Abstracts from the 25th IUSTI World Congress incorporating the Australasian Sexual and Reproductive Health Conference

Basic and laboratory science abstracts

1. Drug resistance among women attending antenatal clinics in the COVID-19 era in Ghana

Enyan P.¹

¹University of Ghana, Ghana.

Background: Initial evidence from resource-limited countries using the WHO HIV drug resistance (HIVDR) threshold survey suggests that transmission of drug-resistance strains is likely to be limited. However, as access to ART is expanded, increased emergence of HIVDR is feared as a potential consequence. We have performed a surveillance survey of transmitted HIVDR among recently infected persons in the geographic setting of Accra, Ghana.

Methods: As part of a cross-sectional survey, 2 large voluntary counselling and testing centres in Accra enrolled 50 newly HIV-diagnosed, antiretroviral drug-naïve adults aged 18 to 25 years. Virus from plasma samples with >1000 HIV RNA copies/mL (Roche Amplicor v1.5) were sequenced in the pol gene. Transmitted drug resistance-associated mutations (TDRM) were identified according to the WHO 2009 Surveillance DRM list, using Stanford CPR tool (v 5.0 beta). Phylogenetic relationships of the newly characterised viruses were estimated by comparison with HIV-1 reference sequences from the Los Alamos database, by using the ClustalW alignment program implemented.

Results: Subtypes were predominantly D (39/70, 55.7%), A (29/70, 41.4%), and C (2/70; 2, 9%). Seven nucleotide sequences harboured a major TDRM (3 NNRTI, 3 NRTI, and 1 PI- associated mutation); HIVDR point prevalence was 10.0% (95% CI 4.1% to 19.5%). The identified TDRM were D67G (1.3%), L210W (2.6%); G190A (1.3%); G190S (1.3%); K101E (1.3%), and N88D (1.3%) for PI.

Conclusions: In Accra the capital city of Ghana, we found a rate of transmitted HIVDR, which, according to the WHO threshold survey method, falls into the moderate (5 to 15%) category. This is a considerable increase compared to the rate of <5% estimated in the 2006–7 survey among women attending an antenatal clinic in Mamobi. As ART programs expand throughout Africa, incident infections should be monitored for the presence of transmitted drug resistance in order to guide ART regimen policies.

2. Artificial intelligence-based diagnosis: distinguishing early syphilis from other sexually transmitted infections (STIs)

Sun J.^1,2, Li Y.³, Yu Z.^1,2,7, Towns J.^1,2, Soe N.^1,2, Latt P.^1,2, Zhang L.^4,5, Ge Z.^6,7,8, Fairley C.^1,2, Ong J.^1,2 and Zhang L.^1,2,9

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³School of Artificial Intelligence, Xidian University, Xi’an, China.

⁴Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China.

⁵School of Public Health and Preventative Medicine, School of Medicine, Nursing and Health Sciences, Monash University, Vic, Australia.

⁶AIM for Health Lab, Monash University, Melbourne, Vic, Australia.

⁷Monash Medical AI, Monash University, Melbourne, Vic, Australia.

⁸Faculty of IT, Monash University, Melbourne, Vic, Australia.

⁹China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China.

Background: Early diagnosis of syphilis is vital for its effective control. We aimed to develop an Artificial Intelligence (AI) diagnostic model, designed based on radiomics technology, to distinguish early syphilis from other sexually transmitted infections (STIs).

Methods: 260 images with different skin lesions caused by Sexually Transmitted Infections (STIs) were collected, including 115 syphilis and 145 other skin lesions. 80% of the dataset was used for developing the Artificial Intelligence (AI) model with 5-fold cross-validation, and the remaining 20% was used for the hold-out test. The exact lesion region was manually segmented as Region of Interest (ROI) in each image with the help of STI experts. 102 radiomics features were extracted from each ROI, and fed into 11 different classifiers (including SVM, Logistic Regression and so on) after deleting the redundant features using Pearson correlation coefficient. Different image filters like Laplacian of Gaussian and Wavelet were also investigated to improve the model performance. The area under the ROC curve (AUC) was used for the evaluation of the model and the Shapley Additive exPlanations (SHAP) was used for interpreting the developed model.

Results: Among the 11 classifiers, the Gradient Boosted Decision Trees (GBDT) classifier with applying the wavelet filter on the images demonstrated the best performance, offering the stratified 5-fold cross-validation AUC of 0.832 ± 0.042 and accuracy of 0.735 ± 0.043. On the hold-out test dataset, the model shows an AUC, accuracy, sensitivity, specificity, and f1-score of 0.792, 0.750, 0.609, 0.778, and 0.683, respectively. The SHAP analysis shows that the low-high grayscale run length matrix (GLRLM) run entropy and original shape 2D sphericity were the most predictive radiomics features for diagnosising early syphilis.

Conclusion: The proposed AI-based model could be used to assist in the diagnosis of early syphilis from other STIs.

Disclosure of interest statement: There is no financial interest to report.

3. Integrating radiomic analysis and machine learning for sexual transmitted infections detection

Sun J.^1,2, Yu Z.^1,2,7, Li Y.³, Towns J.^1,2, Zhang L.^4,5, Ge Z.^6,7,8, Fairley C.^1,2, Ong J.^1,2 and Zhang L.^1,2,9

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³School of Artificial Intelligence, Xidian University, Xi’an, China.

⁴Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China.

⁵School of Public Health and Preventative Medicine, School of Medicine, Nursing and Health Sciences, Monash University, Vic, Australia.

⁶AIM for Health Lab, Monash University, Melbourne, Vic, Australia

⁷Monash Medical AI, Monash University, Melbourne, Vic, Australia.

⁸Faculty of IT, Monash University, Melbourne, Vic, Australia.

⁹China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China.

Background: Symptom-based self-screening is important for the early diagnosis of sexually transmitted infections (STIs). We aimed to develop an artificial intelligence-powered tool by combining machine learning and radiomics techniques to accurately identify symptomatic STIs.

Methods: We analysed 597 skin lesion images from stiatlas.org, a well-known STI image database, and categorised images into six typical STIs by the anatomical sites of infections (unspecific sites, skin, anus and genitals). We first applied nine image filters then 11 machine learning image classifiers to the images. We then extracted radiomics features from the filtered images and trained them with 99 models that combines image filters and classifiers. Model performance was evaluated using the highest area under the receiver operating characteristic curve (AUC) and permutation importance.

Results: When the information of infection sites was unspecified, a combined Gradient-Boosted Decision Trees (GBDT) classifier and Laplacian of Gaussian (LoG) filter model achieved the best overall performance with an average AUC of 0.681 (95% CI 0.628–0.734). This model predicted best for lichen sclerosus (AUC = 0.768, 0.74–0.796). Inclusion of infection site information substantially improved the model performance. In particular, the combined Gaussian Naive Bayes classifier with Square Root filter showed a significant 22.3% improvement for anal infections (AUC = 0.833, 0.687–0.979) and 3.8% for skin infections (AUC = 0.707, 0.608–0.806). At anus, the best performance was for secondary syphilis and warts (both AUC = 0.833, 0.687–0.979). On skin, the best performance was for lichen sclerosus (AUC = 0.755, 0.579–0.931). On genitals, the best performace was for lichen sclerosus (AUC = 0.774, 0.744–0.804). In all models, lesion texture and statistical radiomics features were the most predictive for STIs.

Conclusion: Combining machine learning and radiomics techniques may be an effective method to categorise STIs clinically. Including infection sites information significantly improve the performance of radiomics models to identify STIs.

Disclosure of interest statement: There is no financial interest to report.

4. Comparison of HIV-specific broadly neutralising antibodies resistance prediction using plasma RNA, blood, and gut tissue HIV proviral DNA sequences

Lee M. J.^1,2,*, Zacharopoulou P.^2,*, Fumagalli M.³, Bittar C.³, Ansar M. A.², Caskey M.³, Nussenzweig M.³, Fidler^† S.¹ and Frater^† J.²

¹Department of Infectious Disease, Imperial College London, London, United Kingdom.

²Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom.

³Laboratory of Molecular Immunology, Rockefeller University, New York, USA.

^*These authors have contributed equally to this work.

Background: HIV-specific broadly neutralising antibodies (bNAbs) have demonstrated long-term viral control without anti-retroviral therapy as well as the potential for HIV prevention. Screening for bNAb resistance is common in clinical trials, however the optimal strategy to determine viral sensitivity from plasma virus or proviral samples has yet to be defined.

Methods: We analysed envelope sequences from PBMC and rebound plasma (n = 17), and paired baseline rectal biopsies (n = 4)) from participants in the unblinded placebo arm of the RIO trial (RCT of 3BNC117-LS and 10-1074-LS in primary HIV infection; NCT04319367). A mean of 18 single envelope sequences per person (range: 2–43) were amplified from proviral DNA or from cDNA reverse transcribed from rebound plasma RNA (mean 6 sequences per person, range: 1–26). BNAb resistance was predicted through bNAb-rep (https://github.com/RedaRawi/bNAb-ReP/tree/master) and an in-house algorithm (developed at Rockefeller University). Maximum likelihood trees with x1000 bootstraps were generated using R.

Results: 94.4% of bNAb sensitivity predictions obtained from sequences from either plasma virus or provirus DNA using the Rockefeller algorithm were matched. All but one participant had baseline proviral sequences predicted as sensitive to both bNAbs. Median duration from HIV diagnosis to initiating ART was 26 days (range 1–148), and to study enrolment was 64 months (range 37–244). Of four participants with available baseline rectal proviral sequences, one individual had rebound viruses more closely related to the rectal proviral sequences compared to PBMCs, potentially supporting a gut source for the rebound virus. Median minimum pairwise distances (mMinPD) between rebound viraemia, and baseline blood or gut samples were small (PBMC mMinPD = 0.001, range: 0–0.011; gut mMinPD = 0.00097, range: 0–0.0027).

Conclusions: HIV-1 envelope sequence-based bNAb resistance screening using proviral DNA from PBMC was consistent with predicted viral sensitivities from rebound plasma virus. This has implications for sample choice for bNAb screening.

Disclosure of interest statement: MJL is supported by the UK Medical Research Council and has received travel grants and speaker fees from Viiv Healthcare and MSD not related to this work. All other authors have no relevant disclosures to declare. This study is funded by the Bill and Melinda Gates Foundation and the UK Medical Research Council.

5. Pelvic inflammatory disease: a pilot study to identify microbial and immune biomarkers associated with pelvic inflammatory disease

Sweeney S.^1,3, Laurence L.² and Huston W.²

¹Family Planning Australia.

²University of Technology, Sydney, NSW, Australia.

³University of Newcastle, NSW, Australia.

Background: We hypothesise that people with Pelvic Inflammatory Disease (PID) possess a cervicovaginal microbial and immune profile which differs from those without PID. Certain Chlamydial, Mycoplasma or Gonoccocal strains detected in people with PID may have features more likely to lead to development of PID and its sequelae than other strains. This case-control study compares cervicovaginal microbiota and immune gene expression factors in PID cases with healthy controls.

Methods: 27 PID cases and 31 healthy controls were recruited from Family Planning Australia clinics. Standardised diagnostic criteria were used to define cases. Post-recruitment file reviews were conducted to ensure diagnostic consistency. Study swabs were collected from the cervix (×3) and high vagina (×1) to analyse host microbiome using shotgun metagenomic sequencing, host immune response using RT-qPCR, and pathogens. All participants completed a questionnaire assessing medical and sexual history, STI history and antibiotic use in preceding 3 months.

Results: Meta-data was significantly different between cases and controls. PID cases were significantly associated with recent partner change, vaginal symptoms such as thrush or bacterial vaginosis in the preceding 12 months, and antibiotic use in the preceding 3 months.

Controls had a higher relative abundance of Lactobacillus crispatus, while cases had higher relative abundance of Ureaplasma parvum, Fannyhessea vaginae, Gardnerella vaginalis and Prevotella species. There were also significant changes in host immune gene expression in PID cases.

Conclusion: Our findings support the hypothesis that PID is associated with a shift in the abundance of BV-associated microbes, and that a L. crispatus dominant cervicovaginal microbiome may be protective. The suboptimal microbiota could allow for dominance of microbiota which lead to PID in a susceptible host and modulate host immune response. Larger studies are indicated to further define this relationship and identify potential therapeutic targets.

Disclosure of interest statement: None.

6. Clinicopathological spectrum of syphilis at a tertiary care centre in North India

Palanisamy M.¹, Dewan K.¹ and Sharma S.²

¹Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

²National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India.

Background: Cutaneous manifestations of syphilis, especially in secondary stage, are protean and may therefore be misdiagnosed. Histopathological examination is essential to confirm the diagnosis, especially in atypical clinical presentations.

Materials and Methods: A retrospective review of patients diagnosed with syphilis who underwent biopsy during 2021–22 was performed from database of sexually transmitted disease clinic at a tertiary hospital. Demographic characteristics, clinical presentations, syphilis serology and HIV status were recorded from clinic proformas and histopathologic slides were analysed.

Results: A total of 8 cases were studied, 7 adults with secondary syphilis and 1 infant with congenital syphilis. Mean age was 29 years with male to female ratio of 3:1. Atypical clinical presentations included infiltrated nodules in 3 patients, hyperkeratotic scaly papules with extragenital chancre, lichenoid scaly papules and annular plaques in 1 case each. Most common site of involvement was extremities. Nine biopsies were reviewed (2 biopsies in 1 patient). Common epidermal findings included hyperkeratosis and acanthosis in 4 patients. Interface changes were noted in 2 cases. Majority of cases showed superficial and deep perivascular and periadnexal infiltrates. Lympho-histiocytes were noted in all biopsies, followed by plasma cells in 7, eosinophils in 3, neutrophils in 2, epithelioid cell granulomas with giant cells in 1 case. Additional findings included endothelial swelling in 2 and panniculitis in 1 case. TPHA and VDRL titres ranged from 1:8 to 1:64. HIV was positive in two patients.

Conclusion: Akin to clinical presentations, wide spectrum of histopathologic findings were seen in syphilis, ranging from interface to granulomatous reaction. Lympho-histiocytes and plasma cells constituted the predominant inflammatory infiltrate.

Disclosure of interest statement: None.

7. Genotypes of penicillin susceptible isolates in Saskatchewan, Canada indicate that susceptibility to penicillin may be predictable

Perera S. R.¹, Sanderson H.², Martin I.³, Minion J.⁴, Hamula C.⁵, Thorington R.³ and Dillon J. R.^1,2

¹Department of Biochemistry, Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

²Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, SK, Canada.

³Streptococcus and STI Section, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.

⁴Roy Romanow Provincial Laboratory, Regina, SK, Canada.

⁵Division of Clinical Microbiology, Dept. Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

Background: Neisseria gonorrhoeae isolates have developed resistance to every class of antimicrobial introduced for therapy, including ceftriaxone. As treatment options become limited, re-introduction of previously recommended antimicrobials, such as penicillin, may be a viable option if susceptibility can be predicted. In several world regions, including Canada and the USA, over 80% gonococcal isolates are reported to be susceptible to penicillin. The purpose of this study was to establish the molecular characteristics of penicillin susceptible isolates to ascertain whether the development of a diagnostic test for penicillin susceptibility is feasible.

Methods: 416 isolates (2017–2022) from Saskatchewan, Canada were sequenced using Illumina and genomes were assembled with the Gen2Epi pipeline. NG-STAR sequence types were obtained using PathogenWatch and PAARSNP. MICs were determined using CLSI guidelines. PPNG were excluded from the analysis.

Results: 1104 N. gonorrhoeae isolates were analysed for penicillin susceptibility retrospectively (2003–2022). The percentage of susceptible isolates ranged from 72.46%-100% in any given year and averaged at 93.57%. Only 71 (6.43%) isolates were chromosomally resistant to penicillin and 6 were PPNG. In examining the NG-STAR strain types of 416 isolates (2017–2022), predominant PBP2 PenA types were 14.001, 14.002, 34.001, 2.001, and 5.001, and carried various mutations in PorB1b and MtrR. Several isolates in all PBP2 types carried a 364D penA insertion and a L421P ponA substitution. None of the isolates contained an insertion at codon 345 and Mosaic penA type 34.001 (n = 78) contained I312M, G545S and V316T substitutions. Most of the susceptible and intermediate isolates were non-mosaic.

Conclusion: Gonococcal susceptibility to penicillin has remained high in Saskatchewan for 19 years. None of the isolates (2017–2022) contained the penA 345 insertion predictive of resistance (Mortimer et al., 2022) consistent with our findings of over 93% susceptibility. The introduction of a molecular test to predict chromosomal susceptibility to penicillin remains promising.

Disclosure of interest statement: The authors declare no competing interests.

8. Factors that contribute to the success of primary isolation of Mycoplasma genitalium in urogenital samples from Melbourne, Australia

Huaman J. L.^1,2,3, Chua T. P.^1,2,3, Danielewski J. A.^1,2,3, Plummer E. L.^2,4,5, Vodstrcil L. A.^4,5,6, Bradshaw C. S.^4,5,6, Jensen J. S.⁷, Garland S. M.^1,2,3 and Murray G. L.^1,2,3

¹Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic, Australia.

²Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville, Vic, Australia.

³Molecular Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Vic, Australia.

⁴Melbourne Sexual Health Centre, Alfred Health, Carlton, Vic, Australia.

⁵Central Clinical School, Monash University, Melbourne, Vic, Australia.

⁶Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic, Australia.

⁷Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.

Background: Mycoplasma genitalium is difficult to culture and consequently few laboratories do this. In the absence of culture, direct assessment of antibiotic susceptibility is not routinely performed, and our understanding of this organism is largely based on molecular analysis. In this study, we aimed to understand factors that influenced success in primary isolation of M. genitalium from clinical samples.

Methods: Urogenital samples (89 urine and 53 swabs) were collected at Melbourne Sexual Health Centre from patients with a confirmed or suspected M. genitalium infection. Eligible patients presented for M. genitalium testing and treatment, as a sexual contact of a M. genitalium infection, or for a M. genitalium test of cure with symptoms. Samples were transported to the research laboratory fresh (same day of collection) or frozen (–80°C). Samples testing positive for M. genitalium by routine diagnostic test (Aptima® Mycoplasma genitalium Assay, Hologic) were washed twice and then inoculated into Vero cells with selective antibiotic mixture (Thayer Martin Medium II). Cells were incubated at 37°C with 5% CO₂ and observed daily. In-house quantitative PCR was used to test initial M. genitalium load and growth.

Results: 21.1% (30/142) of samples tested negative for M. genitalium by routine diagnostic test and were discarded. In our preliminary studies an isolate was obtained from 16% (18/112) of samples. M. genitalium growth was detected in 4.9% (2/41) of swab and 22.5% (16/71) of urine. Culture success was highly influenced by initial M. genitalium load, with isolation rates of 0% (0/74) in samples with 0–4 geq/µL, 28.6% (6/21) in samples with 5–19 geq/µL and 100% (17/17) in samples with ≥20 geq/mL. In total, 47.5% (52/112) of samples were overgrown by bacterial contamination, mostly from swabs.

Conclusion: Isolation of primary M. genitalium cultures was most successful from urine samples, and in samples with high initial bacterial concentration.

Disclosure of interest statement: This work was supported by an Australian Research Council (ARC) Industrial Transformation Research Hub Grant (IH190100021).

9. Phenotypic antibiotic resistance of Mycoplasma genitalium and its association to macrolide resistance-associated mutations

Doelman T.¹, Adriaens N.^1,2, Bruisten S.^1,2, Westerhuis B.^1,2, Bouwman F.², Vergunst C.^2,3 and van Dam A.^1,2

¹Amsterdam UMC, University of Amsterdam, Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AI&II), location Amsterdam Medical Centre, Amsterdam, The Netherlands.

²Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

³Department of Dermatology, NWZ, Den Helder, The Netherlands.

Background: Mycoplasma genitalium (MG) is a sexually transmitted bacterium that is associated with urethritis in men. In the Netherlands, over 60% of MG strains harbor different single nucleotide polymorphisms (SNPs) of macrolide resistance-associated mutations (MRAMs). We aimed to establish in vitro cultivation and phenotyping of genetically diverse MG-strains to better understand the association between macrolide resistance and genotype and to assess minimal inhibitory concentrations (MICs) for alternative antibiotics.

Methods: Urine samples positive for MG by transcription mediated amplification and RT-PCR were cultured in the presence of Vero cells. RT-PCR on cultured samples was used to determine MICs for 8 different antibiotics. MICs were defined as the minimum concentration of antibiotic that inhibited growth by 99%. Laboratory-developed PCR was used to determine known MRAMs. Growth inhibition of MG by azithromycin was compared for the different MRAM SNPs.

Results: MG strains were successfully grown from 18/41 (44%) MG-positive urine samples, with phenotypic resistance analysis performed in 15 of these strains. The MIC results ranged as follows: azithromycin (<0.016–>16), levofloxacin (1–4), moxifloxacin (<0.25–1), sitafloxacin (<0.032–0.25), minocycline (<0.25–1), doxycycline (<0.125–2), spectinomycin (<2.5–>25), lefamulin (<0.004–0.064). Growth of strains harbouring the A2058T MRAM was significantly more inhibited at azithromycin concentrations ranging from 4–32 mg/L compared to strains harbouring the A2058G MRAM (P < 0.01).

Conclusion: MG strains showed significant differences in inhibition of MG growth induced by azithromycin between MRAM SNPs, suggesting different levels of macrolide resistance aligned with specific mutations. This may support the notion that macrolide treatment in patients infected with MG harbouring particular MRAM SNPs is associated with differences in treatment efficacy. Based on MICs only, fourth generation fluoroquinolones, tetracyclins and lefamulin may be considered as an effective treatment. With ongoing increase of antibiotic resistance in MG, this study emphasises the need to culture genetically diverse MG strains to associate genotypic to phenotypic antibiotic resistance.

10. Genital inflammation test (GIFT) for sexual and reproductive health: point-of-care screening tool for sexually transmitted infections and bacterial vaginosis

Lurie M.¹, Manhanzva M. T¹, Khumalo F.¹, Cawe N.¹, Tanko R.¹, Pidwell T.¹, Meyer B.¹, Radebe P.¹, Lombard C.¹, Mehou-Loko C.¹, Ganief Y.¹, Kpokiri E.⁶, Crucitti T.⁷, Mayouya-Gamana T.⁷, Gill K.^1,8, Thomas N.⁸, Madikida A.⁸, Mahlangu K.⁸, van de Wijgert J.⁹, Huynh B. T.^10,11, Fortas C.^10,11, Dziva Chikwari C.^6,12,13, Kranzer K.^6,13, Mwaturura T.^12,13, Mungur L.¹⁴, Uys A.¹⁴, Uys D.¹⁴, Honda A.¹⁵, Bernays S.^6,16, Bekker L. G.^1,8, Sinanovic E.¹⁷, Smith E.¹⁷, Francis S.^6,18, Marais S.¹⁹, Mackworth-Young C. R. S.^6,13, Harding-Esch E.⁶, Anderson D.², Passmore J. S.^1,4,20 and Masson L.^1,2,3,4,5

¹Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa.

²Maternal Child and Adolescent Health Program, Public Health Discipline, Burnet Institute, Vic, Australia.

³Disease Elimination Program, Life Sciences Discipline, Burnet Institute, Vic, Australia.

⁴Centre for the AIDS Programme of Research in South Africa, South Africa.

⁵Central Clinical School, Monash University, Vic, Australia.

⁶London School of Hygiene & Tropical Medicine, England.

⁷Institut Pasteur de Madagascar, Madagascar.

⁸Desmond Tutu HIV Centre, University of Cape Town, South Africa.

⁹University Medical Center, Utrecht, The Netherlands.

¹⁰Institut Pasteur, France.

¹¹UVSQ, Inserm, France.

¹²Organization for Public Health Interventions and Development, Zimbabwe.

¹³The Biomedical Research and Training Institute, Zimbabwe.

¹⁴Medical Diagnostech, South Africa.

¹⁵Hitotsubashi University, Japan.

¹⁶School of Public Health, University of Sydney, NSW, Australia.

¹⁷Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa.

¹⁸International AIDS Vaccine Initiative, The Netherlands.

¹⁹Research Contracts and Innovation, University of Cape Town, South Africa.

²⁰National Health Laboratory Service, South Africa.

Background: Genital inflammation caused by treatable conditions like sexually transmitted infections (STIs) and bacterial vaginosis (BV) is a key risk factor for HIV acquisition. In resource-limited settings STIs/BV are currently managed syndromically following WHO recommendations. However, most STI/BV cases are asymptomatic and therefore missed. We have validated biomarkers of vaginal inflammation (IL-1α, IL-1β, IP-10) caused by STIs/BV in five African cohorts. We aim to develop and implement a low-cost rapid point-of-care test (POCT), called the Genital InFlammation Test (GIFT), to measure these biomarkers and increase STI/BV case-finding.

Methods: We developed two lateral flow immunochromatographic prototypes measuring both IL-1α/IL-1β in a multiplexed assay and IP-10. The devices were evaluated using recombinant cytokines and vaginal swabs collected from asymptomatic non-pregnant South African women (14–35 years) and the results were compared to ELISA. Optimal vaginal swab type and equipment-free processing methods were determined. Cytokine yields were compared following different: (1) swab processing conditions (vortex vs manual compression); (2) swab types (FloQ vs dacron); (3) elution volumes.

Results: The prototype devices had analytical sensitivities <50pg/mL for IL-1α and IL-1β and <70pg/mL for IP-10. The test line intensities observed by the naked eye correlated with ELISA concentrations (r = 0.76, P < 0.0001; r = 0.86, P < 0.0001; r = 0.97, P < 0.0001) for IL-1α and β and IP-10, respectively. Swab compression by hand in soft nozzle tubes preloaded with PBS buffer yielded higher cytokine concentrations compared to processing with a vortex. Cytokine concentrations yielded from FloQ swabs were greater than those from dacron swabs.

Conclusion: GIFT results correlated significantly with ELISA results, showing the devices can detect cytokines in lateral vaginal wall swabs, with IP-10 and IL-1β detection most accurate than IL-1a. This POCT could significantly improve STI and BV management by increasing case-finding. The GIFT device, prospective user acceptability and cost-effectiveness are currently being evaluated in three settings in Africa.

Disclosure of interest statement: Lindi Masson and Jo-Ann Passmore are on European and South African patents for a Method for Diagnosing an Inflammatory Condition in the Female Genital Tract and co-lead the development of the GIFT device.

11. Dynamics in mpox vaccine immunity after Imvanex vaccination among men who have sex with men in Amsterdam, The Netherlands

Teker B.^1,7, Jongen V. W.^1,6, Van Dort K. A^3,4,8, Prins M.^1,3,4, Hoornenborg E.^1,3, Soors D’ Ancona M.¹, Davidovich U.^1,9, De Vries H. J. C.^1,3,4,7 and Kootstra N. A.^3,4,8

¹Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.

²Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

³Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands.

⁴Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands.

⁵Department of Medical Microbiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

⁶Stichting HIV monitoring, Amsterdam, The Netherlands.

⁷Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

⁸Department of Experimental Immunology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

⁹Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands.

Background: From July 2022, men who have sex with men (MSM) were eligible for mpox vaccination following the mpox outbreak in Europe, using Modified vaccinia Ankara—Bavarian Nordic (Imvanex). However, new cases of mpox have been observed among vaccinated individuals, leaving the duration of protection unclear. Here, we assessed the dynamics of mpox vaccine immunity and assessed immunological responses after one (in addition to a previous smallpox vaccination) or two vaccines.

Methods: Thirty-four MSM from the Amsterdam Cohort Studies were included. Demographical and sexual behavioural data were collected at T0. Blood samples were collected at pre-vaccination (T0), 1 month post-vaccination (T1), and 6–9 months post-vaccination (T2). Antibody titres were measured using an IgG mpox antibody ELISA (Eurofins Ingenasa). Virus/vaccine-specific CD4 and CD8 T-cell responses were analysed using Activation Induced Marker (AIM).

Results: The median age of 34 MSM was 52 years (IQR = 46–58), with 3 (8.8%) of them living with HIV. Among these 34 MSM, 15 were vaccinated once, while 19 were vaccinated with two vaccinations. Mpox antibody response was observed in 21/34 (62%) participants at T1. Immunological T-cell responses with AIM-CD4 and AIM-CD8 were observed for 26/34 (76%) and 25/34 (74%) participants at T1, respectively. Among responders on AIM-CD4 and AIM-CD8, 10/26 and 10/25 had T2 test results, with 2/10 and 2/10 showing decreased responses, respectively. The odds of immunological AIM-CD8 response were lower among participants who received two Imvanex vaccinations compared to those who received one dose after childhood smallpox vaccine (OR = 0.1, 95% CI = 0.01–0.91).

Conclusion: Two-thirds of participants showed an mpox-specific immune response 1 month post-vaccination. Vaccination induced T cell immunity declined in some responders at 6–9 months post-vaccination, which may contribute to breakthrough mpox infections. The combination of childhood smallpox vaccination and one dose Imvanex resulted in a higher AIM-CD8 immunological response compared to two Imvanex vaccinations.

Disclosure of interest statement: None.

12. Spontaneous clearance of Chlamydia trachomatis infection is characterised by distinct differences in interferon-gamma-producing memory CD4-T cell populations

Coss L.¹, Gupta K.², Geisler W. M.² and Jordan S. J.¹

¹Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.

²Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.

Background: Murine models show that clearance of Chlamydia trachomatis (CT) is mediated by interferon-gamma (IFNγ)-producing CD4+ T-cells. In women, spontaneous clearance of CT infection is found in approximately 20% of women on returning for treatment of a positive test and may indicate development of immunity. We hypothesised that spontaneous clearance in women would be associated with an increase in IFNγ-producing memory T-cell responses compared to women with persisting infection.

Methods: We enrolled women returning for treatment of a recent positive CT NAAT. Repeat CT NAAT differentiated women as having spontaneous clearance (NAAT-negative) versus persisting infection (NAAT-positive). Peripheral blood mononuclear cells from 114 matched women who spontaneously cleared (N = 57) or had persisting CT infection (N = 57) were stimulated with CT antigens and intracellular levels of IFNγ were measured by intracellular cytokine staining and flow cytometry. Memory CD4+ T-cells were defined as naïve T-cells (CD45RO^lo/CCR7^hi), central memory T-cells (CD45RO^hi/CCR7^hi, effector memory T-cells (Tem, CD45RO^hi/CCR7^lo) and terminally differentiated effector memory T-cells (CD45RO^lo/CCR7^lo). Significant associations were evaluated by Mann-Whitney or Kruskal-Wallis. Significance was defined as P < 0.05.

Results: Comparing women with spontaneous clearance versus persisting infection, no difference in frequency of specific memory T-cell subpopulations or percent IFNγ-producing T-cells was found. Comparing IFNγ-producing T-cell responses across memory populations by clearance outcome, there was a significant difference in distribution of IFNγ-producing T-cells in women with spontaneous clearance (P = 0.017), but not persisting infection; this difference was driven by an almost 4-fold increase in IFNγ-producing Tem T-cells (25% vs 7% in Tcm T-cells, P = 0.02).

Conclusion: Women who spontaneously cleared CT had a significant increase in the proportion of IFNγ-producing effector memory T-cells, suggesting that a critical threshold of effector T-cells may be required to effectively traffic to the genital tract and confer protection against CT.

Disclosure of interest statement: LC and KG have nothing to disclose. SJ consults for prevent and receives research funding from Hologic and NIH/NIAID. Add WMG disclosures.

13. Performance of sexually transmitted disease laboratories for Neisseria gonorrhoeae detection in Guangdong, China, 2020–2022

Zheng H.¹

¹Guangdong Center for Skin Disease and Std Control, China.

Background: Gonorrhea’s rising incidence poses a global public health challenge. The accuracy of Neisseria gonorrhoeae detection is pivotal for gonorrhea diagnosis, treatment and prevention. This study aimed to assess the performance of sexually transmitted disease (STD) laboratories for N. gonorrhoeae detection in Guangdong Province, southern China.

Methods: Questionnaire surveys on N. gonorrhoeae detection in clinical laboratories and external quality assessment (EQA) for the proficiency of STD laboratories in conducting gonococcus isolation and nucleic acid amplification tests (NAATs) were annually conducted from 2020 to 2022.

Results: A total of 1047 laboratories from different healthcare institutions in Guangdong responded to the survey during 2020–2022. Smear Gram staining and culture were primary methods (44.3% and 40.4%); only 11.7% of laboratories used NAATs. The number of clinical samples for N. gonorrhoeae was detected increased from 545,369 in 2020 to 1093,147 in 2022. The testing ratio of male-to-female samples was 1:3.4, but the positive ratio was 3.6:1. Males exhibited significantly higher positivity (10.0%) than females (0.9%; P < 0.0001). EQA for gonococcal culture and identification proficiency in 892 laboratories revealed an overall accuracy of 90.8%, highest in maternal and children’s hospitals (97.5%) and lowest in STD Control and Disease Prevention Centers (82.4%). NAAT EQA involving 260 laboratories achieved an overall accuracy of 93.1%, decreasing with lower gonococcal DNA copy numbers (100.0% to 84.5%). Specificity was 89.0% in interference samples without N. gonorrhoeae. Varying false-positive and false-negative rates among commercial reagents might cause gonorrhea misdiagnosis.

Conclusions: Smear Gram staining and culture are the most commonly used methods in laboratories. A higher percentage of males with urogenital infection were detected via the smear method. Culturing and identifying N. gonorrhoeae in EQA samples is highly accurate, and NAATs are highly sensitive. NAATs for screening and culture for identification and antibiotic susceptibility should be recommended in clinical practice.

Disclosure of interest statement: None.

14. Cervicovaginal bacterial communities in adult malagasy women of reproductive age with human papillomavirus infection and female genital schistosomiasis

Christina Hey Jana^1,2,3, Saalfrank Johanna⁴, Rasamoelina Tahinamandranto⁵, Ravo Razafindrakoro Anjarasoa⁵, Razafindralava Matthieu⁵, Gildas Rajaoniarivo Valeri⁶, Kutz Jean-Marc^1,3, Ratefiarisoa Sonya⁶, Kislaya Irina^1,3, Rakotomalala Zoly⁶, Sahondra Randrianasolo Bodo⁷, Solotiana Rakotomalala Rivo⁶, Marchese Valentina^1,3, Rakotozandrindrainy Raphael⁸, Andrianarimanana Diavolana⁶, Rausche Pia^1,3, Remkes Aaron^1,3, May Jürgen^1,3,9, Gheit Tarik¹⁰, Andry Rakotoarivelo Rivo¹¹, Bang Corinna⁴ and Fusco Daniela^1,3

¹Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.

²Leibniz Institute of Virology (LIV), Hamburg, Germany.

³German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.

⁴Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany.

⁵Centre d’ Infectiologie Charles Mérieux (CICM), University of Antananarivo, Antananarivo, Madagascar.

⁶Centre Hospitalier Universitaire (CHU) Androva, Mahajanga, Madagascar.

⁷Association K’OLO VANONA, Antananarivo, Madagascar.

⁸Department of Microbiology and Parasitology, University of Antananarivo, Antananarivo, Madagascar.

⁹Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.

¹⁰International Agency for Research on Cancer (IARC), Lyon, France.

¹¹Department of Infectious Diseases, University of Fianarantsoa Andrainjato, Fianarantsoa, Madagascar.

Background: Vaginal microbiome (VM) was described to have a role in the persistence of HPV infection. Recent findings suggest that female genital schistosomiasis (FGS), caused by a chronic infection with Schistosoma haematobium, might exacerbate the risk of both HPV infection and cervical cancer. Typical symptoms of FGS are non-specific and diagnosis is made with colposcopy. Few studies have described the characteristics and variability of the VM in association with FGS, showing different bacterial communities or abundant Trichomonas vaginalis.

The objective of our study was to characterise the VM of women of reproductive age in Madagascar, a country with high burden of both FGS and HPV.

Methods: A cross-sectional study was conducted at three Primary Health Care Centres (PHCCs) in the district of Marovoay in the Boeny region of Madagascar. Data was collected from women aged 18–49 years between March and August 2021, including colposcopy results, cervicovaginal lavage sample (CVL), socio-demographics, personal habits and clinical history. CVL Samples were shipped to the laboratory in Kiel for 16S rDNA sequencing.

Results: The sequencing of 16S rDNA of 414 women showed that Gardnerella, Sneathia and Mycoplasma were more abundant in HPV-positive women, but no differences were observed among women with different FGS and HPV/FGS statuses. Variability in the alpha and beta diversity was associated with urbanicity, profession, diet behaviour, antibiotics usage and dyspareunia. Four community state types (CST) were characterised: CST-M1 and CST-M4 were highly diverse and without Lactobacillus dominance, CST M3 was dominated by L. iners and CST-M2 dominated by other unidentified Lactobacillus species.

Conclusion: This first study of VM in Madagascar showed no Lactobacillus dominance and non-classifiable species that could be unique of the Malagasy population. Further studies are needed to characterise the role of VM for high burden gynaecological disorders, especially those affecting the most neglected populations.

Disclosure of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization.

15. High rates of ciprofloxacin and doxycycline resistance in Neisseria gonorrhoeae infection in Lesotho

Maduna L. D.¹, Taole M.¹, Motanteli K.¹, Mothobi I.², Mosehle T.² and Peters R. P. H.³

¹Department of Biology, National University of Lesotho, Lesotho.

²Ministry of Health Lesotho, Lesotho.

³Department of Medical Microbiology, University of Pretoria, South Africa.

Background: Drug resistance in Neisseria gonorrhoeae has emerged worldwide; however, there are no data about the situation in Lesotho. In Lesotho, ciprofloxacin and doxycycline are used for the syndromic management of gonorrhoea. However, both drugs have been abandoned globally for the treatment of gonorrhoea because of the high rates of resistance to N. gonorrhoeae. We investigated the antimicrobial resistance profile of N. gonorrhoeae infections in men from Maseru, Lesotho.

Methods: We conducted a cross-sectional study at a primary healthcare clinic in Maseru, Lesotho. Men with urethral discharge were recruited. Neisseria gonorrhoeae culture was performed from urethral swabs by direct inoculation of Modified Thayer-Martin medium, followed by antimicrobial susceptibility testing using the E-test with minimum inhibitory concentration (MIC), according to the EUCAST criteria. Penicillinase-producing Neisseria gonorrhoeae isolates were identified by using nitrocefin disks. Chlamydia trachomatis and Neisseria gonorrhoeae PCR was performed on urine samples.

Results: We recruited 160 men; PCR was positive for N. gonorrhoeae in 99 men (62%) and C. trachomatis was detected in 20 (13%) samples. Gonococcal cultures were positive for 62% (61/99) of men, with N. gonorrhoeae detected molecularly. Isolates showed resistance to ciprofloxacin in 97% (59/61), azithromycin in 5% (3/61), and tetracycline in 100% (61/61); 67% (41/61) of isolates demonstrated high-level tetracycline resistance (MICs > 12 mg/L). Penicillin G resistance was reported in 51% (31/61) of isolates and 58% (18/31) was due to penicillinase production. All isolates were susceptible to spectinomycin, ceftriaxone (MIC range 0.002 mg/L–0.004 mg/L), and cefixime (MIC range 0.016 mg/L–0.023 mg/L).

Conclusion: The high prevalence of antimicrobial resistance in Neisseria gonorrhoeae raises concerns about the efficacy of ciprofloxacin and doxycycline for Gonococcal infections in Lesotho. To address this, the syndromic treatment regimen should be updated to include azithromycin and ceftriaxone. Our results emphasise the need for improved diagnostics for sexually transmitted infections in Lesotho.

Disclosure of interest statement: This work was carried out with aid of a grant in the UNESCO-TWAS programme, “Seed Grant for African principal investigators” financed by the German Federal Ministry of Education and Research (BMBF). The views expressed herein do not necessarily represent the those of UNESCO-TWAS or BMBF.

16. Relationship between bacterial vaginosis and vaginal proteomic profiles of South African adolescent girls and adult women at high risk of HIV acquisition

Abrahams A. G.^1,2, Radzey N.^1,2, Ganief T.¹, Mehou-Loko C.², Harryparsad R.², Meyer B.², Manhanzva M. T.², Humphries H.^3,4, Gumbi P.^5,6, Busakwe F.⁷, Samsunder N.⁵, Abdool Karim Q.^5,8, Bell L.^9,10,11, Du Plessis M.^1,10, Ahmed N.⁷, Fortune F.⁷, Bekker L. G.^2,7, Passmore J. S.^2,5,12, Jaspan H. B.^2,13, Blackburn J.^1,10,* and Masson L.^2,5,14,15,*

¹Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, South Africa.

²Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa.

³Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa.

⁴Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa.

⁵Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

⁶School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa,

⁷Desmond Tutu HIV Centre, South Africa.

⁸Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

⁹Distributed Platform in Omics (DIPLOMICS), Cape Town, South Africa.

¹⁰D-CYPHR, Department of Integrative Biomedical Sciences, University of Cape Town, South Africa.

¹¹Centre for Proteomic and Genomic Research (CPGR), Cape Town, South Africa,

¹²National Health Laboratory Service, South Africa.

¹³Seattle Children’s Research Institute, University of Washington, Department of Biochemistry, USA.

¹⁴Life Sciences Discipline, Burnet Institute, Melbourne, Vic, Australia.

¹⁵Central Clinical School, Monash University, Carlton, Vic, Australia.

^*Co-senior authors.

Background: Bacterial vaginosis (BV), characterised by a non-optimal vaginal microbiome, has been associated with increased inflammation in the female genital tract (FGT), both of which predicts later HIV acquisition. The aim of this study was to evaluate the impact of BV on the vaginal proteomic profiles of South African adolescent girls and adult women, to understand its role on the high rates of HIV infection seen in young women in this setting.

Methods: Vaginal swabs were collected from 168 adolescents (14–19 years old) and 85 adults (25–35 years old) in Cape Town and KwaZulu-Natal, South Africa, enrolled in the Mucosal Injury from Sexual Contact study. Vaginal smears were Gram-stained for BV diagnosis by Nugent scoring. Vaginal swabs were analysed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The R/Bioconductor limma package and DAVID Bioinformatics were used for differential protein expression and functional analyses.

Results: Of the 2114 host proteins detected, 583 were significantly differentially expressed in women who had BV (n = 108) compared to BV negative women (n = 91, FDR adj. P < 0.05), with 214 overexpressed and 369 underexpressed proteins. Overexpressed proteins mapped to several inflammatory functions, including innate (adj. P = 0.026) and adaptive (adj. P = 8 × 10^–11) immunity and NIK/NF-kappaB signalling (adj. P = 3.3 × 10^–6). Underexpressed proteins mapped to cytoskeleton (adj. P = 3.1 × 10^–4) and cell junction (adj. p = 4.7 × 10^–4) cellular components, and the actin-binding molecular function (adj. P = 9.9 × 10^–4). Protein profiles did not differ between adolescents (n = 69) and adults (n = 39) who had BV, with both groups having similar inflammatory and epithelial barrier signatures compared to BV negative women.

Conclusion: BV prevalence is high among South African young women and is associated with protein signatures of inflammation and epithelial barrier disruption in the FGT. Strategies such as point-of-care screening for FGT inflammation and BV, as well as improved treatment, are needed to reduce associated HIV susceptibility in this population.

Disclosure of interest statement: This study was funded by the National Institute of Health.

17. A 2D in-vitro cell-based model for antimicrobial susceptibility testing against oral gonorrhoea

Paolini R.¹, Moore C.¹, Hamza S. A.¹, McCullough M.¹, Unemo M.², Hocking J. S.³, Celentano A.¹ and Kong F. Y. S.³

¹Melbourne Dental School, The University of Melbourne, Carlton, Vic, Australia,

²WHO Collaborating Centre for Gonorrhoea and other STIs, örebro University Hospital, Sweden.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic, Australia.

Background: Treatments for Neisseria gonorrhoeae (NG) remain scarce as NG becomes increasingly resistant with higher treatment failure in the oropharynx. However, little is known about oral NG infection dynamics. We developed the world’s first in vitro co-culture model for NG with human oral cells to understand infection dynamics and to rapidly screen for new antimicrobials to treat oral NG.

Methods: In our preliminary model, we infected three oral cell subtypes – gingiva, tonsils and floor-of-the-mouth with either an antimicrobial-susceptible (FA1090) or an antimicrobial-resistant (FC428) strain of NG. We assessed tissue invasion (colony forming units; CFUs) and intracellular kill following exposure to tetracycline, ciprofloxacin, azithromycin, ceftriaxone, cefixime and gentamicin at 1, 2, 3× MIC after 30, 60 and 120 min post-infection and at 15 and 30 min prior to infection to validate the model. Pre- and post-treating cells with tetracycline was done to simulate doxycycline pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Post-treatment cells were washed with gentamicin, cells lysed for CFU counting, and internalised bacteria were visualised using confocal microscopy.

Results: NG infected all cell types, with highest CFUs observed in the tonsils and gingiva for both strains. Gentamicin showed ineffective intracellular clearing of NG, while other antibiotics demonstrated clearing of NG, with significant CFU reductions within 2 h. These findings reflect clinical observations, and strongly support the validation of our model. Data from tetracycline treatment suggests that pre-treatment of cells (DoxyPreP) was more effective against FC428 strain (MIC90 2mcg/mL) vs post-treatment of cells (DoxyPEP).

Conclusion: We have developed a validated 2D-model of oral NG infection, testing currently recommended treatments in three different oral cell types, demonstrating our results align with clinical findings. With this model, we will study oral NG infection dynamics, screen novel antimicrobials to find new treatments for oral NG and to support the development of a 3D model.

Disclosure of interest statement: This work was supported by the Australian Research Council Industrial Transformation Research Hub to Combat Antimicrobial Resistance (IH190100021). JSH is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT 2025960). FYSK is supported by a CR Roper Postdoctoral fellowship.

Keywords: antimicrobial resistance, sexually transmitted infections, treatment.

18. Machine learning based multi-omics data integration for diagnosis of bacterial vaginosis in Indian women

Challa A.¹, Nagpal S.^2,3,4, Taneja B.^3,4, Sharma U.⁵, Tyagi R.⁵, Kumar P.⁵, Sood S.⁶, Kachhawa G.⁷ and Gupta* S.¹

¹Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

²BioSciences R&D, TCS Research, Tata Consultancy Services Ltd, Pune, India.

³CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.

⁴Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.

⁵Department of Nuclear Magnetic Resonance (NMR), All India Institute of Medical Sciences, New Delhi, India.

⁶Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.

⁷Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Background: Bacterial vaginosis (BV) is a common vaginal disorder among reproductive-age group women. Existing diagnostic modalities rely on laboratory-based Nugent’s scoring of vaginal morphotypes or clinical assessment of Amsel’s signs. However, subjectivity and disconcordance between the criteria, pose severe limitations to their use. Additionally, molecular diagnosis is restricted by vast inter- and intra-individual diversities of vaginal communities warranting population specific tests. The use of machine learning (ML) tools to aid disease diagnosis have gained immense popularity. The aim of the present study was to explore the potential of ML in multi-omics data integration to identify markers for BV diagnosis in Indian women.

Methods: V3-V4 16S rRNA gene sequencing and ¹H-NMR spectroscopy-based metabolomics were performed on vaginal swabs obtained from 40 women with BV (mean age = 30.5 years, Nugent score ≥7) and 20 healthy controls (mean age = 30.0 years, Nugent score ≤3). Sequencing was performed on a MiSeq V2 instrument (Illumina) to generate 0.2 million, 250 base pair (bp) paired end reads per sample. Raw reads were quality checked, assembled and classified using RDP classifier v18. ¹H-NMR spectra were processed on a Dell 390 N, PC, Red Hat Enterprise Linux workstation using VnmrJ 2.3 and metabolites were identified and quantified using Chenomx NMR Suite. Utilising 10 features with a 80/20 training/testing split on the datasets, a ML classification model was built deploying the Random Forest classification algorithm. A 10-fold cross validation (CV) was performed and the model was evaluated in terms of its accuracy, precision, recall, F1-score, and area under the curve (AUC) for classification of BV.

Results: Classification model was built using 10 features and included Sneathia spp., Dialister micraerophilus, Gardnerella spp., members of Eggerthellaceae family, Fannyhessea vaginae and maltose. Average accuracy (CV), precision, recall, F1 and area under the curve (AUC) for BV diagnosis was found to be 0.87±0.15, 1.00, 0.75, 0.86, 1.00 respectively.

Conclusion: Supervised machine learning has a promising potential in identification of omics-based markers for diagnosis of BV in Indian women.

19. Developing a rapid point of care test for diagnosis of active syphilis

Williams E.^1,2, Zheng S.^1,2, Hess S.^1,2, Center R.^1,6, Michalak E.^1,2, Pham M.^1,3, Stoove M.^1,3,5, Zhang S.^3,4, Kiggundu R.^3,4, Ong J.^3,4 and Drummer H.^1,2,3,6

¹Burnet Institute, Melbourne, Vic, Australia.

²Burnet Diagnostics Initiative, Melbourne, Vic, Australia.

³Monash University, Clayton, Vic, Australia.

⁴Melbourne Sexual Health Centre, Melbourne, Vic, Australia.

⁵Deakin University, Vic, Australia.

⁶The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Vic, Australia.

Background: Reported cases of syphilis have increased three-fold in Australia over the past 10 years. Globally, 7.1 million cases were reported worldwide in 2020, with outcomes including 200,000–300,000 neonatal deaths and still births. While treatment of syphilis is relatively straightforward and cost-effective using long-acting penicillin, diagnosis of active syphilis requires complex laboratory diagnosis involving multiple patient interactions with trained health care practitioners. Traditional serological tests for anti-treponemal antibodies cannot distinguish active versus past-treated infections as antibodies persist post-cure. There remains an urgent need to develop simple, quick, point of care tests to diagnose active syphilis to reduce the burden of disease.

Methods: Treponema pallidum antigens were either purchased or expressed in E. coli, purified by affinity chromatography and used individually and in combination in a lateral flow assay. Clinical samples collected from the Melbourne Sexual Health Centre (Alfred Ethics 625/22) were used to develop the lateral flow assay and select the best performing antigen set for discriminating active and past-treated syphilis. Plasma and serum samples were collected from 40 confirmed cases of active syphilis, 40 past-treated and 17 volunteers with no history of syphilis infection.

Results: We defined the optimal combination of treponemal antigens to detect anti-treponemal antibodies that differentiate active and past-treated syphilis infection. The final prototype provides 95% sensitivity and 92% specificity in a 30 min, two step assay. The positive predictive value is 90% and negative predictive value is 96%. The test can utilise serum, plasma or whole blood (venous or finger prick). HIV status did not impact performance of the test.

Conclusion: We have successfully developed a point of care assay to diagnose active syphilis. In ongoing work, we are simplifying the assay to improve patient usability, by decreasing the number of steps, time to result, and exploring integrating controlled buffer release and sample delivery.

Disclosure of interest statement: This study was funded by the Burnet Institute. No pharmaceutical grants were received in the development of this study.

20. Validation of a point of care test for active syphilis

Zheng S.^1,2, Williams E.^1,2, Hess S.^1,2, Michalak E.^1,2, Pham M.^1,3, Stoove M.^1,3,5, Zhang S.^3,4, Kiggundu R.^3,4, Ong J.^3,4 and Drummer H.^1,2,3,6

¹Burnet Institute, Melbourne, Vic, Australia.

²Burnet Diagnostics Initiative, Melbourne, Vic, Australia.

³Monash University, Clayton, Vic, Australia.

⁴Melbourne Sexual Health Centre, Melbourne, Vic, Australia.

⁵Deakin University, Vic, Australia.

⁶The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Vic, Australia.

Background: Syphilis, caused by Treponema pallidum (TP), is a sexually transmitted infection (STI) and remains a major global public health concern, especially for high-risk group such as men who have sex with men (MSM). Syphilis cases continue to rise among the population, and many are asymptomatic. Untreated Syphilis infection can cause serious health problems such as brain infections, dementia, lung and heart failure, blindness, and death. However, early diagnosis and timely treatment with penicillin can cure syphilis easily. Point-of-care tests (POCT) detecting total antibodies against treponemal pallidum are available, but they cannot distinguish between active and past-treated infections. The Burnet Diagnostics Initiative has developed a 30-min two-step TP lateral flow test that shows promise as a point of care test for active syphilis infection.

Methods: 97 pre-characterised (40 active, 40 past-treated, 17 negative) venous whole blood samples were collected at Melbourne Sexual Health Centre (MSHC) and delivered to Burnet institute, where serum samples were obtained and used for evaluation. Performance of Burnet Active Syphilis prototype was assessed against two commercial tests, Abbott Bioline™ Syphilis 3.0 and Abbott Determine™ Syphilis TP.

Results: Using 97 pre-characterised serum samples, Burnet Active Syphilis prototype demonstrated 95% sensitivity and 92% specificity for detecting active syphilis. Abbott Bioline™ Syphilis 3.0 and Abbott Determine™ Syphilis TP identified 97%, and 100% of active syphilis cases and correctly identified 100% and 94% of never infected patients as negative. However, the two commercial tests identified the majority of past-treated patients (91% and 100%) as positive for syphilis, in comparison to only 16% of past-treated patients misidentified as positive using the Burnet Active Syphilis test.

Conclusion: The Burnet Active Syphilis test can diagnose active cases of syphilis and could play an important role in diagnosis of active syphilis and accelerating access to treatment.

Disclosure of interest statement: This study was funded by the Burnet Institute. No pharmaceutical grants were received in the development of this study.

21. Prolonged stability of syphilis quality control solution for use on qualitative immunochromatographic test strips

Rivers-Kennedy A.¹, Woelk V.¹, Prisk E.¹, Matthews S.¹ and Shephard M.¹

¹Flinders University International Centre for Point of Care Testing, SA, Australia.

Background: Syphilis positive quality control (QC) testing is required to confirm immunochromatographic test strip integrity in the Enhanced Syphilis Response and Western Australian Syphilis Point-of-Care Testing (POCT) Programs. Compliant with the manufacturer’s instructions, QC materials are stored at 2–8°C with a 60-day open vial stability. The restricted QC storage and stability often leads to high QC wastage, elevated cost per test, and frequent operator stock ordering and receipt. The aim of this study was to evaluate the QC stability outside of the manufacturer’s documented storage conditions to facilitate extended “off-label” product use.

Methods: QC solutions (SeraCare ACCURUN® 155 Series 5000 Anti-Treponema) were stored in a standard reagent freezer or fridge, at room temperature (RT) or within a 30°C heat block (controlled). For a period of 140 days, QC solutions were removed from storage every 7 days for 10 min, mixed and tested by placing 50 microliters onto the test strip (Abbott Determine™ Syphilis TP) sample pad. Syphilis results were qualitatively interpreted using the control and test line (reactive) after 15 min. Solutions were then returned to the defined storage conditions until the next test event.

Results: Over 140 days, the mean freezer, fridge, RT and controlled temperatures were –18.9°C (SD 0.5), 7.4°C (SD 0.5), 22.1°C (SD 1.9), and 30.1°C (SD 0.3), respectively. Reactive results were recorded for all QC solutions stored across the 4 different temperature conditions at every 7 days for the 140-day period.

Conclusion: This study verifies 140-day open vial SeraCare QC stability for the TP immunochromatographic test strip irrespective of storage at –18.9°C (SD 0.5), 7.4°C (SD 0.5), 22.1°C (SD 1.9), or 30.1°C (SD 0.3). These findings facilitate an extended QC material shelf-life of 233%, which when implemented in the Syphilis POCT Programs, will reduce QC wastage, provide operational program savings, and reduce operator workload.

Disclosure of interest statement: The Enhanced Syphilis Response Point-of-Care Testing Program is funded by the Australian Government Department of Health and Aged Care and managed through a partnership between NACCHO and ICPOCT. The WA Syphilis Point-of-Care Testing Program is funded by the Department of Health, Government of Western Australia. The artwork developed for the programs was created by Jasmin Sarin, a proud Kamilaroi and Jerrinja women. The authors acknowledge the contribution of Michelle D’Souza during the study, enrolled Aboriginal community controlled and government-funded health services, and NGOs. The authors have no conflict of interest to declare.

22. Disulfiram exhibits potent antimicrobial activity against Mycoplasma genitalium

Xiao Li¹, Geisler William M.¹ and Prescott Atkinson T.²

¹Departments of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

²Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.

Background: Mycoplasma genitalium (Mgen) is a human sexually transmitted urogenital pathogen that is associated with urethritis, cervicitis, and pelvic inflammatory disease. Surveillance studies in sexually transmitted disease clinics demonstrate that Mgen is increasingly becoming resistant to the limited classes of antibiotics that have been shown to inhibit its growth. Disulfiram is an FDA approved drug for treatment of alcohol dependence that works by inhibiting aldehyde dehydrogenase and thereby producing unpleasant symptoms if the patient ingests alcoholic beverages.

Methods: Antimicrobial susceptibility test was used to test the minimal inhibitory concentration (MIC) of disulfiram against Mgen. In vitro selection was conducted by passing the reference strain G37 in increased concentrations of disulfiram.

Results: Disulfiram exhibits copper-dependent antimicrobial activity against Mgen strains, including the multidrug resistant ones, with MIC values in the low nanomolar range. Isolates growing in elevated disulfiram concentrations has been selected by in vitro induction and mechanisms of antimicrobial activity of disulfiram are under investigation.

Conclusion: Disulfiram showed antimicrobial activity against Mgen. This study provided a new potential treatment option for Mgen infections, especially for those infected with multiple drug resistant strains.

Disclosure of interest statement: None to disclose.

Clinical management and implementation abstracts

23. The development and performance of a machine-learning based mobile platform for visually determining the aetiology of penile pathology

Allan-Blitz L. T.¹, Ambepitiya S.², Tirupathi R.³ and Klausner J. D.⁴

¹Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA.

²HeHealth Inc. San Francisco, CA, USA.

³Keystone Infectious Diseases, Keystone Health, Chambersburg, PA, USA.

⁴Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Background: Machine-learning algorithms can facilitate low-cost, user-guided visual diagnostic platforms for addressing disparities in access to sexual health services.

Methods: We developed a clinical image dataset using original and augmented images for five penile diseases: herpes eruption, syphilitic chancres, penile candidiasis, penile cancer, and genital warts. We used a U-net architecture model for semantic pixel segmentation into background or subject image, the Inception-ResNet version 2 neural architecture to classify each pixel as diseased or non-diseased, and a salience map using GradCAM++. We trained the model on a random 91% sample of the image database using 150 epochs per image, and evaluated the model on the remaining 9% of images, assessing recall (or sensitivity), precision, specificity, and F1-score (accuracy).

Results: Of the 239 images in the validation dataset, 45 (18.8%) were of genital warts, 43 (18.0%) were of HSV infection, 29 (12.1%) were of penile cancer, 40 (16.7%) were of penile candidiasis, 37 (15.5%) were of syphilitic chancres, and 45 (18.8%) were of non-diseased penises. The overall accuracy of the model for correctly classifying the diseased image was 0.944. Between 1 July and 1 October 2023, there were 2640 unique users of the mobile platform. Among a random sample of submissions (n = 437), 271 (62.0%) were from the United States, 64 (14.6%) from Singapore, 41 (9.4%) from Candia, 40 (9.2%) from the United Kingdom, and 21 (4.8%) from Vietnam. The majority (n = 277 [63.4%]) were between 18 and 30 years old.

Conclusion: We report on the development of a machine-learning model for classifying five penile diseases, which demonstrated excellent performance on a validation dataset. That model is currently in use globally and has the potential to improve access to diagnostic services for penile diseases.

Disclosures: LAB and JDK received consulting fees from HeHealth Inc. SA is a Medical Executive at HeHealth Inc. A startup, HeHealth has raised funding from institutional investors and angel investors, and would like to specifically acknowledge Plug and Play Tech Center as well as ARKRAY Corporate Venture Capital.

24. Economic evaluation alongside a clinical trial of near-to-patient testing for sexually transmitted infections

Zhang Y.^1,2, Vodstrcil L. A.^1,2,3, Htaik K.^1,2, Plummer E. L.^1,2, De Petra V.⁴, Sen M. G.⁴, Williamson D. A.^5,6, Owlad M.², Murray G.^7,8,9, Chow E. P.^1,2,3, Fairley C. K.^1,2, Bradshaw C. S.^1,2,3 and Ong J. J.^1,2,10

¹Central Clinical School, Monash University, Melbourne, Vic, Australia.

²Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁴Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Vic, Australia.

⁵Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

⁶Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

⁷Murdoch Children’s Research Institute, Parkville, Vic, Australia.

⁸Women’s Centre for Infectious Diseases, The Royal Women’s Hospital, Parkville, Vic, Australia.

⁹Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic, Australia.

¹⁰Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: Current clinical care for common bacterial STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG)) involves empiric antimicrobial therapy when clients are symptomatic, or if asymptomatic, waiting for laboratory testing and recall if indicated. Near-to-patient testing (NPT) can improve pathogen-specific prescribing and reduce unnecessary or inappropriate antibiotic use in treating sexually transmitted infections (STI) by providing same-day delivery of results and treatment.

Methods: We compared the economic cost of NPT to current clinic practice for managing clients with suspected proctitis, non-gonococcal urethritis (NGU), or as an STI contact, from a health provider’s perspective. With a microsimulation of 1000 clients, we calculated the cost per client tested and per STI- and pathogen- detected for each testing strategy. We also imposed an antimicrobial resistance (AMR) tax to determine whether this measure could impact the cost-effectiveness of testing strategies. Sensitivity analyses were conducted to assess the robustness of the main outcomes. Costs are reported as Australian dollars (2023).

Results: In the standard-of-care arm, cost per client tested for proctitis, NGU in men who have sex with men (MSM) and heterosexual men were the highest at $247.96 (95% Prediction Interval (PI): 246.77–249.15), $204.23 (95% PI: 202.70–205.75) and $195.01 (95% PI: 193.81–196.21) respectively. Comparatively, in the NPT arm, it costs $162.36 (95% PI: 161.43–163.28), $158.39 (95% PI: 157.62–159.15) and $149.17 (95% PI: 148.62–149.73), respectively. Using NPT resulted in cost savings of 34.52%, 22.45% and 23.51%, respectively. Among all the testing strategies, substantial difference in cost per client tested between the standard-of-care arm and the NPT arm was observed for contacts of CT or NG, varying from 27.37% to 35.28%. In our sensitivity analysis, AMR tax was the most influential cost driver in all the strategies.

Conclusion: We found that NPT is cost-saving compared with standard clinical care for individuals with STI symptoms and sexual contacts of CT, NG, and MG.

Disclosure of interest statement: Cepheid and SpeeDx provided test kits and loaned the GeneXpert Systems for this trial. This trial was funded by an Australian Research Council Industrial Transformation Research Program Hub Grant Project ID IH190100021. CSB and CKF were supported by an Australian National Health and Medical Research Council Leadership Investigator Grant (GNT1173361 and GNT1172900, respectively). JJO and EPFC are supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955 and GNT1172873). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.

25. Alopecia syphilitica in a 27-year-old Filipino MSM: a case report

Reyes-Ramos A. R.¹, Templonuevo J.¹, Jamisola L.¹ and Lopez C.¹

¹Department of Dermatology and Venereology, Tondo Medical Center, Balut, Tondo, Manila, Philippines.

Background: Essential alopecia syphilitica (AS) is a rare presentation of secondary syphilis that is known to affect approximately 3–7% of the population. To the best of our knowledge, this is the first report of this case in the country. Herein we present a rare case of alopecia syphilitica in a 27-year-old Filipino MSM male.

Methods: This is a case of a 27-year-old male who presented with a 3-week history of irregularly shaped, moth-eaten appearing alopecia without any history or presence of mucosal ulcers and copper penny-looking macules and plaques on the palms and soles. Thorough history-taking revealed multiple casual unprotected sexual practices. Syphilis enzyme immunoassay and rapid plasma reagin titre were reactive. Skin biopsy was consistent with syphilitic alopecia. Warthin Starry stain demonstrated spirochetes. Patient was counselled and screened for other STI and blood transmitted diseases. Benzathine penicillin G 2.4M units was given and there was noted improvement of alopecia on follow-up.

Results: Syphilis, a highly prevalent STI presents in different spectra, usually starts as a painless, indurated ulcer on the genitals or mucosal areas. Left untreated, this ulcer may heal but disease may progress to its secondary stage. Patients would usually present with copper penny-looking erythematous to hyperpigmented macules and plaques on palms and soles, condylomata lata and erythematous papules and plaques on the trunk, and rarely as moth-eaten alopecia. Atypical presentation might lead to a missed diagnosis and untreated disease. This may give rise to an infectious and potentially debilitating and deadly disease.

Conclusion: AS may be mistaken as other forms of alopecia. Keen clinical eye, high index of suspicion, thorough history-taking with emphasis on sexual history and complete physical exam are needed to prevent missed diagnoses in these cases. Prompt treatment, close follow-up and proper counselling are essential to completely diagnose and treat.

Disclosure of interest statement: No disclosures.

26. Financial incentives to improve uptake of partner treatment for sexually transmitted infections in Zimbabwe antenatal care: a cluster randomised trial

Martin K.^1,2, Dziva Chikwari C.^1,2, Dauya E.², Mackworth-Young C. R. S.^1,2, Tucker J. D.¹, Simms V.^1,2, Bandason T.², Ndowa F.³, Machiha A.⁴, Marks M.¹, Kranzer K.^1,2,5 and Ferrand R. A.^1,2

¹London School of Hygiene & Tropical Medicine, London, UK.

²Biomedical Research and Training Institute, Harare, Zimbabwe.

³Skin & Genito-Urinary Medicine Clinic, Harare, Zimbabwe.

⁴AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.

⁵LMU University Hospital, LMU Munich, Munich, Germany.

Background: Partner treatment is an essential component of STI case management to prevent index case re-infection. This is particularly pertinent in pregnancy, where STIs are associated with adverse birth outcomes. However, partner treatment is often not completed, and alternative strategies to facilitate uptake are required. The aim of this study was to assess the impact of a financial incentive on uptake of partner treatment for STIs within antenatal care (ANC) in Zimbabwe.

Methods: This trial (Pan African Clinical Trials Registry: PACTR202302702036850) was embedded within a prospective study evaluating point-of-care screening for STIs among pregnant women attending ANC in Harare, Zimbabwe. Clinic days were randomised 1:1 to be an incentive or non-incentive day. On incentive days, participants diagnosed with either a curable STI or symptoms of an STI (indexes) were treated and offered a partner notification (PN) slip that entitled their partners to $3 (USD) in compensation if they attended for treatment. On non-incentive days, PN slips without an incentive were offered. The primary outcome measure was the proportion of indexes with at least one partner who attended for partner treatment within 28 days of the index diagnosis. Trial arms were compared using individual-level logistic regression, with robust standard errors to account for clustering.

Results: 294 individuals were issued at least one PN slip during the trial period. Partner treatment within 28 days of index diagnosis was 28.7% (39/136) and 26.6% (42/158) in the incentive and non-incentive arms, respectively (OR 1.11; 95% CI 0.66–1.86; P = 0.69). Median number of days from index diagnosis to partner treatment was 3 in both arms. No index case had more than one partner attend for treatment.

Conclusion: There was no evidence that a relatively small financial incentive improved uptake or timeliness of partner treatment. Further research is needed to identify effective PN strategies.

Disclosure of interest statement: This study was funded by the Wellcome Trust (UK). No pharmaceutical grants were received for this study.

27. Validation of a novel lateral flow assay for screening for Neisseria gonorrhoeae infection among pregnant women in Zimbabwe

Martin K.^1,2, Dauya E.², Dziva Chikwari C.^1,2, Bandason T.², Machiha A.³, Mazzola L.⁴, Blumel B.⁴, Gleeson B.⁴, Ferreyra C.⁴, Marks M.¹, Kranzer K.^1,2,5 and Ferrand R. A.^1,2

¹London School of Hygiene & Tropical Medicine, London, UK.

²Biomedical Research and Training Institute, Harare, Zimbabwe.

³AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.

⁴FIND, Geneva, Switzerland.

⁵LMU University Hospital, LMU Munich, Munich, Germany.

Background: Across many regions in the Global South, testing for Neisseria gonorrhoeae (NG) is unavailable. High costs and limited diagnostic infrastructure are major barriers. A novel lateral flow assay for NG (NG-LFA) has been shown to have high sensitivity and specificity (>90%) in symptomatic individuals in South Africa. However, performance as a screening tool has not been assessed. We investigated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the NG-LFA among pregnant women.

Methods: This study was embedded within a prospective study evaluating point-of-care STI screening in antenatal care (ANC) in Harare, Zimbabwe. Provider-collected vaginal swabs were tested on-site for NG using the NG-LFA as well as molecular testing using the GeneXpert platform (reference test).

Results: 913 pregnant women attending routine ANC were enrolled, with a median age of 25 (IQR 22–30) years and a HIV prevalence of 10.0% (91/913). Only 5.6% (51/913) reported any of abnormal vaginal discharge, pelvic pain, or dyspareunia.

Based on GeneXpert, NG prevalence was 4.2% (38/913). The sensitivity, specificity, PPV, and NPV of the NG-LFA were 65.8% (25/38; 95% CI 48.6%–80.4%), 99.2% (868/875; 95% CI 98.4–99.7%), 78.1% (25/32; 95% CI 60.0–90.7%), and 98.5% (868/881; 95% CI 97.5–99.2%), respectively.

Of 13 false-negative results, 8 (61.5%) had an GeneXpert NG2 and/or NG4 target cycle threshold (Ct) value of above 30.

Conclusion: Among predominantly asymptomatic pregnant women, the NG-LFA had high specificity and NPV, but lower sensitivity than in studies in symptomatic individuals. Although the NG-LFA correctly ruled out infection in the majority of individuals, one in three cases of NG were not detected. Most false-negative cases had high Ct values, suggestive of low bacterial load. Further studies are needed to assess the NG-LFA in different settings and populations, and to explore the relationship between NG-LFA positivity and bacterial load.

Disclosure of interest statement: This study was funded by the Wellcome Trust and via FIND by the UK Department of Health and Social Care as part of the Global AMR Innovation Fund (GAMRIF), by UK International Development from the UK government and with support from the Ministry of Foreign Affairs of the Government of the Netherlands. GAMRIF is a One Health UK aid fund that supports research and development around the world to reduce the threat of antimicrobial resistance in humans, animals and the environment for the benefit of people in low- and middle-income countries (LMICs). The views expressed in this publication are those of the author(s) and not necessarily those of the UK Department of Health and Social Care and they do not necessarily reflect the UK government’s official policies. No pharmaceutical grants were received for this study.

28. A multifaceted intervention to support chlamydia management in Australian general practice: qualitative study exploring resource implementation and adoption

Munari S.^1,2, Coombe J.¹, Bittleston H.¹, Temple-Smith M.¹, Fairley C.^3,4, Bateson D.⁵, Hellard M.^1,2,6, Goller J. L.¹ and Hocking J. S.¹

¹Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia.

²Burnet Institute, Melbourne, Vic, Australia.

³Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁴Central Clinical School, Monash University, Melbourne, Vic, Australia.

⁵The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

⁶Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic, Australia.

Background: Chlamydia is one of the most common sexually transmissible infections worldwide and can lead to significant reproductive morbidity, including pelvic inflammatory disease (PID) and infertility. The Management of Chlamydia Cases in Australia (MoCCA) study is an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. MoCCA is a multifaceted intervention comprising resources (e.g. a website, documentation shortcuts and patient factsheets) that focus on timely retesting, partner management and early detection and treatment of complications including PID. This qualitative study explored implementation and adoption of MoCCA resources to support chlamydia management in general practice.

Methods: Semi-structured interviews were conducted with 13 staff from 9 participating general practices during July–October 2023. Interviewees were asked about the ease of implementing the chlamydia management resources, their adoption and utility, and perceived changes to practice arising from resource adoption. Data were analysed using Inductive Content Analysis and interpreted through the lens of the Consolidated Framework for Implementation Research and Normalisation Process Theory.

Results: Facilitators to resource adoption included staff motivation to support best practice chlamydia management, the presence of practice champions and resources that improved workflow efficiency and enhanced patient interactions. A lack of consistent staffing, varying practitioner engagement and competing clinic priorities hindered engagement. MoCCA chlamydia management resources were reported to complement existing workflow processes, facilitate teaching and learning among clinic staff, increase confidence during chlamydia consultations and improve patient communication. However, not all resources were adopted and not all practitioners felt the study had changed their practice.

Conclusion: Identifying factors contributing to the successful implementation of a multifaceted chlamydia intervention can inform the ongoing sustainability and scale up of MoCCA resources within Australian general practices. The overarching aim of MoCCA is to strengthen chlamydia management and reduce chlamydia-associated disease burden.

Disclosure of interest statement: SM is supported by a Burnet Institute PhD scholarship, JH by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT2025960), MH by an NHMRC Investigator Grant (GNT1194322). MoCCA is an NHMRC partnership project (APP1150014).

29. Comparative study of aptima Mycoplasma genitalium assay and SYD mycoplasma assay to detectMycoplasma genitalium from urine or vaginal swab specimens in Japan in 2022–2023

Hamasuna R.¹, Yasuda M.² and Takahashi S.²

¹Department of Urology, Shin-Kokura Hospital, Kitakyushu, Japan.

²Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.

Background: Mycoplasma genitalium (MG) is one of major pathogens for male urethritis and female cervicitis. We compared the performance of Aptima Mycoplasma Assay (TMA method) and STD Mycoplasma Assay (Invader method) to detect MG in Japan.

Methods: From March 2022 to July 2023, the urine and vaginal swab specimens from patients, who attended urology, gynecology or STI clinics in Japan were collected. MG was detected by TMA or Invader methods and Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) were detected by Aptima Combo2. The discordant specimens for detecting MG between TMA or Invader method were re-examined by MgPa PCR according to Jensen’s paper or detecting 23S rRNA according to Getmen’s method. If Mg was positive by any methods, the specimens were determined as “positive”.

Results: Total 1005 (506 male and 499 female) patients were attended and included in this study from 15 clinics. Median age of patients was 31 years old (max: 60, min; 20). The detection rates of MG, CT or NG in urine by TMA methods or Aptima Combo2 was 17.5%, 44.7% and 19.2% in males and 28.2%, 9.2% and 3.8% in females, respectively. Sensitivity of TMA to detect MG in male urine, female urine and vaginal swab were 100%. 97.4% and 99.2%, respectively. The specificity in male urine, female urine and vaginal swab were 97.8%, 84.4% and 90.6%, respectively.

Conclusions: TMA method showed good performance to detect MG in Japan.

Disclosure of interest statement: This study was funded by Hologic Japan. Hamasuna received the honorarium as an investigator from Hologic Japan.

30. Efficacy of doxycycline-sitafloxacin sequential therapy for urogenital Mycoplasma genitalium infection in Nanjing, China

Su X.¹, Yuan M.¹, Zhao Y.¹, Gan L.¹ and Li S.¹

¹Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China.

Background: Increasing macrolide and quinolone resistance in Mycoplasma genitalium calls for new treatment approaches. The aim of this study was to evaluate the efficacy of doxycycline-sitafloxacin sequential therapy in the treatment of urogenital M. genitalium infections in Nanjing, China.

Methods: M. genitalium infected men and women with urethritis or cervicitis attending STD Clinic, the Institute of Dermatology, Chinese Academy of Medical Sciences, in Nanjing, China, between April 2022 and April 2023, were treated with doxycycline-sitafloxacin sequential therapy. Microbiological cure was defined as a negative result for nucleic acid amplification testing (NAAT) at test of cure (TOC) at least 21 days after completion of the regimen. Macrolide and fluoroquinolone resistance-associated mutations in 23S rRNA, parC, gyrA and gyrB genes were detected in urine/cervical swabs specimen from all cases at basement.

Results: 35 patients (29 heterosexual males, 1 men who have sex with men and 5 females) were included in the final analysis. Treatment was discontinued in 1 patient due to adverse reactions. Test of cure was performed in 22 cases (64.7%), and 20 cases got microbiological cure (90.9%), and 2 cases failed treatment. Another 12 cases were clinical cure (followed-up by phone interview). The overall response rate of doxycycline-sitafloxacin sequential therapy was 94.1% (32/34, 95% CI 80.3–99.3%). In pre-treatment specimen, 96.6% (28/29) M. genitalium harboured macrolide resistance-associated mutations, 75% (21/28) harboured parC mutations, including 64.3%(18/28) with G248T(S83I) mutation, and 12.0% (3/25) harboured gyrA mutations. Microbiological cure rate was 100% among patients infected with M. genitalium strains harbouring parC and gyrA WTs, and 90% for strains harbouring parC G248T(S83I) and gyrA WT. Three patients who had ParC S83I mutation and failed prior sequential doxycycline-moxifloxacin therapy were cured by doxycycline-sitafloxacin regimen. No serious adverse effects occured.

Conclusion: Doxycycline-sitafloxacin sequential therapy was well tolerated and effective against urogenital M. genitalium infections in Nanjing, China.

Disclosure of interest statement: The authors reported no conflicts of interest in this work.

31. Sociodemographic characteristics, clinical manifestations, and serological features of syphilis among HIV-infected patients: a retrospective study from a tertiary referral hospital in Yogyakarta, Indonesia

Alfieri A.¹, Rusetiyanti N.¹, Susetiati D. A.¹ and Pudjiati S. R.¹

¹Departement Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

Background: Syphilis remains a global problem and has been reported to increase among patients with HIV co-infection. This co-infection can affect the clinical manifestations of syphilis and also influence the serological response, resulting in unusual findings. The intense interaction has earned them the nickname “epidemiological synergy”. This study aims to report the characteristics, clinical manifestations, and serological features of syphilis among HIV-positive patients

Methods: This retrospective observational study collected data from the medical records of syphilis patients at Dr. Sardjito General Hospital in Yogyakarta, Indonesia between January 2018 and December 2022. The inclusion criteria were newly diagnosed syphilis, HIV co-infected, and ≥18 years old. Detailed sociodemographics, sexual behaviours, blood contact history, syphilis stage, mucocutaneous lesions, and baseline/follow-up VDRL titres were evaluated.

Results: In this study there were 205 subjects who met the inclusion criteria. The average age was 30.28 ± 8.4 years and most were male (97.6%). Risky behaviours were common to be found like multiple partners (82%) and anal sex (72.7%). For syphilis stage, secondary syphilis was most common (46.3%) and four patients had overlapping stages. Diverse mucocutaneous lesions were documented, including the non-specific secondary lesions like malignant syphilis, keratoderma palmoplantare, psoriasiform, annular, and papulosquamous were also found. The median baseline VDRL titre was 1:32 (range: 1:1–1:1024). Follow-up serological testing rates remained suboptimal, with only 41.4%, 19%, and 9.2% of patients returning for repeat titres at 6, 12, and 24 months post-treatment, respectively. For those tested on follow-up, median titres declined over time.

Conclusion: Syphilis/HIV co-infection has been increasing, likely connected to high-risk sexual behaviours. Secondary stages predominates, with diverse mucocutaneous findings possible. However, post-treatment titre follow-up is challenging with very low rates of return testing. Serological monitoring remains an important gap needing further study.

Disclosure of interest statement: No pharmaceutical grants were received.

32. Creating an anatomically correct model of the clitoris and vulva – cliterate

Brown-Major A.¹ and Glover J.²

¹Thrive Rehab, Melbourne, Vic, Australia.

²Royal Melbourne Institute of Technology, Melbourne, Vic, Australia.

Background: The World Health Organization acknowledges that understanding genital anatomy is crucial for sexual and reproductive health. Despite increased medical research, there is still limited understanding regarding vulva and clitoris anatomy within the wider public as well as health professionals. Health professionals have not had access to tools that quickly and accurately explain genital anatomy in an accessible format. Bridging the gap between health provider and client knowledge is crucial for providing optimal care.

Our aim was to create an anatomically correct model to educate people about genital anatomy in a clinical setting.

Methods: An occupational therapist working in the disability sector, identified a lack of accurate models and engaged an industrial design team from Royal Melbourne Institute of Technology. This team were provided with an educational brief, two existing inaccurate models and original research articles from Dr. Helen O’Connell. This information was converted into a printed 3-D model and sent to occupational therapists, Nurses, Teachers, Physiotherapists, Sexologists and Doctors for feedback. Further consultation with the International Clitteratti informed the final design.

Results: The research resulted in the production of the Cliterate model, a spherical, pull-apart design that accurately explains the relationship between the clitoris, vulva, and pelvis. It will support health professionals to educate people of all abilities regarding sexual and reproductive health.

Conclusions: This project identified gaps in educational materials used by health professionals. Collaboration between industrial designers, health, and educational professionals and the international Clitteratti (an international group of model makers and medical experts in the area of clitoris anatomy) resulted in a practical way to increase the knowledge of genital anatomy.

Disclosure of interest statement: Anita Brown-Major is the founder of Cliterate, part of the occupational therapy Thrive Rehab practice. This research project has produced an anatomical working model that is available for purchase. Anita has personally funded the development of the model.

33. What’s the bottom line? Cost analysis comparing sexual health clinic-based versus a novel telehealth pathology centre-based sexually transmissible infection (STI) & bloodborne viruses (BBV) screening

Wong A.^1,2, Turner F.¹, Houghton R.¹, Varma R.^1,2 and Watts C.²

¹Sydney Sexual Health Centre, NSW, Australia.

²Kirby Institute, UNSW, NSW, Australia.

Background: A novel nurse-led e-testing pathway (“MyCheck”) has been developed in response to increasing demand for asymptomatic STI/BBV screening. This involves a brief telephone consultation and referral to a pathology centre of patient’s choice for sample collection. Although MyCheck has been implemented since 2021, the cost compared to standard of care is unknown.

Methods: A cost analysis was conducted comparing asymptomatic screening via MyCheck versus Xpress (clinic-based, face-to-face) using a health system and societal perspective and a 12-month time horizon. Mean cost per patient was calculated using a bottom-up approach between January to July 2023. Cost associated with testing were based on the number of attendances (men who have sex with men (MSM), trans and gender-diverse (TGD) patients and heterosexual men and women), tests conducted, time taken to attend Xpress, nursing time and resources used. It was estimated that a clinic visit requires 2 hours considering travel time. Sensitivity analyses were performed to evaluate the impact of different attendance patterns.

Results: There were 1398 Xpress and 1150 MyCheck attendances over the six-month period. MyCheck saw a significantly higher proportion MSM and TGD patients compared to Xpress (93.6% vs. 63.6%) and have 30–60% higher costs per test compared to Xpress. Using current attendance patterns, per patient tested MyCheck compared to Xpress had a higher health system ($126.94 vs $91.04) but lower societal ($126.94 vs $142.69) cost. If current patients using MyCheck tested via Xpress instead the mean societal cost per patient would be $147.88 compared to $126.94. Lastly, if all current Xpress patients are screened with MyCheck instead, this will lead to an overall societal cost saving of $72,908 over a year.

Conclusion: Promotion of MyCheck as a screening pathway is likely to lead to overall societal cost savings. Future studies should investigate factors influencing the differing uptake rates between populations.

Disclosure of interest statement: None.

34. Improved rates of culture collection for N. gonorrhoea following an educational intervention at the Alfred Hospital, Melbourne, Australia

Jude Armishaw¹, Jennifer Hoy^1,2, Philip Rawson-Harris¹, Danielle Collins¹ and Anna Pierce¹

¹Alfred Health, Melbourne, Vic, Australia.

²Monash University, Melbourne, Vic, Australia.

Background: Surveillance for antimicrobial resistance for Neisseria gonorrhoea (NG) is essential and guidelines recommend that a swab for culture and antimicrobial susceptibility is collected prior to treatment for NG. An audit revealed that culture collection was not routine when treating patients for NG in the Infectious Diseases (ID) and PrEP Clinics at The Alfred Hospital, Melbourne. An educational intervention was provided for clinic nursing staff and the audit was repeated to determine its impact.

Methods: All patients who tested positive by nucleic acid testing and were treated for NG between 1/11/2022 and 30/4/2023 were identified using data extracts. Clinical notes were reviewed to determine the number of patients who had a specimen collected for culture at the time of treatment, as well as the treating nursing team. Education on the importance of collecting a specimen for culture was provided to clinic nursing staff. The audit was repeated between 1/6/2023 and 30/11/2023 and rates of culture collection were compared pre and post intervention.

Results: Following the intervention, culture collection improved overall from 71% to 91% (P = 0.02). The greatest increase was seen in those treated by the ID clinic nursing team where, prior to the intervention culture collection was 38% and increased to 79% (P = 0.03) following the intervention. All specimens collected were susceptible to the recommended antibiotic treatment given.

Conclusion: This audit demonstrates that a simple educational intervention can significantly improve rates of NG culture collection. The development of a validated extract and dashboard for this project facilitates ongoing monitoring of culture rates going forward.

Disclosure of interest statement: No disclosures of interest.

35. Unmasking genital wart masqueraders: the role of biopsy in the sexual health clinic

Nicholas Comninos^1,2, Pradeep Kumar¹, Jennifer Kim^2,3, Raghwa Sharma³, Louise Tomlins¹ and David Lewis^1,2

¹Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.

²Sydney Medical School-Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.

³Department of Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Westmead, NSW, Australia.

Background: Pre-malignant conditions can mimic anogenital warts (AGW). Indications for biopsy vary across guidelines. We present vulval/genital biopsy outcomes in 5 cisgender, heterosexual adult females. All were HIV-seronegative, immunocompetent non-smokers without previous anogenital/cervical dysplasia/cancer (any time) or bacterial sexually transmitted infections (past 6 months).

Methods: Case 1: Aged 56. GP-referred, presumptive AGW. AGW (cryotherapy) 10 years previously. 2-month history: growing, itchy lump, no pain/bleeding. 7 × 7mm exophytic papule with an irregular surface and prominent vascular markings at lower left vulval/genital vestibule, no lymphadenopathy. Biopsy: High-grade Squamous Intraepithelial Lesion-Vulval Intraepithelial Neoplasia (’HSIL-VIN3’-undifferentiated/HPV-associated), condylomata.

Case 2: Aged 36. GP-referred, presumptive AGW. Itchy rash to wrists 5 years previously. 6-month history: untreated, itchy lump, no pain/bleeding. 10 × 15mm keratotic white plaque at posterior fourchette; no lymphadenopathy. Biopsy: Lichen Planus.

Case 3: Aged 50. Presumptive AGW (clinic-based cryotherapy) for 12 months. 1-month history: vulval/genital lump, painful to touch, no itch/bleeding. 4mm flat area of variable pigmentation with irregular margins to midline posterior fourchette; no lymphadenopathy; background AGW features (posterior fourchette). Biopsy: HSIL-VIN3-undifferentiated/HPV-associated.

Case 4: Aged 22. Presumptive AGW (clinic-based cryotherapy) for 9 months, background of general/anogenital psoriasis. 9-month history: itchy lumps, dyspareunia, no bleeding. 10 × 10mm cluster of smooth flat white lesions, ’cobblestone’ appearance to lower left inter-labial sulcus; no lymphadenopathy; background Dermatitis features (labia majora). Biopsy: Vulval Acanthosis-Altered Differentiation/HPV-independent, p53-independent VIN.

Case 5: Aged 54. Presumptive AGW (clinic-based imiquimod, cryotherapy) for 12 months. 6-month history: vulval/genital lump, dyspareunia, no itch/bleeding. 10 × 10mm nodule with surface ulceration, distinct/sharp margins, circumferential pallor in posterior vestibule; no lymphadenopathy; background Lichen Sclerosus features (labia majora). Biopsy: VIN-differentiated/HPV-independent.

Onward referral: Gynaecological Oncology (Cases 1,3,5); Dermatology (Cases 2,4).

Results: Initially diagnosed as AGW, these histopathological diagnoses carry risk of malignant transformation, requiring further management and follow-up.

Conclusion: Paired with history/symptoms, vulval/genital biopsy has high utility. Biopsy-taking could form part of Sexual Health specialty training.

Disclosure of interest statement: the authors declare no conflicts of interest. Ethics approval: Research Office, WSLHD Research & Education Network

36. Safety of and satisfaction with conventional circumcision and disposable circumcision suture device among men who have sex with men: findings from the CoM Study

Zhang W.^1,#, Gao Y.^2,#, Sun Y.³, Fu L.¹ and Zou H.^4,5,6

¹School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.

²Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.

³The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

⁴School of Public Health, Fudan University, Shanghai, China.

^#These authors contributed equally to the manuscript.

Background: Voluntary medical male circumcision (VMMC) may be an effective strategy for HIV prevention among MSM. However, evidence from studies comparing the safety and satisfaction of different circumcision methods among MSM is limited.

Methods: The participants in this study are individuals who underwent circumcision in a multicenter randomised controlled trial designed to evaluate the efficacy of VMMC in preventing HIV infection among MSM, and the method of circumcision was freely chosen by themselves. Safety assessments commenced immediately after VMMC, with participants completing weekly follow-up visits for 6 weeks. Satisfaction was assessed at 6 and 12 months post-operatively. Chi-squared tests or Fisher’s exact tests were used to compare adverse events (AEs) rates, and Wilcoxon tests were used to compare pain scores. The time to complete wound healing was compared using Kaplan-Meier survival analysis with a log-rank test.

Results: A total of 118 participants completed the circumcision: Group DCSD (disposable circumcision suture device, n = 59), Group CC (conventional circumcision, n = 59). The median surgical costs were higher in the DCSD group compared to the CC group (DCSD vs CC, 2056.1 vs 1828.5, P = 0.004). Over the six-week period following circumcision, AEs rate decreased from 89.9% to 23.7% in the DCSD group and from 93.2% to 20.3% in the CC group. No significant difference in AEs rates was observed between the two groups. The early resumption of sexual intercourse rate was high in both groups (DCSD vs CC, 54.3% vs 64.4% P = 0.349). The median time to complete wound healing was 4 weeks (IQR 3,5) in the DCSD group and 4 weeks (IQR 2,5) in the CC group. No statistical difference in wound healing time between the two groups was found (P = 0.380). For comparisons of satisfaction, appearance was the dimension with the lowest level of satisfaction (DCSD vs CC, 64.4% vs 60.7%), and there were no differences between the two groups in comparisons of satisfaction across dimensions at 6 and 12 months.

Conclusion: Comparable safety and satisfaction were found between MSM who underwent DCSD and CC. In future promotion of VMMC, prioritising the lower-cost conventional circumcision, especially in impoverished regions, may be advisable. Emphasis should be placed on post-operative abstinence and care to ensure wound healing.

Disclosure of interest statement: This study was supported by the Natural Science Foundation of China Excellent Young Scientists Fund [82022064]. All funding parties did not have any role in the design of the study or the explanation of the data.

37. Observational comparison of three treatment regimens for late latent/unknown stage syphilis

Hunt T. J.^1,3, Berzkalns A.², Cannon C. A.^1,2, Dombrowski J. C.^1,2,3 and Golden M. R.^1,2,3

¹Department of Medicine, University of Washington, Seattle, WA, USA.

²HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, WA, USA.

³Department of Epidemiology, University of Washington, Seattle, WA, USA.

Background: CDC guidelines recommend treating latent syphilis of unknown duration (LSUD) with 3 doses of benzathine penicillin (BPG) or 28 days of doxycycline. This recommendation is based on expert opinion, and optimal treatment is uncertain.

Methods: We conducted a retrospective cohort study to evaluate the association of a two-titre drop in RPR (serological cure) with three treatment regimens: 1 dose of BPG, 3 doses of BPG, and 28 days of doxycycline. Subjects included persons reported with LSUD in King County, Washington, USA, from 2007 to 2020 with an initial RPR ≥1:2 and any follow-up RPR reported ≤36 months following diagnosis. Analyses used RPR results from public health surveillance. We used chi-squared tests to assess the association of treatment regimen with serological cure, stratifying cases into high (≥1:32) or low (<1:32) initial titre groups, and Cox proportional hazards to compare regimens.

