSW and their association with nongonococcal urethritis (NGU).MethodsMSW without Neisseria gonorrhoeae attending an urban STD clinic from 2014–2018 completed a computer-assisted self-interview, clinical interview and examination. NGU was defined as ≥5 polymorphonuclear leukocytes/hpf on a urethral Gram stain plus urethral symptoms or visible discharge. Urine specimens were tested for Chlamydia trachomatis and Mycoplasma genitalium using Aptima (Hologic, Inc.) and for BVAB2, Mageeibacillus indolicus, Sneathia spp., Trichomonas vaginalis, Ureaplasma urealyticum, herpes simplex virus, and adenovirus using quantitative PCR (qPCR). A subset of men contributed serial monthly specimens over 6 months.ResultsOf 317 MSW ages 17–71, 67 (21.1%) had Sneathia spp., 36 (11.4%) had BVAB2, and 17 (5.4%) had M. indolicus at enrollment. Co-colonization with >1 BVAB was observed in 50% (36/71). No demographic and few behavioral characteristics were associated with these BVAB; only having multiple partners (≥3 past two months) was more common among men with than without these BVAB (BVAB2: 47% vs. 23%, M. indolicus: 53% vs. 24%, Sneathia spp: 42% vs. 22%, p≤0.03 for all). Sneathia spp. were associated with lower odds of prevalent NGU (adjusted Odds Ratio [aOR]=0.36, 95% CI=0.13–0.97) whereas neither BVAB2 nor M. indolicus were associated with prevalent NGU (aOR=0.62; 95%=CI 0.15–2.55; aOR=3.12; 95% CI=0.63–15.54). In 34 men with serial samples, persistence was common and not significantly different between BVAB (median persistence for BVAB2=2 months (range=2–6); M. indolicus= 4 months (range=3–5); Sneathia spp.=3 months (range=2–8); p≥0.20 for each comparison).ConclusionsBVAB2, M. indolicus, and Sneathia spp. were frequently detected in MSW attending an STD clinic, but not associated with increased risk of prevalent NGU.

BackgroundYoung African American (AA) heterosexual men have high rates of sexually transmitted infections (STIs). Consistent condom use effectively prevents STIs, but condom use decisions are made in the context of individual sexual relationships. This analysis describes partnership characteristics and condom use among young AA men.MethodsAA men aged 15–24 who lived or spent most of their time in New Orleans, Louisiana and had vaginal sex in the past 2 months were screened at non-clinical venues for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) using nucleic acid amplification testing. Men provided information on sexual partnerships including perception of risk behaviors on an audio computer-assisted self-interview. Generalized estimating equation is used to fit a marginal model to account for multiple partnerships.ResultsParticipants (n=1152) reported characteristics of 1733 partnerships. In partnerships where condoms were not always used, men were more likely to be committed to the partner (47% vs 28%, p<0.01), plan to have sex with her again (72% vs 56, p<0.01), able to re-contact her (87% vs 78, p<0.01), already have a child (11% vs 3%, p<0.01), financially support her (27% vs 20%, p<0.01), and feel closer to her (median 8 vs 6, p<0.01), compared to partnerships where condoms were always used. Men not always using condoms were also more likely to have sex while drunk/high (52% vs 31%, p<0.01). Rates in men were 10% for CT and 1% for GC; men with CT and/or GC were less likely to always use condoms (44% vs 60%, p<0.01) compared to men negative for CT and/or GC.ConclusionSTI rates are high, especially for those in partnerships where condoms are not always used. Consistent condom use is lower in committed, closer partnerships, suggesting that prevention interventions should focus on condom use among this group.DisclosureNo significant relationships.

