Background: Sexually transmitted infections (STIs) during pregnancy contribute to adverse maternal and neonatal outcomes. Guidelines from the US Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend routine screening for syphilis, HIV, chlamydia, gonorrhea, and risk-based screening for trichomoniasis for pregnant women. We assessed pre-COVID-19 prenatal STI screening patterns among privately insured pregnant persons in the United States to assess whether practice aligns with guidelines. Methods: We conducted a retrospective descriptive analysis of pregnancies among persons aged 15 to 44 years captured in the Merative MarketScan® commercial claims database from 2016 to 2019. Pregnancies were identified using ICD-10, CPT-4, and Healthcare Common Procedure Coding System codes and classified by delivery type. Screening coverage was summarized overall and by pregnancy outcome, age group, and metropolitan statistical area. Results: Among 917,859 pregnancies, overall screening coverage was highest for syphilis (90.5 %), followed by HIV (82.4%), chlamydia (80.4%), and gonorrhea (79.5%), while trichomoniasis screening was substantially lower (22.4%). Screening was lowest among pregnancies ending in spontaneous abortion and declined with increasing maternal age for chlamydia, gonorrhea, and trichomoniasis. Urban–rural differences were small, with slightly higher screening in urban areas. Conclusions: We provide a pre-COVID-19 baseline for prenatal STI screening among privately insured pregnant persons. STI screening adherence was high, but further progress is needed to mitigate STIs’ costly but preventable health outcomes.
Background: Metabolic syndrome (MetS) is common among people living with HIV, especially those receiving long-term antiretroviral therapy (ART). This study aimed to identify risk factors for MetS in adults with HIV receiving ART and to develop a predictive nomogram. Methods: This cross-sectional study included 1135 adults with HIV receiving ART at Tangdu Hospital, Xi’an, China, between January 2022 and January 2025. MetS was defined using modified NCEP ATP III criteria. Sociodemographic, lifestyle, clinical, and laboratory data were collected. Logistic regression and LASSO-penalized regression were used to identify predictors. A nomogram was developed and internally validated. Results: The mean age was 39.49 ± 10.10 years, 54.4% of participants were male, and the mean body mass index (BMI) was 24.23 ± 3.72 kg/m 2 . Overall, 315 participants (27.8%) met the criteria for MetS. Compared with those without MetS, participants with MetS were older, had higher BMI, and had longer ART duration (all P < 0.001). Current smoking, regular alcohol use, physical inactivity, and poor fruit/vegetable intake were more common in the MetS group (all P < 0.001). The final nomogram included age, smoking status, alcohol consumption, physical activity, dietary habits, BMI group, ART duration, ART regimen class, and viral suppression. It showed good discrimination, with an area under the curve of 0.898 in the training cohort and 0.881 in the validation cohort. Conclusions: MetS was common among adults with HIV receiving ART. The nomogram may support individualized metabolic risk stratification and help identify adults with HIV who may benefit from closer metabolic monitoring and targeted lifestyle assessment.
Mycoplasma genitalium is an increasingly drug-resistant sexually transmitted infection, with widespread macrolide resistance rendering azithromycin frequently ineffective. Moxifloxacin, the main second-line treatment, is now threatened by fluoroquinolone resistance linked to the parC gene. Resistance-guided therapy, which tailors treatment to macrolide-resistance mutations detected after nucleic acid amplification testing, shows promise, but its pooled cure rate has not been quantified. Following a protocol registered in PROSPERO (CRD420251077720), we searched 5 databases for studies of resistance-guided therapy reporting cure (negative test-of-cure 14–90 days after treatment); 11 studies were eligible. Cure proportions were pooled with a random-effects Freeman–Tukey model with Hartung–Knapp adjustment and, as a co-primary approach, a generalized linear mixed model; we performed sensitivity analyses, a temporal meta-regression of moxifloxacin cure, and stratification by parC mutation. Pooled cure was 94.6% (95% confidence interval [CI], 92.4–96.4) and 93.9% (95% CI, 91.7–95.5) across the 2 models, with no heterogeneity (I 2 = 0%) and robust in sensitivity analyses. However, moxifloxacin cure declined over time (odds ratio per calendar year 0.92; 95% CI, 0.85–0.99; P = 0.033), driven by the parC S83I mutation (98% cure in wild-type vs 38% in mutants). In a modeled high-resistance Brazilian scenario (79% macrolide resistance), expected cure with empirical azithromycin fell to approximately 22%, versus approximately 93% with resistance-guided therapy. The evidence derives predominantly from a single-center and a short-term surrogate outcome, with low-to-very-low certainty. Resistance-guided therapy achieves high short-term cure and should be prioritized over empirical therapy, yet its efficacy is time-limited and calls for parC -guided regimens as resistance evolves.
Background: We examined the availability of HIV services offered in local jurisdictions’ primary sources of safety-net sexually transmitted infection (STI) services between 2018 and 2021. Methods: We used data from the 2018 and 2021 Local Health Department STD Infrastructure Surveys. Survey questions included HIV services offered at the jurisdiction’s primary safety-net clinic for STI services. Rao-Scott chi-square tests were used to compare HIV services offered by geographic characteristics and clinic type in 2018 and 2021. Results: The provision of most HIV services was higher in 2021 than in 2018 based on observed values. There was a significant increase in large jurisdictions that offered HIV PrEP initiation (23.6% in 2018 to 53.8% in 2021, P = 0.015) and HIV nPEP (18.0% in 2018 to 48.3% in 2021, P = 0.001). Differences were observed primarily in the South, with significant increases in HIV PrEP risk assessment and education (32.5% in 2018 to 68.9% in 2021, P < 0.0001) and HIV PrEP initiation (6.7% in 2018 to 19.3% in 2021, P = 0.02). STI clinics significantly increased provision of HIV PrEP risk assessment and education (47.7% in 2018 to 76.6% in 2021, P = 0.001), HIV PrEP initiation (12.7% in 2018 to 29.5% in 2021, P = 0.008), and HIV PrEP referrals (54.1% in 2018 to 71.5% in 2021, P = 0.047). There were no significant differences in HIV services offered among non-STI clinics. Conclusions: We identified progress in the availability of HIV services in STI clinics, large jurisdictions, and the South. STI clinics and other primary points of clinical care for STIs can be useful to provide HIV preventive services.