Results: The study population included 761 cases. Median age was 35, 62% were cisgender MSM, and 38% had HIV. Mean time to cure or most recent RPR was 341 days (SD = 295). Of 483 high-titre cases, serological cure occurred in 36 (88%) of 41 cases that received 1 dose of BPG, 330 (88%) of 376 that received 3 doses of BPG, and 58 (88%) of 66 that received doxycycline (P = 1.00). Among 278 low-titre cases, 4 (31%) of 13 treated with 1 dose of BPG, 114 (49%) of 235 treated with 3 doses of BPG, and 14 (47%) of 30 treated with doxycycline had serological cure (P = 0.458). Controlling for initial RPR, serological cure did not differ significantly between cases receiving 1 and 3 doses of BPG (hazard ratio: 0.87; 95% CI: [0.63, 1.21]).

Conclusion: Based on serological outcomes, the three regimens were similarly effective in treating high-titre LSUD. Many high-titre LSUD cases are likely early infections treatable with 1 dose of BPG.

Disclosure of interest statement: Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number 5T32AI007140.

38. Empowering detection: advocating for HIV testing among teens to prevent missed diagnoses

Laura Benjamins^1,2, Eric McGrath¹ and Elizabeth Secord¹

¹Wayne State University School of Medicine, Department of Pediatrics, Detroit, MI, USA.

²McGovern Medical School, UTHealth Science Center, Department of Pediatrics, Houston, TX, USA.

Background: According to the CDC youth aged 13 to 24 account for more than 1 in 5 new HIV diagnoses in the United States. Despite this, approximately 60% of youth living with HIV do not know that they are positive. Additionally, youth with HIV are the least likely out of any age group to be linked to care. Several organizations, including the CDC, USPTF and the AAP have all advocated for screening adolescents and young adults for HIV, however teens consistently report that they are not offered this testing, and several studies have found that medical professionals do not consistently test according to guidelines.

Methods: Cases of three adolescents will be detailed to demonstrate how easily identification of a new HIV diagnoses can be missed. The first case is a young man who presented with rhabdomyolysis. The second is a teen hospitalised for pneumomediastinum. The final case is a young man who had been prescribed PreP, but had not opted to take it. A year later he presented to three different emergency rooms with fever, malaise, sore throat and dehydration; he was not once tested for HIV in these settings. During a follow up visit with his PCP, a viral load and 4^th Generation test was ordered and consistent with acute HIV.

Results: This case-based approach will bring to light circumstances that may hinder medical providers from testing for and identifying new cases of HIV.

Conclusion: Teens may present with early HIV infection in atypical ways. Additionally, many medical providers do not always understand the time to positivity for antibody-based testing during acute HIV. Having a low threshold for testing, a high suspicion even when other disease processes may be present, as well as advocating for universal screening is key to ensuring that new HIV diagnoses are not missed among this population.

Disclosure of interest statement: Drs. McGrath and Secord receive funding from GSK Clinical Trials ViiV Healthcare – EBONI trial (Engaging Black Women on Cabotegravir LA for PrEP by Optimizing Novel Implementation Strategies); Dr. Benjamins serves as a site co-investigator for this study, but does not receive funds. Dr. McGrath receives funding from Gilead – Biktarvy for Children study. No pharmaceutical grants or funds were utilised for the development of this abstract.

39. Digital consumer pathways: innovative solutions for PrEP - clinical efficiency and consumer satisfaction

Colin Roberts¹, Charlotte Bell¹, Carole Khaw¹, Mahesh Ratnayake¹ and Belinda Hull²

¹Adelaide Sexual Health Centre, CALHN – Royal Adelaide Hospital, SA, Australia.

²Personify Care, Lot Fourteen, North Terrace, Adelaide, SA, Australia.

Background: Adelaide Sexual Health Centre implemented digital consumer pathways supporting consumers’ choices with how they access and manage their PrEP. This approach allows attendance management, testing at recommended intervals and access to PrEP as outlined in the ASHM PrEP Guidelines.

This approach reduces the frequency of consumer in person visits, providing efficient use of time and encompassing key domains: appointment management, medication script management, pathology collection before appointments and consumer information and reminders.

Methods: Consumers are invited to the digital PrEP consumer pathway. Via their phone the consumer receives appointment notifications, electronic pathology form, task reminders and confirmation of pathology samples received. The consumer completes digital online assessments before telephone consults, improving time management and providing efficiencies for patients and providers.

Staff can manage a client’s progress on the PrEP pathway through a real-time dashboard, ensuring the consumer is prepared, or can reschedule appointments as needed.

Results: With the success of PrEP and move towards HIV elimination, providing consumers with choice and flexibility in access to PrEP is of paramount importance.

Through this platform consumers can choose the time and location of their pathology collection while maintaining their PrEP supply and current testing requirements with fewer face to face appointments.

Conclusion: The objectives of implementing digital consumer pathways are categorised under three pillars: efficiency improvement, improved consumer experience and access, and reduced clinical risk.

Efficiency improvements result from digital pathology forms/collection prior to consultation, client data collection and automatic reminders.

Digital access to educational content and ability for consumers to confirm utilisation of educational content, enables better informed/prepared consumers.

Digital consumer pathways provide a comprehensive easy to use platform, providing efficiencies for both the client and provider, through attendance management, reminders for clients, online completion of questionnaires prior to appointments providing relevant up to date information, facilitating focused clinical consultations.

Disclosure of interest statement. Personify Care is a SA Wide Health Partner. The initiative was supported by the expertise and resources contributed by Personify Care in the context of healthcare innovation and digital patient pathway optimisation and through no other commercial arrangement.

40. Evaluation of clinical and microbiological diagnoses of cervicitis and pelvic inflammatory disease (PID) in patients presenting to Sydney Sexual Health Centre (SSHC)

Chawla S.¹, Wong A.^1,2 and Varma R.^1,2

¹Sydney Sexual Health Centre, Level 3, Nightingale Wing, Sydney Eye Hospital, NSW, Australia.

²Kirby Institute, University of New South Wales, NSW, Australia.

Background: Previous studies show the imprecision of current diagnostic approaches for cervicitis and pelvic inflammatory disease (PID). Over-diagnosis and presumptive treatment for sexually transmitted infections (STI) in these syndromes lead to antibiotic overuse. This study investigated what patient and clinician characteristics are associated with an accurate diagnosis of bacterial STI-positive cervicitis and PID. It also quantified the amount of unnecessary antibiotics prescribed in pathogen-negative cases.

Methods: A retrospective cohort study of 243 cervicitis and 179 PID patients between January 2020–2023 was conducted. Patient demographics, sexual behaviours, symptoms, examination, test results and the clinician type were extracted from electronic medical records. Analyses were conducted on STATA V.18.0 (StataCorp, Texas) using Pearson’s chi-squared test, stepwise logistic regression and multivariate model to identify factors associated with positive diagnosis of STI (C. trachomatis, N. gonorrhoeae or M. genitalium).

Results: 70 cervicitis (28.8%) and 28 PID (15.6%) patients were bacterial-STI positive. In multivariable analysis, age less than 25 years (aOR: 2.78, 95% CI: 1.25–6.25, P < 0.001) was associated with bacterial STI-positive cervicitis; the presence of endocervical mucopurulent discharge on examination (aOR: 6.05, 95% CI: 2.20–16.68, P < 0.001) and current use of contraception (aOR: 7.69, 95% CI: 2.13–25.00, P = 0.002) were associated with bacterial STI-positive PID. No other factors were significantly associated with STI-positivity in either syndrome. For cervicitis, there were 139 doxycycline (69.2%), 11 azithromycin (78.6%) and 5 ceftriaxone (71.4%) courses that were unnecessary. For PID, there were 148 doxycycline (89.2%), 7 azithromycin (63.6%) and 152 ceftriaxone (95.6%) courses that were unnecessary.

Conclusion: This study identified several characteristics that predict STI-positive cervicitis and PID. However, none predicted the presence or absence of pathogens with high degrees of confidence. Presumptive treatment leads to significant unnecessary antibiotic use but ceftriaxone may have additional coverage beyond gonorrhoea. Rapid molecular point-of-care testing should be trialed to reduce unnecessary antibiotics for these syndromes.

Disclosure of interest statement: There are no conflicts of interest to disclose.

41. World Pride 2023: an innovative model of sexual health care and HIV prevention

Sarah Holliday¹, John McAllister¹, Rachael Ling², Danielle Austin², Michelle Le³ and Susan Welch³

¹Department of HIV Medicine.

²Incident Response Disaster Management.

³Pharmacy Department, St. Vincent’s Hospital, Darlinghurst, Sydney, NSW, Australia.

Background: 500,000 visitors were expected to visit Sydney for World Pride (WP) 2023. To support our Emergency Department (ED), a WP Medical Hub was commissioned.

Methods: To describe a nurse-led clinic run by a Nurse Practitioner and Clinical Nurse Specialist. Based on previous Pride events we identified sexual health care and HIV prevention to be key components of The Hub, which operated 7 days a week for 26 days. Pharmacy support systems were established, access was walk-in and the service was promoted in the WP media.

Results: The Hub treated 199 individuals free of charge. 85% (n = 169) male, 12% (n = 24) female and 3% (n = 6) transgender. 50% (n = 99) were Medicare ineligible and 40% (n = 80) lived outside the hospital’s catchment area. The most common reason for attendance was testing for and/or managing symptomatic sexually transmitted infection (45%, n = 90). HIV prevention accounted for around one third (n = 64) of presentations. No individuals required referral to ED. Overall medication costs were $1864 which was 11% of The Hub running cost of $17,413. PEP contributed to 61% ($1146) of the medication costs. Per patient cost was $88 versus $533 for a non-admitted patient managed in an ED.

Conclusion: Our Hub provided a targeted public health service during Sydney WP 2023. It provided equitable access to visitors without Medicare and diverted individuals away from ED at a cost of approximately one-fifth of ED care. These findings may assist other WP event organisers, other hospitals and pharmacy departments.

Disclosure of interest statement: Nothing to disclose.

42. Implementing a learning framework to guide evidence-based and patient-centred contraceptive consultations

Lipa A.¹, Bennett C.^1,2,3, Maunsell S.¹, Gibbs C.¹, Brown L.⁴ and Whitburn S.⁴

¹ASHM Health, NSW, Australia.

²Sydney Sexual Health Centre, NSW, Australia.

³The Kirby Institute, University of New South Wales, NSW, Australia.

⁴Sexual Health Victoria, Vic, Australia.

Background: A needs assessment of 119 ASHM course participants revealed knowledge gaps within the counselling and provision of contraceptive options, particularly Long-Acting Reversible Contraceptives (LARCs), contributing to low uptake of LARC in Australia. This project aimed to develop a learning framework for primary care providers to increase their confidence and skills to conduct an evidence-based, patient-centred contraceptive consultation.

Methods: The learning framework aimed to support clinicians to develop and maintain their consultation skills and confidence through a multi-modal learning hub. ASHM partnered with Iris Education to develop a decision-making tool that supports clinicians in their contraceptive consultations. A national online course expanded on the principles of the tool, addressing additional knowledge gaps identified by survey respondents, including contraception myth-busting; referral pathways for insertion; and clinical auditing. In response to positive feedback and a large number of users of the tool and course, ASHM is developing a roleplay video that demonstrates a best practice contraceptive consultation in a primary care setting.

Results: In 2023, 3200 users viewed the Decision Making in Contraception tool. The Contraception Essentials in Primary Care live facilitated course was delivered nationally to 288 participants in 2023, with 100% (n = 78) of post-course survey respondents reporting that their learning outcomes were met. Participants reported a 53% increase in their ability to structure an evidence-based, patient-centred contraceptive consultation. An additional survey 3 months after the course revealed that LARCs were the most common contraceptive option that respondents recommended to patients in the last 30 days (n = 17). Data on the roleplay video will be available from June 2024.

Conclusion: The learning framework supports clinicians to develop their contraceptive consultation skills, which addresses gaps in existing training on contraception that primarily focuses on practical skills such as insertion. The needs assessment survey ensured that the learning framework addressed learner-identified needs, supporting clinicians to develop their contraceptive consultation skills and confidence. The comprehensive multi-modal approach differs from existing training and caters to different learning needs and contexts, offering introductory training and accessible resources that clinicians can continue to refer to.

Disclosure of interest statement: This work was financially supported by Organon. Sponsorship is governed by ASHM’s sponsorship policy. Organon had no control over content, tone, emphasis or allocation of funds. ASHM does not endorse or promote any sponsor’s product or service.

43. Acceptance and implementation of 2021 CDC guidelines for treatment of uncomplicated urogenital chlamydial infections by adolescent medicine (AM) providers

Hammerschlag M.¹ and Suss A.¹

¹State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.

Background: In 2021, the CDC recommended a major change in the recommendations for treatment of urogenital chlamydia infections in adolescents and adults based on studies that found that single-dose azithromycin (AZI) was not as effective as 7-days doxycycline (DOX) for treatment of rectal infection in men who have sex with men. These guidelines may not be generalizable to adolescents; DOX is associated with higher rate of side effects and potentially lower compliance with a 7-day, twice/day regimen.

Methods: An anonymous questionnaire was sent to AM providers in NY State. Variables included years of training, and barriers to provider use of the new guidelines. The protocol was approved by the SUNY Downstate IRB as an exempt study.

Results: The questionnaire was sent to 6 programs, for a total of 23 responses: 95.7% respondents were aware of the new guidelines; 78.3% were implementing them; 17.4% were not. The most frequent reason for not implementing was patient choice followed by side effects and duration. Expedited partner therapy (EPT) was offered by 73.9% respondents. Reasons for not offering EPT included patient preference, duration, and side effects.

Conclusion: The results of this preliminary study found that although 96% AM providers in NY are aware of the new STI treatment recommendations, only 80% are implementing them, mainly because of patient choice. The new recommendations appeared to have a negative effect on the use of EPT as the major reason for not offering EPT was patient choice. Compliance with 7-day DOX was a concern. Any increase in efficacy of DOX for treatment of chlamydial genital infection may be obviated by lower compliance among adolescents. There is a need for surveillance of implementation of the new guidelines, including treatment outcomes, in adolescent populations.

Disclosure of interest statement: No pharmaceutical grants were received in the development of this study.

44. Motivations, barriers and facilitators to work as sexual assault examiners in NSW, Australia

Edmiston N.^1,2,3, Freedman E.², Sperring S.¹, Power R.¹ and Evans K.⁴

¹Western Sydney University, NSW, Australia.

²NSW Health Education Centre Against Violence, Western Sydney Local Health District, NSW, Australia.

³Northern NSW Local Health District, NSW, Australia.

⁴South West Sydney Local Health District, NSW, Australia.

Background: Throughout Australia, there are significant shortages of sexual assault examiners. Doctors and nurses with New South Wales (NSW) Health Sexual Assault Services (SAS), provide medical care and forensic examinations as part of an integrated psychosocial, medical and forensic crisis response to people who have experienced sexual assault. This study aimed to understand the motivations, barriers and enablers for nurses and doctors to work as examiners in NSW, Australia.

Methods: Semi-structured interviews were conducted with 31 participants (27 (87%) female; 23 (74%) doctors), who were currently working as examiners in NSW Health SAS, or within the last 3 years had left the role or undertaken training to work as an examiner. Recruitment was by email invitation from NSW Health Education Centre Against Violence (ECAV). Videoconference interviews occurred from May to August 2023. Inductive and deductive coding was used for thematic analysis of the transcripts. The study received ethics approval from WSLHD HREC (ref. no. 2022/ETH01945).

Results: We determined four key themes affecting workforce participation. The responsibility burden; The sexual assault medical workforce was highly motivated and in the absence of sufficient organisational support, this became a responsibility burden. On-call challenges; For many, the most challenging aspect of their role was being predominantly on-call, which made them feel isolated and affected preferred mechanisms for managing the traumatic aspects of the work, which were peer support and compartmentalisation. Medicolegal role; Medicolegal aspects of the role were motivating for some but represented a significant barrier for many due to high expectations and unfamiliarity. Additional support requirements; Despite the valued role of education, it was insufficient to support the workforce in the face of significant organisational challenges.

Conclusion: Improved work conditions including adequate on-call staff and additional support can overcome some of the barriers and maintain the motivation to participate in the SAS workforce.

Disclosure of interest statement: Western Sydney University received funding from NSW Ministry of Health for the conduct of this research. EF is the Clinical Advisor to NSW Health PARVAN.

45. Key elements of equitable, timely, safe and accessible abortion services in Aotearoa New Zealand: a mixed methods study of women’s experiences and views

Gibson M.¹, Sparkes N.¹, MacDonald E. J.¹, Macfarlane E.², Paterson H.², Wise M.³, Dallas-Katoa W.¹, Lawton B.¹ and Slater T.¹

¹Te Tātai Hauora o Hine - National Centre for Women’s Health Research Aotearoa, Faculty of Health, Victoria University of Wellington, New Zealand.

²Department of Women’s and Children’s Health, Otago University.

³Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.

Background: In March 2020, Aotearoa (New Zealand) decriminalised abortion, defining it as a reproductive health issue allowing self-referral and removing legal criteria for abortion under 20 weeks. However, recent data suggest that access is still not equitable. This research aimed to identify aspects of equitable and accessible abortion services i.e. what works now and what can be improved.

Methods: This mixed methods study used an anonymous survey and qualitative interviews and was conducted between January and November 2023 in six abortion services serving a range of populations. Inclusion criteria: anyone having an abortion from 14 years of age. Participants could complete the survey, take part in an interview, or both. Interviews with Māori and Pacific women were undertaken by Māori and Pacific researchers, underpinned by Kaupapa Māori and Pacific research methodologies.

Results: The experiences of women were collected in 126 anonymous surveys and seven confidential interviews. In the survey, 31.5% were Māori (n = 39) and 14.5% (n = 18) were Pacific. Nearly half of participants were rangatahi (<25 years old). Most participants (77.7%) had their abortion under 10 weeks’ gestation. Most participants lived in urban areas and 16.5% lived rurally.

The surveys and interviews both consistently highlighted the importance to women of:

Conclusion: Abortion care does not begin or end with the abortion procedure itself. Protecting choices in abortion care, culturally safe staff, removing time and cost barriers, and whānau inclusiveness are all important for making abortion accessible. Many steps have been taken towards delivering equitable and accessible abortion services in Aotearoa. This research provides a platform for further action.

Disclosure of interest statement: This research was funded by the Aotearoa New Zealand Ministry of Health and Istar Ltd.

46. Uropathogens, resistance profiles and antibiotic prescribing patterns for acute urinary tract infections at Australia’s largest sexual health service

Carter S. E.^1,2, Plummer E. L.^1,2, Vodstrcil L. A.^1,2,3, de Petra V.^2,4, Sherry N.⁴, Abbott I.⁵, Fairley C. K.^1,2 and Bradshaw C. S.^1,2,3

¹School of Translational Medicine, Monash University, Vic, Australia.

²Melbourne Sexual Health Centre, Alfred Health, Vic, Australia.

³Melbourne School of Population and Global Health, The University of Melbourne, Vic, Australia.

⁴Melbourne Diagnostic Unit, Royal Melbourne Hospital, Vic, Australia.

⁵Department of Infectious Diseases, Alfred Health, Vic, Australia.

Background: Urinary tract infections (UTIs) are one of the most common infections affecting adults with a vagina. UTIs are often treated with empirical antibiotics, which can contribute to antibiotic overuse in an era when antimicrobial stewardship is a global priority. We investigated the prevalence of antimicrobial resistance and empirical prescribing practices to inform antibiotic use for UTIs at Melbourne Sexual Health Centre (MSHC).

Methods: We conducted a retrospective audit of clinician-diagnosed UTIs in non-pregnant, premenopausal adults with a vagina attending MSHC from 2/1/2018 to 24/1/2023. We determined the antimicrobial resistance profiles of isolated uropathogens with 95% confidence intervals (CI). We compared empirical antibiotic prescriptions with antibiotic resistance profiles of isolates and assessed adherence to first-line Australian Therapeutic guideline (eTG) recommendations for acute uncomplicated lower UTIs (trimethoprim, nitrofurantoin, cephalexin).

Results: We included 1694 acute UTI episodes (n = 1582 patients). Midstream urine culture was performed in 1517 episodes, with a pathogen(s) isolated in 921 (60.7%, 95% CI: 58.2–63.2) samples. The most common isolates were Escherichia coli (n = 609/921; 66.1%, 95% CI: 62.9–69.1) followed by Staphylococcus saprophyticus (n = 171/921; 18.6%, 95% CI:16.5–21.7). One-third of E. coli isolates were trimethoprim-resistant. Empirical antibiotics were prescribed for 1547 (91.3%, 95% CI: 89.8–92.6) episodes, with trimethoprim accounting for 842 (54.4%, 95% CI: 51.9–56.9) prescriptions. Most prescriptions (1465/1547; 94.7%, 95% CI: 93.5–95.8) adhered to first-line eTG recommendations. Despite this, for patients prescribed an empirical antibiotic, 17.5% (128/730, 95% CI: 14.8–20.5) of infections were resistant to the prescribed antibiotic. The proportion of patients potentially requiring an alternative antibiotic was highest for those empirically prescribed trimethoprim, with 25.8% (85/329, 95% CI: 21.2–30.9) of these isolates demonstrating resistance.

Conclusion: At MSHC, E. coli was the leading uropathogen, with 1/3 demonstrating resistance to trimethoprim. Empirical antibiotics were commonly prescribed and compliant with national recommendations. Trimethoprim accounted for >50% of empirical prescriptions. However, trimethoprim resistance was present in 1/4 cases where it was prescribed, suggesting changes to empirical antibiotic recommendations are needed.

Disclosure of interest statement: CSB is supported by an Australian NHMRC Leadership Investigator Grant (GNT1173361).

47. Empowering patients and providers: the impact of digital pathways

Jane Baird¹, Helen Gibbons¹, Tracey Greaves¹, Nicole Trebilcock¹ and Suzanne Foot²

¹Pregnancy Advisory Centre, Central Adelaide Local Health Network, SA, Australia.

²Specialty Medicine, Central Adelaide Local Health Network, SA, Australia.

Background: Traditionally, consumer preparation and information collection at the Pregnancy Advisory Centre (PAC) relied heavily on manual processes. The consumer would arrive without preparation, with registration paperwork completed in the waiting room, resulting in clients spending up to 2.5 h at the centre. This approach not only burdened consumers but also limited the efficiency of healthcare delivery. Recognising the need for improvement, a digital pathway was introduced, aiming to enhance consumer experience and operational efficiency by streamlining pre-appointment processes.

Methods: Consumers are invited by SMS to their digital pathway. They confirm their appointment, receive educational videos pre and post-appointment, and receive activity reminders, in a comprehensive digital pathway provided by a web-based platform.

Staff manage the pathway through a real-time “dashboard” ensuring the consumer is prepared for care. Appointments can be rescheduled easily, reducing consumer fail to attend rates and overall wait times for services. A flag system within the digital pathway highlights clinical risks or administrative needs in real time.

Results: The transition to a digital platform resulted in operational efficiencies, reducing administrative burden, increasing workplace satisfaction among healthcare providers, while enhancing consumer knowledge and supporting informed consumer decision-making.

Implementing digital pathways resulted in the following:

Conclusion: This initiative represents a significant innovation in healthcare delivery, streamlining accessibility and improving health literacy and understanding for clients accessing abortion care, including those with limited literacy, or non-English speakers, thereby ensuring a more equitable healthcare experience.

Disclosure of interest statement: Personify Care is a SA Wide Health Partner. The initiative was primarily supported by the expertise and resources contributed by Personify Care in the context of healthcare innovation and digital patient pathway optimisation and through no other commercial arrangement.

48. Systematic review and meta-analysis of the association between Mycoplasma genitalium and pelvic inflammatory disease (PID)

Htaik K.^1,2, Vodstrcil L.^1,2,3, Plummer E.^1,2, Sfameni A.², Machalek D.^4,5, Manhart L.⁶ and Bradshaw C.^1,2,3

¹Melbourne Sexual Health Centre, Alfred Health, Carlton, Vic, Australia.

²School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁴Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville, Vic, Australia.

⁵The Kirby Institute, University of New South Wales, Kensington, Sydney, NSW, Australia.

⁶Departments of Epidemiology and Global Health, Center for AIDS and STD, University of Washington School of Public Health, Seattle, USA.

Background: Mycoplasma genitalium is an established cause of non-gonococcal urethritis. However, there are fewer data examining the association between M. genitalium and pelvic inflammatory disease (PID). Differences in opinion around the association between M. genitalium and PID has resulted in inconsistencies across global guidelines regarding testing and treatment recommendations for PID. We aimed to determine the association between M. genitalium and PID and the proportion of PID cases with M. genitalium from all published studies to 2023 to provide a contemporary evidence base to inform clinical practice and health policy.

Methods: PubMed, Embase, Medline and Web of Science were searched to December 2023 for studies that included an assessment of women for PID and used established clinical criteria and nucleic acid amplification tests to detect M. genitalium. We calculated summary estimates of the association of M. genitalium with PID (pooled odds ratio [OR]) and the proportion of PID cases with M. genitalium detected (pooled M. genitalium positivity in PID), using random-effects meta-analyses, with 95% confidence intervals (CI). PROSPERO: CRD42022382156.

Results: After duplicate removal and abstract screening, 10 studies that estimated M. genitalium association with PID, and 19 that estimated M. genitalium positivity in PID were included. M. genitalium infection was significantly associated with PID with a pooled OR of 1.67 [95% CI:1.24–2.24]. The pooled positivity of M. genitalium in PID was 10.3% [95% CI: 5.63–15.99]. Subgroup and meta-regression analyses showed that M. genitalium positivity in PID was highest in the WHO-defined Americas and African region, in studies conducted in both inpatient/outpatient setting, and in populations at higher risk of sexually transmitted infections.

Conclusion: M. genitalium was associated with a 67% increase in odds of PID and was detected in one in ten clinical diagnoses of PID. These data support testing women with PID at presentation for M. genitalium.

Disclosure of interest statement: KH is supported by an Australian Government Research Training Program (RTP) Scholarship and Research Entry Scholarship Royal Australasian College of Physicians (RACP). CSB is supported by National Health and Medical Research Council (NHMRC) Leadership Investigator grant (1173361). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest for this project.

49. Efficacy and tolerability of combination minocycline and metronidazole for treatment of M. genitalium

Htaik K.¹, Vodstrcil L.^1,2,3, Plummer E.^1,2, Aguirre I.¹, Fairley C.^1,2, Chow E.^1,2,3 and Bradshaw C.^1,2,3

¹Melbourne Sexual Health Centre, Alfred Health, Carlton, Vic, Australia.

²School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: High levels of macrolide resistance and increasing fluoroquinolone resistance are making Mycoplasma genitalium infections increasingly difficult to treat. We published data to show that minocycline monotherapy cures 68% of macrolide resistant M. genitalium infections. Recent in vitro data indicated that metronidazole may have activity against M. genitalium. Therefore, we hypothesised that metronidazole combined with minocycline may be more effective than minocycline monotherapy and serves as an alternative treatment for patients with macrolide-resistant M. genitalium infections with fluoroquinolone contraindications or resistance.

Methods: We evaluated the efficacy and tolerability of combined minocycline 100 mg BD and metronidazole 400 mg BD for 14 days for patients attending the Melbourne Sexual Health Centre from September 2021. Microbial cure was defined as a negative test-of-cure within 14–90 days after completing therapy. We calculated the proportion cured with 95% confidence intervals (CI) and assessed adherence and adverse effects.

Results: Data from 74 patients with macrolide-resistant M. genitalium who received 14 days of combined minocycline and metronidazole were analysed; 59 (79.73%, [95% CI 68.78– 88.19%]) experienced microbial cure within 14–90 days of completion. Adherence was high; 65 of 71(92%) cases reported taking all doses. Overall, (39/70, 56%) reported one or more adverse effects that include dizziness (14/70,20%), headache (13/70,19%), lethargy (12/70,17%), diarrhoea (9/70,13%), mood changes (8/70,11%), vomiting (5/70,7%), photosensitivity (6/70,4%), abdominal pain (3/70,4%), insomnia (3/70,4%), or another adverse effect (11/70, 16%). Six reported ceasing treatment due to the reported adverse effects. A larger dataset will be available in September 2024.

Conclusion: Combination minocycline and metronidazole cured 80% of macrolide-resistant M. genitalium infections. While this regimen appears to have higher efficacy than minocycline alone (80% vs 68%), a significant proportion of cases reported adverse effects. With increasing fluoroquinolone resistance, and a need for non-quinolone alternatives, combination minocycline and metronidazole may represent an effective option for treating M. genitalium.

Disclosure of interest statement: KH is supported by an Australian Government Research Training Program (RTP) Scholarship and Research Entry Scholarship Royal Australasian College of Physicians (RACP). CSB and CKF are supported by National Health and Medical Research Council (NHMRC) Leadership Investigator Grants (GNT1173361 and GNT1172900). EPFC is supported by an NHMRC Emerging Leadership Investigator Grant (1172873). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest for this project.

50. Cervical screening and follow up for people with a cervix living with HIV

Guianna Noble¹, Andrea Long¹, Maggie Smith¹, Yen Li Lim¹ and Kathryn Acklom¹

¹The Albion Centre, Sydney, NSW, Australia.

Background: People with a cervix living with Human Immunodeficiency Virus (HIV) are at greater risk of developing cervical cancer. In December 2017 the National Cervical Screening Guidelines were updated for people aged between 25 and 74 years. Cervical screening test (CST) modality was changed from Papanicolaou test (PAP test) to human papilloma virus (HPV) testing. Routine screening for HPV negative individuals became five yearly. For people living with HIV (PLWHIV), the recommended recall is every 3 years due to immunosuppression. There is no ability to modify the National Cancer Screening Program (NCSP) recall timeframe, therefore relying on the national recall system is problematic for this subgroup.

Methods: A retrospective clinical file audit of all PLWHIV with a cervix at The Albion Centre was conducted to review CST attendance and follow-up from 1 Jan 2018 to 31 Dec 2023. Data assessed included date of last CST and result, due date for next CST, and identifying patients who declined testing or were lost to follow up. Change strategies implemented included offering self-collect CST and use of electronic medical record (EMR) appointment reminders to improve timeliness of CSTs. A re-audit was conducted.

Results: A total of 98 people were identified. 64.3% were up to date with CST recommendations. 35.7% were overdue. A repeat audit showed 83.5% were up-to-date and 16.5% were overdue this included people who declined CSTs or were no longer receiving care at The Albion Centre.

Conclusion: Self-collection was offered opportunistically at regular pathology appointments. In addition, a robust recall system utilising available EMR and systemic process changes with clinicians was implemented. The new EMR clearly displayed dates, results of previous CSTs, and next CST due date. The current automated medical process now prompts clinicians with the next CST due date. This resulted in an improvement in the total number of PLWHIV who had CST screening within NCSP recommended time frames.

Disclosure of interest statement: The authors have no conflicts of interest to declare.

51. Improvement on documentation of partner notification (PN) for patients with a sexually transmitted infection (STI) accessing the busy central London integrated sexual health (ISH) service

Sri Narayana¹, Hannah Yeend¹, Torshie Annan¹ and Rita Browne¹

¹Mortimer Market Centre, London, UK.

Background:

Methods:

Results:

Conclusion:

52. The impact of testosterone therapy on the vaginal microbiota of transgender men and non-binary people: results from a prospective study

Muzny C. A.¹, Van Gerwen O. T.¹, Aaron K. J.¹, Kay-Duncan E. S.², Siwakoti K.³, Eastlund I. C.¹, Graves K. J.¹, Tamhane A.⁴, Elnaggar J. H.⁵, Van Wagoner N. J.¹, Nelson D. E.⁶, Toh E.⁶ and Taylor C. M.⁵

¹Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.

²School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.

³Division of Endocrinology, University of Alabama at Birmingham, Birmingham, AL, USA.

⁴Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.

⁵Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.

⁶Departments of Medicine, Microbiology, & Immunology, Indiana University School of Medicine, Indianapolis, IN, USA.

Background: We investigated changes in vaginal microbiota composition in transgender men and non-binary people (TGM) initiating testosterone (T) for gender-affirming hormone therapy, including development of vaginal dysbiosis and incident bacterial vaginosis (iBV).

Methods: Participants aged ≥18 years assigned female sex at birth and reporting TGM identity, interested in starting injectable T, with normal vaginal microbiota (no Amsel criteria, Nugent score 0–3), and no STI(s) were enrolled. Participants self-collected daily vaginal swabs for 7 days prior to T initiation and 90 days thereafter for vaginal Gram stain and 16S rRNA gene sequencing. Episodes of vaginal dysbiosis and iBV were defined as Nugent scores ≥4 or ≥7, respectively, each for ≥2 consecutive days.

Results: Between February 2022 and November 2023, 62 individuals were phone-screened, 17 screened in-person, and 9 enrolled. Median age was 22 (IQR 19–23). All were White, 7 identified as TGM, 1 as non-binary, and 1 as non-conforming. Four community state types (CSTs) were identified: CST I (L. crispatus-dominated), CST III (L. iners-dominated), CST IV-B (G. vaginalis, F. vaginae-dominated), and CST IV-C (dominated by a variety of BV-associated bacteria). 89% of participants (8/9) developed ≥1 episode(s) of vaginal dysbiosis a median of 17 days (IQR 12–39) after T initiation while 56% (5/9) developed iBV a median of 26 days (IQR 19–31) after T initiation; 1/5 (20%) had symptomatic BV. CST I was found most often in participants who did not develop iBV, CST IV-B most often in participants who developed iBV, and CST III equally in both groups. CST IV-C was uncommon, occurring more often in those who did not develop iBV, often during menses. Of 5 participants with iBV, 2 (40%) reported no sexual activity during the study.

Conclusion: The majority of participants developed vaginal dysbiosis including iBV during this study; the influence of T on these results requires further investigation.

Disclosure of interest statement: This study is funded by the National Institute of Allergy and Infectious Diseases (R21AI167754-01). Muzny CA has received research grant funding to her institution from Lupin Pharmaceuticals, Abbott Molecular, Gilead, and Visby Medical. Van Gerwen OT has received research funding to her institution from Abbott Molecular and Gilead. Van Wagoner NJ has received research funding to his institution from Moderna.

53. Brazilian experience in offering a hybrid strategy for HIV/HBV/HCV viral load tests (laboratory and point-of-care): accessibility, demand coverage, and turnaround time optimisation

Fernanda L. Conte¹, Amanda A. C. Morais¹, Nivea O. O. Guedes¹, Philippus Ana Cláudia¹, Pamela C. Gaspar¹ and álisson Bigolin¹

¹Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections, Brazilian Ministry of Health, Brasília DF, Brazil.

Background: Viral load (VL) tests are carried out to confirm the diagnosis and monitor the clinical evolution of people living with HIV and/or viral hepatitis. The Brazilian National Network of Laboratories/Health Facilities for HIV/HBV/HCV-VL uses two different strategies: 1) Laboratory tests, available on clinical laboratories of large centres to cover the high demand for VL-tests; 2) Point-of-care (POC) tests in Health Facilities that presents infrastructure and/or geography limitations, aiming to promote accessibility and faster response. In order to optimise the methodologies, both strategies can be integrated with testing for other injuries/disease.

Methods: This work aimed to evaluate the differences and similarities between these two approaches in Brazil, analysing the following indicators obtained from Brazilian official information systems, from January to December 2023: number of sample collection points, number of HIV/HBV/HCV-VL tests released, and turnaround time of results (TAT).

Results: There are 82 sites using laboratory approach and 1.514 points of collection samples for these tests. POC strategy counts with 54 health services executing the tests and 103 sites for sample collection. Laboratory approach was responsible for 1.060.931 HIV-VL, 81.459 HBV-VL and 59.642 HCV-VL tests, with an average TAT of 6 days (HIV-VL), 7 days (HBV-VL) and 8 days (HCV-VL). POC strategy was responsible for 43.170 HIV-VL, 5.159 HBV-VL and 2.500 HCV-VL tests, presenting an average TAT of 4 days for HIV-VL and 1 day for both HBV and HCV-VL tests.

Conclusion: The data indicates that the combination of strategies allows achieve capillarization of sample collection, absorption of tests demand and accessibility, contributing to HIV/HBV/HCV early diagnosis and prompt health care. Although POC strategy promotes celerity, efforts must be made for a faster HIV-VL TAT, considering the benefits to the patients. Brazil’s experience can encourage other countries that intend to associate the use of resources in their health programs.

Disclosure of interest statement: None.

54. Reach and impact of a national community-led molecular point-of-care testing program for sexually transmitted infections in regional and remote Australia

Louise M. Causer¹, Joshua Riessen^2,*, Amit Saha¹, Kelly Andrewartha³, Kirsty Smith¹, Sarah Betts^2,*, Annie Tangey^1,4, Sean O’Connor⁵, Mel Fernando^1,*, Lauren Cooney¹, Susan Matthews³, Lorraine Anderson^6,*, Mark Shephard³ and Rebecca Guy¹, on behalf of the TTANGO3 and First Nations Infectious Diseases Point-of-Care Testing Programs

¹The Kirby Institute, UNSW Sydney, NSW, Australia.

²Aboriginal Health Council of South Australia, Adelaide, SA, Australia.

³Flinders University International Centre for Point of Care Testing, Bedford Park, SA, Australia.

⁴Ngaanyatjarra Health Service, Warburton, WA, Australia.

⁵Townsville Public Health Unit, Townsville Hospital Health Service, Queensland Health, Townsville, Qld, Australia.

⁶Kimberley Aboriginal Medical Services, Broome, WA, Australia.

^*Author identifies as Aboriginal and/or Torres Strait Islander.

Background: In Australia, molecular point-of-care testing (POCT) for chlamydia (CT), gonorrhoea (NG) and trichomonas (TV) has been programmatically implemented since 2016 in regional and remote Aboriginal and Torres Strait Islander communities. POCT is community-led and delivered through primary care clinics, often located significant distances from centralised laboratories. We evaluated POCT program reach and testing uptake to understand the individual and public health impact.

Methods: Using program data from 2020–2023 we described the POCT network, target population, and test positivity by sex, age group and infection type. We estimated the number of infectious days averted using published median difference in time-to-treatment following a POC compared with a laboratory-based test.

Results: During the implementation period, 68 clinics offered POCT (10 regional, 4 remote, 54 very remote) across 6 jurisdictions. In total, 13459 CT/NG dual and 10800 TV single patient POC tests were conducted; 59.1% were in women, 63.5% in those 15–29 years and 95.9% in Aboriginal and/or Torres Strait Islander people. Test positivity for CT was 10.0%, NG was 9.0%, and TV was 8.5%. Among those tested with both CT/NG and TV tests (n = 9393), positivity for any infection was 22.6% (women 22.1%, men 20.9%). Among those 15–19, 20–24, 25–29, and 30+ years, any positivity was 26.3%, 27.3%, 20.2% and 15.9.% respectively; 5.7% were positive for more than one STI, 1.1% were positive for all three (CT, NG and TV). POCT averted 25,570 infectious days for CT/NG and 23,050 days for TV.

Conclusion: Young people experience the highest POC test positivity, with almost one in four having at least one infection. Future activities should focus on increasing access and uptake of POCT as part of a comprehensive approach to STI control to ensure all young people benefit from rapid treatment of all three infections, limiting both adverse sequelae and onward community transmission.

Disclosure of Interest Statement: The First Nations Molecular Point-of-Care Testing Program has been funded by the Australian Government Department of Health and Aged Care. The authors acknowledge the contribution to the program of many stakeholders including the National Aboriginal and Torres Strait Islander Health Protection Sub-Committee, participating Aboriginal community controlled and government health services, national, jurisdictional and local Aboriginal Community Controlled Health Organisations, State and Territory health departments, and other government services, industry and pathology providers. Professor Guy, Dr Causer and Dr Matthews are investigators on a research project that receives free Streptococcus A and Human Papilloma Virus test cartridges from Cepheid. Professor Guy is an investigator on a research project that receives cash and in kind support from Cepheid.

Aboriginal and Torres Strait Islander approvals: This analysis was conducted using publicly available TTANGO3/First Nations Molecular Infectious Diseases POCT program data. POCT program governance includes oversight from the National Aboriginal and Torres Strait Islander Health Protection AHPPC Sub-Committee and POCT Leaders group. Program data are regularly shared and disseminated to stakeholders through online forums and newsletters.

55. Detection of high-risk human papilloma virus type 26 and 70 in condylomata acuminata penil: a rare case report

Sunrise Dewantara Satria¹, Hafidzah Nurmastuti¹, Devi Artami Susetiati^1,2 and Angela Satiti Retno Pudjiati^1,2

¹Departement of Dermatology dan Venereology Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia.

²Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

Background: Condylomata acuminata (CA) is a benign epithelial skin lesion that appears in the external genitalia area caused by the Human Papilloma Virus (HPV). CA is one of the most common sexually transmitted diseases. HPV is associated with a risk of malignancy. There are high-risk malignancy HPV subtypes, most commonly HPV types 16 and 18. Other subtypes are HPV types 26, 53, 66, 67, 68, 70, 73, and 82. This case report aims to report detection of type 26 and 70 HPV in CA penile lesions.

Case: Twenty-year-old male with progressive penile warts. On the sulcus coronary penile, closed by the preputial and ostium urethra external, shows multiple erythematous verrucous papules of varying sizes, partly covered in blood and painful to touch.

Acetowhite tested positive. Electrosurgery was performed, and the entire lesion was removed. Histopathological examination is suitable for CA. HPV DNA examination types 26 and 70 which potentially high risk of carcinogenesis were found.

Discussion: HPV infection can manifest clinically according to the infecting HPV subtype. KA lesions in the form of verrucous papules that develop progressively, are painful, and bleed easily should be suspected as an HPV infection with a high risk of carcinogenesis. Histopathological confirmation and genotyping are useful to indicate the prognosis. Evaluation and screening with cervical intraepithelial neoplasias (CIN) or penile swab cytology for early detection of malignancy that may develop from infection with HPV types 26 and 70.

Conclusion: A case of CA with genotype HPV 26 and 70 which is possibly carcinogenic based on IARC 2B has been reported with clinical symptoms of erythematous verrucous papules that bleed easily and are painful. Evaluation by cytological examination of the penile shaft swab or OUE is an alternative evaluation carried out for early detection of cancer caused by HPV types 26 and 70.

Disclosure of interest statement: All authors have declared no conflict of interest.

56. Descriptive analysis of sexually transmitted infections risk factors among participants included in the global zoliflodacin Phase 3 clinical trial

Luckey A.¹, Broadhurst H.², Bettiol E.¹ and Srinivasan S.¹, for the zoliflodacin Phase 3 study group

¹Global Antibiotic R&D Partnership (GARDP).

²Plus Project.

Background: With new treatments for sexually transmitted infections (STIs), relevance of the data to a diverse population is important. A global randomised controlled Phase 3 trial, enabled through a public-private partnership, showed that a single oral 3 g dose of zoliflodacin (a first-in-class oral bacterial topoisomerase inhibitor with potent in vitro activity against Neisseria gonorrhoeae, including multidrug-resistant strains) is non-inferior to a combination of a single dose each of intramuscular ceftriaxone 500 mg and oral azithromycin 1 g, in participants with uncomplicated urogenital gonorrhoea. This analysis describes the baseline characteristics and risk factors for STIs within this study population.

Methods: Data was collected for all randomised participants from South Africa, Thailand, USA, Netherlands and Belgium by direct enquiry at screening.

Results: Data from 930 randomised participants was analysed. Of the 815 participants assigned male at birth, 36.2% (295/815) reported having sex with men, 1.5% (12/815) with transgender women (MSM), 67.4% (549/815) with women and 0.5% (4/815) with transgender men. Of the 115 participants assigned female at birth, one reported bisexual and the remainder heterosexual behaviour. In terms of STI history, 56.1% (522/930) of the randomised population reported a prior history of STI at any time, with 3.3% (31/930) having had gonorrhoea in the 3 months prior to screening and 21.4% (199/930) being HIV-positive. Regarding other risk factors, 13.5% of participants (126/930) were PrEP users and 6.2% (58/930) reported being frequent or occasional sex workers. Participants reported a median of 2.0 sexual partners in the 3 months prior to screening (range: 0–150). The identified risk factors were evenly distributed between the zoliflodacin and the ceftriaxone+azithromycin arms.

Conclusion: The participants randomised in the global zoliflodacin Phase 3 trial included representative sub-populations considered high-risk for STIs, including MSM, sex workers and HIV-positive status.

Disclosure of interest statement: Zoliflodacin is co-developed by the Global Antibiotic Research & Development Partnership (GARDP) in collaboration with Innoviva Specialty Therapeutics, a subsidiary of Innoviva, Inc. (Nasdaq: INVA). This trial was funded with support from the governments of Germany (BMBF and BMG), UK (GAMRIF, part of DHSC, and DFID), Japan (MHLW), the Netherlands (Ministries of VWS and BZ), Switzerland (FOPH), The Grand Duchy of Luxembourg, as well as the Canton of Geneva, South African Medical Research Council (SAMRC), and the Leo Model Foundation.

57. Oral zoliflodacin for treatment of uncomplicated gonorrhoea in high-risk populations: subgroup analyses of a global Phase 3 randomised controlled clinical trial

Luckey A.¹, Broadhurst H.², Bettiol E.¹, Srinivasan S.¹ and Hook E. W. 3rd³, for the zoliflodacin Phase 3 study group

¹Global Antibiotic R&D Partnership (GARDP).

²Plus Project.

³University of Alabama at Birmingham, USA.

Background: The first-in-class oral bacterial topoisomerase inhibitor zoliflodacin has potent in vitro activity against Neisseria gonorrhoeae (NG), including multidrug-resistant strains. A global randomised controlled Phase 3 trial, enabled through a public-private partnership, evaluated zoliflodacin efficacy and safety for uncomplicated gonorrhoea treatment in a diverse group of participants. Urogenital microbiological cure rates (95% confidence interval [CI]) were 90.9% (88.1–93.3) vs 96.2% (92.9–98.3) for zoliflodacin vs ceftriaxone-azithromycin, respectively, demonstrating non-inferiority of zoliflodacin to the comparator with a 5.31% difference (95% CI: 1.38–8.65). Cure rates for pharyngeal and rectal infections were comparable between treatment arms.

Methods: The primary endpoint was microbiological cure, determined by culture from urethral/endocervical sites at Day 6 ± 2 in the microbiological intention-to-treat (micro-ITT) population (i.e. randomised participants with baseline cultures positive for NG and no resistance to both ceftriaxone and azithromycin). Descriptive subgroup analyses were performed using demographics, baseline characteristics and STI risk factors in the micro-ITT and evaluable populations (EP), defined as participants in micro-ITT with an assessable microbiological outcome at Day 6 ± 2.