IntroductionWe evaluated predictors of consistent condom use among female sex workers (FSWs), a core group for controlling the spread of HIV.MethodsIn an analysis of data collected in 2004–2005 from 140 Kenyan FSWs who completed questionnaires administered during a baseline study visit and three bimonthly follow-up visits, we used a case-crossover design to identify predictors of consistent condom use during all coital acts in the preceding 2 weeks, overall and by partner type.ResultsParticipants (n=140) completed the baseline visit and 390 bimonthly follow-up visits. Alcohol use during sex was negatively associated with consistent condom use with helping partners (defined as regular sex partners to whom the woman could go for help or support if needed) (adjusted odds ratio [AOR], 2.6, 95% confidence interval [CI] 1.0–6.5) but not associated with condom use with other partners. Coital frequency was associated with condom use with other partners only. Women who reported 1–5 (AOR 11.0, 95% CI 4.3–28.3) or 6–9 recent coital acts (AOR 3.8, 95% CI 1.7–8.8) with other partners were more likely to report consistent condom use with those partners than were women who reported ≥10 acts. Having a recent partner delay payment was inversely associated with consistent condom use with helping, other, or all partners.ConclusionCorrelates of consistent condom use differed by partner type. By using a case-crossover design, we were able to identify potentially modifiable factors associated with consistent condom use by FSWs who used condoms consistently with a given partner type during some periods but not others.

Background: Valid and reliable instruments are required to measure the level of information on contraceptive methods in adolescents to promote their correct use. Objective: To construct and validate a test of knowledge of contraceptive methods for adolescents between 15 and 19 years old. Method: A 36-item test was developed that included the different contraceptive methods and information on the characteristics, use, efficacy, advantages and disadvantages of these methods. Once validated by expert judges, a college in Ecatepec was randomly selected as data collection site. Students of the three school grades answered the test. Results: The test was applied to a total of 229 students between 15 and 19 years old (M = 16.22; SD = .978). The majority were women (66%), single (88.5%) and lived with their parents (62.9%). Of the 36 initial items, 31 showed discriminatory power between those who performed well on the test and those who did not. The difficulty index of the questionnaire was .45 and revealed a reliability index value of .739. Around 60% of the participants obtained a percentage below 50% of correct answers in the entire test. Only about 4% of participants got a percentage of correct responses higher than 70%. The categories of characteristics and use were those in which the participants performed best when answering 48% of these questions correctly. The worst was effectiveness, advantages and disadvantages with 33%. Conclusion: The test’s psychometric properties showed that it is a valid and reliable test for its application in Mexican adolescents. The results indicate that most adolescents of the simple do not have complete information about contraceptive methods and that they know the least about their effectiveness and side effects.

Previous research indicates that young men may experience condom-associated erection loss and that these problems may lead to inconsistent or incomplete condom use. The primary aim of this study was to assess, using a retrospective recall period of 2 months, correlates of condom-associated erection problems among young Black men attending sexually transmitted infection (STI) clinics. Data were collected in clinics treating patients with STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) condom use were eligible. A total of 494 men participated. Nineteen percent reported that condom-associated erection problems during condom application occurred at least once, and 17.8% indicated erection difficulties occurred during sexual intercourse at least once in the past 2 months. Multivariate analyses identified that condom-associated erection problems were associated with reports of sex with more than one partner during the recall period, reported problems with condom fit and feel, lower motivation to use condoms, and attempts at condom application before having a full erection. Findings suggest that clinic interventions should address possible condom-associated erection problems among young Black men who are at risk of STIs. Encouraging men who may be vulnerable to erection loss when condoms are used to allow sufficient time for sexual arousal to build may be an effective strategy.

