STI testing and subsequent clinic attendance amongst test negative asymptomatic users of an internet STI testing service:one-year retrospective study

AIM: To explore the characteristics of online STI test users, and assess the frequency and factors associated with subsequent service use following a negative online STI test screen in individuals without symptoms.METHODS: One-year retrospective study of online and clinic STI testing within a large integrated sexual health service (Umbrella in Birmingham and Solihull, England) between January and December 2017. A multivariable analysis of sociodemographic and behavioural characteristics of patients was conducted. Sexual health clinic appointments occurring within 90 days of a negative STI test, in asymptomatic individuals who tested either online or in clinic were determined. Factors associated with online STI testing and subsequent clinic use were determined using generalized estimating equations and reported as odds ratios (OR) with corresponding 95% confidence intervals (CI).RESULTS: 31 847 online STI test requests and 40 059 clinic attendances incorporating STI testing were included. 79% (25020/31846) of online STI test users and 49% (19672/40059) of clinic STI test takers were asymptomatic. Online STI testing was less utilised (p&lt;0.05) by men who have sex with men (MSM), non-Caucasians and those living in neighborhoods of greater deprivation. Subsequent clinic appointments within 90 days of an asymptomatic negative STI test occurred in 6.2% (484/7769) of the online testing group and 33% (4960/15238) for the clinic tested group. Re-attendance following online testing was associated with being MSM (aOR 2.55[1.58 to 4.09]-MSM vs Female) and a recent prior history of STI testing (aOR 5.65[4.30 to 7.43] 'clinic tested' vs 'No' recent testing history).CONCLUSIONS: Subsequent clinic attendance amongst online STI test service users with negative test results was infrequent, suggesting that their needs were being met without placing an additional burden on clinic based services. However, unequal use of online services by different patient groups suggests that optimised messaging and the development of online services in partnership with users are required to improve uptake.</p

Frequency and correlates of Mycoplasma genitalium antimicrobial resistance mutations and their association with treatment outcomes: findings from a national sentinel surveillance pilot in England.

BACKGROUND Mycoplasma genitalium infection is a public health concern due to extensive antimicrobial resistance (AMR). Using data from a pilot of M. genitalium AMR surveillance, we determined the prevalence and risk factors for resistance among specimens from sexual health clinic attendees and assessed treatment outcomes. METHODS Seventeen sexual health clinics in England sent consecutive M genitalium-positive specimens to the national reference laboratory from January to March 2019. Regions of the 23S rRNA, parC and gyrA genes associated with macrolide and fluoroquinolone resistance, respectively, were amplified and sequenced where appropriate. Fisher's exact tests, univariate and multivariable logistic regression models were used to determine associations between demographic, clinical and behavioural factors and resistance-associated mutations. RESULTS Over two-thirds (173/249, 69%) of M. genitalium specimens had mutations associated with macrolide resistance, while predicted fluoroquinolone (21/251, 8%) and dual-drug (12/237, 5%) resistance were less prevalent. No specimens had both gyrA and parC resistance associated mutations. Macrolide resistance was more common in specimens from men who have sex with men (MSM) compared to heterosexual men (aOR: 2.64; 95% CI: 1.09-6.38; p = 0.03). There was an association between both macrolide and fluoroquinolone resistance and having a previous STI (p = 0.06).Only 19% of individuals returned for a test-of-cure. Of those infected with a macrolide-resistant genotype who were given azithromycin, 57/78 (73%) were known or assumed to be clinically cured; however, 43/57 (75%) of these also received doxycycline. Of the 21 with a macrolide-resistant genotype who failed treatment, 18/21 (86%) also received doxycycline. CONCLUSIONS While macrolide resistance was widespread, particularly among specimens from MSM and those with a previous STI diagnosis in the past year, resistance-associated mutations in M. genitalium did not appear to be unequivocally predictive of treatment failure