Results: Urogenital cure rates in subgroups were consistent with the primary endpoint analysis. Among the subgroup of men who reported sex with men (MSM), cure rates with zoliflodacin vs ceftriaxone-azithromycin were 94.4% (n/N: 153/162; 95% CI: 89.7–97.4) vs 96.3% (79/82; 89.7–99.2) in the micro-ITT and 98.7% (153/155; 95.4–99.8) vs 100% (79/79; 95.4–100) in the EP, respectively. In heterosexual males, cure rates were 88.1% (259/294; 95% CI: 83.8–91.6) vs 97.1% (134/138; 95% CI: 92.7–99.2) in the micro-ITT and 95.6% (259/271; 95% CI: 92.4–97.7) vs 100% (134/134; 95% CI: 97.3–100) in the EP for zoliflodacin vs ceftriaxone-azithromycin, respectively. Subgroup analyses in the EP of urogenital cure rates for PrEP users, persons living with HIV and sex workers were comparable between treatment arms.

Conclusion: Descriptive analysis of subgroups at high-risk for STIs demonstrated cure rates for zoliflodacin vs ceftriaxone-azithromycin comparable to the primary endpoint analysis.

Disclosure of interest statement: Zoliflodacin is co-developed by the Global Antibiotic Research & Development Partnership (GARDP) in collaboration with Innoviva Specialty Therapeutics, a subsidiary of Innoviva, Inc. (Nasdaq: INVA). This trial was funded with support from the governments of Germany (BMBF and BMG), UK (GAMRIF, part of DHSC, and DFID), Japan (MHLW), the Netherlands (Ministries of VWS and BZ), Switzerland (FOPH), The Grand Duchy of Luxembourg, as well as the Canton of Geneva, South African Medical Research Council (SAMRC), and the Leo Model Foundation.

58. Neisseria gonorrhoeae treatment and culture compliance at four publicly funded sexual health services in South Eastern Sydney, Australia

Lim Y. L.¹, Acklom K.¹, Silins E.^2,5, Gilliver R.², Ray A.³, Liyanage R.^4,6, Egerton Smith A.⁴ and Smith D. E.¹

¹The Albion Centre, Sydney, NSW, Australia.

²Kirketon Road Centre, Sydney, NSW, Australia.

³Sydney Sexual Health Centre, Sydney, NSW, Australia.

⁴Short Street, Sydney, NSW, Australia.

⁵NDARC, UNSW, Sydney, NSW, Australia.

⁶UNSW, Sydney, NSW, Australia

Background: South Eastern Sydney Local Health District (SESLHD) reported the highest number of Neisseria gonorrhoea (NG) cases in NSW in 2022. NG is challenging to treat due to reduced susceptibility to many antibiotics. Dual antibiotic treatment (azithromycin/ceftriaxone) is recommended. Newer guidelines suggest ceftriaxone and doxycycline is adequate for syndromic management. The Australian STI guidelines recommend a culture before treatment with dual antibiotic regimens. The purpose of the audit was to confirm correct management of NG within SESLHD four publicly funded sexual health clinics (PFSHCs) and review adequacy of treatment.

Method: A retrospective audit of Nucleic Acid Amplification Tests (NAAT) positive cases at SESLHD PFSHCs from 1 January to 30 June 2023 was conducted to compare treatment compliance with Australian STI Management Guidelines, audit gonococcal culture and sensitivity (MCS) collection, identify potential AMR and evaluate sector performance.

Results: In 762 individuals, there were 1102 positive NG NAATs. Positive test sites: 430 rectal (39%), 305 genital (28%), and 367 throat (33%). NG was detected at a single site in 62.4% of individuals, at two sites in 30.4%, and at three sites in 7.1%. Identified risk factors included men who have sex with men (80.1%), pre-exposure prophylaxis users (49.5%), people living with HIV (14.2%), sex workers (9.8%), and injecting drug users (7.6%). 704 (92.4%) had documented adequate antibiotic therapy as per guidelines. 31 (4.1%) were lost to follow up or treated elsewhere. 27 (3.5%) were considered inadequately treated. 299 (39.2%) were treated at presentation, with cultures completed in accordance with symptoms. Of the 463 individuals not treated at presentation and who returned for treatment (median 6 days), 411 cultures were completed: 174 rectal (70% compliance), 32 genital (41% compliance), and 205 throat (79% compliance). No cases of ceftriaxone resistance were identified. 1 case of azithromycin resistance was found.

Conclusion: SESLHD PFSHCs were 92.4% compliant with treatment guidelines but culture compliance varied from 41–79% reducing possibility of non-detection of AMR or reduced antibiotic sensitivity.

Disclosure of interest statement: The authors have no conflicts of interest to declare.

59. Sexually transmitted infections screening and management for adolescents as part of a community-based comprehensive health check-up in Zimbabwe (Y-Check)

Dziva Chikwari C.^1,2, Nzvere F. P.^1,2, Simms V.^1,2, Li Lin I.², Manyau S.¹, Bandason T.¹, Weiss H. A.², Bernays S.^4,6, Baltag V.³, Banati P.³, Ross D. A.⁷, Ferrand R. A.^1,5 and Doyle A. M.^1,2

¹The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

²MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.

³Adolescent and Young Adult Health Unit, Department of Maternal Newborn, Child and Adolescent Health and Ageing, World Health Organization.

⁴Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.

⁵Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.

⁶School of Public Health, University of Sydney, Sydney, NSW, Australia.

⁷Institute for Life Course Health Research, Stellenbosch University, South Africa.

Background: Adolescents are at high risk for STIs. We evaluated STI screening and management as part of a free comprehensive community-based health and well-being check-up program for urban older adolescents (Y-Check) in Chitungwiza, Zimbabwe.

Methods: Between October 2022 and March 2023, adolescents aged 16–19 years were invited to Y-Check. Participating adolescents self-completed a questionnaire and provided urine samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing with GeneXpert. Girls also self-collected vaginal swabs for Trichomoniasis vaginalis (TV) testing with the OSOM lateral flow assay. Same day TV results and treatment were provided. Adolescents with positive CT/NG tests were followed up via telephone within 24–48 h and asked to return for treatment. Adolescents who tested positive for any STI were followed up 4–6 months after the baseline “screen” and rescreened. Adolescents with an STI were offered partner notification (PN) slips.

Results: Overall, 630 adolescents (median age 17 years; IQR 16–17; 55.2% female) were screened for CT/NG and 344 female adolescents (median age 17 years; IQR 16–17) were screened for TV. The prevalence of CT was 5.1% (95% CI 3.6–7.1) and NG 1.0% (95% CI 1.0–1.0). The prevalence of CT, NG or both was 5.7% (95% CI 4.1–7.8) (2.1% in males, 8.6% in females). 21 (6.1%) adolescent girls tested positive for TV. Treatment uptake was 69.4% (25/36) for CT/NG and 100% (21/21) for TV. Only 24/54 (44.4%) adolescents with an STI accepted PN slips. At follow-up, 11/30 (36.7%) adolescents who had been treated at baseline re-tested positive for CT and/or NG and 2/11 (18.2%) treated female participants re-tested positive for TV.

Conclusions: The study showed that community based STI screening and management for adolescents was feasible. However, less than half of those with an STI accepted PN slips and reinfection within 4–6 months was quite common.

Disclosure of interest statement: This research is supported by funding from UK Research and Innovation and Fondation Botnar.

60. Performance of a large language model-Artificial Intelligence based chatbot Otiz for counselling patients of sexually transmitted infections and genital diseases

Mehta N.¹, Sithira A.² and Yudara K.²

¹Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India.

²HeHealth Inc., San Francisco, CA, USA.

Background: There is a shortage of adequately trained counsellors for sexually transmitted infections (STIs) and genital diseases. Current large language models (LLMs) like chatGPT are not specifically designed for STI/genital concerns. So we designed an AI-based chatbot platform Otiz, and assessed its performance in addressing these concerns.

Methods: Six disease classes were studied – anogenital warts, gonorrhea/chlamydia/urinary tract infection(UTI)/proctitis, primary syphilis, anogenital herpes, penile candidiasis, penile cancer. Five initiating text prompts, inclusive of diverse presentations, were created per class. Each prompt was evaluated by 2 independent venereologists, and each disease class by 10 different venereologists. Only the initial text prompt was provided, and they were instructed to interact with the chatbot in patients’ language, simulating real life scenarios. They were asked to grade their conversation, on a Likert scale of 0 to 5, for each domain of diagnosis, accuracy, relevance, correctness of information, comprehensibility, and empathy.

Results: Twenty-three venereologists evaluated 60 prompts. The mean scores of diagnosis, accuracy, relevance, correctness of information, comprehensibility, and empathy were 4.1,4.3,3.4,5.0,4.3, and 4.6 for anogenital warts, 4.8,4.6,3.4,5.0,4.4, and 4.8 for anogenital herpes, 4.6,4.6,2.9,5.0,4.3, and 4.8 for gonorrhea/chlamydia/UTI, 3.9,4.3,3.2,5.0,4.0, and 4.6 for penile candidiasis, 4.0,4.2,2.8,5.0,4.1, and 4.7 for primary syphilis, and 3.6,4.0,3.4,5.0,4.1, and 4.7 for penile cancer.

Conclusion: Otiz AI-chatbot offers correct, accurate, easily understandable information in an empathic way. Improvements are desired to make responses more concise and relevant, reducing redundancy.

Disclosure of interest statement: Otiz chatbot platform was developed by HeHealth Inc., which is a for-profit startup. SA is a Medical Executive at HeHealth Inc. YK is the CEO of HeHealth Inc. NM has not received any fee or financial or other incentives of any kind for the development of this chatbot and study. A startup, HeHealth has raised funding from institutional investors and angel investors and would like to specifically acknowledge Plug and Play Tech Center as well as ARKRAY Corporate Venture Capital.

61. “Provided power is there, it will be a good initiative”: structural challenges to aetiological screening for curable STIS in Botswana

Mussa A.^1,2, Russell J.¹, Hansman E.³, Babalola C. M.⁴, Klausner J. D.⁴, Wynn A.^1,5 and Morroni C.^1,2

¹Botswana Harvard Health Partnership, Gaborone, Botswana.

²University of Edinburgh, Edinburgh, UK.

³University of California, Los Angeles, USA.

⁴University of Southern California, California, USA.

⁵University of California, San Diego, La Jolla, USA.

Background: Aetiological screening has the potential to improve diagnosis and treatment of STIs during pregnancy and improve health outcomes among women and infants in low- and middle-income countries (LMICs). To inform roll-out and scale up of antenatal aetiological STI screening in LMICs, it is important to understand the facilitators and barriers to implementation. We explored healthcare worker perspectives on aetiological Chlamydia trachomatis and Neisseria gonorrhoeae screening during pregnancy through in-depth interviews.

Methods: This study was nested within the Maduo Study, a non-randomised trial among asymptomatic pregnant women in Botswana investigating the effect of antenatal C. trachomatis and N. gonorrhoeae screening on health outcomes in women and infants (February 2021–December 2022). Between April and October 2023, we conducted 15 in-depth interviews with healthcare providers providing antenatal/STI care in Gaborone, Botswana. Interviews were audio-recorded, transcribed, coded using NVivo and emergent themes were identified.

Results: While all providers supported roll-out of aetiological screening for C. trachomatis and N. gonorrhoeae during pregnancy, they identified structural issues that need to be considered within the existing healthcare system prior to implementation including power (“provided power is there it will be a good initiative”), space (“…like I was saying, another challenge is space”), supply stock-outs (“the system, sometimes it collapses…the supplies run off” and “there are times when you don’t have even the treatment”), staffing constraints (“there is this issue of staf.t’s the only issue that can bring maybe failure”), and lack of equipment maintenance (“…things they are put. Then after, they no longer work”). In addition to ensuring sufficient infrastructure and resources, other facilitators to implementation of STI screening included staff training and healthcare education for patients.

Conclusion: While the majority of providers supported aetiological STI screening during pregnancy, they also noted several barriers that need to be considered prior to roll-out.

Disclosure of interest statement: The authors declare no competing interests.

62. Cure of persistent urethritis due to Mycoplasma genitalium infection with long-term minocycline

Stephen J. Jordan¹ and Kathryn B. Robertson²

¹Division of Infectious Diseases, Departments of Medicine and Microbiology and Immunology, Indiana University, Indianapolis, IN, USA.

²Infectious Diseases Care, Community Health Network, Indianapolis, IN, USA.

Background: Mycoplasma genitalium (MG) causes persistent urethritis and is increasingly resistant to macrolides and quinolones. When resistance testing is unavailable, US guidelines recommend sequential therapy for MG with doxycycline and moxifloxacin. We report a case of persistent urethritis due to MG that failed multiple antibiotics and was cured with long-term minocycline.

Methods: A 25-year-old male was referred to a urologist for urethral symptoms and treated empirically with ceftriaxone and azithromycin. Urine NAAT was negative for gonorrhea, chlamydia and trichomoniasis, but positive for MG. Although he reported clinical improvement with treatment, he remained persistently positive by urine MG NAAT and his symptoms recurred despite subsequent treatment with high-dose azithromycin, doxycycline and/or moxifloxacin, and 14-days of moxifloxacin. He was then referred to an infectious diseases specialist and prescribed 14-days of minocycline, but his symptoms and infection persisted so he was referred to the Bell Flower STD Clinic.

As macrolide and quinolone resistance was suspected, salvage regimens that were supported either by in vitro data or a plausible bactericidal mechanism of action were prescribed, including tinidazole, methenamine, and omadacycline. With all antibiotics, his urethral symptoms transiently resolved but returned within days after completing treatment and he remained positive by urine MG NAAT. This observation raised concern that antibiotic failure was due to a lack of source control, not antibiotic resistance or reinfection, and he was prescribed prolonged minocycline.

Results: After 6 weeks of minocycline, his symptoms recurred, and he was prescribed an additional 3 weeks of minocycline. After 9 weeks of minocycline, a urine MG NAAT was negative. Two weeks post-treatment, he remained asymptomatic and repeat urine MG NAAT was negative.

Conclusions: We report cure of persistent urethritis due to MG with 9 weeks of minocycline. When multiple antibiotics fail to cure MG or resolve symptoms, long-term antibiotic may be needed to achieve adequate source control.

Disclosure of interest statement: KR has nothing to disclose. SJJ is a consultant for Preventx and receives research funding from Hologic and NIH/NIAID.

63. Evaluation of a ciprofloxacin gyrA assay for resistance-guided therapy for Neisseria gonorrhoea

Holzhauer K.^1,2, Mclaughlin S.^1,2, Barbee L.¹, Golden M.^1,2 and Soge O.¹

¹University of Washington, USA.

²Public Health Seattle King County, USA.

Background: Resistance-guided treatment has the potential to expand treatment options for N. gonorrhoeae (NG) and may be useful as an antimicrobial stewardship strategy. In an ongoing clinical study, we are evaluating the utility of the SpeeDx ResistancePlus assay, which detects the gyrA S91 (wild type) and gyrA S91F (mutant) markers of ciprofloxacin susceptibility and resistance.

Methods: The study offers enrolment to all patients undergoing routine asymptomatic sexually transmitted infection (STI) testing at a sexual health clinic in Seattle, WA, USA. Specimens that test positive for NG are then tested for the gyrA mutation. The study offers patients with gyrA wild type NG treatment with a single 500 mg oral dose of ciprofloxacin and treats participants with the gyrA s91 mutation with intramuscular ceftriaxone. All NG positive participants are asked to return to the clinic for a test of cure visit (NAAT and culture) 14 days (+/–2) following treatment.

Results: Enrolment began in March 2022, was paused in June 2022 due to the mpox epidemic, resumed in March 2023, and is currently ongoing. As of 31 January 2024, a total of 771 participants were enrolled, 41 (5.3%) of whom tested positive for NG. Seventeen (41%) of 41 participants with NG had gyrA wild type, 15 (37%) had gyrA s91 mutation, and 9 were indeterminant (22%). Fifteen (88%) of the 17 participants with gyrA wild type were treated with ciprofloxacin. All participants treated with ciprofloxacin had negative tests of cure. Mean time to reflexed gyrA test result was 3.6 working days (SD = 1.2 days), including participants with indeterminant gyrA results requiring repeat testing.

Conclusion: An assay that detects the gyrA mutation conferring quinolone resistance allowed 37% of patients with NG to be successfully treated with ciprofloxacin. The gyrA reflex testing added ~1.6 working days to results reporting.

64. Evaluation of an implementation support package to address increasing rates of syphilis in pregnancy in Victoria, Australia: what works to make change in antenatal care

Bond S.^1,2,3, Wigan R.¹, Giles M. L.^3,4,5,6, Kane S. C.^3,7, De Luca L.⁴, Sampson B.⁴, Hodges R.⁵, McCully B.⁸, Giarrusso R.⁴, Almond C.⁸, Ivan M.⁹, Hooker J.⁹, Ryder N.¹⁰, Bilardi J.^2,11, Temple-Smith M.¹¹, Ong J.^1,2, Chow E.^1,2, Fairley C. K.^1,2, Tomnay J.¹², Hocking J.¹³, Kaldor J.¹⁰ and Chen M.^1,2

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Royal Women’s Hospital, Melbourne, Vic, Australia.

⁴Western Health, Vic, Australia.

⁵Monash Health, Vic, Australia.

⁶Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.

⁷Department of Obstetrics and Gynaecology, The University of Melbourne, Vic, Australia.

⁸Mildura Base Hospital, Vic, Australia.

⁹Department of Health, Vic, Australia.

¹⁰The Kirby Institute, University of New South Wales, NSW, Australia.

¹¹Department of General Practice, University of Melbourne, Melbourne, Vic, Australia.

¹²Centre for Excellence in Rural Sexual Health, University of Melbourne, Vic, Australia.

¹³Melbourne School of Population and Global Health, University of Melbourne, Vic, Australia.

Background: The incidence of syphilis is increasing globally, resulting in increased congenital syphilis. Universal repeat syphilis screening during the third trimester was implemented across 5 antenatal services in Melbourne, Australia to replace risk-based screening. This study assessed the effectiveness of an implementation support package that supported universal screening.

Methods: The effectiveness of each of the elements of the screening support package (guideline change, automation of pathology ordering, a new data field for repeat screening in the electronic clinical record, and tailored clinician education sessions) was evaluated through an anonymous survey of clinicians (midwives and obstetricians) 6–12 months after implementation.

Results: 85% (62/73) of midwives and 69% (9/13) of obstetricians reported offering syphilis screening as part of routine practice in the third trimester of pregnancy after implementation. 73 % (67/92) of respondents described guideline change to be helpful to their practice. The new data field in the electronic clinical record was reported as most helpful in ensuring repeat screening for every patient. The syphilis training resources were used widely with 82% (75/92) aware of the resources. Only 11% (8/73) of midwives reported concerns in ordering the test for every patient, with themes being concerns about patient reaction, use of resources, and beliefs that the patient is not at risk. Reasons given for not using electronic ordering included lack of awareness of how to use electronic health record systems, time constraints and accidental omission. Some sites encountered delays in implementation of automated pathology ordering.

Conclusion: This study demonstrates the experience of clinicians in the roll out of a multifaceted implementation support package that was designed to support repeat syphilis screening in later pregnancy. Optimal methods to implement clinical change, including diverse implementation strategies, may be used in the introduction of practice changes in other clinical settings.

Disclosure of interest statement: Stephanie Bond is funded to undertake her PhD research by an NHMRC Postgraduate scholarship. No pharmaceutical grants were received in the development of this study.

65. Female genital schistosomiasis and human papillomavirus in rural Madagascar: a longitudinal study to assess progression and resolution of the diseases

Valentina Marchese^1,2, Jean-Marc Kutz^1,2, Pia Rausche^1,2, Tahinamandranto Rasamoelina³, Sonya Ratefiarisoa⁴, Ravo Razafindrakoto³, Philipp Klein^1,2, Anna Jaeger^1,2, Rivo Solotiana Rakotomalala⁴, Zoly Rakotomalala⁴, Bodo Sahondra Randrianasolo⁵, Sandrine McKay-Chopin⁶, Jürgen May^1,2,7, Raphael Rakotozandrindrainy⁸, Dewi Ismajani Puradiredja¹, Elisa Sicuri⁹, Monika Hampl¹⁰, Irina Kislaya^1,2, Eva Lorenz^1,2, Tarik Gheit⁶, Rivo Andry Rakotoarivelo¹¹ and Daniela Fusco^1,2

¹Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.

²German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.

³Centre Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar.

⁴Centre Hospitalier Universitaire (CHU) Androva, Mahajanga, Madagascar.

⁵Association K’OLO VANONA, Antananarivo, Madagascar.

⁶International Agency for Research on Cancer (IARC), Lyon, France.

⁷University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.

⁸University of Antananarivo, Antananarivo, Madagascar.

⁹Barcelona Institute for Global Health (IS Global), Barcelona, Spain.

¹⁰Köln-Hohenlind Hospital, Cologne, Germany.

¹¹University of Fianarantsoa, Fianarantsoa, Madagascar.

Background: Schistosomiasis is highly endemic in Madagascar. Female genital schistosomiasis (FGS) is the chronic manifestation of Schistosoma haematobium infection. Complications include infertility, ectopic pregnancy and increased risk of HIV acquisition, while the association with HPV infection is still unclear. The objective of this study is to estimate the baseline prevalence of FGS and HPV and to assess possible factors associated with lesion resolution after praziquantel treatment so as HPV clearance dynamics in presence of FGS.

Methods: The study started in 2021 in three Primary Health Care Centers (PHCCs) in Maravoay district. Women of reproductive age were invited to participate through community outreach activities. FGS was diagnosed using colposcopy (CLP). CLP images were reviewed by two specialists through a double-blinded review. A Luminex bead-based assay was performed on cervical vaginal lavages (CVL) for HPV testing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated. Annual reassessment with CLP and CVL collection is being offered for a maximum of four years to all women enrolled in 2021.

Results: To date, 1053 women underwent CLP and CVL at least once, 508 twice and 93 three times. Among 500 women enrolled in 2021, 302 had complete information on FGS and HPV diagnosis: FGS prevalence was 62.6% (189, 95% CI: 56.9–68.1), HPV prevalence 42.7% (129 women, 95% CI: 37.1–48.5 of which 106 82.0% with high-risk infection), and FGS/HPV prevalence was 26.5% (80, 95% CI: 21.6–31.8). No association was observed between FGS and HPV positivity. The analysis of CLP images and CVLs collected in 2022 and 2023 is ongoing.

Conclusion: Both diseases had high baseline prevalence, supporting the need for targeted interventions and the benefit of colposcopy in PHCCs. The analysis of the longitudinal data will contribute to clarify the dynamics of coinfection providing information for the clinical management.

Disclosure of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization.

66. The characteristics of syphilis reinfections among patients attending a Melbourne clinic over a 12-year period

Towns J. M.^1,2,*, Huang T.^1,*, Chow E. P. F.^1,2,5, Zhang L.^2,6,7, Fairley C. K.^1,2, Azzato F.³, Graves S. R.³ and Chen M. Y.^1,2

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

⁴Australian Rickettsial Reference Laboratory, Vic, Australia.

⁵Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁶Clinical Medical Research Center, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210008, China.

⁷Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

^*Joint first authors.

Background: Syphilis is increasing in a number of high- and middle-income countries. Syphilis reinfections are common, including among people living with HIV (PLWH) and those taking HIV Pre-exposure-Prophylaxis (PrEP). We characterised syphilis re-infections among individuals diagnosed over a 12-year period.

Methods: This was a retrospective study of patients with two or more syphilis infections between 2011 and 2022 at Melbourne Sexual Health Centre. Patients with risk factors or symptoms were routinely tested with syphilis serology and lesions swabbed for Treponema pallidum PCR.

Results: 474 patients, 98% men who have sex with men (MSM), had a total of 1,327 syphilis infections. 357 (27%) had primary syphilis, 279 (21%) secondary syphilis, and 640 (48%) with early latent syphilis. 240 patients (51%) had 2 infections,139 (29%) 3 infections, 58 (12%) 4 infections, 28 (6%) 5 infections, and 9 (2%) had ≥6 infections. The proportion of PLWH increased with each subsequent infection, from 190/474, (40%) of first infections, to 29/37 (78%) of cases at the time of the fifth infection. The proportion of early latent syphilis cases increased, and the proportion with primary or secondary syphilis decreased, with reinfection, from 37%, 31% and 22% for the first infection to 78%, 16% and 5% for the fifth infection, respectively. The median duration between first and second infections, and between second and third infections, were 656 days (IQR 325–1262) and 656 days (IQR 352–1114) respectively. The median duration between first and second infections was lower among PrEP-users 341 vs 656 days (P < 0.0001).

Conclusion: Syphilis reinfections are common. The median period between infections was similar across all groups except those currently using PrEP, who had a significantly shorter period between infections. The increase in asymptomatic syphilis with subsequent reinfections may be related to immune responses, more frequent screening, or a combination of these.

Disclosure of interest statement: We declare no competing interests. Acknowledgement of funding: JMT and MYC are supported by Australian National Health and Medical Research Council (NHMRC) Partner Project Grant APP2003399. EPFC, and CKF are supported by Investigator Grants from the NHMRC (GNT1174555, GNT1172873 and GNT1172900 respectively.

67. Mycoplasma genitalium positivity and co-infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae at various care sites across the United States

Van Der Pol B.¹, Arcenas R.², Boraas C.³, Chavoustie S.⁴, Crane L. L.⁵, d’Empaire N.⁶, Ermel A. C.⁷, Harnett G.⁸, Hinestrosa F.⁹, House S.¹⁰, Lillis R.¹¹, Miller J.¹², Mills A.¹³, Poblete R.¹⁴ and Young S. A.¹⁵

¹University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.

²Roche Diagnostics Ltd., Pleasanton, CA, USA.

³Planned Parenthood North Central States, Saint Paul, MN, USA.

⁴Segal Trials North Miami Office, North Miami, FL, USA.

⁵Planned Parenthood Gulf Coast, Houston, TX, USA.

⁶BioCollections Worldwide, Inc., Miami, FL, USA.

⁷Indiana University School of Medicine, Indianapolis, IN, USA.

⁸No Resistance Consulting Group, LLC, Birmingham, AL, USA.

⁹Orlando Immunology Center, FL, USA.

¹⁰Washington University School of Medicine, St. Louis, MO, USA.

¹¹Louisiana State University Health Sciences Center, New Orleans, LA, USA.

¹²Henry Ford Hospital, Detroit, MI, USA.

¹³Mills Clinical Research, Los Angeles, CA, USA.

¹⁴North Jersey Community Research Initiative, Newark, NJ, USA.

¹⁵TriCore Reference Laboratories, Albuquerque, NM, USA.

Background: Mycoplasma genitalium (MG) has increasingly been recognised as a pathogen of importance given its association with persistent urethritis, antibiotic resistance and potential complications (e.g., pelvic inflammatory disease). Here, we assess MG positivity and co-infection with Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) during a trial assessing the clinical performance of the cobas® CT/NG/MG test (assay not cleared by US FDA. Submission currently under review and subject to change per health authority feedback), a polymerase chain reaction (PCR)-based assay for point-of-care testing.

Methods: This non-interventional study assessed MG positivity in prospectively collected (by clinicians/participants) specimens (urine/vaginal swabs in cobas® PCR Media) from symptomatic/asymptomatic patients ≥14 years of age from 13 sites across the US. Participants were designated as being infected (+) or not infected (−) with CT, NG and MG based on combined results from three FDA-cleared assays and one laboratory-developed test. Co-infection rates were determined for samples with valid results for CT, NG and MG.

Results: Median (range) age of the study population (N = 4800) was 35.0 (15.0–81.0) years, 40.4% were symptomatic and 51.9% were assigned female at birth. MG positivity among all/symptomatic/asymptomatic participants was: 9.1%/12.3%/7.3% (male urine), 9.2%/12.1%/6.9% (clinician-collected vaginal swab), 11.2%/10.5%/11.8% (self-collected vaginal swab) and 10.2%/11.3%/9.2% (female urine). Co-infection results were as follows: CT+/NG+/MG+ (n = 2), CT+/NG+ (n = 15), CT+/MG+ (n = 19) and NG+/MG+ (n = 11) in male urine samples; CT+/NG+/MG+ (n = 5), CT+/NG+ (n = 4), CT+/MG+ (n = 35) and NG+/MG+ (n = 7) in vaginal samples; CT+/NG+/MG+ (n = 3), CT+/NG+ (n = 3), CT+/MG+ (n = 27) and NG+/MG+ (n = 6) in female urine samples.

Conclusions: In this US-based population, rates of MG positivity were high and MG co-infection with CT and/or NG was common. The ability to detect MG may facilitate improved antimicrobial stewardship by supporting early treatment optimisation, in addition to reducing onward MG transmission. Co-infection frequency strongly supports multiplex testing.

Disclosure of interest statement: This study was funded by Roche Diagnostics Ltd.

68. High rates of sexually transmitted infections among young people living with HIV in urban Zimbabwe; integrating STI services into HIV care

Lowe S.¹, Simms V.² and Pascoe M.¹

¹Newlands Clinic, Harare, Zimbabwe.

²London School of Hygiene and Tropical Medicine, United Kingdom.

Background: Young people living with HIV (YPLHIV) have high rates of co-infection with sexually transmitted infections (STI). STI directly impact sexual and reproductive health and increase HIV transmission risk. WHO guidelines support syndromic management as standard of care in low-income countries however recommend molecular testing where possible. We report STI incidence and associated risk factors in a cohort of YPLHIV receiving integrated molecular STI/HIV services in urban Zimbabwe.

Methods: From April 2021 to February 2024 all YPLHIV (18–24 years) attending routine HIV care were offered annual STI risk assessment and screening for Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV). STI incidence was calculated. A multivariable Cox proportional hazard model was performed to assess factors associated with STI incidence.

Results: 3210 STI screens were performed on 1181 YPLHIV (57.0% female), of whom 291/341 (85.3%) were virally suppressed (<1000 copies/mL) at first screen. Behavioural risk factor data was collected at 1172 visits. The incidence of any STI (NG, CT, TV) was 27.5/100 py (95% CI 24.7–30.6). CT: 14.4/100py (12.4–16.7), NG: 8.2/100 py (6.8–10), TV: 10/100py (8.3–11.9). Female sex, age <22 years, a new or casual partner and previous history of STI were associated with increased hazard of an STI. Only 8% of patients with a positive STI result reported symptoms. Of 880 patients screened more than once, 199 (22.6%) had an STI on only 1 visit and 116 (13.2%) on >1 visit. Reporting a new partner was associated with increased risk of repeat infection. At visits where the patient reported no previous sex, 5.7% had an STI. At 54% of visits, YPLHIV reported never (20%) or only sometimes (34%) using condoms.

Conclusion: The high rates of asymptomatic STI in this cohort of YPLHIV highlight the inadequacy of syndromic management. Prioritising integration of molecular STI testing into routine HIV care is essential to meet the needs of YPLHIV and HIV elimination targets.

69. Syphilis incidence in pregnant women attending antenatal care in East London, Eastern Cape, South Africa

Mdingi M. M.^1,2, Gigi R. M. S.^1,3, Babalola C. M.⁴, Muzny C. A.⁵, Taylor C. M⁶, Low N.³, Medina-Marino A.⁷, Klausner J. D.⁴ and Peters R. P. H.^1,2,8

¹Research Unit, Foundation for Professional Development, East London, South Africa.

²Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.

³Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

⁴Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

⁵Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.

⁶Department of Microbiology, Immunology, and Parasitology, Louisiana State; University Health Sciences Center, New Orleans, LA, USA.

⁷Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

⁸Department of Pathology, University of Cape Town, Cape Town, South Africa.

Background: In South Africa all women should be routinely screened for syphilis using a rapid treponemal antibody diagnostic test (RDT) at every antenatal care visit. Despite this, the incidence of syphilis in pregnancy is not well-documented. We aim to determine syphilis incidence and associated risk factors in pregnant women in East London, South Africa.

Methods: Women at 5 primary healthcare clinics in East London, South Africa were included in a study about STI testing strategies. Eligibility criteria included age ≥18 years and <27 gestational weeks. At enrolment and follow-up (30–34 gestational weeks), we tested women for syphilis with a rapid diagnostic test (RDT) (Abbott® Determine^TM Syphilis TP, Abbott Diagnostics Medical Co., Ltd, Matsuhidai, Japan). Women with positive test results were treated as per guidelines. We calculated percentages, incidence rates per 1000 person-years and incidence rate ratios (IRR) (with 95% confidence intervals, CI).

Results: From March 2021 to December 2023, 1581 women were enrolled and had follow-up data available. At enrolment, the median gestational age was 14 weeks (IQR 10–19) and 444/1581 (28.1%) were living with HIV. Syphilis RDT was positive for 49/1581 (3.1%) women. At follow-up, among women with a negative test result at baseline, syphilis incidence was 36 per 1000 person-years (95% CI 21.6–57.7). The crude incidence rate ratio for syphilis was 1.31 (95% CI 0.49–3.48). The incidence was 44 per 1000 person-years for women living with HIV and 34 per 1000 person-years for women without HIV. The IRR was 0.96 (95% CI 0.36–2.57) for women ≤25 years compared to those >25 years.

Conclusion: Third-trimester rapid antibody testing showed high incidence of syphilis in pregnant women. Our findings confirm the relevance of repeat syphilis testing in third trimester in our high-prevalence setting.

Disclosure of interest statement: This study was funded by NIH grant number (R01AI49339-01A1) and Cepheid provided GeneXpert® machines.

70. High prevalence of sexually transmitted infections in pregnant women living with HIV in Harare, Zimbabwe: a cross-sectional study

Chawafambira T. A.¹, Kufa T.¹, Pascoe M.¹ and Lowe S.¹

¹Newlands Clinic.

Background: Pregnant women living with HIV (WLHIV) are at increased risk of acquiring sexually transmitted infections (STIs) Untreated STIs during pregnancy are associated with adverse birth outcomes and increased risk of mother to child transmission of HIV. WHO currently supports syndromic STI management in low-income settings but recommends molecular testing where available. We report STI prevalence and neonatal outcomes, in pregnant WLHIV following integration of molecular STI screening into routine HIV care in urban Zimbabwe.

Methods: From April 2021 to February 2024, all pregnant women attending routine HIV care were offered risk assessment and STI screening. Socio-demographic, clinical and sexual behaviour data were collected. The prevalence of 4 curable STI; Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Treponema pallidum (TP) and corresponding neonatal outcomes were evaluated. Frequencies and percentages were used to describe the cohort characteristics.

Results: A total of 267 women with a median age of 26 years (IQR: 22–30) were screened. 27% (71/267) tested positive for an STI, of whom only one reported symptoms. CT was the most common STI at 11% (29/267), TV in 9% (24/267), NG 3% (9/267) and TP 4% (10/267). 13 women (18%) had more than 1 STI. Adverse neonatal outcomes were reported in 8 (11%) women. 7 (10%) had preterm births (2 women with untreated STIs, 1 had pre-eclampsia), one still birth at 24 weeks in a woman with untreated syphilis. 7 women are currently pregnant and 3 neonatal outcomes are unknown (women were lost to follow up).

Conclusion: We report a high prevalence of asymptomatic STIs and adverse birth outcomes in a cohort of WLHIV. Early detection using molecular screening and effective treatment of STIs in this high-risk group is essential and may reduce adverse maternal and perinatal outcomes.

71. Field evaluation of a dual treponemal/non-treponemal point-of-care test for syphilis within an HIV prep program in Hanoi, Vietnam

Biba U.¹, Nguyen L. T. P.², Bui T. T.², Nguyen T. C.², Dau N. S.², Bui H. T. M.², Le G. M.² and Adamson P. C.¹

¹David Geffen School of Medicine, University of California, Los Angeles, USA.

²Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam.

Background: Syphilis infections are high among men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP). Point-of-care testing (POCT) may improve diagnosis and treatment. We performed a field evaluation of a dual treponemal/non-treponemal POCT within an HIV PrEP program in Hanoi, Vietnam.

Methods: From December 2023 to March 2024, MSM age ≥18 years reporting sexual activity in the last year were enrolled to evaluate the Chembio DPP Syphilis Screen and Confirm (Medford, NY). Demographic, behavioral, and clinical data were collected. Participants underwent fingerstick for DPP testing and venous blood draw for treponemal (Abbott Bioline or Determine) and non-treponemal (Rapid Plasma Reagin [RPR]) testing. Positive percent agreement (PPA), negative percent agreement (NPA), Cohen’s kappa, and 95% confidence intervals were calculated for the DPP versus treponemal/non-treponemal tests.

Results: The study enrolled 98 participants (median age: 26.8 years; IQR: 22.9–29.6). In the prior 6 months, 15.3% (15/98) reported group sex and 48.0% (47/98) reported sexualised drug use. Prevalence of treponemal reactivity was 37.9%. PPA for the DPP treponemal test was 75.0% (95% CI: 57.8%–87.9%) and NPA was 93.2% (95% CI: 83.5%–98.1%), with Cohen’s kappa of 0.70 (95% CI: 0.52–0.82). Prevalence of RPR reactivity was 17.5%. PPA for the DPP non-treponemal test was 47.1% (95% CI: 23.0%–72.2%) and NPA was 98.8% (95% CI: 93.2%–100.0%), with Cohen’s kappa of 0.56 (95% CI: 0.29–0.76). For RPR titres ≥1:8, PPA and NPA of the DPP were 100.0% (95% CI: 54.1%–100.0%) and 96.7% (95% CI: 90.7%–99.3%), respectively, with Cohen’s kappa of 0.82 (95% CI: 0.48–0.95).

Conclusion: Among MSM with a high prevalence of syphilis, DPP tests performed well compared to treponemal tests. While the non-treponemal DPP performance was lower, performance was very high for RPR titres ≥1:8. The DPP test holds promise for identifying high-priority, active syphilis infections within this population.

Disclosure of interest statement: All Chembio DPP Syphilis Screen and Confirm tests were provided at no cost by an in-kind donation by Chembio Diagnostic Systems, Inc. (Medford, NY, USA). This study was funded by the United States National Institutes of Health Fogarty International Center (K01TW012170 to Adamson PC and D43TW009343 to Bui HTM), the University of California Global Health Institute, and the Global Health Program at the David Geffen School of Medicine, University of California, Los Angeles.

72. A case report on difficult-to-treat symptomatic trichomoniasis in south-east Queensland

Wang L.¹, Spinks A.², Cowley S.² and Thng C.¹

¹Gold Coast Sexual Health Service, Gold Coast, Australia.

²Ipswich Sexual Health and BBV Service, Ipswich, Australia.

Background: Refractory Trichomonas vaginalis infection to standard metronidazole treatment has been reported with limited high-level evidence in alternative treatment options. The lack of resistance testing in Australia also results in a delay in reaching this diagnosis hence a delay in resistance-guided management.

Methods: Here we describe the challenges in management of three cases of symptomatic trichomoniasis infection.

Results: Three patients were referred to their local sexual health services after failing multiple courses of the standard recommended regimen for symptomatic Trichomonas vaginalis infections. Re-infections were excluded, and higher courses of metronidazole treatment were attempted (i.e., 2g daily orally for 5 to 7 days and/or 800 mg orally three times daily for 7 days) but were unsuccessful. Subsequent treatment with a very high dose of metronidazole (i.e., 2 g twice daily orally plus 5 g twice daily intravaginally for 14 days) was given. One patient completed the course and cleared the infection, but experienced debilitating side effects of peripheral neuropathy. The other two patients were unable to complete this regimen due to the side effects. Further treatment with high dose of tinidazole (i.e., 2 g twice daily for 14 days) was provided with better tolerability and had cleared the infections for both patients. The average time taken from symptomatic to test-of-cure was around 7 months for all three patients.

Conclusion: This case report is the first to highlight the challenges and limitations in treatment for metronidazole-resistant trichomonas infection in Australia. It is important to review the local treatment protocol to guide this difficult-to-treat and debilitating infection which resulted in burden to both the patients and the health services. Research on new and better tolerated treatment options is limited and should be addressed to improve patient treatment outcome.

Disclosure of interest statement: Nil.

73. Antibiotic resistance (ceftriaxone, cefixime, gentamycin) in Neisseria gonorrhoeae in a tertiary care hospital of Padang, West Sumatera, Indonesia

Yossy V.¹, Anum Q.¹ and Chalik C.²

¹Dermatology, Venereology and Aesthetic Department, Medical Faculty of Andalas University/Dr. M. Djamil Hospital, Padang, Indonesia.

²Dermatology, Venereology and Aesthetic Specialist Program, Medical Faculty of Andalas University/Dr. M. Djamil Hospital, Padang, Indonesia.

Background: Gonorrhoea is a commonly occurring sexually transmitted infection. Numerous cases in recent years have demonstrated resistance to antibiotics. Antibiotic resistance in gonorrhoea infections decreases the effectiveness of treatment, leading to incomplete eradication and increasing the likelihood of the disease recurrence.

Methods: The study design was a retrospective cross-sectional using a total sampling method. The data was acquired from the Department of Dermatology and Venereology at Dr. M. Djamil Hospital in Padang, Indonesia, from January 2021 to December 2022.

Results: There was a total of 43 patients diagnosed with gonorrhea infection. The infection rate among males was four times compared to females. The age group of 25–29 had the highest percentage (25.6%) compared to other groups. Neisseria gonorrhoeae isolates showed resistance rates of 37.2%, 30.2%, and 13.9% to cefixime, gentamycin, and ceftriaxone, respectively.

Conclusion: This study highlights a considerable concern regarding antibiotic resistance in the management of gonorrhea. A significant number of Neisseria gonorrhoeae have been identified as being resistant to ceftriaxone, gentamycin, and cefixime. It is important to develop more effective strategies for the treatment of gonorrhea.

Disclosure of interest statement: None.

74. An online survey of quality of services, training, and attitude of dermatology trainee residents about sexually transmitted infections in teaching hospitals across India

Mehta N.¹, Agrawal S.¹, Kaur J.¹ and Gupta S.¹

¹Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India.

Background: The incidence of sexually transmitted infections (STIs) and non-venereal genital diseases (NVGD), especially syphilis, has increased in recent years, however, STI services in India and the world are sub-optimal. It is uncertain how many residents trained in STI services plan to practice it later. This study aimed to assess self-rated quality of training and attitudes about STI amongst residents of teaching hospitals across India.

Methods: In this descriptive cross-sectional survey study, a questionnaire was formulated for assessing opinions in three domains of STIs- institutional STI management practices, quality and satisfaction with training, and attitude towards STI services. The questionnaire was circulated thrice in a WhatsApp group comprising predominantly of postgraduate trainee residents throughout India.

Results: Total 192 responses were included in final analysis from 61 institutes. There was lack of a separate area for examination of STIs/NVGD patients at centres of 52.2% residents. Easily available bedside tests like pH testing for discharge and Whiff test were available in less than half centres, with only 37.5% respondents using them regularly when indicated. Only 55.2% respondents ensured contact tracing and partner treatment. Only 63.7% institutes were providing benzathine penicillin to syphilis patients. Posting duration of less than or equal to 2 months out of 36 months of Dermatology and Venereology residency was reported by 29% residents, with 59.7% wishing for increase in academic schedule duration dedicated to STIs. Under-confidence in managing STIs independently was reported by 21%. Inadequate training was the second reason for wishing to discontinue venereology services upon completion of training; with 30.1% not willing to continue STI practice.

Conclusion: STI care is associated with reluctance. Current STI services and training in Indian teaching hospitals is less than desired and need improvement. Alarmingly, a significant proportion of residents wished not to continue STI practice.

Disclosure of interest statement: None of the authors have any conflict of interest.

75. Empowering recovery: a narrative of success with combination therapy for anal giant condyloma – serial cases

Darmasatria R.¹, Anum Q.², Yossy V.², Ariani T.² and Rizal Y.³

¹Resident of Dermatology, Venereology and Aesthetic Specialist Program, Medical Faculty of Andalas University/Dr. M. Djamil Hospital, Padang, Indonesia.

²Dermatology, Venereology and Aesthetic Specialist Program Department, Medical Faculty of Andalas University/Dr. M. Djamil Hospital, Padang, Indonesia.

³Dermatology, Venereology and Aesthetic Specialist Program Department, Medical Faculty of Andalas University/Dr. Ahmad Mochtar Hospital Bukittinggi, Padang, Indonesia.

Background: Giant Condyloma Acuminatum (GCA) or Buschke-Lowenstein tumor is one of the sexually transmitted diseases caused by Human Papiloma Virus (HPV). Clinical manifestation of GCA is characterised by large tumour with cauliflower shaped. Incidence of these diseases increase in patient associated with immunocompromised such as Human Immunodeficiency Virus (HIV). There is no standard therapy in the management of GCA.

Methods: Three male patients (aged 29, 22, and 23 years old) were identified with a diagnosis of GCA on the anal area and were found to have HIV infection. These patients reported a history of engaging in multiple unprotected male sex male practices (MSM) and admitted to being receptive partners. In the venereological findings on the anal area of all patients, whitish vegetations with a verrucous surface were observed, with an average size of 5.16 cm × 2.83 cm × 1.5 cm. Dermoscopic examination of the verrucous lesions revealed a mosaic and finger like pattern. The Acetowhite test yielded positive results. The diagnosis of GCA was confirmed through the presence of koilocytosis in histopathological examination, and HPV PCR testing revealed type 6 and 11 (low risk) in patients two and three, while patient one exhibited genotyping of HPV 11 and 16 (low and high risk). The patients’ GCA was treated with combination therapy, including serial chemosurgery sessions using 90% trichloroacetic acid, cryotherapy, and HPV vaccination.

Results: The patient shows clinical improvement after had the therapy.

Conclusion: Utilising a combination of 90% trichloroacetic acid, Cryotherapy, and HPV vaccination is beneficial for Giant Condyloma Acuminatum (GCA).

Disclosure of interest statement: None.