BackgroundThree randomised controlled trials have either reported that mouthwash may increase the susceptibility of the oropharynx to Neisseria gonorrhoeae or potentially decrease its transmissibility. We modelled these potential impacts on gonorrhoea incidence.MethodsWe calibrated a susceptible-infected-susceptible compartmental model to examine the effectiveness of antibacterial mouthwash on the transmission of Neisseria gonorrhoeae in men who have sex with men (MSM). Four scenarios include: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx to Neisseria gonorrhoeae; (3) mouthwash reduced the transmissibility of Neisseria gonorrhoeae from the oropharynx; (4) we combined the effect of mouthwash from scenarios 2 and 3.ResultsUnder scenario 1, the overall incidence of gonorrhoea was 44 (95% CI: 37–50)/100 person-years (PY). Site-specific incidence/100 PY at the oropharynx, anorectum and urethra were 26 (22–31), 9 (8–11) and 8 (5–12). Under scenario 2, with between 20–80% mouthwash coverage in the MSM population, the incidence increased at all three anatomical sites by between 7.4% (5.9–60.8%) and 136.6% (108.1–177.5%). Under scenario 3, with the same coverage, the incidence decreased at all anatomical sites by between 11.6% (10.2–13.5%) and 99.8% (99.2–100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the transmissibility and susceptibility with both leading to large increases of nearly 130% or large declines of almost 100%.ConclusionsThe effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases the susceptibility to or reduces the transmissibility of Neisseria gonorrhoeae, highlighting an urgent need for further empirical investigation.

Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes. The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide. The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted. All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability. Data highlight the role of providers as gatekeepers to FC access in public and non-public sectors and provide support for further FC programme expansion in SA and globally.

Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir–emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64–96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3–11·3). 13 men (90% CI 9–23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. In this high incidence population, daily tenofovir–emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences.

In this trial of preexposure prophylaxis with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) in men who have sex with men, TDF-FTC was found to be effective in preventing HIV-1 infection when it was taken before sexual activity. The prevention of infection with human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) remains a major public health challenge. 1 Owing to the lack of an effective HIV vaccine, consistent condom use remains the cornerstone of prevention, but biomedical interventions such as male circumcision and the use of antiretroviral drugs for the treatment of HIV infection represent additional prevention strategies. 2 – 5 Among the promising interventions is preexposure prophylaxis, in which antiretroviral drugs are started in HIV-negative persons before potential exposure to the virus. Daily oral preexposure prophylaxis with either tenofovir disoproxil fumarate (TDF) or the combination of TDF and . . .

Background Condoms decrease sexually transmitted infection(STI) transmission, good evidence supports this, if used correctly. This study investigates individuals understanding of the correct use of male latex condoms. Methods Random individuals completed a questionnaire and were requested to conduct an observed demonstration of condom application, marked against criteria from British Association for Sexual Health and HIV(BASHH) guide for condom use and Centers for Disease Control and prevention(CDC) Condom fact sheet. Results 127 responders, 45 participants in the observed demonstration(57%males, 46%females, age 12–66) 100% believed they used condoms correctly, 68% were self taught. 100% knew condoms were barrier contraception. 67% indicated condoms protection against all STIs and 5% indicated no STI protection: 11% gonorrhoea and Chlamydia only, 10% HSV and warts only and 7% HIV only. 7% felt condoms decreased STI transmission during oral sex and 10% during anal sex(100% of men who have sex with men) During observed demonstration, 33% correctly applied a condom. Mistakes: not squeezing air from condom, unrolling before applying and condom contact when opening. Factors stated to increase latex condom splitting: 25% penis size, 22% sexual vigour, 7% certain lubricants, 46% unsure(25% admitted to doubling condoms once since coitarche, all unaware of risk) 38% believed condoms not required throughout intercourse, 100% of these believed STI transmission was decreased if worn at the end. Conclusion Perceived good condom technique, however, practical adherence to guidance is poor(particularly younger cohorts) Inadequate heterosexual awareness of STI transmission and prevention during oral and anal intercourse. Poor understanding of condom STI prevention, risks for condom splitting and timing of condom use. Good quality sexual education to include male condoms is important. Age of education is crucial capturing individuals before and timely to coitarche. Self teaching is common and requires quality accessible material. Opportunistic teaching is required, condom use competence should not be assumed.