Sexual behaviour, STI knowledge and Chlamydia trachomatis\textit {Chlamydia trachomatis} (CT) and Neisseria gonorrhoeae\textit {Neisseria gonorrhoeae} (NG) prevalence in an asymptomatic cohort in Ruhr-area, Germany

$\textbf {Background and objectives}$ STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic $\textit {Chlamydia trachomatis}$ (CT) and $\textit {Neisseria gonorrhoeae}$ (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time. $\bf Methods$ In this study, 272 subjects (14–31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time – TAT) and (ii) test to therapy initiation was documented. $\bf Results$ Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h. $\bf Conclusion$ Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day

Sexuelle Gesundheit und Medizin im WIR – Walk In Ruhr

$\bf Hintergrund:$ Ein ganzheitliches Konzept sexueller Gesundheit und Medizin berücksichtigt die Diversität von Lebenswelten, um Klient*innen für Prävention, Testung, Beratung und Behandlung sexuell übertragbarer Infektionen (STI) zu gewinnen. Mit diesem Verständnis arbeiten die Immunologische Ambulanz, das Gesundheitsamt, die Aidshilfe sowie weitere Selbsthilfeorganisationen im WIR – Walk In Ruhr, Zentrum für Sexuelle Gesundheit und Medizin, in Bochum zusammen. $\textbf {Ziel der Arbeit:}$ Am Beispiel des WIR, das mit seinem innovativen Konzept eines Versorgungszentrums multiprofessionell innerhalb eines Settings sektor- und rechtsformübergreifend arbeitet, wird gezeigt, dass Erreichbarkeit, Test- und Behandlungsquote und HIV/STI-Risiko-Selbsteinschätzung sich verbessern. Das WIR wurde zudem im Auftrag des Bundesministeriums für Gesundheit über 3 Jahre extern evaluiert auch diese Ergebnisse werden dargestellt. $\bf Methode:$ Das Konzept des WIR und die im WIR durchgeführten Studien werden deskriptiv dargestellt. Bei der externen Evaluation wurde ein Mixed-Method-Design aus quantitativen und qualitativen Erhebungen angewandt. $\bf Ergebnis:$ Durch die Kooperation werden häufiger Frauen (27,7 %) und Heterosexuelle (56,4 %) als in der Ambulanz allein erreicht. Die Rate positiver Testergebnisse im WIR stieg von 2017 bis 2018 von 9,3 % auf 12,6 %. $\bf Diskussion:$ Durch das integrative Versorgungskonzept des WIR gelingt es, Menschen mit HIV/STI früh zu erreichen und zu behandeln. Der Übergang von Prävention zu medizinischer Versorgung ist im WIR von zentraler Bedeutung. Gesundheitsberater sind ein wichtiges Instrument für die aufsuchende Arbeit. Psychosoziale sowie psychotherapeutische Beratung werden in hohem Maße genutzt. Durch die vielschichtigen Angebote von Prävention, Test, Beratung werden bessere medizinische Ergebnisse erreicht sowie die Eigenverantwortung für sexuelle Gesundheit gesteigert. Die Übertragung des Konzeptes in die Fläche kann einen Beitrag zur besseren Versorgung zu sexueller Gesundheit leisten.$\bf Background:$ Holistic sexual healthcare factors in diversity of social habitat and aims to improvise client outreach for prevention, testing, counseling, and treatment of STIs. Towards this goal, the immunology outpatient clinic, the public health department of Bochum, the AIDS Service Organization Bochum e. v., and other community-driven NGOs mutually cooperate under the umbrella of WIR – Walk In Ruhr, Centre for Sexual Health and Medicine. $\bf Objectives:$ WIR is an innovative concept for multi-professional in-house ambulatory healthcare with cross-sectoral and cross-legal reach. It has successfully improved accessibility, testing and treatment rates, and HIV/STI self-assessment. We present the results achieved at WIR. $\bf Methods:$ A mixed-method design of qualitative and quantitative surveys. $\bf Results:$ The WIR reaches more women (27.7%) and heterosexuals (56.4%) than other counseling/test centers. The rate of positive test results at the WIR increased from 9.3% in 2017 to 12.6% in 2018 and progress from prevention to medical care is a significant aspect of WIR. The Federal Ministry of Health has externally evaluated WIR for over three years. $\bf Discussion:$ The integrative care model of WIR allows for early outreach and treatment of individuals with HIV/ST infections. Health advisors remain an important instrument facilitating outreach and psychosocial/psychotherapeutic counseling is administered frequently. Such a multi-layered approach in prevention, testing, and consultation, leads to improvement in both medical outcomes and the self-responsible attitude of patients towards their sexual health. Hence, expansion of integrative care models like WIR on a wider scale could arguably contribute to better health service and sexual health

HIV pre-exposure prophylaxis during the SARS-CoV-2 pandemic

$\bf Aims:$ Since 2017, HIV pre-exposure prophylaxis (PrEP) care has been provided through an intersectoral collaboration at WIR (Walk-in-Ruhr, Center for Sexual Health and Medicine, Bochum, Germany). The aim of this study was to establish possible impact of COVID-restrictions on the sexual behavior of PrEP users in North Rhine-Westphalia. $\bf Methods:$ The current PrEP study collected data of individuals using PrEP, their sexual behavior and sexually transmitted infections (STIs) before (each quarter of year 2018) and during the COVID-19 pandemic (each quarter of year 2020). $\bf Results:$ During the first lockdown in Germany from mid-March until May 2020, PrEP-care appointments at WIR were postponed or canceled. Almost a third of PrEP users had discontinued their PrEP intake in the $2^{nd}$ quarter of 2020 due to alteration of their sexual behavior. The number of sexual partners decreased from a median of 14 partners in the previous 6 months in $1^{st}$ quarter of 2020, to 7 partners in $4^{th}$ quarter of 2020. Despite such a significant reduction in partner number during the pandemic in comparison to the pre-pandemic period, a steady rate of STIs was observed among PrEP users in 2020. \(\bf Conclusion:\9 The SARS-CoV-2-pandemic has impacted PrEP-using MSM in North Rhine-Westphalia with respect to their PrEP intake regimen and sexual behavior in 2020. Our study revealed a steady rate of STI among PrEP users even during the pandemic, thus highlighting the importance of ensuring appropriate HIV/STI prevention services in times of crisis