76. Brazilian national strategies for mpox in people living with HIV: lessons learnt from the epidemic scenario

Romina S. M. Oliveira¹, Isabella M. C. D. Souza¹, Pamela C. Gaspar¹, Ana R. P. Pascom¹ and Maria C. G. G. Ribeiro¹

¹Brazil’s Ministry of Health, Brasília, Brazil.

Background: Mpox epidemic status at November 2023 indicated 91,123 cases and 157 deaths globally. South America confirmed 127 deaths. The Brazil’s Ministry of Health recorded 10,715 cases and 16 deaths by September 2023, all of them in immunocompromised patients. Brazil was the country with the highest mortality worldwide in 2022.

Methods: As one of the parallel measures to avoid severe immunocompromise in PLWHA (segment with the highest frequency of death), actions for rapid initiation of ART were emphasised. Services that notify and treat suspected cases of mpox should investigate the status of HIV infection and other STIs (syphilis, gonorrhoea, chlamydia, viral hepatitis) in adults/adolescents with a history of exposure to HIV risk, and under suspicion or confirmation of mpox. Also consider the importance of symptom control measures, such as adequate pain management, control of associated pruritus and clinical guidelines related to proctitis. Advise patients about complications and the need for immediate clinical evaluation such as: pain not controlled with oral analgesics, rectal bleeding, extent of the lesions, genital edema, odynophagia. One of the recommended national strategy was to evaluate the offer of HIV Pre-Exposure Prophylaxis for who were at increased risk of HIV infection. In addition to prioritizing vaccination for the cis gay men, transgender and PrEP-using population.

Results: Occurrence of new cases nowadays, despite of lower magnitude is compatible with viral circulation. It is necessary to invest in educational actions to reduce risk, and emphasised the differential clinical diagnosis. The national epidemic data improved technical documents emphasised diagnostic for cases that meet the criteria, improve of diagnostic tests and notification of suspected cases.

Conclusion: Strategic actions at HIV care services should be monitored in parallel with the epidemiological curve, with scenario of endemicity and maintenance and improve of national materials with language developed for priority populations, focusing on prevention.

77. Recurrent herpes-associated erythema multiforme after COVID-19 vaccination

Amelia Pungky^1,2, Angela Satiti Retno Pudjiati^1,2, Niken Indrastuti^1,2, Devi Artami Susetiati^1,2 and Sri Awalia Febriana^1,2

¹Department of Dermatology and Venereology Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia.

²Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

Background: Erythema multiforme (EM) is an acute mucocutaneous reaction with characteristic target lesions. EM is self-limiting and has a mild course, but the burden of this disease lies in recurrence. Infections, medications, systemic conditions, and vaccines are known to be associated with EM. This paper aims to report the herpes simplex virus (HSV) and COVID-19 mRNA vaccine as trigger factors of EM.

Methods: A case of EM minor was investigated with the aim of tracing the aetiology to establish a definitive treatment. A 41-year-old woman presented with multiple typical and atypical target lesions on the trunk and extremities, as the pathognomonic lesions for EM. The patient had EM episodes that recur four times a year. She had a history of genital herpes three years ago, with recurrence thrice a year for two years. One month before the first episode of EM, she received the COVID-19 mRNA vaccine. Serologic examination showed an increase in anti-HSV-2 IgG titre. Histopathologic examination revealed interface dermatitis with vacuolar changes. The patient was treated with systemic corticosteroids, but the EM lesions reappeared.

Results: The patient was given HSV suppression therapy with 800 mg acyclovir divided into two doses for 6 months, resulting in zero recurrence. The most common etiology of EM is HSV infection in about 70% of cases, with recurrence in 20–25% of cases, caused by reinfection or periodic reactivation of HSV. The pathognomonic target lesion resulted from delayed-type hypersensitivity, which caused keratinocyte damage. COVID-19 vaccine, especially mRNA, has a spike protein as an antigenic component, which triggers delayed-type hypersensitivity.

Conclusion: Suppression therapy with acyclovir provides good outcomes in herpes-associated erythema multiforme cases. The COVID-19 vaccine can be a new precipitating factor for immune response reactions resulting in skin lesions. The COVID-19 vaccine history must be considered in the timeline of the lesion onset.

Disclosure of interest statement: All authors have declared no conflict of interest.

78. Overlapping primary syphilis, secondary syphilis, and ocular syphilis in immunodeficiency patient

Pravitaningrum A.¹, Alfieri A.¹, Susetiati Da^1,2, Anggatama M.¹ and Pudjiati Sr^1,2

¹Department of Dermatology dan Venereology Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia.

²Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

Background: Syphilis is a reemerging and potentially serious disease. Neurological involvement is one of the most important clinical manifestations of syphilis. Ocular syphilis is a well-described entity that can result from acquired or congenital infection. In cases of both early and late syphilis, anterior uveitis is the most commonly observed ocular manifestation. This disease can manifest in any part of the eye but as posterior uveitis and panuveitis or immune-mediated optic neuritis.

Methods: Forty-eight-year-old male with blurred vision was referred to the dermatology clinic from the eye clinic in Dr. Sardjito General Hospital with a suspicion of syphilis. From the eye clinic, the patient was diagnosed with Panuveitis non-granulomatosis with clinical manifestation of synechia, a decrease of visual visibility, and conjunctivitis. The toxoplasmosis examination yielded negative results. Dermatological examination shows multiple erythematous plaques of the skin and on the glans penile, there are multiple painless chancres. Muscle weakness was also found in the patient. The laboratory examinations venereal disease research laboratory (VDRL) test and treponema pallidum hemagglutination assay (TPHA) test showed positive results for Treponema pallidum infection. The patient was on ARV, with a CD4 count of 163. Meanwhile, the result from cerebrospinal fluid (CSF) shows a negative result.

Results: The overlapping of primary and secondary syphilis, in this case, is evident from specific cutaneous manifestations such as non-painful ulcers on the penis and multiple erythematous plaques on the body and the palms of the hand. This often occurs in individuals with compromised immune systems such as HIV infection. Eye abnormalities such as panuveitis are also likely ocular syphilis, although the TPHA test on the cerebrospinal fluid yielded negative results. Ocular syphilis can occur at various stages of syphilis.

Conclusion: Bring awareness to the clinicians if they find similar complaints of acuity in syphilis patients especially with immunodeficiency.

Disclosure of interest statement: All authors have declared no conflict of interest.

79. Management of gonorrhoea contacts: evaluation of a change from universal to selective treatment

Ng S.^1,2, Thanthree D. K. J.¹, Chen M. Y.^1,2, Fairley C. K.^1,2, Bradshaw C. S.^1,2,3, Ong J. J.^1,2, Aguirre I.¹ and Chow E. P. F.^1,2,3

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: Australian guidelines recommend considering presumptive treatment for individuals who reported sexual contact with someone with gonorrhoea (hereafter gonorrhoea contacts). In October 2016, the Melbourne Sexual Health Centre (MSHC) changed from routinely treating all gonorrhoea contacts with ceftriaxone plus azithromycin (pre-period) to only treating if subsequent test results were positive for gonorrhoea, unless there was a reason for treatment at presentation (post-period). This study aimed to evaluate whether this policy change led to a fall in ceftriaxone administration and the indications for treatment in the after period.

Methods: This was a retrospective study using existing clinical data from MSHC, 2016–2023. We performed a chart review on a subset of cases between January and February in an alternative year to determine the reasons for treatment. We stratified the data into pre-period (2016) and post-period (2018, 2021, 2023).

Results: 761 chart reviews were performed, most were males (98.4%, 686/761). Overall, gonorrhoea positivity did not differ before (23.6%, 30/127) versus after (30.4%, 192/632) (P = 0.135) routine treatment was stopped. The proportion of gonorrhoea contacts who received treatment on the day of attendance reduced significantly from 95.3% (123/129) to 37.3% (236/632) (P < 0.001) respectively. Of the 236 cases who received treatment in post-period, most were because of patient preference without symptoms (32.2%, 76/236), followed by anogenital symptoms at presentation (31.4%, 74/236). Of the 74 who reported symptoms, 24 (32.4%) tested positive for gonorrhoea. The proportion of individuals who tested negative for gonorrhoea but received ceftriaxone decreased from 74.8% (92/123) to 60.6% (143/236) (p = 0.007). Of the 396 who did not receive ceftriaxone in the after period, 99 (25.0%) tested positive for gonorrhoea and most (89.9%, 89/99) returned to MSHC for treatment.

Conclusion: Our findings indicate that although ceftriaxone use fell, a high proportion of gonorrhoea contacts still received ceftriaxone even though they tested negative for gonorrhoea.

Disclosure of interest statement: EPFC is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). All other authors have no conflicts of interest.

80. Viral load suppression and profile of HIV patients on antiretroviral treatment in Yogyakarta Indonesia: a university hospital-based study

Rusetiyanti N.^1,2, Kusuma R. H.², Rustiyanto E.² and Purnamawati N.²

¹Department of Dermatology dan Venereology Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia.

²Universitas Gadjah Mada Academic Hospital, Yogyakarta, Indonesia.

Background: HIV viral load suppression (VLS) is the most important indicator of successful antiretroviral therapy. Universitas Gadjah Mada (UGM) Academic Hospital started monitoring HIV patients on ART using viral load tests in an effort to meet the third 95 of the UNAIDS 95-95-95 strategy which is VLS. The objective of this study was to describe the profile and achievement of VLS among HIV patients on ARV at UGM Academic Hospital, Yogyakarta, Indonesia.

Methods: A cross-sectional study design was used. Data sources from medical records of HIV infected patients on ART at UGM Academic Hospital year 2021–2023 were reviewed. Data were summarised using descriptive statistics. Univariate analysis was used to examine the profile and VLS of HIV patients.

Result: In this study, there were 47 medical records of HIV patients that meet the criteria. Profile of HIV patients on ART, mean of age was 33 years old, and men were the gender majority (n = 37, 78.7%). Of the patients (n = 43, 91.5%) had attained VLS. Among patients who had not attained VLS, 1 patient had died. The other 3 patients, all are men and they received ART (Efavirenz, Lamivudine, Tenofovir) for therapy.

Conclusion: These findings suggest that in UGM Academic Hospital, at 91.5% VLS is on track to attaining the third 95 of the UNAIDS 95-95-95 strategy global targets by 2025.

Keywords: antiretroviral treatment, HIV patients, viral load suppression.

Disclosure of interest statement: No grants were received in the development of this study.

81. Cost-benefit evaluation of implementation of HPV DNA testing and treatment at a workplace setting in Papua New Guinea

Taganny J.¹, Doro M.¹, Jethro F.¹, Asuari J.¹, Ban L.¹ and Stinshoff V. J.¹

¹Santos

Background: Cervical cancer is a significant public health concern in Papua New Guinea (PNG), ranking as the second leading cause of premature mortality among women. The implementation of a national protocol involving Human Papillomavirus (HPV) testing with self-collected specimens, alongside same-day thermal ablation for precancerous lesions, presents a promising strategy to address this challenge. Santos, an Oil & Gas company in PNG, has implemented free HPV screening and treatment for its female workforce and their families as part of a corporate social responsibility initiative. This paper evaluates the cost-benefits of workplace HPV screening and testing in resource-limited settings.

Methods: Free HPV testing commenced in August 2023 at all Santos clinics in PNG. A Genexpert device was utilised for lab analysis after self-swabbing. Patients who tested positive underwent thermal ablation and follow-up visits as per national guidelines. The cost-effectiveness of the intervention was analysed, considering expenses versus benefits.

Results: In the first 6 months, 156 women presented for HPV testing. 26 women (16.7%) tested positive and received thermal ablation. Utilising existing health facilities and staff, testing and thermal ablation were easily integrated.

Apart from the positive long term health outcomes through easy access HPV screening and treatment, the employer benefitted from high employee satisfaction, reduced lost work time, fostering of inclusivity and gender equality, reduced health care costs and better mental health.

Total cost for program implementation in the first 6 months was USD 8000, with ongoing operating costs of USD 3000/year.

Conclusions: Demonstrating care for women’s health aligns with broader corporate social responsibility objectives reflecting a company’s commitment to the well-being of its employees and the community. This can enhance the company’s brand value and attractiveness. This program demonstrates that workplace HPV screening is an easy-to-implement, low cost, and high impact intervention benefiting both for employees and employer.

Acknowledgement of funding: This program was funded by Santos Ltd, PNG.

82. Impact of the introduction of molecular point-of-care testing for sexually transmitted infections on testing uptake and infections detected in remote and regional Aboriginal and Torres Strait Islander communities in Australia

Tangey A.¹, Smith K.¹, Wand H.¹, Zhang Y.¹, Saha A.¹, Ward J.^2,*, Huang R³, Anderson L.^4,*, Riessen J.^5,*, Betts S.^5,*, Carroll C.⁵, Walshe V.⁶, Andrewartha K.⁷, Shephard M.⁷, Guy R.¹ and Causer L.¹, on behalf of the TTANGO2 collaboration

¹The Kirby Institute, UNSW Sydney, NSW, Australia.

²UQ Poche Centre for Indigenous Health, Toowong, Qld, Australia.

³Nganampa Health Council, SA, Australia.

⁴Kimberley Aboriginal Medical Services, Broome, WA, Australia.

⁵Aboriginal Health Council of South Australia, Adelaide, SA, Australia.

⁶Aboriginal Health Council of Western Australia, Highgate, WA, Australia.

⁷Flinders University International Centre for Point of Care Testing, Bedford Park, SA Australia.

^*Author identifies as Aboriginal and/or Torres Strait Islander.

Background: Remote and regional Aboriginal and Torres Strait Islander communities experience high rates of chlamydia (CT), gonorrhoea (NG) and trichomonas (TV). In these settings, long distances to centralised laboratories, hinder access to timely diagnosis. We evaluated the impact of introducing STI molecular point-of-care testing (POCT) performed by primary care staff on overall tests done and infections detected.

Methods: We conducted interrupted time series analysis to assess changes and compare mean monthly tests and infections detected before (9 months) and after (15 months) the introduction of CT/NG POCT and TV POCT in the TTANGO2 program (2016–2019). We included routine collected testing data from 20 clinics (18 remote, 2 regional) of CT/NG and TV tests (either laboratory or POC), where all clinics contributed data, among Aboriginal and Torres Strait Islander people aged 15–54 years.

Results: There were 14667 CT/NG tests (69% women, 73% 15–34 yrs) and 14160 TV tests (65% women, 68% 15–34 years) conducted. There was an immediate and large increase of CT/NG tests (P = 0.008) when CT/NG POCT was introduced, and a 17% increase in the mean monthly tests in the after period compared with the before period (648 vs 553 P < 0.001). Similarly, there was an immediate and large increase of TV tests (<0.001) when TV POCT was introduced and a 46% increase compared with before (668 vs 456, P < 0.001). The mean monthly number of positive tests also increased in the after period (CT 48%, NG 45%, TV 43%) compared with the before period.

Conclusion: This analysis uniquely demonstrates that the introduction of molecular POCT increased testing and early detection of STIs in remote and regional primary care clinics. The additional STIs diagnosed would have reduced the risk of onward transmission and pelvic inflammatory disease, which are at high rates in these settings. To optimise these benefits, health services must be supported to enable greater uptake of molecular POCT.

Disclosure of Interest Statement: TTANGO2 was funded through a National Health and Medical Research Council Partnership Grant, the Australian Government Department of Health, WA Health, and Queensland Health. The authors acknowledge the contribution to the program of many stakeholders, including participating Aboriginal community-controlled and government-funded health services, pathology providers, communities, academic research institutions, and industry.

Aboriginal and Torres Strait Islander approvals: The study was approved by the Western Australian Aboriginal Health Ethics Committee, Far North Queensland Human Research Ethics Committee, Aboriginal Health Research Ethics Committee of South Australia, Central Australian Human Research Ethics Committee, Human Research Ethics Committee of NT Health and Menzies School of Health Research, Townsville Hospital and Health Service Human Research Ethics Committee, and the Kimberley Aboriginal Health Forum Research Sub-committee. The TTANGO2 program was governed by an Executive Group which included representatives of state and territory peak Aboriginal Community Controlled Health Organisations and partnering Aboriginal Community Controlled Health Services.

83. Barriers, facilitators, and strategies in implementing the etiological approach for managing sexually transmitted infections causing urethral discharge in men in Brazil

Gaspar P. C.^1,2, Díaz Bermúdez X. P.², Bazzo M. L.³, Miranda A. E.^1,4 and Benzaken A. S.^2,5

¹Ministry of Health of Brazil, Brazil.

²University of Brasília, Brazil.

³Federal University of Santa Catarina.

⁴Federal University of Espírito Santo.

⁵Global Program, AIDS Healthcare Foundation (AHF).

Background: In Brazil, managing Sexually Transmitted Infections (STIs) in men with urethral discharge relies mainly on a syndromic approach, posing challenges to adopting the aetiological one. This study aims to identify barriers, facilitators, and strategies for implementing the aetiological approach using the Consolidated Framework for Implementation Research (CFIR), an Implementation Science tool.

Methods: A qualitative study was conducted through semi-structured online interviews. Codes for analysing the interviews were defined deductively based on the CFIR Codebook and inductively supplemented as needed. ATLAS.ti software was used for analysis, and the study received Ethics Committee approval.

Results: From March to April 2023, 15 professionals from all Brazilian regions were interviewed, including five clinicians (doctors or nurses), five from the laboratory, and five public health managers. The main barriers identified were the lack of systematic epidemiological data, the absence of immunochromatographic rapid diagnostic tests for STIs causing urethral discharge, the reduced team sizes, and the high turnover of professionals. Key facilitators for implementing the etiological approach included the opportunity for timely identification and treatment of asymptomatic infections, thereby interrupting the transmission chain; targeted treatment based on specific STI diagnoses; and surveillance for antimicrobial resistance through sample collection. Proposed strategies involved phased introduction, with both approaches initially coexisting. This includes syndromic treatment for symptomatic cases, sample collection for diagnostic tests to identify the causative agent, discussing results during follow-up consultations, and screening asymptomatic cases. Additionally, they recommended compulsory STI notification for standardised data generation, raising awareness, and informing public policy planning. Lastly, they emphasised the need for national meetings on STIs beyond syphilis, HIV, and Viral Hepatitis.

Conclusion: The study highlights significant barriers to implementing the etiological approach. While the syndromic approach remains necessary in the national scenario, professionals demonstrate readiness for change, recognising the importance of delivering quality services for STI prevention and control.

Disclosure of interest statement: No conflicts of interest to declare.

84. Clinical outcome of patients with HPV and its association with various genotypes in STD clinic attendees: a study at tertiary care centre in India

Dewan K.¹

¹Safdarjung Hospital.

Background: HPV infection is most common infection in STD clinic attendees. Majority of HPV infections are subclinical. As each genital infection takes different course, it is impossible to predict the way genital lesions spread, resolve or recur. It is important to treat the clinically evident lesions. Various home-based/hospital-based treatments are employed for its management. Objective of this study is to evaluate clinical outcome of HPV genotypes in sexually transmission infections.

Methods: Between January 2022 and December 2023, patients attending STD clinic at tertiary care hospital were enrolled in a prospective study. Real-time HPV PCR was performed from genital swabs. Complete data were recorded and analysed after informed consent. Patients were subjected to topical therapy/ablative treatment, surgical/immunotherapy depending on HPV genotypes and its site. Patients with high-risk genotypes were referred for proctoscopy and or colposcopy evaluation or lesional biopsy. Patients were followed for 1 year.

Results: A total of 450 patients attending STD clinic were enrolled in the present study. There was male preponderance (252/450, 56%). Mean age of patient-cohort was 33.20 ± 8.74 years. HPV-DNA was detected in 53.78% (242/450) samples. Single HPV genotype was detected in 28.00% patients. Majority of the HPV subtypes were of low risk (most common HPV-11). Low-risk subtypes were more common in males than females (P < 0.05). Among HPV high risk, HPV-16 (44/450) was the commonest subtype. The most common presentation was genital warts in 53.3% (129/242) followed by vaginal/urethral discharge in 41.32%. Majority of low-risk HPV STDs (54.6%) showed complete clearance at 9 months. Persistent disease (>1 year) was seen in 13 low-risk patients. Among high-risk patients, colposcopy revealed CIN-2/CIN-3 in 13.26% patients and referred to gyneoncologist. Recurrent HPV infection was noted in 6.19% patients.

Conclusions: All patients attending sexually transmitted clinic should be evaluated and managed, so as to reduce the HPV burden in the community.

Disclosure of interest statement: No disclosure.

85. Evaluating the impact of regional disasters on STI testing in the United States: a claims data

Holt J. E.¹, Pinto C. N.¹, Chinchilli V. M.¹, Leslie D. L.¹ and Agbese E.¹

¹Penn State University College of Medicine, Department of Public Health Sciences, Hershey, PA 17033, USA.

Background: Disaster events can impact secondary STI prevention practices, potentially increasing rates of transmission; yet, there is a paucity of data supporting this assertion. We aim to assess the impact of disasters on STI testing within the United States.

Methods: We used MarketScan claims data to evaluate changes in STI testing during five disaster events. The frequency of testing was measured by weekly counts of STI tests over 24-months. Descriptive statistics and stratified regression time-series analyses were conducted using weekly STI testing counts. A zero-inflated Poisson regression of the cubic polynomial spline model of the count variable was performed to investigate robustness of the temporal changes.

Results: For each of the five disasters, females represented at least 78% of all STI testing and the highest frequency of testing was among individuals aged 25–34 years old. Disasters that experienced a decline in testing reported at least 22.3% (2450 tests) to 58.8% (9,491 tests) drop in overall STI testing frequency during the week of occurrence. During disasters where STI testing rose, the increase amounted to only 7.2% (220 additional tests).

Conclusion: The results of this study demonstrated a decrease in STI testing claims following Snowmageddon, Hurricane Sandy, and Hurricane Harvey. Winter Storm Jonas and 2018 Carolina Floods experienced minimal increases in STI testing frequency, possibly reflecting the limited impact of the disaster on STI testing. These findings can provide valuable insights for future research investigating the association between disaster events and trends in STI testing. Moreover, this research can inform public health responses aimed at enhancing testing efforts to mitigate the transmission of STIs during and after disasters.

Disclosure of interest statement: None.

Disclosure of interest statement – industry: None.

Acknowledgement of funding: This study was funded in part by the American Sexually Transmitted Disease Association.

86. A district-wide approach to preventing congenital syphilis in South Eastern Sydney Local Health District

Anna Crawford¹, Caitlin Swift¹, Almedina Nurkic¹ and Karen Chee¹

¹South Eastern Sydney Local Health District (SESLHD) Public Health Unit, Sydney, NSW, Australia.

Background: There has been a dramatic increase in syphilis cases in NSW in the last decade, including in women of childbearing age with the potential increased risk of congenital syphilis. Although the risk factors for congenital syphilis are well documented in the literature, policies and initiatives to prevent cases are not as well documented.

Methods: An audit was conducted of syphilis notifications in pregnant women residing in South Eastern Sydney Local Health District (SESLHD) who were diagnosed between 2018 to 2021. The maternal risk factors associated with congenital syphilis in SESLHD included:

Results: Identifying these risk factors allowed us to embed prevention measures into existing community services often used by women who may not engage with traditional antenatal services.

Primary prevention:

Primary care providers are aware that patients can access free testing and treatment at public sexual health clinics, without a Medicare card.

Community-based Drug and Alcohol (D&A) services now screen for pregnancy and syphilis in female clients of childbearing age and discuss contraception.

We engage with Culturally and Linguistically Diverse (CALD) communities (who were over-represented in our audit) to raise awareness of syphilis, testing and treatment in pregnancy.

Secondary prevention:

The Public Health Unit coordinates and facilitates hospital-based antenatal and community-based services (particularly, drug and alcohol, and sexual health) to ensure pregnant women with syphilis have tailored and timely access to treatment.

Conclusion: Our audit findings guided the collaboration of community and hospital-based services to develop and implement primary and secondary prevention initiatives, tailored specifically to women in SESLHD. Our work will contribute to policy and health service evidence on preventing congenital syphilis in vulnerable populations.

Disclosure of interest statement: None.

87. Syphilis in pregnancy management has improved so why does congenital syphilis continue to rise

Dean J. A.^1,2, Moore A.³, Rowling D.⁴, Britton S.⁵, Fowler J. A.¹, Warzywoda S.¹, Safa H.⁶, Wu M. X.⁷ and Nourse C.^3,8

¹The School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Qld, Australia.

²UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, Qld, Australia.

³Queensland Children’s Hospital, Brisbane, Qld, Australia.

⁴Queensland Syphilis Surveillance Service (South), Metro North Public Health, Windsor, Qld, Australia.

⁵Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Herston, Qld, Australia.

⁶Department of Obstetrics and Gynaecology, Mater Mothers’ Hospital, Brisbane, Qld, Australia.

⁷Redcliffe Hospital, Metro North Hospital and Health Service, Qld, Australia.

⁸Faculty of Medicine, The University of Queensland, Herston, Qld, Australia.

Background: Infectious syphilis among people of reproductive age and congenital syphilis cases have continued to increase in Queensland over the last decade despite updated management guidelines. This calls for an urgent review of the management of syphilis diagnosed in pregnancy to identify areas in need of improvement.

Methods: A retrospective audit of syphilis notification data was conducted to evaluate management of syphilis diagnosed in pregnancy in South-East Queensland. Data extracted for 2-timeperiods 2016 to 2018 and 2019 to 2021 (including valid notifications of primary, secondary, early latent, and late latent syphilis in pregnant women, maternal demographics, along with details of testing, results, gestation at diagnosis and management during pregnancy and at delivery) were assessed to determine if management had been consistent with current guidelines (stage-appropriate penicillin regimen, appropriate dosing interval and treatment completed >30 days before delivery).

Results: Between 2016–2018, 22 (73%) of the 30 women identified had management consistent with the guidelines current for this period: 25 (83%) received IM Benzathine benzylpenicillin, 22(73%) completing treatment >4 weeks before delivery and 6 (32%) of the 19 women with a reactive RPR at diagnosis achieved a four-fold reduction in RPR at the time of delivery. Between 2019 and 2021, all 42 women identified completed stage-appropriate treatment with appropriate dosing interval and the correct penicillin, consistent with the revised 2018 guidelines. All received IM Benzathine benzylpenicillin, 35(83%) completed treatment >4-weeks prior to delivery and 20 (60%) of the 33 women with a reactive RPR at diagnosis achieved a four-fold reduction in RPR at the time of delivery.

Conclusion: Concordance of syphilis in pregnancy management with current guidelines has improved. However, if we are to tackle the ongoing congenital syphilis crisis, urgent actions are needed to address the system and personal level barriers experienced by those not engaged in care.

Disclosure of interest statement: The authors have no conflicts of interest to declare. This research was funded by the Sexual Health Research Fund Grant (Round 2) 2019. Administered on behalf of Queensland’s Department of Health by Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). No pharmaceutical grants were received in the development of this study.

88. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea: nucleic acid amplification testing (NAAT) outcomes in a randomised, multicentre Phase 3 trial (EAGLE-1)

Flight W. G.¹, Wilson J. D.², Lewis D. A.³, Ross J. D. C.⁴, Gatsi S.⁵, Scangarella-Oman N. E.⁵, Jakielaszek C.⁵, Lythgoe D.⁶, Janmohamed S.¹, Absalon J.⁵ and Perry C. R.⁵

¹GSK, London, UK.

²The Leeds Teaching Hospitals NHS Trust, Leeds, UK.

³Sydney Medical School-Westmead, University of Sydney, Sydney, NSW, Australia.

⁴University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

⁵GSK, Collegeville, PA, USA.

⁶GSK, Stevenage, UK.

Background: A Phase 3 trial (EAGLE-1; NCT04010539) demonstrated that oral gepotidacin, a first-in-class triazaacenaphthylene bactericidal antimicrobial, was efficacious in treating uncomplicated urogenital gonorrhoea (uGC), assessed by bacterial culture. Microbiological success rate by culture at the urogenital body site was 92.6% (gepotidacin) versus 91.2% (ceftriaxone/azithromycin). Nucleic acid amplification testing (NAAT) offers practicality and reflects real-world practice. Exploratory outcomes determined by NAAT are presented.

Methods: EAGLE-1 compared efficacy and safety of 2 × 3000 mg oral gepotidacin with 1 × 500 mg intramuscular ceftriaxone plus 1 × 1000 mg oral azithromycin for uGC. Participants provided urogenital specimens for culture and NAAT at baseline and test-of-cure (day 4–8). The microbiological intent-to-treat (micro-ITT) population included all participants who received ≥1 dose of treatment with confirmed ceftriaxone–susceptible urogenital Neisseria gonorrhoeae isolated at baseline. NAAT-confirmed treatment success in the micro-ITT population was defined as nucleic acid clearance at test-of-cure. Missing/unable to determine NAAT at test-of-cure were considered failures.

Results: Of 628 participants randomised, 89% were male and median age was 32 years. At baseline, concordance between central laboratory urogenital NAAT and culture was 98.4% (post-hoc analysis). In the micro-ITT population, urogenital NAAT-confirmed success rates at test-of-cure were 82.5% (151/183) for gepotidacin and 75.0% (132/176) for ceftriaxone/azithromycin (adjusted difference: 8.2%, 95% confidence interval [CI]; –0.1%, 16.5%). In the microbiologically-evaluable NAAT population (324 micro–ITT participants with valid NAAT results who followed important study components), urogenital NAAT-confirmed success rates at test-of-cure were 88.3% (151/171) for gepotidacin and 86.3% (132/153) for ceftriaxone/azithromycin (adjusted difference: 3.8%, 95% CI; –3.6%, 11.2%).

Conclusion: Despite timing of test-of-cure being optimised for culture, NAAT success rates at the urogenital site were high and similar between gepotidacin and ceftriaxone/azithromycin, and were lower than culture-defined success rates, as expected. Baseline NAAT-culture concordance was high, suggesting NAAT may be a promising alternative to culture in uGC trials.

Disclosure of interest statement: WGF is an employee of and shareholder in GSK. JDW provides external expert advice to GSK. DAL provides external expert advice to GSK. JDCR is a shareholder in GSK and AstraZeneca. Member of the European Sexually Transmitted Infections Guidelines Editorial Board. Editor for UK National Institute for Health Research Journals Library. SG is an employee of and shareholder in GSK. NESO is an employee of and shareholder in GSK. CJ is an employee of and shareholder in GSK. DL is an employee of and shareholder in GSK. SJ is an employee of and shareholder in GSK. JA is an employee of and shareholder in GSK. CP is an employee of and shareholder in GSK. EAGLE-1 (GSK study BTZ116577) was funded in part by GSK and in part with Federal funds from the US Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority (HHSO100201300011C).

89. Gonorrhoea culture recovery after positive nucleic acid amplification test results - preliminary results

Jung J.^1,4, Chen M.^1,2, De Petra V.^1,3, Fairley C.^1,2 and Chow E.^1,2

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Monash University, Vic, Australia.

³Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Vic, Australia.

⁴Department of General Practice and Primary Care, The University of Melbourne, Vic, Australia.

Background: Culture of N. gonorrhoeae remains important for providing antimicrobial resistance (AMR) data for surveillance. To date, the culture recovery rate for N. gonorrhoeae at female genital sites is not well documented. Our study aimed to determine the yield rate of culture among women recalled for treatment following a positive nucleic acid amplification test (NAAT) result and to compare this with the yield rate from pharyngeal and rectal cultures among males.

Methods: We identified individuals who attended the Melbourne Sexual Health Centre for N. gonorrhoeae culture after a positive NAAT result between April 2015 and March 2023. Hologic Aptima Combo 2 test was used for NAAT test and culture was performed on modified Thayer Martin agar by direct inoculation and was read at 48 h after inoculation. Individuals who had received penicillin, macrolide and tetracycline-based antibiotics prior to culture were excluded. Descriptive statistics and logistic regression analyses were utilised to investigate factors associated with gonorrhoea culture recovery rate.

Results: We identified 109 male throat, 109 male rectal, 109 female high vaginal and 39 cervical culture cases. The gonorrhoea culture recovery rate was lower in male throat (n = 53, 48.7%, adjusted odds-ratio [aOR] 0.50, 95% confidence interval [CI] 0.29–0.86), female high vaginal (n = 37, 33.9%, aOR 0.26, 95% CI 0.15–0.45) and cervical (n = 13, 33.3%, aOR 0.26, 95% CI 0.12–0.56) sites than in the male rectal site (n = 72, 66.1%, 95% CI 56.58–74.40).

Conclusion: The lower gonorrhoea culture yield rate in the female high vaginal and cervical sites suggests the proportion of gonorrhoea infections among women where data on AMR will be more limited than among males with rectal infections. Alternative antimicrobial susceptibility testing may be required in female genital tract gonorrhoea infections.

Disclosure of interest statement: None.

90. The development of a clinical algorithm in response to new cases of symptomatic urogenital disease due to Neisseria meningitidis at a sexual health clinic in inner West Sydney, Australia

Hillary M. McArthur¹, David J. Templeton¹ and Rachel M. Burdon¹

¹Department of Sexual Health Medicine, Community Health, Sydney Local Health District, NSW, Australia.

Background: Neisseria meningitidis (NM) is an obligate commensal organism of the human nasopharynx, occasionally causing invasive meningococcal disease. Globally, outbreaks of invasive meningococcal disease (IMD) have occurred among men who have sex with men (MSM) acquired through orogenital contact.

Five cases of symptomatic genital infections due to NM were observed in 2023–2024 at our clinic in Sydney, Australia. In each case, Neisseria gonorrhoeae (NG) was the presumed diagnosis on gram stain findings, and each was treated as such with NM subsequently diagnosed on culture. Ongoing management was challenging, with limited guidelines to inform appropriate clearance antibiotics, contact tracing and vaccination. We outline the characteristics of the NM cases and the clinical algorithm developed.

Methods: A file review of the five cases of symptomatic urogenital NM was performed. Key characteristics were collated including gender, presenting symptoms, PCR and culture results, antibiotic sensitivities, serotype, and final management provided to index case and contacts.

The clinical algorithm was developed by reviewing local and national public health guidelines and literature and meeting relevant stakeholders. Given the limited number of cases of urogenital NM globally, much of this was extrapolated from guidelines for IMD which may not be appropriate.

Results: Timely management is critical to reduce transmission and sequelae of NM infections, including pelvic inflammatory disease, infertility, and IMD. Ciprofloxacin is the first line choice for clearance antibiotics, and contact tracing includes sexual contacts in the preceding 7 days since symptom onset in the index case. Vaccination is offered to the index case and their contacts, depending on the NM serotype.

Conclusions: This clinical algorithm was developed to respond to cases of sexually acquired NM and manage their contacts. This will provide guidance for clinicians managing this syndrome, allowing for standardised care.

Disclosure of interest statement: The authors declare no conflicts of interests.

91. Problematic of weak community support by mothers mentors in monitoring exposed children born from HIV+ mothers and retention in paediatric HIV care

Kinngu Kikumbi R.¹, Kendy M.², Edwige M.³, Marie-Agnes M.⁴ and Daniel M.⁵

¹CALI Ladies Foundation for Excellence – CALFE.

²EventsDRC.

³CALI Ladies Foundation for Excellence – CALFE.

⁴National Program Against VIH/AIDS in DRC – PNLS.

⁵General Hospital of Reference of Kitambo.

Background: In 2023, the DRC had around 490,000 PLHIV, including 60,000 children, 33,000 from them, or 55%, did not have access to ART. Inequalities in access between adults and children are observed: 88% versus 44%. Furthermore, in 16,000 new HIV infections, 46% occur in children under 15 or 20 children diagnosed every day or 7300 per year. Then the contribution of the mother-mentor to eliminate vertical transmission.

Methods: The study was conducted in 10 provinces and covered PMTCT data from 2019 to 2021. This involved an evaluation of the performance of PMTCT interventions, identification of bottlenecks and the contribution of the mother-mentor to exposed children. The approach quantitative focused on the collection, analysis, consolidation of quantitative data. The qualitative part involved semi-structured interviews with HIV+ pregnant and breastfeeding women on ARTs, healthcare providers and Technical and financial stockholders.

Results: Coverage of ARV prophylaxis among exposed children in 2021 was only 23%. In 28,995 exposed children, only 2692 or 9% had received a virological test within 6 weeks of their birth. These percentages declined, 33% of HIV+ children started ART. Also, the Mother Mentor approach was not effective: The insufficiency of trained Mother Mentors, the lack of standardised tools, the total demotivation of Mother Mentors, had a negative impact with the consequence of high loss of HIV+ women and their children in the PMTCT program (31%).The causes explaining these bottlenecks: Low involvement of mother mentors due to lack of motivation, unavailability of inputs such as Nevirapine, cartridges for EID.

Conclusion: The problem of poor community support from mother-mentors in the paediatric service is the determining important factors, reason for poor access to paediatric HIV care service. The legislative and political framework agree to revitalise this approach because of clinical services and availability of inputs, and the success of PMTCT from communities.

Disclosure of interest statement: Acknowledgement of Funding: National HIV Program: PNLS.

92. Quinolone resistance-associated mutations in Mycoplasma genitalium infections in Denmark: prevalence and genotypes from 2018 to 2024

Drud S. T.¹, Norgaard C.¹ and Jensen J. S.¹

¹Research Unit for Sexual and Reproductive Microbiology, Department of Bacteria Parasites and Fungi, Denmark.

Background: Resistance to fluoroquinolones for the treatment of Mycoplasma genitalium (MG) is on the rise and single nucleotide polymorphisms (SNPs) in the parC and gyrA genes have been implicated. Our objective was to identify quinolone resistance-associated mutations (QRAM) in these genes in a subset of MG samples received at the Statens Serum Institut, Denmark between 2018 and 2024.

Methods: We tested 2110, male and female, MG positive, macrolide susceptible and resistant samples for QRAMs in the parC gene. If detected, QRAMs in the gyrA gene were sequenced with published primers. QRAMs in positions S83 (except S83N) and D87 of the parC gene were considered significant. SNP’s in positions M95I or D99N of the gyrA gene were considered additive.

Results: 104 samples had parC QRAM (4.9%, 95% CI 3.9%–5.8%) with 2021 reporting an unusually high rate of 9.1% (95% CI 6.5%–11.6%). The prevalence in males was slightly higher though not statistically significant (5.4% vs 4% in females, P = 0.13). Consistent with findings globally, S83I (64, 61.5%) was identified as the dominant QRAM, followed by D87N (28, 27%) and D87Y (22, 21.1%). QRAMs in the gyrA gene were detected in 17.3% (18 of 104, 95% CI 10–25.5%) samples. Additionally, we will present annual prevalence and revised data as the analyses are not final.

Conclusion: This nationwide study of randomly selected clinical specimens provides insight into QRAM epidemiology and highlights an increasing trend towards fluoroquinolone resistance, upwards of 5% in the later years in Denmark. Treatment failure with moxifloxacin in the presence of QRAM has been well documented though not absolute, so in the absence of suitable and efficient alternatives, resistance-guided therapy with the inclusion of QRAM analyses is not currently advised in Denmark. Detection of QRAMs after moxifloxacin treatment failure, however, is key to distinguishing re-infection from resistance.

Disclosure of interest statement: JS Jensen reports grants, personal fees and non-financial support from Hologic, personal fees from Roche, grants and personal fees from SpeeDx, grants and personal fees from Nabriva, grants and personal fees from Cepheid, grants and personal fees from Abbott and grants and personal fees from GSK all outside the submitted work. Other authors have no conflicts of interest.

93. Effect of antenatal point-of-care screening and treatment for chlamydia and gonorrhoea on neonatal conjunctivitis and pneumonia: pragmatic cluster-randomised crossover trial in Papua New Guinea

Low N.¹, Riddell M. A.^2,3, Mengi A.², Spycher B. S.¹, Vallely L. M.^2,3, Wand H.³, Cunningham P. H.⁴, Laman M.³, Pomat W. S.³ and Vallely A. J.^2,3, WANTAIM study group

¹Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

²Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.

³The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

⁴NSW State Reference Laboratory for HIV, St. Vincent’s Hospital, Sydney, NSW, Australia.

Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cause neonatal conjunctivitis and CT can cause pneumonia. Antenatal screening and treatment for CT/NG are conducted in several countries to prevent neonatal disease. The objective of this study was to evaluate the effect of an antenatal screening intervention on neonatal conjunctivitis and pneumonia.

Methods: The Women And Newborn Trial of Antenatal Interventions and Management (WANTAIM) was a randomised cluster crossover trial in Papua New Guinea. We conducted a substudy in 5/10 clusters (July 2017–August 2021). The intervention was point-of-care screening (GeneXpert) and treatment for CT, NG, Trichomonas vaginalis and bacterial vaginosis at three antenatal visits, the last at 34–36 weeks. The control group received syndromic management. Eye and/or nasal swabs were collected from babies at three visits up to 6 weeks after birth. The primary outcome was clinically diagnosed conjunctivitis or moderate/severe pneumonia. A secondary outcome was PCR-positive CT/NG. Analysis was by intention-to-treat, accounting for phase and cluster.

Results: We enrolled 2054 newborns (1038 intervention; 1016 control). By 6 weeks, 184 babies had a clinical outcome (168 conjunctivitis, 17 pneumonia, 1 with both); intervention 7.9% (n = 82), control 10.0% (n = 102) (relative risk 0.86, 95% CI 0.50, 1.48). Among babies with conjunctivitis, 14/168 (8.3%) had CT and 3/168 (1.8%) had NG in an eye swab. Among babies with pneumonia 1/17 (5.9%) had CT in a nasal swab. By 6 weeks, 133/2054 babies, irrespective of clinical outcome, had PCR-positive CT (n = 102) or NG (n = 38) (7 had both); 4.3% (n = 45) in intervention and 8.7% (n = 88) in control groups. The relative risk of CT/NG detection was 0.38 (95% CI 0.04, 3.95).

Conclusion: This is the first randomised trial to evaluate effects of antenatal screening and treatment on CT/NG-associated neonatal outcomes; the small number of clusters limited statistical power. The intervention might reduce clinical outcomes and PCR-positive CT/NG.

Disclosure of Interest Statement: Cepheid (Sunnyvale, CA, USA) contributed diagnostic consumables at subsidised cost. No authors have any other interests to disclose. This study was funded by the Swiss National Science Foundation Research for Development award (number IZ07Z0_160909), Joint Global Health Trials award from the UK Department of Health and Social Care, UK Foreign Commonwealth and Development Office, UK Medical Research Council and Wellcome Trust (number MR/N006089/1) and Australian National Health and Medical Research Council (number GNT1084429).

Epidemiology and surveillance abstracts

94. Attack of the bots: when an STI survey goes viral

DeWitt M. E.^1,2, Wenner J. J.¹, Madola A.¹ and McNeil C. J.¹

¹Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

²Department of Biology, Wake Forest University, Winston-Salem, NC, USA.

Background: Surveys using anonymous, respondent-driven sampling (RDS) approaches using financial incentives are a valuable tool for understanding attitudes, sexual behaviours, and practices among difficult to reach populations. However, what happens when the survey itself unintentionally goes viral, and becomes inundated with non-human, bot traffic attempting to exploit the financial incentive. We describe results from a limited recruitment in person survey that unexpectedly was converted to an RDS survey via a social platform infiltrated by bots.

Methods: We deployed an in person limited audience survey via QR code at select locations in the Piedmont Triad area of NC to understand the use of geolocation applications among marginalised MSM. The survey was unexpectedly posted on a social media platform and went viral. We used time series analysis to track the number of respondents over time. Descriptive statistics were performed on the frequency of repeated responses, length of free text responses, and agreement amongst demographic and baseline variables.

Results: A total of 4,709 responses were captured between August 2022 and March 2023, with only 13 respondents over a 6-month period until a clear change occurred: over 500 responses were recorded in a single hour and over 2000 in a single day. The initial responses were primarily from within 30 miles of the recruitment site. The remaining responses included many out-of-state and international locales. Open text responses were remarkably sophisticated; however, many multiple-choice responses were internally inconsistent.

Conclusion: All internet-based survey platforms should use defensive techniques to prevent assault by bots. This could include use of data validation fields, multiple questions asking the same thing in different ways, validation of survey response times, and IP address screens. With the rise of large language models, bot attacks with sophisticated responses to open-ended questions can threaten the integrity of research studies.

Disclosure of interest statement: None. This study utiliSed a REDCap survey funded by the Clinical & Translational Science Institute at the Wake Forest University School of Medicine. No industry or pharmaceutical grants were received in the development of this study.

95. Linkage to care and prevention after HIV self-testing: a systematic review and meta-analysis

Zhang Y.^1,2, Goh S. M.³, Tapa J.^1,2, Johnson C. C.⁴, Chow E. P.^1,2,5, Zhang L.^1,2, Phillips T. R.^1,2, Fairley C. K.^1,2 and Ong J. J.^1,2,6

¹Central Clinical School, Monash University, Melbourne, Vic, Australia.

²Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Vic, Australia.

³Chelsea and Westminster Trust, London, United Kingdom.

⁴Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.

⁵Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁶Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals who are linked to prevention and care after HIV self-testing (HIVST) and describe factors associated with linkage.

Methods: A literature search was conducted across eight databases, including conference abstracts, up to October 2023. Linkage to care after HIVST was defined as getting a confirmatory test or antiretroviral therapy (ART) if the self-test was reactive, and/or pre-exposure prophylaxis (PrEP) if the self-test was non-reactive. A random-effects meta-analysis was performed to summarise the linkage to prevention and care.

Results: A total of 10,071 studies were screened, of which, 174 were included in this meta-analysis. Most studies were conducted in the African region among key populations using oral fluid-based HIVST kits. Overall, 92% (95% confidence interval (CI): 89–96) of those whose HIVST was reactive were linked to confirmatory testing, and 89% (95% CI: 84–93) of those newly-diagnosed with HIV initiated ART. Eighty-four percent (95% CI: 74–93) of self-testers were linked to care. Of the individuals whose HIVST was non-reactive, 9% (95% CI: 2–19) were linked to PrEP. Studies utilising assisted HIVST demonstrated a higher linkage to confirmatory testing 98% (95% CI: 88–100) and ART initiation (91% (95% CI: 84–96)) compared to studies using unassisted self-testing (91% (95% CI: 86–95), 89% (95% CI: 83–95), respectively). Our meta-regression analysis found that the type of delivery model for the HIVST kits influenced linkage and that individuals who obtained their HIVST kits through a social network–based approach (SNA) were more likely to be linked to confirmatory testing (adjusted odds ratio (aOR) = 1.28 (95% CI: 1.10–1.50), P = 0.001) compared to non-SNA service delivery model.

Conclusion: In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly with assisted HIVST and when SNA was used to obtain the HIVST kits.

Disclosure of interest statement: JJO and EPFC are supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955 and GNT1172873). CKF is supported by an Australian National Health and Medical Research Council Leadership Investigator Grant (GNT1172900). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.

96. A global review of national guidelines of post-exposure prophylaxis for the prevention of HIV

Zhang Y.^1,2, Maisano M.^1,2, Tran D.³, Macdonald V.⁴, Baggaley R.⁴, Ford N.⁴, Johnson C. C.⁴ and Ong J. J.^1,2,5

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Monash University, Melbourne, Vic, Australia.

³Melbourne Medical School, The University of Melbourne, Melbourne, Vic, Australia.

⁴Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.

⁵Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: The World Health Organization (WHO) recommends the use of post-exposure prophylaxis (PEP) for preventing HIV infection in occupational and non-occupational exposures. To inform the development of global WHO recommendations on PEP, we conducted a global review of national PEP guidelines.

Methods: Policies addressing PEP from 38 WHO HIV priority countries were obtained by searching governmental and non-governmental websites and consulting country and regional experts; these countries were selected based on HIV burden, new infections and the number of HIV-associated deaths. We reviewed national guidelines published as of August 2023 to collate data on who can prescribe PEP, recommended drug regime, linkage to other interventions, recommended investigations prescribed with PEP, and HIV self-test recommendation related to PEP.

Results: In total, 46 guidelines across 36 countries were included, with the majority (70%) of documents published on or after 2020. There was significant variation across guidelines regarding where PEP can be accessed and who can provide/prescribe PEP. Six countries (17%) described being able to access PEP from a primary care facility, four countries (11%) from hospitals and two (6%) from community-based services. Only three countries (8%) specifically considered dispensing PEP by professionals other than doctors (e.g. nurses). None mentioned pharmacists as prescribers. We found a lack of consistency across countries regarding who is eligible for PEP, regimens used, interventions integrated into PEP provision and recommended investigations for PEP users. No country guidance provided considerations on using HIV self-tests for starting or after stopping PEP.

Conclusion: The findings from this review underscore the need for a globally unified approach to PEP recommendations that is in line with best practices and the latest evidence. This should include recommendations for decentralisation and task-sharing to achieve sufficient scale for impact. Improving timely access to PEP among those who need it would contribute to reducing the incidence of HIV globally.

Disclosure of interest statement: JJO is supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.

97. HIV self-test: knowledge, attitudes, and practices among Asian-born gay, bisexual, and other men who have sex with men in Australia

Zhang Y.^1,2, Fairley C. K.^1,2, Zhang L.^1,2, Chow E. P.^1,2,3, Ong J. J.^1,2,4 and Phillips T. R.^1,2

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Monash University, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁴Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: To explore novel interventions to improve awareness of HIV status, we aimed to examine the knowledge, attitudes, and practices of HIV self-testing (HIVST) among Asian-born gay, bisexual and other men who have sex with men (GBMSM).

Methods: This qualitative study used semi-structured interviews of self-identified GBMSM who are of Asian ethnicity and were born overseas. Participants were recruited from personal networks, social media platforms, snowballing, and the Melbourne Sexual Health Centre. Twenty-five participants were purposively sampled with a range of ages and previous experiences of HIVST.

Results: A majority of participants were unaware of HIV self-testing before the interview and only a few had ever used one before. Most had limited sexual health knowledge prior to their arrival in Australia. Upon learning about HIV self-testing during the interview, many expressed willingness to use HIVST, but only under limited circumstances, such as travelling overseas, interim testing while taking on-demand PrEP, and point-of-sex testing. Almost all (23/25) of them were open to distributing HIVST to their casual partners or friends, especially those who they know engaged in high-risk sexual behaviour and were not engaged in sexual health care. However, about half of the participants still preferred traditional serology testing. The reasons cited include regular HIV testing as part of PrEP prescription, need for STI tests, HIVST has a long window period and lack of self-confidence in performing the HIV self-test correctly. Seven participants who had prior experience of HIVST either in their country of origin or in Australia knew or received the HIVST from their friends or partners. Their reasons for utilising HIVST were: to avoid facility-based testing due to confidentiality and privacy reasons, fear of judgement from healthcare staff, point-of-sex testing, and testing after high-risk exposure.

Conclusion: Peer education and secondary distribution may help raise HIV self-testing rates and awareness among the Asian-born GBMSM population.

Disclosure of interest statement: JJO and EPFC are supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955 and GNT1172873). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.

98. HIV, hepatitis, and syphilis self-testing among adolescents and young people: a systematic review and meta-analysis

Zhang Y.^1,2, Tapa J.^1,2, Johnson C. C.³, Baggaley R. C.³, Fairley C. K.^1,2,4 and Ong J. J.^1,2,5

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Monash University, Melbourne, Vic, Australia.

³Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.

⁴University of Melbourne, Melbourne, Vic, Australia.

⁵Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: Adolescents and young people make up a disproportionate share of the world’s HIV and sexually transmitted infections (STI). Self-testing can increase testing coverage and strengthen the uptake of HIV/STI prevention and treatment services. We aimed to critically appraise the literature regarding HIV, hepatitis, and syphilis self-testing among adolescents and young people (age 10–24 years, based on WHO definition), and assess its acceptability, feasibility, usability, and cost-effectiveness.

Methods: We conducted a systematic review, searching six databases between January 2010 and October 2023. We included all studies on HIV, hepatitis and syphilis self-testing in adolescents and young people. A random-effects meta-analysis was used to summarise the uptake, proportion of first-time testers and linkage to care. Qualitative data were narratively synthesised.

Results: We identified 104 relevant studies, of which 98 were on HIV, four on hepatitis and two on syphilis self-testing. Among these, 46 studies were included in the meta-analysis. Most studies were conducted in the African region (n = 33/46,72%) and lower-middle-income countries (n = 17/46, 37%). Approximately 90% (95% confidence interval (CI): 82–96%, I² = 99%) of adolescents who were offered any of the three types of self-test completed the test. Around 78% (95% CI: 26–100%, I² = 98%) of adolescent self-testers reporting reactive result subsequently linked to further testing and onward care as needed. In general, there was high acceptability and usability among adolescents and young people towards self-testing. Adolescents aged 10–14 preferred receiving a self-test kit with pre-test counselling or assisted video/audio instructions from a healthcare worker. Most individuals aged 15–24 liked the confidentiality, convenience and non-invasiveness of self-test. They also found self-testing easy to perform without assistance and were confident of interpreting the results by themselves.

Conclusion: Self-testing is a safe, effective and accessible way to increase HIV, hepatitis and syphilis testing in adolescents and young people. Efforts to ensure access to self-testing for this population should be prioritised across disease areas to maximise public health impact.

Disclosure of interest statement: JJO is supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955). CKF is supported by an Australian National Health and Medical Research Council Leadership Investigator Grant (GNT1172900). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.

99. Dynamic Neisseria gonorrhoeae sequence types during sudden increase of gonorrhoea among young women in 2022 and 2023 in The Netherlands

Visser M.^1,2, Zondag H. C. A.^3,4, van Benthem B. H. B.¹, Bruisten S. M.^3,4, Götz H. M.⁵, Klaassen C. H. W.⁶, van Veen S. Q.⁷, de Vries H. J. C.^8,9, Wolffs P. F. G.¹⁰ and van Dam A. P.^3,4

¹Centre for Infectious Disease control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

²Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

³Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

⁴Department of Medical Microbiology, University of Amsterdam, Amsterdam Institute for Infection & Immunity, Amsterdam Medical Center, Amsterdam, The Netherlands.

⁵Department of Sexual Health, Public Health Service Rotterdam, Rotterdam, The Netherlands.

⁶Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

⁷Department of Medical Microbiology and Infection Prevention, Haaglanden Medisch Centrum, The Hague, The Netherlands.

⁸Department of Dermatology, University of Amsterdam, Amsterdam Institute for Infection & Immunity, Amsterdam Medical Center, Amsterdam, The Netherlands.

⁹Department of Infectious Diseases, Center for Sexual Health, Public Health Service Amsterdam, Amsterdam, The Netherlands.

¹⁰Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.

Background: Since September 2022, a nationwide increase in gonorrhoea diagnoses and positivity rate among heterosexuals visiting Sexual Health Centres was observed in the Netherlands. Especially young women with high education level and Dutch ethnicity were affected. This study aims to investigate this gonorrhoea surge by gaining insight into molecular diversity, transmission, and clustering of Neisseria gonorrhoeae (NG) among young women.

Methods: Between January 2022 and March 2023, stored NG isolates from vaginal samples from 279 women aged under 25 years were included from four regions in the Netherlands (Amsterdam: 208, Rotterdam: 39, Maastricht: 23, The Hague: 9). Isolates were whole-genome sequenced. We assessed prevalence of sequence types (ST) by multi-locus sequence typing over time and used univariable logistic regression analysis to investigate associations between patient characteristics (age, education, ethnicity) and ST.

Results: Before the gonorrhoea surge (first half of 2022), ST8135 (9/55, 16%) and ST8163 (7/55, 13%) were most prevalent. However, their prevalence decreased to 1% (both 1/104) in the first quarter (Q1) of 2023. In Q1 2023 most prevalent STs were ST7359 (21%), ST7822 (23%) and ST9363 (14%). Prevalence increased for ST7359 and ST7822 significantly, starting from 6% and 9% in the first half of 2022. In regression analysis, women with high education level were more likely to have ST7359 (OR 3.8, [95% CI 1.8–9.3]) and ST9363 (3.07 [1.91–9.91]), and less often had ST8135 (0.2, [0.1–0.5]). Age <21 was associated with ST7822 (2.21, [1.0–5.3]). Non-Dutch ethnicity was associated with ST8163 (6.2, [2.0–21.7]) and negatively with ST9363 (0.22 [0.04–0.70]).

Conclusion: The current NG surge among young women is not caused by a single strain. Certain STs are associated with distinct risk groups. The shift in ST prevalence over time suggests a rapid clonal expansion of several circulating STs. This could be indicative of increased transmission within specific sexual networks.

Disclosure of interest statement: None.

100. Risk factors for infection with antimicrobial resistance NEISSERIA gonorrhoeae in men with gonococcal urethritis in Nanjing, China

Li S.¹, Le W.¹, Wang B.¹, Genco C. A.², Rice P. A.³ and Su X.¹

¹Sexually Transmitted Disease Clinic, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.

²Department of Immunology, Tufts University School of Medicine, USA.

³Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Chan Medical School, USA.

Background: N. gonorrhoeae rapidly develop antibiotic resistance (AMR). This study explored potential risk factors associated with AMR of N. gonorrhoeae in men with gonococcal urethritis in Nanjing.

Methods: Antimicrobial susceptibility was tested by agar dilution method according to the clinical and laboratory standards institute (CLSI) guidelines. Case report forms were used to collect demographic and behavioural factors and clinical information during separate time periods (January 2013 to August 2015 and December 2017 to December 2019). Logistic-regression was used to investigate variables associated with resistance to penicillin, tetracycline, reduced susceptibility to ceftriaxone, cefixime or azithromycin and to infection with multidrug-resistant N. gonorrhoeae (MDR-NG).

Results: 831 cases of gonococcal urethritis males, identified successively in each time period, were analysed. A history of antibiotic use in the previous 30 days, especially β-lactam use, was the single variable associated with MDR-NG identified in both univariable and multivariate analysis. Other variables that were examined included age, marital status, educational level, number of sexual partners, prior history of gonorrhoea, numbers of polymorphic neutrophils (PMNs) on urethral Gram’s stain or coinfection with other organisms. Subjects who used antibiotics in the previous 30 days were 1.51 (95% CI 1.09–2.05, P = 0.012) times more likely to be infected with an MDR-NG isolate compared to those who did not use antibiotics. No factors were associated with resistance to individual antimicrobials.

Conclusion: Recent antibiotic use is the major variable associated with MDR-NG infection in men with gonococcal urethritis and warrants directed partner notification and test of cure to curtail possible spread.

Disclosure of interest statement: We have no conflicts of interest to disclose.

101. Epidemiology of Trichomonas vaginalis infection in The Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

Harfouche M.^1,2, Sekkal Gherbi W.^1,2, Alareeki A.^1,2, Alaama A. S.³, Hermez J. G.³, Smolak A.¹ and Abu-Raddad L. J.^1,2,4,5,6

¹Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.

²World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.

³Department of Communicable Diseases, HIV/Hepatitis/STIs Unit, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.

⁴Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA.

⁵Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.

⁶College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.

Background: Trichomoniasis, caused by the parasite Trichomonas vaginalis (TV), remains an underappreciated sexually transmitted infection (STI), primarily due to inadequate understanding of its epidemiology and public health implications. This study aimed to characterise TV epidemiology in the Middle East and North Africa (MENA).

Methods: Systematic review and analysis of evidence sourced from international, regional, and national databases were conducted. Findings were reported following PRISMA guidelines. Random-effects meta-analyses and meta-regressions were performed to determine pooled mean prevalence, investigate associations with prevalence, and identify sources of between-study heterogeneity.

Results: The review identified 250 relevant publications, encompassing 416 TV prevalence measures. The pooled mean TV prevalence was estimated as follows: 4.6% (95% CI: 3.7–5.5%) in the general population of women, 17.2% (95% CI: 5.4–33.6%) among intermediate-risk populations, 10.3% (95% CI: 6.2–15.3%) among female sex workers, 13.3% (95% CI: 11.7–15.1%) among symptomatic women, 7.4% (95% CI: 1.9–15.5%) among infertility clinic attendees, 2.3% (95% CI: 0.1–6.3%) among women with miscarriages or ectopic pregnancies, and 1.6% (95% CI: 0.8–2.7%) among STI clinic attendees. Limited data were found for men. Multivariable meta-regressions explained >40% of the prevalence variation, unveiling a hierarchical prevalence pattern by population type, an inverse correlation with national income, and a prevalence decline at a relative rate of 1% per year.

Conclusions: Despite conservative sexual norms, MENA has a substantial TV prevalence, comparable to the global TV prevalence. The unexpectedly high prevalence of this curable infection may, in part, be attributed to limited access to and underutilization of STI screening and treatment services.

102. Syphilis testing trends in people attending sexual health services in North Coast NSW, by self-reported substance use

Ellis M.^1,2, Auld R.¹, Collins K.¹, Heslop J.¹, O’Neill G.¹, Sa aga-Banuve R.², Shapiro J.¹, Stewart T.² and Delpech V.¹

¹North Coast Population and Public Health, NSW Health, NSW, Australia.

²Australian National University, ACT, Australia.

Background: The North Coast of NSW is experiencing an outbreak of infectious syphilis with a concerning rise among heterosexuals. Substance use has previously been identified as a risk factor for sexually transmitted infections in urban settings. We examined substance use in clients tested for syphilis at sexual health services (SHS) in a regional setting.

Methods: Retrospective analyses of routinely collected syphilis testing data among clients aged 16 years and over seen at one of six SHS clinics on the North Coast NSW between 1 January 2022 to 31 December 2023. Demographics and data on substance use and injecting drug use were examined.

Results: A total of 4952 tests were included in the analysis (majority of tests were among people aged 16–30 years, males and those identifying as heterosexual: 10% reported substance use). Syphilis test positivity in people reporting substance use was 3.2 times higher than those who did not report substance use (11.3% vs 3.5%, relative rate (RR) 3.2, Confidence Interval (CI) 2.34–4.31). A statistically significant association was observed between recency of intravenous drug use and positivity rate. The highest positivity rate was in people reporting injecting drug use in the past 3 months (18.9%, RR 6.8, CI 4.4–10.3), followed by people reporting injecting drug use in the last 3–12 months (14.5%, RR 5.3, CI 2.5–9.8), people reporting non-injecting drug use (6.6%, RR 2.4, CI 1.3–4.1) and people reporting injecting drug use over 12 months ago (4.4%, RR 1.6, CI 0.8–4.1).

Conclusion: We found a strong relationship between recent substance use, including injecting drug use, and infectious syphilis among SHS clients tested for syphilis in a regional setting. The study highlights the importance of increasing syphilis testing and targeted health promotion interventions among people who use drugs.

Disclosure of interest statement: None.

103. Identifying individuals at high risk for HIV and sexually transmitted infections with an artificial intelligence-based risk assessment tool

Latt P. M.^1,2, Soe N. N.^1,2, Xu X.^1,3, Ong J.^1,2, Chow E. P. F.^1,2,4, Fairley C. K.^1,2 and Zhang L.^1,2,5

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

⁴Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁵China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, China.

Background: We have previously developed an artificial intelligence-based risk assessment tool to identify the individual risk of HIV and sexually transmitted infections (STIs) in a sexual health clinical setting. Based on this tool, the study aims to determine the optimal risk score thresholds to identify individuals at high risk for HIV/STIs.

Methods: Using 2008–2022 data from 216,252 HIV, 227,995 syphilis, 262,599 gonorrhoea, and 320,355 chlamydia consultations at a sexual health centre, we applied MySTIRisk machine learning models to estimate infection risk scores. Optimal cut-offs for determining high-risk individuals were determined using Youden’s index.

Results: The HIV risk score cut-off for high risk was 0.56, with 86.0% sensitivity (95% confidence interval (CI): 82.9–88.7%) and 65.6% specificity (65.4–65.8%). Thirty-five percent of participants were classified as high-risk, which accounted for 86% of HIV cases. The corresponding cut-offs were 0.49 for syphilis (sensitivity 77.6%, 76.2–78.9%; specificity 78.1%, 77.9–78.3%), 0.52 for gonorrhoea (sensitivity 78.3%, 77.6–78.9%; specificity 71.9%, 71.7–72.0%), and 0.47 for chlamydia (sensitivity 68.8%, 68.3–69.4%; specificity 63.7%, 63.5–63.8%). High-risk groups identified using these thresholds accounted for 78% of syphilis, 78% of gonorrhoea, and 69% of chlamydia cases. The odds of positivity were significantly higher in the high-risk group than otherwise across all infections: 11.4 (9.3–14.8) times for HIV, 12.3 (11.4–13.3) for syphilis, 9.2 (8.8–9.6) for gonorrhoea, and 3.9 (3.8–4.0) for chlamydia.

Conclusions: Risk scores generated by the AI-based risk assessment tool MySTIRisk, together with Youden’s index, are effective in determining high-risk subgroups for HIV/STIs. The thresholds can aid targeted HIV/STI screening and prevention.

Disclosure of interest statement: None declared.

104. Extragenital gonorrhoea in MSM: changing landscape in India

Sood S.¹, Verma R.¹ and Gupta S.²

¹Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

²Department of Dermatology & Venereology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Background: Anorectal and pharyngeal infections with NG are common in men who have sex with men (MSM). However, they are often asymptomatic and found in the absence of concurrent infection at genital site. These lead to onward transmission and play an important role in sustaining high rates of bacterial STIs in a population. Additionally, they drive the transmission of other STIs including HIV and may contribute to the development of AMR. Although India has one of the largest numbers of men who have sex with men (MSM) population, limited data is available on extra-genital NG infections. The aim was to assess prevalence of overall and anatomic site distribution of N. gonorrhoeae in MSM over the years at a tertiary care hospital in India.

Methods: In-house duplex PCR was performed on samples collected from three sites (urethral, oropharyngeal and rectal) from MSM presenting to the STI clinic using standard methods. Additionally, all samples were processed by conventional methods (microscopy and culture).

Results: During February 2017 to November 2018, 54 MSMs were enrolled. No samples were received during 2020–21 due to COVID. Thereafter, 196 MSMs were recruited from April 2022 to September 2023. During 2017–2018, overall prevalence was 31.5% by PCR and the most common site of infection was pharynx (24%) followed by rectum (7%) and urethra (3.7%). Subsequently, the prevalence rate was 21.4%. The most common site of infection was rectal (8.6%) followed by urethral (8.2%), and pharyngeal (3.1%). None of the extragenital samples were positive by culture throughout the study period.

Conclusion: A decrease in the number of cases with pharyngeal gonorrhoea was observed which may reflect changes in sexual behaviours. There is a need to move away from genital centred approach in MSM and embrace molecular methods of detection.

Disclosure of interest statement: Funded by AIIMS, New Delhi, India.

105. Rapid gonorrhoea rise (2022–2023) among heterosexuals visiting sexual health centres in The Netherlands

Visser M.^1,2,*, Twisk D. E.^3,*, Ibrahim A.³ and van Benthem B. H. B.¹

¹Centre for Infectious Disease control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.

²Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

³Department of Public Health, Public Health Service Rotterdam, Rotterdam, The Netherlands.

^*Equal contributions

Background: In the third quarter of 2022 (2022-Q3), Sexual Health Centres (SHCs) in the Netherlands reported an increase in gonorrhoea diagnoses, particularly among heterosexuals. To comprehend this sudden increase, we assess trends and characteristics of gonorrhoea patients at SHCs.

Methods: We used detailed surveillance data with complete national coverage from all women and heterosexual men visiting SHCs in the Netherlands between January 2016 and October 2023. Data include information on STI tests and diagnoses per anatomical location, demographics and sexual behavioural characteristics. We describe trends in gonorrhoea diagnoses, test positivity, and patient characteristics.

Results: Gonorrhoea diagnoses among women and heterosexual men increased by 135% from 2022-Q2 to 2023-Q3 (408 to 957). Test positivity increased from 1.9% to 4.3% in women and from 1.8% to 4.0% in heterosexual men between 2022-Q2 and 2023-Q3, after fluctuating between 1.2% and 2.2% from 2016-Q1 to 2022-Q2. Increases in positivity were seen nationwide, both in urban and less urbanised regions. Among women, positivity at the pharyngeal location rose more (2.1% to 4.9%) than anogenital positivity (1.5% to 3.2%). Characteristics of persons diagnosed with gonorrhoea shifted significantly from 2022-Q2 to 2023-Q3, with higher proportions of ≤25-year-olds (69% to 83%), Dutch ethnicity (56% to 74%) or highly educated (36% to 53%) (X²-test: P < 0.001). Test positivity in these groups also increased more than among older, migrant, and low/middle-educated heterosexuals. No changes were seen in proportions with partner notification or reporting symptoms. Trends for men who have sex with men or chlamydia remained unaffected.

Conclusion: Detailed surveillance data showed a surge in gonorrhoea diagnoses and test positivity, especially at the pharyngeal location. This is noteworthy and requires further investigation, since testing policies were not changed. The shift in patient characteristics indicate increased gonorrhoea transmission within specific sexual networks. These findings can provide guidance for developing and targeting gonorrhoea control interventions.

Disclosure of interest statement: None.

106. Machine learning methods as a tool for predicting risk of symptoms and reproductive tract complications of chlamydia infection

Alexiou Z. W.^1,2, Hoenderboom B. M.^1,2, Hoebe C. J. P. A.^3,4,5,6, Ouburg S.⁷, van Benthem B. H.¹ and Morré S. A.^2,6,8

¹Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

²Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.

³Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

⁴Department Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, The Netherlands.

⁵Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands.

⁶Dutch Chlamydia trachomatis Reference Laboratory, Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.

⁷Microbe&Lab, Amsterdam, The Netherlands.

⁸Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India.

Background: Identifying women at the highest risk for Chlamydia trachomatis (Ct) complications is crucial for effective disease management. Most women clear the infection, but in some, Ct ascends the upper genital tract, causing complications. Host genetic factors influence the immunological response; however, the complexity, and high dimensionality of genetic data make traditional regression models less suitable for risk prediction. To address this challenge, we explore the use of random forest decision trees (RFDT), a highly flexible artificial intelligence method, in a large-scale prospective cohort to assess its advantages over conventional prediction models.

Methods: From women of reproductive age, DNA for single-nucleotide polymorphism (SNP) determination was extracted from buccal swabs, vaginal swabs, or urine and analysed using kompetitive allele specific PCR sequencing. Ct status was determined by NAAT results, self-report, and antibodies. Outcomes included self-reported Ct with symptoms and complications (pelvic inflammatory disease, ectopic pregnancy, tubal infertility). Prediction models were built using RFDT and conventional multivariable logistic regression (MLR). Performance was assessed by area under the curve (AUC). Models were stratified by Ct status and included socio-demographics, sexual behavior, chlamydia/gonorrhea diagnoses, and 24 SNPs in candidate genes with three variants (wildtype, heterozygous, homozygous). Variable importance was calculated to identify key predictors.

Results: In total 5094 women were included, 669 (13.2%) reported Ct infection(s) with symptoms and 299 (5.9%) complications. For symptomatic Ct infection RFDT models showed higher performance (AUC 0.9) than MLR models (AUC 0.8). Different SNPs were identified as most important when comparing RFDT and MLR models. For complications RFDT models and MLR models showed poor prediction accuracy (AUC 0.6).

Conclusion: Host genetic data, when analysed using RFDT methods, may enhance the accuracy of predicting immediate host response to Ct infection. For long-term complications, it should be studied whether alternative machine learning algorithms better handle imbalanced data and rare outcomes.

Disclosure of interest statement: Funding was received from the Netherlands Organisation for Health Research and Development (ZonMW Netherlands) and Research Funding from the Ministry of Health, Welfare and Sports.

107. Chlamydia trachomatis infection incidence and years lived with disability for 31 provinces in China: a systematic analysis for The Global Burden of Disease Study from 1990 to 2019

Li C. C.^1,2,3, Yang Y. Q.^1,2,4, Ye P. P.⁵ and Huang S. J.^1,2,3

¹Dermatology Hospital of Southern Medical University.

²Southern Medical University Insitute for Global Health.

³Guangdong STDs Prevention and Control Centre, China.

⁴Guangzhou Dermatology Hospital, China.

⁵National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention.

Background: Chlamydia trachomatis (Ct.) infection and its impact on fertility have become a public concern worldwide, but a comprehensive assessment of its burden in mainland China is lacking. We investigated the burden of Ct. infection at the national and sub-national levels in mainland China and explored spatio-temporal trends.

Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated incidence and years lived with disability of Ct. Infection by sex and age, and assessed these indicators at the subnational level in 31 provinces. We examined the overall trend in the burden of Ct. Infection and assessed the change in burden by sex, age and province from 1990 to 2019.

Results: In 2019, there were an estimated 66.49 million (95% uncertainty interval [UI] 49.69–86.67 million) new cases of Ct. Infection (age-standardised incidence rate 4097.98 [3058.95 to 5338.10] per 100,000 population) and 21.16 [16.39–39.52] thousand YLDs (age-standardised YLDs rate 1.60 [0.99–2.44]) per 100,000 population) due to Ct. infection. Both incidence and YLD rates were higher among males and those aged 30–34 years, and the sex difference was also observed in 31 provinces except Sichuan. Between 1990 and 2019, the average annual percentage change (AAPC) was 0.23% (0.08%–0.37%) and 0.00 (–0.13%–0.13%) for incidence rate and YLDs rate, respectively. The highest increase in the incidence rate occurred in women aged 30–34 years (0.54% [ 0.44–0.63]) and the largest decrease in YLDs rate occurred in women aged 15–19 years (–0.91% [ –1.00% to –0.82%]). A similar temporal change was observed across 31 provinces, with an increase in population aged 20–39 years. Young people (15–19 years) in Shanghai and Henan showed a rapid increasing incidence rate.

Conclusion: During 1990–2019, the incidence rate of Ct. infection remained at a high level and slightly increased in mainland China, while the rates of YLDs remained relatively stable.

Disclosure of interest statement: None.

108. Epidemiology of herpes simplex virus type 1 in the United States: systematic review, meta-analyses, and meta-regressions

Ageeb R.^1,2, Harfouche M.^1,2, Chemaitelly H.^1,2,3 and Abu-Raddad L. J.^1,2,3,4,5

¹Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.

²World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar.

³Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA.

⁴Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.

⁵College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.

Background: Herpes simplex virus type 1 (HSV-1) is a prevalent infection that causes a spectrum of diseases, ranging from mild mucocutaneous manifestations like cold sores to more severe neurological conditions such as meningitis, encephalitis, and corneal blindness. This study aimed to provide an analytical description of the epidemiology of HSV-1 in the United States.

Methods: The study conducted a systematic review, synthesis, and reported its findings adhering to PRISMA guidelines. Random-effects meta-analyses were used to determine the pooled mean seroprevalence and proportion of HSV-1 virus detection in laboratory-confirmed genital herpes cases. Meta-regression analyses were employed to investigate associations, time trends, and sources of heterogeneity across studies.

Results: This study reviewed 159 relevant publications, identifying 190 seroprevalence measures, including 427 stratified measures, and 43 proportions of HSV-1 detection in genital herpes, with 55 stratified proportions. The pooled mean antibody prevalence (seroprevalence) of HSV-1 infection was 38.0% (95% CI: 30.9–45.4) in general-population children, 63.5% (95% CI: 61.3–65.7) in general-population adults, and 63.5% (95% CI: 58.8–68.1) in clinical adult populations. Age alone explained 43% of the variation in seroprevalence, with seroprevalence increasing progressively with age. Seroprevalence showed a decline at a rate of 0.99-fold (95% CI: 0.99–0.99) per year. The pooled mean proportion of HSV-1 detection in genital herpes was 15.4% (95% CI: 10.8–20.6), increasing by 1.02-fold (95% CI: 1.00–1.04) per year. Recurrent genital herpes showed a 0.17-fold (95% CI: 0.09–0.32) lower proportion of HSV-1 detection compared to first-episode genital herpes.

Conclusions: HSV-1 epidemiology is undergoing a shift, marked by a decline in oral acquisition in childhood and a corresponding increase in genital acquisition during adulthood. While seroprevalence is decreasing by 1% annually, there is a simultaneous 2% annual increase in HSV-1 genital herpes. Development of an HSV-1 vaccine is essential to mitigate the burden of HSV-1-related diseases.

Disclosure of interest statement: The authors have no conflict of interest to declare.

109. Estimations of the incidence and prevalence of chlamydia infection among adult aged 15–49 in China from 2000 to 2021: using the Spectrum-STI model

Gong X.^1,2, Jian H.¹, Lu W. J.³, Chen Z.¹, Liang S.³, Yue X. L.^1,2, Li J.^1,2 and Zhang J. H.^1,2

¹Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.

²National Center for STD Control, Nanjing, China.

³School of Public Health, Nanjing Medical University, Nanjing, China.

Background: Genital chlamydia infection is the most common bacterial sexually transmitted infection (STI) in the world, which can damage reproductive health or cause serious long-term adverse consequences if left untreated. The World Health Organization estimated that there were 128.5 million new cases of chlamydia infection among adults aged 15–49 worldwide in 2020, with the prevalence of 128 million. Estimating the real epidemiologic status of STI has great significance for preventing and controlling diseases. The Spectrum-STI model is a statistical estimation model developed by WHO and was used to estimate national STI (syphilis, gonorrhoea and chlamydia) incidence and prevalence trends among adults over time. We intend to estimate the incidence and prevalence of chlamydia infection among the population aged 15–49 in China from 2000 to 2021, to understand its disease burden and guide public health strategies.

Methods: We conducted a thorough literature search on articles related to chlamydia prevalence study in China from 1 January 2000 to 30 June 2023. National incidence and prevalence of chlamydia infection between 2000 and 2021 among 15–49 years old population in China were estimated using Spectrum-STI model, a statistical trend-fitting model.

Results: Fifty-seven eligible studies with 87 Chlamydia infection prevalence data points were identified. In 2000 and 2021, Chlamydia infection prevalence estimated with Spectrum-STI model was 3.41% (95% CI: 1.69%–5.61%) and 2.44% (95% CI: 1.64%–3.32%) among overall population aged 15–49 in China, equating to 23.733 (8.356–46.070) millions and 16.447 (9.159–25.251) millions prevalent cases, respectively. The estimated incidence rate was 3573 (1520–7318) per 100,000 population and 2,573 (1485–4445) per 100,000 population in 2000 and 2021, corresponding incidence was 23.244 (6.917–61.610) millions and 16.206 (7.785–35.434) millions new cases in the country, respectively. It appeared a decreasing trend in the prevalence and incidence of chlamydia infection during 2000 to 2021.

Conclusion: The first nationwide estimate of chlamydia shows high incidence and prevalence, as well as severe disease burden in China. As a serious public health issue, it is necessary to develop national control strategies.

Disclosure of interest statement: The authors report no conflict of interest in this work.

110. Screening for STIs and syphilis during pregnancy in Aboriginal community controlled health services

West R.¹, Williams S.¹, Ho A.¹, Bradley C.^1,2,3, Schwenn P.¹ and Ward J.¹

¹Poche Centre for Indigenous Health, University of Queensland, Qld, Australia.

²Wardliparingga Aboriginal Health Equity, South Australian Health, and Medical Research Institute, SA, Australia.

³College of Medicine and Public Health, Flinders University, SA, Australia.

Background: Congenital syphilis cases in Australia have increased tenfold between 2016 and 2023. Aboriginal and Torres Strait Islander women diagnosed with gestational syphilis and Aboriginal and Torres Strait Islander babies with congenital syphilis are overrepresented in national data. Early testing and treatment can reduce adverse pregnancy outcomes; however, studies suggest that screening for pregnant women is suboptimal. To date there have been limited testing data available for syphilis and other STIs during pregnancy among Aboriginal and Torres Strait Islander people.

Methods: This study used deidentified clinical data collected from 35 Aboriginal Community Controlled Health Service (ACCHS) sites nationally as part of the ATLAS Indigenous Primary Care Surveillance and Research Network to examine syphilis and other STI testing during pregnancy for the period 2016–2023.

Results: Of 15,262 unique women who attended the ACCHSs, there were 4950 with complete antenatal records, with 6016 pregnancies recorded. Sixty-four percent of pregnancies were screened for syphilis at least once between the first antenatal visit to 6 weeks postpartum (range: 56.7%–69.6% across states). Of the 64% (3848) screened, 37.8% (2272) were tested once only, 21.8% (1310) twice and 4.4% (266) three times. A low proportion (2.3%) were reactive.

Conclusion: Within the context of the increasing cases of infectious syphilis and congenital syphilis, this data will be used to identify gaps in service delivery and for quality improvement initiatives, as well as adding to the evidence base on testing during pregnancy nationally. Results of this study can be translated to other primary care services and provide a greater understanding of opportunities for syphilis prevention among Aboriginal and Torres Strait Islander people who are recognised as a priority population.

Disclosure of interest statement: The ATLAS Indigenous Primary Care Surveillance and Research Network is funded through a National Health and Medical Research Council Partnerships Grant, GNT2006987 and a MRFF Primary Healthcare Research Data Infrastructure Grant, PHRDI000054. Neither the NHMRC or MRFF has a role in the study design or the analysis and interpretation of ATLAS data.

Publication approval of research findings has been given by the ATLAS Clinical Hub Reference Group, as the data custodian on behalf of the sovereign owners of the data contributing to this study. The Clinical Hub Reference Group provides Indigenous governance and oversight of all data collected through the ATLAS network.

111. Prevalence of chlamydia and gonorrhoea among patients presenting with genital ulcer disease in Botswana

Mussa A.^1,2, Bame B.¹, Chakona S.¹, Pintye J.³, Beale M. A.⁴, Thomson N.⁴, Marks M.⁵ and Morroni C.^1,2

¹Botswana Harvard Health Partnership, Gaborone, Botswana.

²University of Edinburgh, Edinburgh, United Kingdom.

³University of Washington, Seattle, USA.

⁴Wellcome Sanger Institute, Cambridge, United Kingdom.

⁵London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: In most low- and middle-income countries, a syndromic approach is used for management of sexually transmitted infections (STIs). Under Botswana national STI guidelines, patients presenting with genital ulcer disease (GUD) are treated for herpes, syphilis and chancroid. In the absence of diagnostic screening, other STIs such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), which are often asymptomatic, may go undetected. We investigated prevalence of CT and NG in patients presenting with GUD in Botswana.

Methods: Participants with genital ulcer(s) were recruited in Gaborone, Botswana. Two genital ulcer swabs were collected for GUD aetiology (data presented elsewhere). Participants also provided either a self-collected vaginal swab (females) or a urine specimen (males) for screening using the Cepheid Xpert® CT/NG assay. All participants were treated for GUD at enrolment and participants positive for CT/NG were offered further treatment.

Results: Between October 2022 and December 2023, 186 participants with GUD enrolled in the study; 142 (76%) were female. Median age was 31 (interquartile range 25–38). Forty-five participants (24%) were living with HIV. Thirty of 186 (16%) participants tested positive for at least one additional STI; 25 (13%) for CT, nine (5%) for NG (four CT and NG co-infections). Twenty-four (80%) were asymptomatic for vaginal discharge and/or pelvic pain. All participants positive for CT/NG returned for additional treatment (median time to treatment 1 day). Older age (odds ratio [OR] = 0.92, 95% CI 0.88–0.99) and tertiary education (OR = 0.35, 95% CI 0.15–0.84) were associated with lower odds of testing positive for CT and/or NG. HIV was not associated with CT and/or NG positivity.

Conclusion: A significant proportion of GUD patients in Botswana were coinfected with CT and/or NG. For comprehensive patient care, diagnostic screening for CT and NG should be considered for patients presenting with other STI syndromes such as GUD.

Disclosure of interest statement: The authors declare no competing interests.

112. Trends in the incidence of sexually transmissible infections among transgender and gender non-binary people in Australia: a 10-year national study

Callander D.¹, Cook T.^1,2, Asselin J.³, Templeton D. J.⁴, Menon A.⁵, Tuck Meng Soo C.⁶, Bell C.⁷, Fairley C. K.^8,9, Stoove M.³, Hellard M.^3,10, Cornelisse V.^1,4,9,11, Guy R¹ and Donovan B.¹

¹The Kirby Institute, UNSW Sydney, NSW, Australia.

²ACON.

³Burnet Institute, Vic, Australia.

⁴RPA Sexual Health Centre, NSW, Australia.

⁵Townsville Sexual Health Clinic, Qld, Australia.

⁶Hobart Place General Practice, Tas, Australia.

⁷Adelaide Sexual Health Centre, SA, Australia.

⁸Melbourne Sexual Health Centre, Vic, Australia.

⁹Monash University, Vic, Australia.

¹⁰Department of Infectious Diseases, Alfred Hospital, Vic, Australia.

¹¹Clinic 16, Northern Sydney Sexual Health Clinic, NSW, Australia.

Background: Globally, transgender and gender non-binary (hereafter ’trans’) people experience disproportionate rates of HIV, but less is known about other sexually transmissible infections (STIs). In Australia, epidemiological details on STIs among trans populations is also lacking, impeding programming and policy. To address this gap, we undertook a longitudinal national study of STI incidence.

Methods: Ten years of de-identified data were extracted from 83 general practices, sexual health clinics, hospitals, and community services participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). Among trans patients, repeat testing estimated annual incidence. Poisson regression analyses assessed time-trends and within-population differences.

Results: During 2013–2022, 5701 trans people attended a sentinel site, with 4525 tested for HIV/STIs (2,846 trans women, 1273 trans men, 406 non-binary people). Chlamydia incidence (any anatomical site) increased (28.7/100 PY in 2013 to 33.7/100 PY in 2022, P = 0.005) with differences by gender: 36.2/100 PY among trans women (95% CI: 34.8–37.8), 24.9/100 PY among non-binary people (95% CI: 21.3–29.1), and 14.2/100 PY among trans men (95% CI: 12.3–16.3, P’s < 0.001). While urogenital and pharyngeal infections were stable, anorectal incidence increased 79% during the study period (P < 0.001). Gonorrhoea incidence (any site) was stable (24.5 in 2013 and 28.1/100 PY in 2022, P = 0.2) and similar among trans women (32.1/100 PY, 95% CI: 30.7–33.5) and non-binary people (32.0/100PY, 95% CI: 27.9–36.8, P = 0.9) but lower among trans men (10.5/100 PY, 95% CI: 8.9–12.4, P < 0.001). Again, while urogenital and pharyngeal infections were stable, anorectal incidence increased 30% (P < 0.001). Infectious syphilis incidence was stable (4.3 and 2.3/100 PY, P = 0.09) and higher among non-binary people (5.5/100 PY, 95% CI: 4.2–7.2) compared to trans women (4.1/100 PY, 95% CI: 3.7–4.5, P < 0.001) and men (1.7/100 PY, 95% CI: 1.3–2.2, P = 0.045).

Conclusion: Trans people in Australia have an STI epidemiology heterogenous by gender. As incidence of these infections has increased or remained stable, there is need for enhanced prevention and management. Testing for anorectal infections should be prioritised, while Australia’s STI strategies should include trans people as a ’key population’.

Disclosure of interest statement: The authors have no conflicts of interest to declare. ACCESS is funded by the Australian Department of Health.

113. Sero-prevalence of syphilis and associated risk factors among pregnant women attending antenatal care at an urban-poor health centre IV in Kampala Uganda: a cross-sectional study

Simiyu A.^1,2,4, Kazooba P.¹, Atuheire C. G. K.², Dawa B.⁴, Nabwire S. S.⁵, Kiiza E.^2,4, Mwiine F. N.², Kankya C.² and Mugimba K. K.²

¹Reach Out Mbuya Community Health Initiative.

²Department of Biosecurity, Ecosystems and Veterinary Public Health, SBLS, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University.

³Department of Biomolecular & Biolaboratory Sciences, SBLS, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University.

⁴Infectious Diseases Institute, College of Health Sciences Makerere University.

⁵School of Women and Gender Studies, College of Humanities, Makerere University.

Background: Globally, syphilis in pregnancy is a burden in resource-limited settings. In Uganda, healthcare challenges, particularly in urban poor areas like Kampala, worsen syphilis risks for mothers and their children. Socioeconomic disparities and limited healthcare heighten vulnerability to syphilis and HIV. Antenatal care screening is crucial but inconsistent. This study determines syphilis prevalence and associated factors in pregnant women.

Methods: A cross-sectional study was conducted among pregnant women attending antenatal care clinic, Kawaala, Kampala. Social demographics such as age, education, residence, ethnicity, and past obstetric history were collected using a structured questionnaire. Blood samples were collected from the participants and tested for syphilis and HIV infection using HIV Syphilis duo rapid kits (SD Standard Diagnostics, INC, Korea). Results were recorded and analysed using Stata software (Ver. 14.2). The prevalence of syphilis and HIV was assessed across various baseline participant characteristics. Factors associated with syphilis infection were determined and included in a multivariate regression model to identify independent predictors of syphilis infection.

Results: Among 1169 pregnant participants, median age was 25 years (IQR: 23–29), 96% were married and reported a single sexual partner. Syphilis prevalence was 5.9% (69/1169). PLHIV were 6%. Factors significantly associated with syphilis infection included HIV positivity (aOR: 4.13, 95% CI: 2.05–8.34, P < 0.001), elevated blood pressure (aOR: 2.84, 95% CI: 1.42–5.69, P = 0.003), and poor previous pregnancy status (aOR: 0.21, 95% CI: 0.05–0.89, P = 0.034).

Conclusion: The study reveals a high syphilis prevalence among pregnant women in urban poor areas, emphasising proactive screening. Factors like HIV positivity, elevated blood pressure, and previous pregnancies are linked to syphilis infection, highlighting targeted healthcare. Integrating routine syphilis testing into care can improve outcomes, underscoring healthcare systems’ role in addressing STIs during pregnancy.

114. Quinolone resistance-associated mutations in Mycoplasma genitalium in the US (MYGENIUS): 2020 surveillance data

Soge O. O.¹, Jordan S. J.², McNeil C. J.³, Pathela P.⁴, Reno H.⁵, Wendel K.⁶, Geisler W. M.⁷, Parker A.⁸, Leipertz G.⁹, Getman D.¹⁰, Golden M. R.¹¹ and Manhart L. E.¹², for the MyGeniUS Surveillance Group

¹Department of Global Health, and Division of Infectious Diseases, University of Washington, Seattle, WA, USA.

²Division of Infectious Diseases, Department of Medicine, Indiana University, Indianapolis, IN, USA.

³Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

⁴New York City Department of Health and Mental Hygiene, Queens, NY, USA.

⁵Division of Infectious Diseases, Washington University, St. Louis, MO, USA.

⁶Public Health Institute at Denver Health, Denver, CO, USA.

⁷Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.

⁸Department of Epidemiology, and Center for AIDS and STD, University of Washington, Seattle, WA, USA.

⁹Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA;

¹⁰Hologic, Inc., San Diego, CA, USA.

¹¹Center for AIDS and STD, University of Washington, Seattle, WA, USA.

¹²Department of Epidemiology, and Center for AIDS and STD, University of Washington, Seattle, WA, USA.

Background: Antimicrobial resistance in Mycoplasma genitalium (MG) is common with macrolide resistance mutations (MRMs) detected in >50% of US infections. MG surveillance in US sexual health clinics (SHCs) has not previously included quinolone resistance-associated mutations (QRAMs). We estimated the prevalence and correlates of QRAMs in 2020.

Methods: Remnant urogenital specimens from symptomatic and asymptomatic males and females attending SHCs in Denver CO, Greensboro NC, Indianapolis IN, New York NY, Seattle WA, and St. Louis MO were tested for MG using transcription-mediated amplification (Aptima Mycoplasma genitalium assay); MRMs were detected using analyte-specific reagents (Hologic, Inc). QRAMs were detected by PCR and Sanger sequencing of the parC gene.

Results: Of 290 MG-positive specimens, 171 were tested for QRAMs (58 had insufficient volume; 61 are pending). Among tested specimens, 8 (4.7%) were parC PCR-negative, 12 (7.0%) had inconclusive sequencing results, and 22 (12.9%) yielded a weak amplicon. QRAMs previously associated with moxifloxacin treatment failure were detected in 8 (prevalence = 6.2%; 95% CI 2.72–11.85), including S83I [n = 4], S83R [n = 2], D87Y [n = 2]. Also detected were P62S, C234T (silent), A69T, A119E, and Q94Q (n = 1–4 patients each). QRAMs were detected in four of six sites (Seattle, Greensboro, New York, Indianapolis). They were detected in 33% (6/18) of men who have sex with men (MSM) but not in men who have sex with women (n = 53), men with urethritis (n = 33), women with cervicitis or pelvic inflammatory disease (n = 2 each), or people with chlamydia (n = 21). All 8 specimens with QRAMs also had MRMs. QRAMs were not associated with age, race/ethnicity, sex/gender, or symptoms.

Conclusions: In this preliminary analysis, 6.2% of MG-positive specimens in 2020 had QRAMs, with higher prevalence in MSM and full concordance with MRMs. The lack of association between symptoms and QRAMs suggests dual-class resistance often goes undetected. Determining whether sequelae result from asymptomatic MG infections is a priority.

Disclosure of interest statement: L. Manhart and O. Soge declare payments to their institution for investigator-initiated research from Hologic, Inc.L. Manhart also declares payments to her institution for investigator-initiated research from Nabriva Therapeutics. From 2020 to 2023, this surveillance project was funded by Hologic, Inc.

115. Anatomical site distribution of Neisseria gonorrhoeae among female and male sex workers who have sex with men in The Netherlands

Evers Y. J.^1,2, Peters C. M. M.^1,2, Wolffs P. F. G.³, Dukers-Muijrers N. H. T. M.^1,4 and Hoebe C. J. P. A.^1,2,3

¹Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health MOSA, South Limburg Public Health Service, The Netherlands.

²Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands.

³Department of Medical Microbiology, Infectious Diseases & Infection Prevention, National Chlamydia trachomatis Reference Laboratory, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.

⁴Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Background: Female sex workers (FSW) and male sex workers who have sex with men (MSW-MSM) have a higher burden of sexually transmitted infections (STI), including Neisseria gonorrhoeae (NG), than the non-sex worker population, mainly due to social vulnerability and work-related factors as multiple sex partners and inconsistent condom use. No previous data is available on the complete anatomical site distribution of NG among sex workers. This large study evaluated the anatomical site distribution NG among FSW and MSW-MSM visiting STI clinics in the Netherlands.

Methods: Coded STI clinic consultations (n = 22,039) from 9044 individual FSW (median age: 31 years) and 6834 consultations in which tests were performed on three anatomical sites from 2952 individual MSW-MSM (median age: 31years) attending any Dutch STI clinic between 2016 and 2021 were included. Descriptive statistics were used to assess proportion of single and concurrent infections, showed in Venn diagrams.

Results: NG was diagnosed in 3.4% (750) of all consultations among FSW (2.5% urogenital, 2.3% pharyngeal and 1.5% anorectal). Of all NG diagnoses among FSW, 34.9% (262) were single infections, including 10.4% (78) single urogenital NG, 20.7% (155) single pharyngeal NG and 3.9% (29) single anorectal NG. Urogenital-anorectal NG was diagnosed in 17.2% (129), urogenital-pharyngeal in 25.9% (194), pharyngeal-anorectal in 2.1% (16), and urogenital-pharyngeal-anorectal in 19.9% (149) among FSW. Among MSW-MSM, NG was diagnosed in 14.9% (1020), including 8.1% urogenital, 8.3% pharyngeal and 10.5% anorectal NG. Of all NG diagnoses among MSW-MSM, 43.5% (444) were single infections, including 3.9% (40) single urogenital NG, 17.5% (178) single pharyngeal NG and 22.2% (226) single anorectal NG. Urogenital-anorectal NG was diagnosed in 18.2% (186), urogenital-pharyngeal in 8.3% (85), pharyngeal-anorectal in 6.1% (62), and urogenital-pharyngeal-anorectal in 23.8% (243) of MSW-MSM.

Conclusion: The substantial proportion of single diagnoses of NG among FSW and MSW-MSM confirms the relevance of standard multiple site testing among these key populations, especially due to their potential bridging function in further spread of STI into other populations.

Disclosure of interest statement: None. No additional funding was received for this study.

Fig. 1.

Anatomical site distribution of NG among female sex (left) and male sex workers who have sex with men (right) visiting Dutch STI clinics.

116. STI positivity higher in home-based female sex workers compared to female sex workers working in indoor sex venues and escort in The Netherlands

Verhaegh A.^1,2, Peters C. M. M.^1,2, Evers Y. J.^1,2, Werner M.¹, Wolffs P. F. G.³, Dukers-Muijrers N.^1,4 and Hoebe C. J. P. A.^1,2,3

¹Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health MOSA, Public Health Service South Limburg, Heerlen, The Netherlands.

²Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands, Department of Medical Microbiology, Infectious Diseases & Infection Prevention, National Chlamydia trachomatis Reference Laboratory, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.

³Department of Health Promotion, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.

Background: Sex workers are known to be a high-incidence population for sexually transmitted infections (STI). Clinical practice indicated home-based female sex workers (FSW) to have more STI than FSW working at other locations. Limited scientific research is available on STI burden and risk of home-based FSW. This study aimed assess STI burden and risk among FSW working in different sex work locations to inform targeted prevention policy.

Methods: Coded STI consultations (n = 1180) from FSW visiting our Dutch STI Clinic between 2014 and 2019 were analysed, comparing three groups: 1. home-based FSW, 2. FSW working in indoor sex venues and 3. Escort FSW. Multivariable logistic regression analyses assessed associations between groups of FSW and STI positivity on consultation-level data, adjusted for age and ethnicity.

Results: Home-based FSW were slightly older women (median: 36 years), more often had a western-born ethnicity (93.2%) and a high education level (50.8%) than FSW working in indoor venues (all P-values < 0.01). Home-based FSW self-reported less consistent condom use (50.9%) compared to FSW working in indoor sex venues and escort FSW (60.5%, 72.0%; P < 0.001). The proportion of new STI diagnoses differed significantly (16.4%, 9.2%, 10.8%; P = 0.018) between home-based FSW, FSW working in indoor sex venues and escort FSW. Working as a home-based FSW was associated with a new STI diagnosis (aOR: 1.7, 95% CI: 1.0–2.9) compared to sex workers in indoor sex venues.

Conclusion: The burden and risk of STI is highest in home-based FSW. The results of this study highlight the importance of targeted (online) outreach strategies for home-based FSW.

Disclosure of interest statement: None.

117. Mycoplasma genitalium molecular typing in men discriminates between clusters based on sexual preference and antibiotic resistance

Adriaens N.¹, van Dam A.^1,2, Bruisten S.¹, Bouwman F.¹, Vergunst C.^1,3, Doelman T.³ and Westerhuis B.¹

¹Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

²Department of Medical Microbiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.

³Department of Dermatology, NWZ Den Helder, The Netherlands.

Background: Mycoplasma genitalium (MG) is a sexually transmitted bacterium associated with non-gonococcal urethritis (NGU) in men. Increasing antibiotic resistance against macrolides and fluoroquinolones in MG-strains has been reported worldwide. The mgpB/MG309 typing method has mostly been used to investigate MG transmission in men who have sex with men (MSM) whereas only limited molecular typing data is available for strains infecting men who have sex with women (MSW). Therefore, we aimed to explore the molecular epidemiology based on the mgpB/MG309 typing method among MG-positive specimens from MSM and MSW diagnosed with NGU. We additionally investigated the association with antimicrobial resistance profile and epidemiological determinants.

Methods: mgpB/MG309 molecular typing was carried out through Sanger sequencing of the loci mgpB and MG309 for 62 MG-positive urine specimens from 33 MSM and 29 MSW diagnosed with NGU. Additionally, macrolide and fluoroquinolone resistance associated mutations in the 23S rRNA, parC and gyrA genes were determined using multiplex qPCR and Sanger sequencing, respectively.

Results: Using PubMLST as a reference database, 12 and 22 new allelic profiles were found, respectively for MSM and MSW. The mgpB/MG309 phylogenetic tree consisted of three clusters which significantly differed with regard to sexual preference, macrolide resistance, fluoroquinolone resistance, dual-resistance, ethnicity and Chlamydia trachomatis co-infection. In 12/13 cases dual-resistance occurred in MG-strains belonging to one cluster, predominately derived from MSM. Antibiotic resistance against macrolides and fluoroquinolones tended to occur more frequently in MSM compared to MSW, however not significant (84.8% vs. 65.5% (P = 0.07) and 30.3% vs. 17.2% (P = 0.254), respectively).

Conclusion: Antibiotic resistance against macrolides and fluoroquinolones remains of great concern for both MSM and MSW. Molecular typing of MG strains resulted in clusters with different sexual preference and antibiotic resistance profiles. Dual-resistance predominantly occurred in closely related strains, suggesting a possible genotypic influence or the involvement of distinct transmission patterns.

Disclosure of interest statement: None.

118. Multi-disciplinary response to an atypical infectious syphilis outbreak in MID North Coast Local Health District 2021–2024

Kym Collins¹, Ellie Sneddon¹, Karen J. O. B.¹, Damien Brown¹, Nives Houlihan¹, Jess Ward¹, Helen Young¹, Lisa Gott¹, Jenny Heslop¹, Genevieve O’Neill¹, Geoffrey Stewart¹, Robyn Auld¹, Zoe Cutcher¹, Franklin John-Leader¹, Grigori Cheguelman¹ and Phoebe Nicholls¹

¹MNCLHD.

Background: The Mid North Coast Local Health District (MNCLHD) has a population of 226,422 residents. The region is located on the east coast of Australia and is one of 15 LHDs in the state of NSW. Since late 2020, the MNCLHD has had an evolving syphilis outbreak characterised by concerning increases in infectious cases in Heterosexuals (HT), especially Women of Reproductive Age (WoRA). This abstract details the actions taken by the Incident Management Team (IMT) that was formed in response to this emerging outbreak.

The IMT is a collaboration between Public Health, HIV and Related Programs Health Promotion, Clinic 33 (Publicly Funded Sexual Health Clinic) and Aboriginal Health. This group met fortnightly in the initial phase of the outbreak. It now meets monthly.

Methods: Collation of monthly epidemiological data from NCIMS with detailed geographical information on infectious cases. Alerted clinicians across the LHD about the MNCLHD Syphilis Outbreak with multiple in-services, webinars and Grand Rounds across many disciplines.

Syphilis Support Program. Rapid and direct clinical support by the Staff Specialist for clinicians diagnosing infectious syphilis. Development of a comprehensive social marketing and Health Promotion campaign with locally designed content, including a version designed specifically for Aboriginal people. Development of a local Policy Document “Management of Syphilis in Pregnancy” and allocation of a clinician to oversee all pregnancies during which syphilis had been diagnoses, ensuring monitoring of the mother and infant as per ASID guidelines.

Results: In the last quarter of 2023, there was a notable and encouraging decrease in female cases. We are hopeful that with our ongoing efforts, this will continue.

Conclusion: The rapid rate of increase in infectious syphilis in HTs and WoRA necessitated a collaborative, innovative and robust response.

Disclosure of interest statement: None.

119. Chemsex and associated sexual health behavioural outcomes among men who have sex with men in Hong Kong

Choi E. P. H.¹, Choi K. W. Y.^1,2, Chau P. H.¹ and Chow E. P. F.^3,4,5

¹School of Nursing, The University of Hong Kong, Hong Kong.

²Sticky Rice Love, Hong Kong.

³Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁴Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

⁵Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: Chemsex, the practice of consuming psychoactive substances to enhance sexual experiences, has been observed predominantly among men who have sex with men (MSM). While its prevalence is noted, the correlation between chemsex and behavioural outcomes, such as condomless anal sex and the frequency of HIV and other STIs testing, remains underexplored, particularly within the Chinese demographic.

Methods: This investigation utilised baseline data from a randomised controlled trial assessing an interactive eHealth intervention for chemsex prevention in Hong Kong. Eligible participants were required to be MSM, cisgender males, at least 18 years old, and proficient in Chinese. The study focused on three outcomes: engagement in condomless anal sex, the occurrence of HIV testing, and the occurrence of other STIs testing within the past 3 months.

Results: Our analysis of 316 MSM participants revealed that 16.1% reported chemsex, 51.3% engaged in condomless anal sex, 32.9% underwent HIV testing, and 20.3% had other STIs testing, all within the last 3 months. The multiple logistic regression analysis indicated a significant association between chemsex and increased likelihood of engaging in condomless anal sex (aOR: 40.9, P-value: <0.001). Identifying as homosexual rather than bisexual (aOR: 2.15, P-value: 0.044) and being in a relationship (aOR: 2.25, P-value: 0.002) were also associated with higher instances of condomless anal sex. Additionally, those reporting chemsex were more likely to have been tested for other STIs in the last 3 months (aOR: 2.63, P-value: 0.009). In contrast, no significant association was found between chemsex and undergoing HIV testing.

Conclusion: The study highlights a link between chemsex and the practice of condomless anal sex. Considering the limited availability of PrEP within Hong Kong’s public health system and its relatively low usage compared to other regions, it is imperative to intensify efforts to promote consistent condom use among MSM engaging in chemsex.

Disclosure of interest statement: All authors declare no conflict of interest. The study was sponsored by the Council for the AIDS Trust Fund, reference number: MSS 338 R. This HIV/AIDS prevention part of project/programme is sponsored by the AIDS Trust Fund. The content of this article represents the opinion of our organisation only. It does not represent the position of the AIDS Trust Fund. AIDS Trust Fund is not responsible for any claims, demands or liabilities whatsoever arising from or in connection with the use of any information contained in this article or the participation of the sponsored project/programme. Chow EPF is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grants (GNT1172873) outside the submitted work.

120. Responding to syphilis in vulnerable populations: point of care testing in people who use drugs and are experiencing homelessness

Phillip Read^1,2, Hayley Wareing³, Jessica De Dassel⁴, Robin Auld⁴, Erin Sullivan³, Rosie Gilliver¹, Edmund Silins^1,5, Ellouise Davis¹, Stephanie Saladino¹ and Bianca Prain³

¹Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia.

²The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

³Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia.

⁴North Coast Population and Public Health, NSW Health, NSW, Australia.

⁵National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.

Background: Notifications of syphilis continue to increase in NSW. At-risk populations now encompass people who inject drugs and experience homelessness. Many of these individuals may not attend health services where traditional blood testing for syphilis is available. To increase diagnosis and treatment of syphilis in priority populations a pilot point of care test (POCT) program for syphilis was conducted in three outreach clinical services across the Mid North Coast, Northern New South Wales and South Eastern Sydney local health districts. We describe the model of care and report preliminary data.

Methods: The program was conducted in needle syringe programs (NSP), homeless outreach, and pop-up social housing locations where clinics had pre-existing trust and relationships. We used the TGA approved DetermineTM Syphilis TP POCT which provides a result within 15 min. This test cannot distinguish between current and historic infection therefore follow-up laboratory serology is completed for reactive POCTs to identify infectious syphilis. Data collection was minimal to ensure opportunistic testing during brief interventions could occur. Non-clinical staff were trained online, with local practical assessment. Consent was not required as this was a clinically indicated approved test. Serology and treatment were offered on-site or at follow-up.

Results: Between October 2023 and January 2024, there were 177 syphilis POCTs conducted across sites. Three tests were reactive, one of which was for a person with a history of treated syphilis, another was for a person who did not return for follow-up pathology (so unable to determine if treatment was required), and one person with a reactive test required treatment.

Conclusion: Point of care testing on outreach by non-clinical staff is feasible, and may enhance detection of syphilis in high-risk and harder to reach groups. Continued innovation in testing methodologies is required to address the changing profile of people at-risk of syphilis.

Disclosure of interest statement: PR has received research funding from Gilead Sciences, as well as institutional and individual honoraria from Gilead Sciences, Abbvie and MSD.

121. Molecular epidemiology of Neisseria gonorrhoeae isolates pre- and post-COVID (2017–2022): Saskatchewan

Sanderson H.¹, Perera S. R.², Martin I.³, Minion J.⁴, Hamula C.⁵, Thorington R.³, White A.¹ and Dillon J. R.^1,2

¹Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, SK, Canada.

²Department of Biochemistry Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

³Streptococcus and STI Section, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.

⁴Roy Romanow Provincial Laboratory, Regina SK, Canada.

⁵Division of Clinical Microbiology, Dept. Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

Background: Gonorrhoea is the second most prevalent bacterial sexually transmitted infection in Canada and the incidence of gonorrhoea in Saskatchewan has been increasing. The COVID-19 pandemic has had considerable impact on public health related infections, for example, the extinction of the B/Yamagata/16/1988 lineage of influenza. Decreases in gonococcal strain type (ST) diversity during the pandemic have been reported. The purpose of this study was to ascertain trends in gonococcal susceptibility to antibiotics and strain types in Saskatchewan before and after the COVID pandemic (2017–2022).

Methods: Neisseria gonorrhoeae isolates (n = 427) from Saskatchewan, Canada, were collected from 2017 to 2022. DNA was sequenced using Illumina and genomes were assembled with the Gen2Epi pipeline. NG-MLST, NG-MAST and NG-STAR STs were determined using Gen2Epi and PathogenWatch. Phenotypic susceptibilities to 10 antibiotics were determined using CLSI guidelines.

Results: A marked shift in STs for NG-MLST, NG-MAST and NG-STAR was observed. NG-MLST STs1584, 1901 and 12462 were most common from 2017 to 2020. Between 2021 and 2022, these STs became less dominant and STs 14610, 7822 and 16674 represented a larger percentage of the isolates. For MG-MAST, STs 10451, 11933, and 5985 predominated between 2017–2020, and STs 19760 and 14994 dominated in 2021–2022. For NG-STAR, pre-pandemic STs 1061, 160 and 90 were most prevalent and STs 1493 and 4486 prevailed between 2021 and 2022. All isolates were susceptible to ceftriaxone and cefixime and under 5% of the isolates were resistant to azithromycin. Resistance to erythromycin and ciprofloxacin increased during this period and 27.7 % of the isolates, overall, carried plasmid-mediated resistance to tetracycline (TRNG).

Conclusion: Surveillance of antimicrobial susceptibilities between 2017 and 2022 in Saskatchewan indicated that, despite the shift in strain types of N. gonorrhoeae post-pandemic, all isolates remained susceptible to antibiotics recommended for treatment. An outbreak of TRNG isolates was undetected because tetracycline resistance is no longer actively reported.

Disclosure of interest statement: The authors declare no competing interests.

122. Establishment of a direct referral pathway between public health and sexual health services as an intervention to improve syphilis treatments within Western Sydney

Bopage R. I.^1,2, Norton S.³, Lampard J.³, Power M.¹, Moreira C.³, Shaban R. Z.^2,3 and Lewis D. A.^1,2

¹Western Sydney Sexual Health Centre, WSLHD, NSW, Australia.

²Sydney Medical School-Westmead, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

³Western Sydney Public Health Unit, WSLHD, NSW, Australia.

Background: In June 2019, the Public Health Unit (WSPHU) and Western Sydney Sexual Health Centre (WSSHC) introduced a direct referral pathway whereby the WSPHU refers syphilis notifications to WSSHC. This study examined the syphilis referral management and treatment outcomes pre- and post-intervention over an 8-year period.

Methods: We performed a descriptive cross-sectional analysis of all syphilis cases notified to the NSW Notifiable Conditions Information Management System (NCIMS) in Western Sydney Local Health District. Cases were classified according to whether they were notified pre-intervention (1 January 2016 to 31 May 2019) or post-intervention (1 June 2019 to 31 December 2023). We analysed patients’ demographic, treatment, and clinical risk data. ’Unknown’ or ’missing’ treatment initiation status were classified as ’treatment not initiated’. A chi-squared test of independence was performed to examine the relationships. Data was analysed using SAS Enterprise Guide 8.3.

Results: There were 1746 syphilis cases notified during the study period, 574 pre-intervention and 1172 post-intervention. The cohort contained 80% males and 20% females, 59% were aged 25 to 44 years, 44% identified as men who have sex with men (MSM). Treatment initiation rates (TIR) were 67.8% pre-intervention versus 79.2% post-intervention (relative risk (RR): 1.17, CI: 1.04–1.32, P = 0.01). TIR in males was 68.9% pre-intervention versus 79.8% post-intervention (RR: 1.16, CI: 1.01–1.32, P = 0.03). TIR in MSM was 82.7% pre-intervention versus 90.1% post-intervention (RR: 1.09, CI: 0.92–1.28, P = 0.31). TIR in non-MSM was 56.8% pre-intervention versus 70.4% post-intervention (RR: 1.24, CI: 1.05–1.47, P = 0.01). TIR in females was 63.6% pre-intervention versus 77.8% post-intervention (RR: 1.22, CI:0.94–1.60, P = 0.14).

Conclusions: Syphilis treatment outcomes in Western Sydney were improved following the implementation of the referral pathway between Public Health and Sexual Health services. Treatment of men showed significant improvement with the greatest effect in non-MSM men and a modest non-significant improvement in women. The intervention described has the potential to strengthen current syphilis control measures in NSW.

Disclosure of interest statement: None.

123. Epidemiology of infectious syphilis in women of reproductive age in NSW, 2017 to 2023

Walker L. J.¹, Li C.² and Amin J.¹

¹Epidemiology and Data Systems Branch, Health Protection, NSW Health, NSW, Australia.

²Communicable Diseases Branch, Health Protection, NSW Health, NSW, Australia.

Background: Congenital syphilis is on the rise. We describe the epidemiology of infectious syphilis in women of reproductive age (WRA) in NSW to better understand the factors contributing to increases in congenital syphilis.

Methods: We extracted confirmed and probable infectious syphilis notifications in WRA (15–49 years) who resided in NSW from 2017 to 2023 from NCIMS. Using R, we conducted a descriptive analysis of demographics, geographic distribution, and clinical outcome.

Results: 879 infectious syphilis notifications were reported in females 15–49 years. The median age was 30 years (IQR 25–37 years). Aboriginal and Torres Strait Islander women accounted for 20% of total notifications, increasing to 33% notifications among pregnant women. The NSW notification rate increased from 2.2 in 2017 to 11.2 in 2023 per 100,000 WRA-population (42 to 210 notifications). Increases were driven by key metropolitan Sydney regions (avg 3.1 in 2017 to 12.9 in 2023, per 100,000 WRA-population). A rapid rate rise was seen in the Mid North Coast, associated with a localised outbreak (0 to 41.3 notifications per 100,000 WRA-population). GPs were the most frequent diagnosing facility (45%), followed by sexual health clinics (26%). STI screening was the most common reason for testing (38%), followed by symptomatic presentation (28%), typically skin rash (20%) and chancre (17%). 83% were treated, with median time to treatment being 6-days (IQR 3, 11). 121 women were pregnant during their infection (1st-trimester 40.5%, 2nd-trimester 12.5%, 3rd-trimester 9%, at delivery 3%, post-birth 5%, miscarriage/termination 4% and missing stage at diagnosis 23%). 14 pregnancies resulted in congenital syphilis, of which 2 maternal cases were diagnosed in 2nd-trimester, 4 in 3rd-trimester, 3 at delivery and 5 post-birth.

Conclusion: Infectious syphilis in WRA is increasing in NSW, particularly in central and Greater Western Sydney. Reducing late diagnosis of maternal syphilis would reduce the occurrence of congenital syphilis.

Disclosure of interest statement: Nil conflicts of interest.

124. Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated global systematic review and meta-analysis

Chua T. P.^1,2,3,*, Vodstrcil L. A.^4,5,*, Murray G. L.^1,2,3, Plummer E. L.^2,4,5, Jensen J. S.⁶, Unemo M.^7,8, Chow E. P. F.^4,5,9, Low N.¹⁰, Whiley D. M.^11,12, Sweeney E. L.¹¹, Hocking J. S.⁹, Danielewski J. A.^2,3, Garland S. M.^1,2,3, Fairley C. K.^4,5, Zhang L^4,5,13,14,15, Bradshaw C. S^4,5,9,* and Machalek D. A.^2,16,*

¹Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Vic, Australia.

²Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville, Vic, Australia.

³Molecular Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Vic, Australia.

⁴Melbourne Sexual Health Centre, Alfred Health, Carlton, Vic, Australia.

⁵Central Clinical School, Monash University, Melbourne, Vic, Australia.

⁶Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.

⁷WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, örebro University, örebro, Sweden.

⁸Institute for Global Health, University College London, London, UK.

⁹Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic, Australia.

¹⁰Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

¹¹The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.

¹²Pathology Queensland Central Laboratory, Brisbane, Qld, Australia.

¹³China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China.

¹⁴Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China.

¹⁵Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.

¹⁶The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

^*Joint first and joint last contributions.

Background: Previous analysis found global macrolide, fluoroquinolone, and dual-class resistance in M. genitalium increased over time, reaching 51.4%, 9.3%, and 4.0%, respectively in 2016–2017; prevalence was highest in the Western-Pacific region. Contemporary estimates of antimicrobial resistance in M. genitalium are needed to inform treatment guidelines.

Methods: PubMed, Embase, and MEDLINE were searched between 1 January 2019 and 18 April 2023 for studies reporting macrolide and fluoroquinolone resistance-associated mutations in M. genitalium. Data were extracted by year of collection and geographic region. The frequency of each ParC amino acid changes (S83I/R/C/N and D87N/Y) were also extracted. Pooled prevalence estimates (95% confidence intervals [CI]) were calculated using random-effects models.

Results: Overall, 166 studies (107 from the updated search period) were included. In 2018–21, the global prevalence of macrolide, fluoroquinolone, and dual-class resistance was 33.3% (95% CI 27.2–39.7), 13.3% (10.0–17.0), and 6.5% (4.0–9.4), respectively. Over time, macrolide resistance plateaued in the Western Pacific and the Americas but rose in the European region. Fluoroquinolone resistance was highest in the Western Pacific and increased in the European non-Nordic region. ParC S83I was the most common variant associated with fluoroquinolone resistance, increasing from 0.0% (0.0–0.30) before 2012 to 7.3% (4.7–10.3) in 2018–21; P_trend = 0.055).

Conclusion: Macrolide resistance levels appear to be stabilising in some regions, which could be due to the reduction in use of single-dose azithromycin as first-line therapy and increase in the use of resistance-guided therapy for M. genitalium. The continuing rise in prevalence of fluoroquinolone and dual-class resistance mutations highlights the urgent need for new treatment strategies including diagnostic assays that detect fluoroquinolone resistance markers. The steady increase in the ParC S83I change supports emerging evidence of its role in fluoroquinolone treatment failure, making this mutation a target for next-generation resistance-guided therapy assays.

Disclosure of interest statement: This work was supported by the Australian Research Council. The funder had no role in this study.

125. Infectious syphilis in women of reproductive age, and congenital syphilis trends, 2011–2021

Hengel B.¹, McManus H.¹, Monaghan R.¹, Mak D.², Bright A.³, Tolosa M. X.⁴, Anderson L.⁵, Thomas J. R.¹, Ryder N.⁶, Causer L.¹, Guy R.¹ and McGregor S.¹

¹Kirby Institute, UNSW Sydney, NSW, Australia.

²Communicable Disease Control Directorate, WA Department of Health, WA, Australia.

³Public Health and Surveillance Branch, Australian Government Department of Health and Aged Care, Australia.

⁴Public Health Intelligence, Queensland Department of Health, Qld, Australia.

⁵Kimberley Aboriginal Medical Services, Broome, WA, Australia.

⁶Hunter New England LHD, NSW Health, NSW, Australia.

Background: Mother-to-child transmission of syphilis, called congenital syphilis, can cause serious complications to the developing foetus, including stillbirth. Since 2011 there has been a substantial increase in infectious syphilis rates among young women of reproductive age in Australia. We aimed to describe the notification rates and trends in infectious syphilis in women aged 15–44 years and congenital syphilis, along with the gaps in health care access, syphilis testing and treatment for mothers of infants diagnosed with congenital syphilis.

Methods: Using national surveillance data (2011–2021), we calculated infectious syphilis notification counts, rates and time trends. Using enhanced congenital syphilis notification data, we calculated case counts, outcomes, and antenatal care history.

Results: Between 2011 and 2021 there were 5011 infectious syphilis notifications in women. The notification rate was 9 per 100,000 population, with an upward trend over time (P < 0.001). Highest rates were in 15–34-year-old women (11 per 100,000), women living in remote areas (136 per 100,000) and Aboriginal and Torres Strait Islander women (140 per 100,000). There were 74 cases of congenital syphilis, increasing from 6 in 2011 to a peak of 17 in 2020. Rates were highest among Aboriginal and Torres Strait Islander infants (38.3 per 100,000 births in 2021). For congenital syphilis cases, 23% were stillborn, and 56% of mothers resided in major cities, while 43% had not received antenatal care.

Conclusion: Between 2011 and 2021, infectious syphilis cases increased in reproductive aged women in Australia, with an associated increase in congenital syphilis. A quarter of infants with congenital syphilis were stillborn. To reduce congenital syphilis numbers, we urgently need to understand barriers to antenatal care and syphilis screening to ensure effective prevention strategies are developed.

Disclosure of interest statement: No disclosure of interest.

126. STI testing has not fully recovered in post-COVID restriction phase at sexual health clinics in Australia

Aung H. L.¹, Patel P.^1,2, Asselin J.³, Carter A.¹, Traeger M. W.³, Fairley C. K.^4,5, Templeton D. J.^1,6, Varma R.^1,7, Cornelisse V.^1,8, Stoové M. A.³, Donovan B.¹, Hellard M. E.³, Chow E. P. F.^4,5,9,* and Guy R.^1,*

¹The Kirby Institute, NSW, Australia.

²British Columbia Center for Disease Control

³Burnet Institute, Vic, Australia.

⁴Melbourne Sexual Health Centre, Alfred Health, Vic, Australia.

⁵School of Translational Medicine, Monash University, Vic, Australia.

⁶Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia.

⁷Sydney Sexual Health Centre, NSW, Australia.

⁸North Coast Population and Public Health Directorate, NSW, Australia.

⁹Melbourne School of Population and Global Health, The University of Melbourne, Vic, Australia.

^*Co-senior authors.

Background: Previous research indicates COVID-19 restrictions disrupted sexual health services. We explored how these restrictions affected consultations and testing of common bacterial sexually transmitted infections (STI) and their post-restriction recovery at publicly-funded sexual health clinics (SHCs) in Australia.

Methods: We analysed 2018–2023 data from 16 SHCs across six states participating in a national sentinel surveillance system, ACCESS. Using Prais-Winsten regression to adjust autocorrelation, we compared mean monthly consultations, STI tests, and test positivity between pre-COVID (2018–2019) and COVID-restriction (2020–2021) periods, as well as between pre-COVID and post-restriction (2022–2023) periods. Analyses were stratified by population (female sex worker (FSW), heterosexuals, gay and bisexual men (GBM)) and symptom presence.

Results: We included 983,804 consultations from 436,985 clients. Mean monthly consultations during the three phases were 15,827, 11,515 and 13,650. COVID-restriction was associated with a decrease in mean monthly consultations (–25.53%; CI = –35.88, –16.33) and number of chlamydia (–31.09%; CI = –43.60, –20.19), gonorrhoea (–31.02%; CI = –43.54, –20.10) and syphilis (–30.77%; CI = –41.66, –21.11) tests compared to pre-COVID levels. These decreases were consistent across all populations and among both asymptomatic and symptomatic clients. Positivity increased among symptomatic clients for chlamydia (9.73%; CI = 3.32, 15.56) and among both asymptomatic and symptomatic clients for syphilis (43.73%; CI = 34.18,51.65) during COVID-restriction. In the post-restriction phase, compared to pre-COVID, mean monthly consultations (–13.43%; CI = –23.10,–4.83) remained lower and was significant only among asymptomatic clients, while testing for chlamydia (–20.14%; CI = –31.97,–9.82), gonorrhoea (–19.59%; CI = –31.40, –9.28) and syphilis (–18.42%; CI = –28.60,–9.40) continued to be reduced among both asymptomatic and symptomatic clients. Mean monthly positivity for all STIs increased (chlamydia; 17.33%; CI = 11.75, 22.46) (gonorrhoea; 20.96%; CI = 10.58, 29.81) (syphilis; 40.96%; CI = 30.66, 49.51) in post-restriction compared to pre-COVID, attributable to both asymptomatic and symptomatic testing across all populations except FSW.

Conclusion: STI testing has not returned to pre-pandemic levels in the post-restriction era at SHCs, alongside a rise in positivity.

Disclosure of interest statement: None.

127. Enhanced genomic epidemiology of Mycoplasma genitalium reveals lineages displaying transmitted antibiotic resistance

Azzato F.^1,2, Taiaroa G.², Fernando J.², Taouk M. L.², De Petra V.^4,6, Vodstrcil L. A.^4,5, Plummer E.^4,5, Caly L.¹, Howden B. P.³, Bradshaw C. S.^4,5 and Williamson D. A.²

¹Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

²Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

³Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

⁴Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁵School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

⁶Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.

Background: The emergence of antibiotic resistance in M. genitalium poses challenges for patient care and public health. Due to high rates of resistance, treatment guidelines recommend resistance-guided therapy, often incorporating a genotyping component. However, there are considerable gaps in our understanding of the emergence and prevalence of resistant genotypes, as well as the broader population structure of M. genitalium. This has been in part due to the inability to routinely culture this pathogen, making traditional whole genome sequencing impractical.

Methods: To address these gaps, we applied a culture-independent capture-based sequencing approach to generate whole genome sequences from 189 M. genitalium positive patient samples from Victoria, Australia. These were integrated with publicly available genomes for a complete genomic epidemiological analysis of 220 genomes, integrating phenotypic antibiotic resistance and patient-level metadata where available.

Results: Bayesian analysis of population structure (BAPS) revealed multiple M. genitalium lineages with transmitted drug resistance. Major lineages (BAPS 1–8) showed high rates of genotypic macrolide resistance (50–100% with 23S rRNA), with a subset showing high rates of genotypic fluoroquinolone resistance (49–87% with relevant parC and/or gyrA genotypes). Demographic and epidemiological associations were observed, including some lineages were more prevalent among women (27%) compared to the average (9%). Associations were explored between sequence variation and putative doxycycline resistance, as well as with treatment failure.

Conclusion: This research delivers valuable genomic insights into M. genitalium, highlighting the co-circulation of diverse lineages within Victoria, Australia. The study addresses the priority area of antibiotic resistance in this pathogen by examining the prevalence and distribution of antimicrobial resistance determinants among lineages.

Disclosure of interest statement: This project received funding from NHMRC and ARC, including the ARC ITRP Hub to Combat Antimicrobial Resistance, with Professors Catriona Bradshaw and Deborah Williamson as Chief Investigators.

128. Risk of HIV and recent bacterial sexually transmitted infections among transgender and non-binary individuals in 20 European countries: are we overlooking non-binary persons?

Wang H.¹, Kolstee J.¹, Zimmerman H.¹ and Jonas K. J.¹

¹Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands.

Background: Global data show that transgender individuals are disproportionally affected by HIV and sexually transmitted infections (STIs). However, data is scarce for non-binary individuals due to erasure, exclusion, or misclassification. We assessed the prevalence of HIV and other recent bacterial STIs (syphilis, gonorrhea, and chlamydia) in the preceding six months among transgender and non-binary individuals, and compared their risks of acquiring bacterial STIs.

Methods: We conducted a cross-sectional survey (PROTECT) in 20 European countries from October 2023 to February 2024. 345 Transgender (n = 131) and non-binary participants (n = 214) were included in this analysis, using logistic regression for the comparison of the risk of each recent bacterial STI, and multinomial regression for the comparison of the number of recent bacterial STIs among transgender and non-binary individuals, adjusted for their HIV status.

Results: The median age was 31 years (IQR 26–40). Of the transgender individuals, two (1.5%) were living with HIV, nine (6.9%), 26 (19.8%), and 28 (21.4%) had recent diagnoses of syphilis, gonorrhea, and chlamydia, respectively. Of the non-binary individuals, 14 (6.5%) were living with HIV, 40 (18.7%), 66 (30.8), and 53 (24.8%) were diagnosed recently with syphilis, gonorrhea, and chlamydia, respectively. Compared to transgender individuals, non-binary individuals exhibited significantly higher risks of syphilis (aOR = 2.71, 1.25–5.87), and elevated, though nonsignificant, risks of gonorrhea (aOR = 1.62, 0.95–2.75) and chlamydia (aOR = 1.11, 0.65–1.88). Non-binary individuals also demonstrated a significantly higher risk of having at least one bacterial STI (aOR = 1.97, 1.12–3.44) and exhibited increased, though nonsignificant, risks of multiple bacterial STIs.

Conclusion: Both transgender and non-binary individuals face elevated risks of HIV and bacterial STIs in Europe. However, non-binary individuals face an even greater risk, particularly concerning syphilis. Efforts aimed at HIV/STI prevention and surveillance should increase inclusivity for non-binary and other gender-diverse individuals alongside transgender individuals to enhance the provision of tailored HIV/STI prevention and treatment services.

Disclosure of interest statement: This study was co-funded by ViiV Healthcare.

129. Temporal trends in Neisseria gonorrhoeae among cis-gender women and men, and transgender persons in Amsterdam, The Netherlands

Teker B.^1,7, Schim Van Der LOEFF M.^1,2,3,4, Hoornenborg E.^1,3, Stam A.^1,5, De Vries H. J. C.^1,3,4,7,* and Jongen V. W.^1,6,*

¹Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.

²Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

³Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands.

⁴Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands.

⁵Department of Medical Microbiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

⁶Stichting HIV monitoring, Amsterdam, The Netherlands.

⁷Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

^*Contributed equally.

Background: In 2022–2023, various European countries noted an increasing prevalence of Neisseria gonorrhoeae (Ng), especially among cis-gender women and heterosexual cis-gender men. We assessed positivity rates of Ng over time among men who have exclusively sex with men (MSM), men who have exclusively sex with women (MSW), men who have sex with men and women (MSMW), women, and transgender persons.

Methods: We analysed routinely collected data from 2018 to 2023 at the Centre of Sexual Health, Amsterdam, and calculated Neisseria gonorrhoeae (Ng) positivity rates. Temporal changes in Ng were assessed using a multilevel mixed-effect generalised linear model using three time periods: pre-COVID-19 (1 January 2018–12 March 2020), during COVID-19 (13 March 2020–1 March 2022), and post-COVID-19 (2 March 2022–31 December 2023).

Results: In 2018–2023, we diagnosed 20,497 Ng in 304,066 consultations. Positivity rates pre-COVID-19 were 12.4% in MSM, 1.7% in MSW, 6.7% in MSMW, 1.3% in women, and 8.3% in transgender persons. Post-COVID-19, the positivity rate increased to 13.0% in MSM, 2.3% in MSW, 9.9% in MSMW, 2.9% in women, and 10.4% in transgender persons. The risk of Ng increased post-COVID-19 compared to pre-COVID-19 for MSW (prevalence ratio (PR) = 1.31, 95% CI = 1.12–1.53), MSMW (PR = 1.47, 95% CI = 1.26–1.72), and women (PR = 2.25, 95% CI = 2.04–2.49). For MSM, risk of Ng remained similar pre- and post-COVID-19 (PR = 1.03, 95% CI = 0.99–1.07). The risk of Ng increased post-COVID-19 among MSW and women with a larger number of sexual partners and who used alcohol, whereas post-COVID-19 a history of STI, and an age over 24 years decreased the risk of Ng compared to pre-COVID-19.

Conclusion: Post-COVID-19, we noted an increase in Ng among MSW, MSMW and women, but not MSM. This was associated with changes in sexual behaviour and engaging in sex under influence of alcohol among MSW and women. Effective prevention programs for heterosexual clients are needed to curb the spread of Ng.

Disclosure of interest statement: None.

130. Descriptive and spatial evaluation of congenital syphilis cases in children under 1 year old in Brazil, 2019–2022

Silva A. P. B.¹, Gaspar P. C.¹, Lannoy L. H. de¹, Domingues C. S. B.², Silva C. F.¹, Oliveira M. G.¹, Moherdaui F.¹, Aragón M. G.¹, Barreto L. S. A.¹, Diniz I. V. A.¹, Matos A. T. B.¹, Oliveira R. S. M.¹, Colombo M.¹, Júnior L. F. A.¹, Steenhouwer R. S.¹, Lima A. M.¹, Junior S. F.¹, Souza I. M. C. D.¹, Miranda A. E. B.³ and Neto D. B. C.²

¹General Coordination of Sexually Transmitted Infections, HIV/AIDS, Department of Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Health and Environment Surveillance Secretary, Ministry of Health, Brazil.

²Department of Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Health and Environment Surveillance Secretary, Ministry of Health, Brazil.

³Health and Environment Surveillance Secretary, Ministry of Health, Brazil.

Background: Although congenital syphilis (CS) is a treatable disease, it continues to pose a public health challenge. The objective was to evaluate CS in children under 1 year old (<12) and to map high-risk areas for the disease in Brazil, between 2019 and 2022.

Methods: Descriptive and ecological study using data from the National Information System of Notifiable Diseases. The incidence rate (IR) was calculated by CS cases in <12 per number of live births (LB)/year, multiplied by 1000. High-risk CS areas were those with clusters formation, identified by purely spatial scanning within circular window up to 500 km and with relative risk >1; 50% population (LB) at risk; maximum 999 Monte Carlo replications and P-value <0.05. The following software was used: Office 365, R 4.2.2./R studio, SaTScan 10.1.2 and QGIS 3.16.6.

Results: From the 99.883 notifications, 99.182 (99.3%) were classified as CS, with similar distribution between reported gender which 50.1% (46.674/93.138) were female and 49.9% (46.464/93.138) male. In Brazil, the highest CS IR (10.0) occurred in 2022, followed by 2021 (9.8); 2019 (8.7) and 2020 (8.2). Throughout the examination period, 25.7% (2019); 19.7% (2020); 26.1% (2021); 28.5% (2022) of the children’s mothers received adequately treatment. However, when searching those mothers by exact correspondence, only 0.7%, 0.6%; 6.9%; 0.7% of them were found. As for CS high-risk areas, it was identified 17, 22, 20 and 18 high-risk clusters during 2019 to 2022, mostly in capitals or in populous regions of the country.

Conclusion: The clusters identification underscores the existence of CS high-risk areas in the country, while the increased incidence, particularly over the last two years, highlights the critical need to strengthen efforts in prevention, control, and treatment in the population. Also, employing probabilistic linkage is necessary to understand deeper the CS scenario of children born from adequately treated mothers.

Disclosure of interest statement: We declare that there are no conflicts of interest among the authors and no grants were received for the development of this study.

131. Detection of congenital syphilis in the northern territory – a look back at syphilis serology testing in pregnant Aboriginal women

Cherian R. M.^1,2, Moore E.², Dempsey K.³, Jennings B.⁴ and Gunathilake M.¹

¹Sexual Health & Blood Borne Virus Unit, Centre for Disease Control, Northern Territory Department of Health, NT, Australia.

²Aboriginal Medical Services Alliance Northern Territory, NT, Australia.

³Miwatj Health Aboriginal Corporation.

⁴College of Medicine and Public Health, Flinders University, SA, Australia.

Background: Congenital syphilis is a preventable disease and a direct reflection of rates of syphilis in the population. Between 2015 and 2020, Australia had an increase in syphilis notifications in women of reproductive age. From 1 January 2016 to 30 September 2022, 59% (n = 63) of congenital syphilis cases and 67% (n = 12) of deaths were reported in Aboriginal infants. In 2018, the Syphilis Communicable Diseases Network Australia National Guidelines was updated, recommending syphilis testing five times for women during the perinatal period in outbreak areas.

Aim: The aim of the study was to assess the rates, enablers and barriers of antenatal syphilis serology testing in pregnant Aboriginal women and to formulate recommendations on how testing can be improved in the Northern Territory (NT) Aboriginal primary health care (PHC) sector.

Methods: A retrospective electronic file audit of antenatal and postnatal episodes of care and syphilis serology testing of Aboriginal women who birthed a live born or stillborn baby was undertaken at three NT Health remote clinics and one ACCHS. The study period was between 1 May 2019 and 31 March 2021.

Results: Our study found that 93.5% and 93.2% of Aboriginal women had an antenatal episode of care and first antenatal syphilis test respectively. As gestational age increased, the proportion of women receiving syphilis serology testing decreased to a greater extent than the number of women attending antenatal episodes of care. Postpartum episodes of care and syphilis serology tests were attended by 26.9 and 29.2% of Aboriginal women respectively.

Conclusion: While pregnant Aboriginal women are attending for antenatal care, the majority are not having the regimen of five tests. It is recommended that the PHC sector implement a recall system for syphilis serology testing, provide opportunistic syphilis testing during pregnancy and monitor adherence to syphilis testing guidelines in pregnancy.

Disclosure of interest statement: The authors of this project have no conflicts of interest and the research did not receive any specific funding. Miwatj Health Aboriginal Corporation has been involved in the conducting of the research.

132. Antimicrobial susceptibility among oropharyngeal Neisseria isolates from men in a HIV PrEP program in Hanoi, Vietnam

Dong H. V.¹, Adamson P. C.², Pham D. H.³, Pham Q. H.³, Le H. H. L.^3,4, Pham Q. L.⁴, Bui H. T. M.⁴, Le M. G.⁴ and Klausner J. D.⁴

¹Division of Pediatric Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California, USA.

²Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California, USA.

³National Hospital for Dermatology and Venereology, Hanoi, Vietnam.

⁴Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam.

⁵Population and Public Health Sciences, Keck School of Medicine at USC, Los Angeles, California, USA.

Background: Antimicrobial resistance (AMR) among Neisseria gonorrhoeae (NG) is an urgent global health concern. Commensal Neisseria species in the oropharynx are hypothesised to be a reservoir of AMR genes that are transferred to NG yet few data about AMR among commensal Neisseria in populations at risk for AMR exist.

Methods: From 5/2022 to 12/2023, men-who-have-sex-with-men in an HIV Pre-exposure prophylaxis program in Hanoi, Vietnam, were recruited to study AMR of Neisseria in the oral cavity. Participants self-collected oral rinses using 10mL of phosphate buffer solution, which was diluted 1:100 and 1 mL was plated directly onto LB agar containing Vancomycin (3ug/mL) and Trimethoprim (3ug/mL). Gram-negative diplococci isolates were identified using RapID NH system (Remel). Minimum inhibitory concentrations (MIC) to Azithromycin, Ceftriaxone, Cefixime, and Doxycycline were determined using Etests (Biomerieux). CLSI breakpoints for Neisseria gonorrhoeae were used for interpretation; doxycycline was interpreted using tetracycline breakpoints.

Results: There were 42 male participants, the median age was 26 years (IQR 21–28), and 29% (n = 12) reported using antibiotics in the past 6 months. In total, 48 Neisseria isolates were recovered; N. sicca/subflava was the most common species (50%; n = 24), followed by N. mucosa (38%; n = 18). For azithromycin, 85% (n = 41) of isolates were non-susceptible, including 25% (n = 12) with high level resistance (MIC ≥ 256) of which 67% (8/12) were N. mucosa. Non-susceptibility among non-gonococcal Neisseria isolates was 3% (n = 4) to Ceftriaxone, 3% (n = 4) to Cefixime, and 42% (n = 20) to doxycycline; most non-susceptible isolates were N. mucosa.

Conclusion: A high prevalence of azithromycin non-susceptibility and low prevalence of cephalosporin non-susceptibility was found in oropharyngeal Neisseria from MSM in Hanoi, Vietnam. N. mucosa was over-represented among non-susceptible isolates. Further research into the prevalence and genomic determinants of AMR in commensal Neisseria from diverse populations is needed to improve our understanding of the relationship to AMR in NG.

Disclosure of interest statement: The study was supported by the National Institute of Allergy and Infectious Diseases (R21AI157817 to JDK and LMG) and the Fogarty International Center (K01TW012170 to PA) of the U.S. National Institutes of Health. HTMB was supported by the Fogarty International Center and the Office of Disease Prevention of the National Institutes of Health (NIH) under Award Number D43TW009343 and the University of California Global Health Institute (UCGHI). HVD was supported by the National Institutes of Health award T32AI177290, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No pharmaceutical grants were received in the development of this study.

133. High prevalence of ceftriaxone resistance associated with the penA-60 allele among Neisseria gonorrhoeae isolates in Hanoi, Vietnam

Adamson P. C.¹, Hieu V. N.^2,3, Nhung P. H.^2,3 and Chau T. M.^2,3

¹Division of Infectious Diseases, School of Medicine, University of California, Los Angeles, CA, USA.

²Department of Microbiology, Hanoi Medical University, Hanoi, Vietnam.

³Department of Microbiology and Parasitology, Hanoi Medical University Hospital, Hanoi, Vietnam.

Background: Ceftriaxone is recommended as empiric therapy for Neisseria gonorrhoeae infections, but resistance is increasing. The penA-60 allele is associated with ceftriaxone resistance and is of international concern. Our study investigated the prevalence of ceftriaxone resistance and the penA-60 allele in N. gonorrhoeae in Hanoi, Vietnam.

Methods: All N. gonorrhoeae isolates obtained through routine laboratory procedures at the Hanoi Medical University Hospital microbiology laboratory from January to December 2023 were selected for additional testing. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute procedures and minimum inhibitory concentrations (MICs) were determined using Etests (bioMerieux, France). Direct detection of the penA-60 allele was performed for all isolates with ceftriaxone MICs ≥0.125 mg/L; isolates were grown on GC agar with 1% Vitox, and 1% Hemoglobin, (Oxoid, United Kingdom), underwent DNA extraction, followed by a real-time PCR assay to detect the presence of the penA-60 allele. Descriptive statistics were used to summarise the ceftriaxone median MIC, interquartile range (IQR), and MIC₉₀.

Results: Of the 243 N. gonorrhoeae isolates, 12 were non-viable and excluded. Among the 231 available isolates, 97.0% (224/231) were obtained from urethral specimens. The median MIC was 0.023 mg/L (IQR: 0.016–0.25) and the MIC₉₀ was 0.5 mg/L. Ceftriaxone MICs ≥0.125 mg/L were found in 29.4% (68/231) of isolates and 22.1% (51/231) had MICs >0.25 mg/L. The penA-60 positivity was 60.3% (41/68) among those with MICs ≥0.125 mg/L and 60.8% (31/51) among isolates with MICs >0.25 mg/L.

Conclusion: A very high prevalence of ceftriaxone resistance was found among N. gonorrhoeae isolates in 2023 within one hospital system in Hanoi, Vietnam. The penA-60 allele was detected in the majority of ceftriaxone-resistant isolates, increasing concerns about international dissemination. In Vietnam, rapid detection of ceftriaxone resistance by direct detection of the penA-60 allele can aid diagnostic and surveillance efforts.

Disclosure of interest statement: The study was supported by the United States National Institutes of Health Fogarty International Center (K01TW012170 to PA). No pharmaceutical grants were received in the development of this study.

134. Disparities of group sex practice in different at-risk populations and geographic regions: a global systematic review and meta-analysis

Atapattu K.¹, Tieosapjaroen W.^1,2, Ong J. J.^1,2, Phillips T. R.^1,2, Choi E. P. H.³, Fairley C. K.^1,2 and Chow E. P. F.^1,2,4

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.

⁴Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: Group sex is a risk factor for HIV and sexually transmitted infections. However, data on group sex prevalence are scattered. We aim to synthesise data on group sex prevalence.

Methods: We searched four databases (Web of Science, Ovid MEDLINE, Ovid Emcare, and Embase). We included studies that reported group sex prevalence published up to 26 January 2022. The primary outcome was group sex prevalence within 12 months. Subgroup analyses were performed by at-risk populations, continents and study year. Meta-analyses using random-effect models were performed to estimate the pooled group sex prevalence. This review was registered with PROSPERO (CRD42022307006).

Results: We included 166 studies (201 data points) with 178,425 participants from 1991 to 2020. 64.2% (129/201) measured group sex within 12 months. 69.7% (140/201) were conducted among men who have sex with men (MSM). Globally, the pooled prevalence of group sex was 35.7% (95% CI: 27.1–45.4%, n = 40, I² = 99.0%) during lifetime, and 22.5% (95% CI: 19.6–25.6%, n = 129) within 12 months. It ranged across the six continents (P < 0.0001), from 12.8% (95% CI: 9.8–16.4%, n = 30) in Asia to 33.8% (95% CI: 27.7–40.5%, n = 30) in Europe. It also varied between at-risk populations (P < 0.0001). People living with HIV reported the highest prevalence (48.5%, 95% CI: 45.6–54.5%, n = 11), followed by MSM (23.2%, 95% CI: 20.5–26.1%, n = 97) and sex workers (22.2%, 95% CI: 13.6–34.0%, n = 9).

Conclusion: One in four people reported group sex within 12 months, although participants were predominantly from “high-risk” groups. This may help identify group sex participants for interventions such as regular testing and preventive strategies (e.g. safe sex messages and HIV pre-exposure prophylaxis).

Disclosure of interest statement: EPFC and JJO are supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873, GNT1193955). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). All other authors have no conflicts of interest.

135. Roles of lifestyles and clinical presentation associated with RVVC among women of reproductive age in Nigeria

Fayemiwo S. A.^1,2, Novak-Frazer L.^2,3, Adewole I. F.⁴ and Rautemaa-Richardson R.^2,3

¹Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

²Division of Evolution, Infection and Genomics, FBMH, University of Manchester, Manchester, United Kingdom.

³Mycology Reference Centre Manchester (MRCM), Manchester University NHS Foundation Trust.

⁴Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Background: Recurrent vulvovaginal candidosis (RVVC) is a clinical condition defined by a history of four or more acute inflammatory and culture-positive symptomatic episodes of vulvovaginal candidosis (VVC) in 12 months. This study aimed to map the frequency of and lifestyle-associated risk factors for RVVC among women of childbearing age in Nigeria.

Methods: A prospective population-based cross-sectional study was conducted in all six geopolitical zones of Nigeria. Women of childbearing age (18–55) were recruited in two randomly selected local government areas of the selected states in Nigeria. The symptomatic or asymptomatic participants were given pre-tested, standardised symptoms, health, and lifestyle questionnaires. Data were analysed using IBM and SPSS version 26.0.

Results: The mean age was 33.0 years ± 9.0 (range = 18–55, IQR = 12). Of the enrolled 1198 women, 63.5% (761/1198) were symptomatic. The prevalence of participants with true RVVC in Nigeria was 15.8% (189/1198). Overall, the most common lifestyle associated with the RVVC was frequent sexual activities (OR (95% CI) = 1.4 (0.9–2.1; P = 0.14). Others included wearing synthetic underwear (22.7% vs 18.8%) (OR (95% CI) = 1.3 (0.95 – 1.69), P = 0.11); insertion of ’kayamata’(local herbs into the vagina) (OR (95% CI) = 1.1 (0.9–1.5), P = 0.38) and over-washing of the vulva with soap and water. Clinical characteristics associated with RVVC include abnormal vaginal discharge RVVC (OR 3.9, 95% CI = 2.9–5.1; 79.6% vs 49.9%) and genital pruritus RVVC (OR 2.9, 95% CI = 2.5–4.2; 71.4% vs 41.5%). Others include dysuria, intermenstrual bleeding, and dyspareunia. Logistic regression showed that abnormal vaginal discharge is 75th times more likely to have RVVC.

Conclusions: RVVC appears to be more common in Nigeria, with regional epidemiological differences. The most common behavioural risk factors associated with RVVC in Nigeria were over washing and frequent sexual activities.

Disclosure of Interest statement: No pharmaceutical grants were received in the development of this study. We declared no conflicts of interest.

136. Leveraging machine learning to accelerate Neisseria gonorrhoeae molecular target selection

Verich A.^1,2, Ramarao-Milne P.², Reguant Comellas R.², Alharbi B.³, Trembizki E.³, Applegate T. L.¹ and Bauer D. C.²

¹Surveillance and Evaluation Research Program, The Kirby Institute UNSW Sydney, New South Wales, Sydney, NSW, Australia.

²Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, New South Wales, Sydney, NSW, Australia.

³The University of Queensland Centre for Clinical Research, The University of Queensland, Queensland, Brisbane, Qld, Australia.

Background: Neisseria gonorrhoeae (NG) is a WHO ’high priority’ pathogen as strains resistant to last-line treatments having spread since 2016. Molecular diagnostics and surveillance characterising antimicrobial resistance (AMR) profiles provide an option to combat AMR emergence, by guiding effective treatment and reducing inappropriate antimicrobial use.

This study aims to leverage novel machine learning (ML) tools to analyse whole-genome sequence (WGS) datasets for genome-wide association studies of AMR genes. Specifically, CSIRO developed ML tools, VariantSpark and BitEpi will be used, aiming to improve molecular gene panel selection via determining gene variants contributing to phenotypes and identification gene interaction networks (epistasis), respectively.

Methods: Publicly available NG WGS datasets, paired with ciprofloxacin resistance information, were downloaded. A total of 3,297 samples were processed to generate Variant Call Files (VCFs) referencing NZ_AP023069.1. VCFs, with resistance data, were processed on Amazon Web Services using VariantSpark analysis constructing 1,000 random forest trees. The resulting 250 most important VariantSpark variants were analysed using BitEpi for epistatic interactions. RF model’s accuracy was assessed using Out-Of-Bag (OOB) error estimates from self-validation datasets.

Results: VariantSpark identified known ciprofloxacin resistance-related variants in the gyrA and parC genes. The OOB error rate was ~6.5%. VariantSpark highlighted significant AMR associations with tRNA synthesis pathway genes, primarily IleS, tgt, and miaB. BitEpi analysis displayed tRNA genes variants participated in extensive interactions networks.

Conclusions: VariantSpark and BitEpi reaffirmed known resistance genes and highlighted a potential genetic interactions framework within the tRNA synthesis pathway potentially influencing AMR in NG. These are unknown to contribute to AMR in NG, but known to aid the general bacterial antimicrobial stress-responses. Iles mutations in Vibrio cholera are known to affect ciprofloxacin resistance. ML analysis validated known variants but provided potentially new targets of note for testing to verify if they are significant for surveillance or gene panels for diagnostics use.

Disclosure of interest statement: This research is supported by an Australian Government Research Training (RTP) Scholarship and top-up by UNSW-CSIRO Industry PhD program by the Commonwealth Scientific and Industrial Research Organisation and SpeeDx Pty. Ltd. There are no conflicts of interest to declare.

137. Association between Mycoplasma genitalium and preterm birth in pregnant women in South Africa: prospective cohort study

Gigi R. M. S.^1,2, Mdingi M. M.², Jung H.³, Mensah E.³, Bütikofer L.⁴, Babalola C.⁵, Muzny C. A.⁶, Taylor C. M.⁷, van de Wijgert J. H. H. M.⁸, Medina-Marino A.⁹, Klausner J. D.⁵, Peters R. P. H.^2,3,10 and Low N.¹

¹Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

²Research Unit, Foundation for Professional Development, East London, South Africa.

³Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.

⁴CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland.

⁵Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

⁶Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.

⁷Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.

⁸Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht University, Utrecht, Netherlands.

⁹Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

¹⁰Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.

Background: Mycoplasma genitalium during pregnancy has been reported to be associated with preterm birth. Few studies are prospective or from resource-limited settings. This study aimed to investigate M. genitalium among pregnant women and its association with preterm birth in South Africa.

Methods: We conducted a cohort study in East London. Women were enrolled at <27 weeks of gestation, confirmed by ultrasound. A vaginal swab was tested for M. genitalium by PCR at the end of the study. Testing for Chlamydia trachomatis and Neisseria gonorrhoeae was done on-site (GeneXpert, Cepheid) with treatment for women with a positive result. Birth outcome was collected through postnatal visits, birth records and phone calls. Gestational age at birth was analysed in days and as preterm birth (<37 weeks). We conducted univariable and multivariable regression analyses, adjusting for age, educational level, azithromycin exposure and HIV status.

Results: From March 2021 to October 2023, 604 pregnant women were enrolled. To date, complete data are available for 370 women, with 355 live births. Of these 92/355 (25.9%) women were living with HIV and at enrolment, median gestation was 14 weeks (interquartile range 10–19). There were 27/355 (7.6%, 95% CI 5.2 to 11.0) women with M. genitalium and 53 preterm births (14.9, 11.5 to 19.2 per 100 live births; 2/27 with M. genitalium versus 51/328 without). Comparing women with M. genitalium to those without, crude mean gestational age at birth was 1.23 days later (–3.34 to +5.81) and adjusted 1.02 days later (–3.99 to +6.03). Risk ratios were: crude 0.48 (0.12 to 1.85); adjusted 0.46 (0.12 to 1.81).

Conclusion: In this prospective cohort study in a South African population, M. genitalium in pregnancy, controlling for potential confounding, was not associated with shorter gestation or with the proportion of preterm birth. The association between M. genitalium and adverse birth outcomes requires further research.

Disclosure of interest statement: The Foundation for Professional Development received donated GeneXpert machines from Cepheid. All authors declare no competing interests. This study was funded by NIH (R01AI149339) and SNSF (191225 and 197831).

138. Incidence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnant women in East London, Eastern Cape, South Africa

Mdingi M. M.^1,2, Gigi R. M. S.^1,3, Babalola C. M.⁴, Muzny C. A.⁵, Taylor C. M.⁶, Low N.³, Medina-Marino A.⁷, Klausner J. D.⁴ and Peters R. P. H.^1,2,8

¹Research Unit, Foundation for Professional Development, East London, South Africa,

²Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.

³Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

⁴Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

⁵Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.

⁶Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.

⁷Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

⁸Department of Pathology, University of Cape Town, Cape Town, South Africa.

Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are prevalent, often asymptomatic sexually transmitted infections (STIs) associated with adverse birth outcomes. In South Africa, routine screening in pregnancy is not offered. We assessed CT and NG incidence among pregnant women in East London, South Africa.

Methods: As part of an ongoing study of STI screening and treatment in 4 primary healthcare clinics, eligible pregnant women (≥18 years, first antenatal visit, ≤27 weeks’ gestation) were enrolled. At enrolment and a follow up visit at 30–34 weeks, CT/NG (Cepheid, Sunnyvale, USA) and HIV testing were conducted onsite. Women (and their partners) with positive test results were offered treatment.

Results: Between March 2021 and December 2023, we tested 649 women at enrolment, with 116 (17.9%, 95% CI 15.1–21.1) positive results — 97 (14.9%) for CT and 31 (4.8%) for NG. Notably, 193 (29.7%) were living with HIV (WLHIV) and 85 (13.1%) with vaginal discharge, of which 21 (24.7%, 95% CI 16.3–35.5) had an STI. Younger age was associated with STI at enrolment (median age 24 vs. 29 years; P-value <0.001). The odds ratio for WLHIV for CT were 0.37 (0.08–1.58) and NG 1.81 (0.4–8.2), age-adjusted 0.37 (0.08–1.71) and 1.98 (0.46–8.43) respectively. At 30–34 weeks, 391/639 participants were tested according to study arm, 21/391 (5.4%) positive for CT and 9/391 (2.3%) for NG. The incidence for baseline negative participants of CT was 130 per 1000 person-years (95% CI 70.9–217.5) and NG 58 per 1000 person-years (95% CI 23.5–120.4). The age-adjusted incidence rate for WLHIV versus HIV-negative women for CT were 52.91 (6.41–277.66) versus 154.98 (80.01–271.87) and for NG 124.36 (23.49–389.08) versus 48.00 (12.98–124.54).

Conclusion: Our findings underscore the need for better STI prevention strategies in women of reproductive age. The co-occurrence of STIs and HIV highlights the importance of integrated healthcare strategies.

Disclosure of interest statement: This study was funded by NIH grant number (R01AI49339-01A1) and Cepheid provided GeneXpert® machines.

139. Characteristics of measures to prevent mother-to-child transmission of HIV and future challenges in Japan

Rika Yamada^1,2, Masashi Deguchi^2,3, Naoto Yoshino^2,4, Atsushi Sugiura^2,5, Mizue Tanaka^2,6, Masashi Takano^2,7, Koji Kitajima^2,6 and Kita Tsunekazu^2,8

¹Kainan Hospital, Yatomi, Japan.

²The National Cooperative Study Group on HIV Infected Pregnant Women and Mother-to-Child Transmission, Japan.

³Kobe University Graduate School of Medicine, Kobe, Japan.

⁴School of Medicine, Iwate Medical University, Iwate, Japan.

⁵Japanese Red Cross Musashino Hospital, Musashino, Japan.

⁶National Center for Global Health and Medicine, Tokyo, Japan.

⁷National Defense Medical College Hospital, Shimono, Japan.

⁸Nana Prefecture General Medical Center, Nara, Japan.

Background: Epidemiological surveys on HIV-infected pregnancies in Japan began in 1997 and have been conducted annually. The first case of mother-to-child transmission (MTCT) of HIV was in 1984. Since 1995, 30 to 50 cases of HIV-infected pregnancies have continued to be reported, and there is no sign of a decreasing trend. By December 2022, the number of reported HIV-infected pregnancies is 1194, with 63 cases of MTCT.

Methods: Our group published the first manual of prevention of MTCT in 2000 and the first guidelines in 2018. The basics of MTCT prevention measures are the same as in Europe and the United States, but the standard mode of delivery is planned caesarean section (CS). In 2023, guidelines 3rd edition we published.

Results: Since 2000, MTCT has decreased dramatically due to good control of HIV viral load (VL), but MTCT due to pregnant women who have not undergone prenatal checkups or Infection of breastfeeding mothers still occurs sporadically at about one case per 1 or 2 years. And the reason why planned CS is the standard mode of delivery is Japan’s unique medical system, which limits the number of medical staff at night and holidays. Therefore, the introduction of vaginal delivery is limited to mature facilities. Thanks to Japan’s unique prenatal checkup system and medical insurance system, the HIV screening rate is over 99%, and MTCT prevention measures, including early diagnosis of infection, are fully functioning.

Conclusion: The next issue is how to deal with cases in which delivery occurs without undergoing prenatal checkups, and in cases where pregnant women are infected with HIV after their initial screening. In the future, we would like to identify such cases as early as possible and reduce MTCT to zero.

Disclosure of interest statement. Acknowledgement of Funding - Organization The National Cooperative Study Group on HIV Infected Pregnant Women and Mother-to-Child Transmission receive grant funding from the Government Japan. No pharmaceutical/Industry grants were received for this study.

140. Ureaplasma spp. detection in urogenital samples: clinical characteristics, and medical decisions surrounding its diagnosis

Claro M.¹, Riestra S.², Alliende B.², Cordero F.², Silva V.², Durán J.², Villarreal O.³, García P.^3,4 and Reyes T.¹

¹Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

²School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

³Clinical Microbiology Laboratory, Red de Salud UC-CHRISTUS, Santiago, Chile.

⁴Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Background: Ureaplasma spp. is considered normal genital flora in most sexually active individuals, but its role as a sexually transmitted infection remains controversial, which could result in inconsistent medical approaches. We aimed to analyse the clinical characteristics of patients with Ureaplasma spp. detection and the medical decisions surrounding its diagnosis.

Methods: We retrospectively reviewed all patients with a positive culture or real-time polymerase chain reaction (PCR) for Ureaplasma spp. from urogenital samples received by our microbiology laboratory in Santiago, Chile, between 2017 and 2022. Patient data, reasons for testing, coinfections, and post-positive result medical actions were collected from clinical records when available.

Results: 3181 participants with Ureaplasma spp. were included (77.2% female, 16.5% pregnant), with an average age of 33 years (±9.43 years). Coinfections were more common in females (51.1%) than males (21.8%), led by Mycoplasma hominis (32.1% of females), Candida spp. (16.2%) and Gardnerella vaginalis (13.5%). A concurrent Chlamydia trachomatis infection was detected in 3.8% of females and 6.5% of males, and Neisseria gonorrhoeae in 0.4% and 1.8%, respectively. However, the assessment of coinfections was considered incomplete in 30.4% of females and 8.95% of males. Clinical records were available for 834 (26.2%) cases; in 421 (50.5%), Ureaplasma testing was ordered for symptoms. At least one coinfection was found in 53.5% of symptomatic females and 29.3% of males. Of 580 (69.5%) patients for which the physician’s decision to treat was registered, antibiotics were indicated in 82.7%. In symptomatic patients, antibiotics were indicated in 84.2% of such cases.

Conclusion: In this sample, coinfections between Ureaplasma spp. and other potentially pathological microorganisms were common, especially in female patients. Treatment of patients was frequent but did not appear to be universal nor guided by symptoms, which, summed to the high frequency of coinfections in symptomatic patients, points to gaps in medical management.

Disclosure of interest statement: I declare that I have no conflict of interest.

141. Anorectal high-risk human papillomavirus infection and cytological alterations in men living with HIV in Chile

Reyes Barros T.¹, García Cañete P.², Zoroquiain Vélez P.³, Hernández Pizarro J.⁴, Corsi Sotelo O.⁵ and Ceballos Valdivielso M. E.¹

¹Departament of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile.

²Departament of Clinical Laboratories. School of Medicine, Pontificia Universidad Católica de Chile.

³Departament of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Chile.

⁴Microbiology Laboratory, UC-CHRISTUS Health-Network, Santiago, Chile.

⁵Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile.

Background: High-risk human papillomavirus (HR-HPV) is the main risk factor for anal cancer and is highly prevalent in men who have sex with men and live with HIV (MSMLWH). Anal cytology is a widely available screening tool, but its ability to detect preneoplastic lesions has been underwhelming. However, information from different regions remains relevant for developing screening strategies and public policies. We present data on anal cytology and HR-HPV infection in MSMLWH in Chile.

Methods: We invited MSMLWH from an academic outpatient clinic to participate in a cross-sectional study that included anal sampling for liquid cytology and HR-HPV detection using the Cobas 4800® system (Roche®) and an online self-administered questionnaire that collected demographic and behavioral information.

Results: We recruited 95 participants, with a mean age of 36.1 ± 8.4 years. 97.9% of patients were on antiretroviral therapy, with a median CD4 count of 613 (IQR: 480–767). 90.7% had an undetectable viral load, and 88.4% had a history of a sexually transmitted infection, including anal condyloma in 43.5%. Ninety participants answered the survey, among whom the sexual role most often performed was described as receptive (43.4%) or insertive/receptive in similar frequency (41.1%). Of those sexually active in the previous six months, most referred only one sexual partner (47.0%), followed by 2–5 (30.1%). 17.8% of participants had received at least one dose of HPV vaccination. HR-HPV was detected in 77.9% of samples, and HPV-16 and HPV-18 were found in 21.7% and 18.3%, respectively. Of the 79 samples suitable for cytology, 55.7% showed abnormal results.

Conclusion: A high prevalence of anal HR-HPV and altered cytology was detected in this sample of MSMLWH in Chile with good virological control, similar to international reports. These results support both the importance of HPV vaccination and advancing to a widely available anal cancer screening in this population.

Disclosure of interest statement: None.

Acknowledgement of Funding: Resident research fund was awarded from the Faculty of Medicine of the Pontificia Universidad Católica de Chile. HR-HPV PCR kits were donated from Roche® for the purposes of this study.

142. Reproductive tract consequences of bacterial sexually transmitted infections in South Africa: cohort study

Heron L.¹, Taghavi K.^1,2, Folb N.³, Kriel A.³, Helfenstein F.¹, Haas A. D.¹, Ruffieux Y.¹, Maartens G.⁴ and Low N.¹

¹Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

²International Agency for Research on Cancer, World Health Organization, Lyon, France.

³Medscheme, Cape Town, South Africa.

⁴University of Cape Town, Cape Town, South Africa.

Background: The bacterial sexually transmitted infections (STIs) Chlamydia trachomatis and Neisseria gonorrhoeae can cause pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women and epididymoorchitis in men. Non-fatal and fatal reproductive tract consequences are a leading contributor to STI burden, but little is known from resource-limited settings, where STI are most common. This study aims to describe the incidence of upper genital tract conditions associated with bacterial STI in South Africa.

Methods: We conducted a cohort study among beneficiaries of a South African medical insurance scheme aged 15–49 years from 2011 to 2020. Diagnoses were obtained from International Classification of Diseases 10th revision codes from both outpatients and inpatients for pelvic inflammatory disease, ectopic pregnancy, female infertility and epididymoorchitis. We calculated incidence rates per 1000 person-years of follow-up (with 95% Poisson confidence intervals, CI) for the first episode and stratified these by age and HIV status.

Results: A total of 808,423 individuals were included, with 2,974,961 years of follow-up, including 419,050 women and 27,501 people living with HIV. Overall rates per 1000 person years (95% CI, number) were: pelvic inflammatory disease 33.6 (33.3–33.9, n = 51,444); ectopic pregnancy 3.6 (3.5–3.7, n = 5438); female infertility 3.3 (3.2–3.4, n = 4957) and epididymoorchitis 4.2 (4.1–4.3, n = 5991). All diagnosis rates were highest in 25–34 and 35–44-year-olds and higher among people with HIV than those without. Pelvic inflammatory disease diagnoses declined over time.

Conclusion: We generated direct all-cause estimates for reproductive tract conditions that can be caused by bacterial STIs. STI aetiology could not be assigned because most STI in South Africa are managed syndromically and consequences often occur some time after the infection. Health insurance recipients are not necessarily representative of the general population. Nevertheless, these data are essential inputs for modelling and economic analyses of the global STI burden and its impact.

Disclosure of interest statement: No authors have any interests to declare. Research reported in this abstract was supported by the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Fogarty International Center (FIC) under Award Number U01AI069924. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Katayoun Taghavi was supported by a Swiss National Science Foundation Mobility Award.

143. The potential impact of providing post-exposure prophylaxis to msm on the incidence of gonorrhoea and infectious syphilis compared with standard practice

Hui B. B.¹, Gray R. T.¹ and Regan D. G.¹

¹The Kirby Institute, UNSW Sydney, NSW, Australia.

Background: Gonorrhoea and syphilis are frequently diagnosed STIs among men who have sex with men (MSM) in Australia. Clinical trials of doxycycline post-exposure prophylaxis (Doxy-PEP) suggest it could be effective in reducing STI incidence. We used mathematical modelling to estimate the impact of providing Doxy-PEP to MSM on the incidence of gonorrhoea and syphilis in Australia.

Methods: An individual-based model was developed to simulate the transmission of gonorrhoea and syphilis in an urban MSM population in Australia. The estimated incidence of gonorrhoea and syphilis over a 5-year period under standard practice was compared with the provision of Doxy-PEP to 30%, 50% and 70% of MSM.

Results: Under standard practice, the modelled average incidence of gonorrhoea and infectious syphilis over 5 years is 17.16 (IQR: 16.66–17.68) and 2.04 (IQR: 2.02–2.06) per 100 person-years, respectively. If Doxy-PEP – assumed to prevent the development of both STIs following exposure – is used by 70% of MSM following sexual contact, gonorrhoea and infectious syphilis incidence is reduced to 0.69 (IQR: 0.66–0.73) and 0.44 (IQR: 0.43–0.45) per 100 person-years, respectively. Incidence is reduced to 1.66 (IQR: 1.59–1.72) and 0.80 (IQR: 0.79–0.82) per 100 person-years, respectively, if 50% of MSM use Doxy-PEP, and to 3.81 (IQR: 3.67–3.95) and 1.24 (IQR: 1.23–1.26) per 100 person-years, respectively, if 30% of MSM use Doxy-PEP.

Conclusion: Our results suggest that Doxy-PEP could be effective in reducing the incidence of STIs. Doxy-PEP is likely to be more effective for gonorrhoea prevention among MSM than for syphilis because of its higher transmission probability and because it is already endemic in the population. Further modelling is needed to investigate other factors, such as varying effectiveness for different STIs, the effect of dosage and uptake, and the potential impact on antimicrobial resistance.

Disclosure of interest statement: The Kirby Institute is funded by the Australian Government Department of Health and is affiliated with the Faculty of Medicine, University of New South Wales. The views expressed in this publication do not necessarily represent the position of the Australian Government.

144. Can Treponema pallidum genotyping enhance syphilis public health responses? A Queensland, Australia case study

Bell S. F. E.¹, Whiley D. W.^1,2, Jennison A. V.³, Lowry K.¹, Lambert S. B.⁴ and Sweeney E. L.¹

¹Centre for Clinical Research (UQCCR), The University of Queensland, Herston, Qld, Australia.

²Pathology Queensland Central Laboratory, Queensland Health, Herston, Qld, Australia.

³Public and Environmental Health, Forensic and Scientific Services, Queensland Health, Coopers Plains, Qld, Australia.

⁴Communicable Diseases Branch, Queensland Health, Herston, Qld, Australia.

Background: To control syphilis transmission and associated negative sequelae including congenital syphilis, targeted public health interventions are required. We assessed the utility of linking Treponema pallidum sequence types (STs) to enhanced surveillance records to strengthen public health responses in Queensland.

Methods: A total of 570 polymerase chain reaction T. pallidum-positive samples collected in Queensland from January 2011 to July 2020 were genotyped by multi-locus sequence type (MLST). After removal of samples with incomplete sequence typing (n = 139), other T. pallidum subspecies (n = 7), and multiple unique case samples (n = 31), data from 393 samples were linked with cases demographic, behavioural, and geospatial enhanced surveillance data. 219 linked case records, 56% (219/393) of genotyped samples were analysed and mapped.

Results: Most cases were male (82%, 179/219), three-quarters (135/179) had male sex partners. Twenty-three unique STs were identified. Nearly all STs (22/23) were recorded in major cities; ST diversity declined with increasing remoteness (9/23 regional Queensland; 2/23 remote Queensland), despite the ratio of samples to unique ST being similar in each area (7:1 urban; 6:1 regional, 7:1 remote). Two STs accounted for 69% of samples. ST1 (44%, 96/219) accounted for 28%, 73%, and 83% of all STs in urban, regional, and remote Queensland, respectively (P < 0.001). Conversely, ST100 (25%, 55/219) was more prevalent in urban (33%), than regional (10%) or remote (17%) Queensland (P < 0.001). Where sexual orientation was reported (205/219), heterosexual acquisition was attributed to 56% (50/90) of ST1, including all (16/16) First Nations women, at least three-quarters (12/16) of reproductive age (19–45 years). ST100 was almost exclusively among non-Indigenous people (96%, 49/51) and men with male sex partners (80%, 40/51; P < 0.001).

Conclusion: Geospatial, sexual orientation and First Nations status distinctions between prevalent T. pallidum STs in Queensland suggest genotyping could enhance public health surveillance and responses for at-risk populations. Superior data linkage processes will strengthen results.

Disclosure of interest statement: This study was supported by the Queensland Sexual Health Research Fund, as well as an Advancing Queensland Clinical Research Fellowship from the Qld Government, held by David M Whiley. Sara FE Bell is supported by an Australian Government Research Training Program (RTP) Scholarship.

145. Epidemiology of bacterial genitourinary infections among women of reproductive age in Nigeria

Fayemiwo S. A.^1,2, Novak-Frazer L. ^2,3, Adewole I. F.⁴ and Rautemaa-Richardson R.^2,3

¹Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

²Division of Evolution, Infection and Genomics, FBMH, University of Manchester, Manchester, United Kingdom.

³Mycology Reference Centre Manchester (MRCM), Manchester University NHS Foundation Trust, United Kingdom.

⁴Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Background: Women are burdened by sexually transmitted infections (STIs) sequelae, including pelvic inflammatory disease, infertility, ectopic pregnancy, and increased risk of human immunodeficiency virus (HIV) acquisition. This study aimed to map the frequency of aetiologic agents of STIs and associated risk factors among women of childbearing age in Nigeria.

Methods: A prospective population-based cross-sectional study was conducted in all six geopolitical zones of Nigeria. Women of childbearing age (18–55) were recruited in two randomly selected local government areas of the selected states in Nigeria. The symptomatic or asymptomatic participants were given pre-tested, standardised symptoms, health, and lifestyle questionnaires. After pelvic examinations, high vaginal swabs were collected from the sides of the vaginal wall. The DNAs were extracted from the swabs using Quick-DNA mini–Prep ZYMO kits and analysed by CFX-96 Real-time PCR using the AllplexTM Assay system (Seegene, Seoul, Korea). Data were analysed using IBM and SPSS version 26.0.

Results: The mean age was 33.0 years ± 9.0 (range = 18–55, IQR = 12). Of the enrolled 1198 women, 63.5% (761/1198) were symptomatic. About a third (37.5%, 449/1198) were in their thirties, while 73.2% (877/1198) were married. The mean calculated body mass index (BMI) was 27.3 ± 5.7 (IQR 23.4–30.5). Overall, the most common bacterial agents discovered were Ureaplasma parvum (15.0%, 180/1198), Mycoplasma hominis (10.1%, 121/1198), U. urealyticum (8.3%, 99/1198) and M. genitalium infection (1.1%, 13/1198). Others included N. gonorrhoeae (0.9%, 11/1198) and C. trachomatis (0.9%, 11/1198). Of the women, 4.6% had (55/1198) HIV infection, while 2.7% (55/1198) had syphilis. Aetiological agents strongly associated with HIV infection include M. genitalium infection (OR 6.5, 95% CI = 1.7–24.4; 23.1% vs 4.4%)

Conclusion: STIs appear to be more prevalent in Nigeria, with regional epidemiological differences. The most common agent associated with HIV infection in Nigeria was M. genitalium infection.

Disclosure of interest statement: No pharmaceutical grants were received in the development of this study. We declared no conflicts of interest.

146. Syphilis in pregnant women living with HIV/AIDS in Brazil and the relationship between co-infection and mother to child transmission of HIV

Aragón M. G.^1,2, de Lannoy L. H.¹, Gaspar P. C.¹ and Miranda A. E.^1,2

¹Ministry of Health of Brazil, Brazil.

²Federal University of Espírito Santo.

Background: HIV and syphilis are sexually transmitted infections of significant concern during pregnancy, impacting numerous women and children globally. However, limited data exist regarding the prevalence of syphilis infection among pregnant women living with HIV/AIDS and its influence on mother-to-child transmission (MTCT) of HIV. The present research aims to analyse HIV and syphilis co-infection during pregnancy through analysis of surveillance data from Brazil.

Methods: This retrospective cohort study utilised secondary data from the Ministry of Health’s information systems. It included reported cases of pregnant women with HIV and syphilis, with childbirth between 2016 and 2020, and children with HIV/AIDS with year of birth from 2016 to 2020. Cross-referencing was performed between the notification databases of pregnant women with HIV/AIDS and syphilis, and between pregnant women with HIV/AIDS and children with HIV/AIDS to identify potential mother-child pairs. Pregnant women without a paired child with HIV were considered to have no outcome of MTCT of HIV. Logistic regression analysis was performed to estimate the effect of MTCT, with a final significance level of 5%.

Results: Among 40,634 pregnant women with HIV, 2788 were coinfected with syphilis, yielding a coinfection rate of 6.9%. MTCT of HIV was significantly higher among HIV-positive pregnant women coinfected with syphilis (2%) compared to those without coinfection (1.2%), with an odds ratio of 1.704 (CI 1.29–2.25, P ≤ 0.05). Coinfection with HIV and syphilis was more prevalent among younger women (aged 10 to 24), non-white individuals and people with lower educational attainment, and also, on those who did not receive prenatal care and had late laboratory evidence of HIV during pregnancy, indicating a more vulnerable population among coinfected pregnant women.

Conclusion: Coinfection with syphilis was associated with higher MTCT rate of HIV compared to HIV-positive pregnant women without syphilis. Intersectoral public policies addressing social determinants are essential to achieve the goals of MTCT elimination.

Disclosure of interest statement: None.

147. The duration of kissing in different intimate positions among men who have sex with men

Tran J.^1,2, Fairley C. K.^1,2, Ong J. J.^1,2, Bradshaw C. S.^1,2,3, Aung E. T.^1,2, Maddaford K.^1,2, Chen M. Y.^1,2, Hocking J. S.³ and Chow E. P. F.^1,2,3

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: Kissing can be a risk factor for oropharyngeal gonorrhoea. Hypothetically, an individual’s intimate position while kissing may play a role in transmission, where someone who is lying underneath would be more prone to infection as saliva flows downward due to gravity.

Methods: Between May 2019 and March 2020, we invited MSM aged ≥18 years who attended the Melbourne Sexual Health Centre (MSHC) to participate in a survey about the duration of their kissing (minutes) and intimate position while kissing (i.e., kissing while above, or while lying underneath) their most recent partner. Univariable and multivariable negative binomial regressions were performed to examine the associations between the duration of kissing in different intimate positions and demographic characteristics.

Results: Of the 965 men with a recent male kissing partner, 89.0% (n = 859) also had sex with that partner. Our adjusted analyses showed that, on average, men born in Asia (mean 4.17 vs 5.78 min, P < 0.001) and South America or the Caribbean (mean 4.06 vs 5.78 min, P = 0.022) spent less time kissing compared to men born in Oceania, and the same was also observed for kissing while above or lying underneath. Men who had only receptive anal sex spent less time kissing while above than those who only had insertive anal sex (mean 3.04 vs 5.86 min, P < 0.001).

Conclusion: Our study is the first to examine factors that influence duration of kissing in different intimate positions. These factors could be associated with oropharyngeal gonorrhoea if saliva transmitted gonorrhoea and if gravity played a role.

Disclosure of interest statement: EPFC are JJO are each supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873 for EPFC and GNT1193955 for JJO). CKF and CSB are supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900 for CKF and GNT1173361 for CSB). JSH is supported by an NHMRC Senior Research Fellowship (GNT1136117). JT is supported by Australian Government Research Training Program (RTP) Scholarship from Monash University. All other authors have no conflicts of interest to declare.

148. Association between saliva use for masturbation and urethral gonorrhoea in men who have sex with men: a cross-sectional study

Tran J.^1,2, Fairley C. K.^1,2, Ong J. J.^1,2, Aung E. T.^1,2 and Chow E. P. F.^1,2,3

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: The saliva of individuals with oropharyngeal gonorrhoea can contain viable Neisseria gonorrhoeae but no study has examined whether saliva use as a lubricant for masturbation is a risk factor for urethral gonorrhoea. Therefore, our study examined whether four different exposures to the urethra, including saliva use for masturbation, were independent risk factors for urethral gonorrhoea among men who have sex with men (MSM).

Methods: This cross-sectional study surveyed MSM aged ≥18 years who attended the Melbourne Sexual Health Centre between February 2021 and December 2023. They were invited to participate in a short survey collecting data on the number of male partners they had for sexual activities in the past 7 days, including receiving fellatio, condomless insertive anal sex, docking (covering a partner’s penis with foreskin), and the number of times they used their saliva for masturbation. Multivariable logistic regression was used to examine associations between urethral gonorrhoea and these four exposures.

Results: The median age of the 3114 men included in our study was 32 (IQR: 27–40), with 4.7% (n = 145) tested positive for urethral gonorrhoea. After adjusting for all four exposures, urethral gonorrhoea was significantly associated with increasing number of condomless insertive anal sex partners (adjusted odds ratio; aOR = 4.81; 95% CI: 2.31–10.02, P_trend < 0.001). Additionally, men with an increasing number of docking partners had lower odds of having urethral gonorrhoea (aOR = 0.26; 95% CI: 0.03–1.17, P_trend = 0.003). Urethral gonorrhoea was not significantly associated with the number of receiving fellatio (P_trend = 0.940) nor with the number of times men used saliva as a lubricant for masturbation (P_trend = 0.300).

Conclusion: Our findings show that condomless insertive anal sex is the most leading risk factor for urethral gonorrhoea, but not using saliva as a lubricant for masturbation.

Disclosure of interest statement: EPFC are JJO are each supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873 for EPFC and GNT1193955 for JJO). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900 for CKF). JT is supported by Australian Government Research Training Program (RTP) Scholarship from Monash University. All other authors have no conflicts of interest to declare.

149. Epidemiology of sexual transmitted diseases at dermatology and venereology outpatient clinic of a tertiary hospital in West Sumatera, Indonesia from January 2019 to December 2023

Alvares A. D.¹, Anum Q.², Yossy V.², Gustia R.² and Yenny S. W.²

¹Dermatology and Venereology Departement, Medical Faculty of Andalas University/Dr. M. Djamil Hospital Padang, Indonesia.

²Dermatology, Venereology and Aesthetic Specialist Progam, Medical Faculty of Andalas University/Dr. M. Djamil Hospital Padang, Indonesia.

Background: Sexually transmitted diseases (STDs) are a serious global health concern, with the highest prevalence occurring among young individuals. High-risk sexual behaviour often occurs due to a lack of information about the transmission of sexually transmitted infections or the neglect of precautions for safe sex. According to the World Health Organization (WHO), more than 300 million cases of STDs are estimated to occur each year.

Method: This study is a descriptive research with a retrospective cross-sectional design using medical records at the dermatology and venereology outpatient clinic of a tertiary hospital in West Sumatera from January 2019 to December 2023, focusing on patients with STDs.

Results: The top five most common cases of sexually transmitted diseases (STDs) are condyloma acuminata was the most common cases, with total case is 1094 (45,13%), followed by syphilis 857 cases (35,35%), vulvovaginal candidiasis with 214 cases (8.82%) gonorrhoea infection with 155 cases (6,39%), and last bacterial vaginosis with 104 cases (4.29%). The occurrence of STDs is high in the age group of 25–44 years about 1455 cases (60%) and in the male patient with 1.395 cases (57,5%).

Conclusion: The burden of STD’s at dermatology and venereology outpatient clinic of a tertiary hospital in West Sumatera is high with condyloma acuminata is the most cases. Sexual transmitted diseases occurred the most in aged 25–44 years and more than half is among the man.

Disclosure of interest statement: None.

150. Characteristics and cutaneous manifestations of HIV patients in tertiary hospital at Yogyakarta, Indonesia period 2023

Santosa J.¹, Alfieri A.¹, Pudjiati S. R.^1,2, Susetiati D. A.^1,2 and Rusetiyanti N.^1,3

¹Department of Dermatology dan Venereology Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia.

²Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

³Gadjah Mada University Academic Hospital, Yogyakarta, Indonesia.

Background: Human immunodeficiency virus (HIV) is a single-stranded RNA virus of the retrovirus group. Cutaneous manifestations show a unique association with HIV infection, with HIV-infected individuals being more susceptible to opportunistic infections, malignancies, and non-infectious problems that may present as skin disorders. Dermatological problems occur in approximately 90% of patients with HIV. The level of knowledge and information regarding mucocutaneous disorders in individuals with HIV in Indonesia is still inadequate. This study aims to describe the characteristics and cutaneous manifestations of HIV patients at RSUP Dr. Sardjito, Yogyakarta for the period 2023.

Methods: The design of this study is a retrospective descriptive study using data sources from medical records for HIV patients in outpatient and inpatient installations at Sardjito Hospital, Yogyakarta for the period 2023. Univariate analysis was used to examine the characteristics and cutaneous manifestations of HIV patients.

Results: In this study, there were 102 medical records of HIV patients who met the inclusion and exclusion criteria. Based on the characteristics of HIV sufferers, the majority were aged 15–49 years (85.3%) and men (88.2%). Based on education level, almost half of the patients (45.1%) had a high school education. Most were unmarried (61.8%), had a history of tattoos (19.6%), piercings (20.6%), IVDU (5.2%), not using condoms (35.8%), transfusions (15.5%). Regarding sexual orientation in homosexuals (38.5%) bisexuals (20.8%). Cutaneous manifestations related to inflammation were most common in HIV (59.8%) with the most common type being seborrheic dermatitis (16.7%) followed by PPE (14.7%). Related to other cutaneous manifestations such as bacterial infections (16.67%), fungal infections (14.71%), viral infections (6.86%) and parasitic infections (1.96%).

Conclusion: Patients suffering from HIV were predominantly men of reproductive age, with cutaneous manifestations related to inflammation being the most common.

Disclosure of interest statement: All authors have declared no conflict of interest.

151. Defining the eligible population in gay and bisexual men (GBM) for gonorrhoea vaccines using national sentinel surveillance data in Australia

Jin F.¹, Patel P.¹, McManus H.¹, Bottiger D.¹, Applegate T.¹, Medland N.¹, Wong A.^1,2, Stoove M.³, Fairley C.⁴, Cornelisse V.⁵, Shaw M.⁶, Lewis D. A.⁷, Thing C.⁸, Lee F.⁹, Aung H. L.¹, Grulich A. E.¹ and Guy R.¹

¹The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

²Sydney Sexual Health Centre, Sydney, NSW, Australia.

³The Burnet Institute, Melbourne University, Melbourne, Vic, Australia.

⁴Melbourne Sexual Health Centre, Melbourne, Vic, Australia.

⁵HIV and Sexual Health Services, North Coast Population and Public Health Directorate.

⁶M Clinic, Perth, WA, Australia.

⁷Western Sydney Sexual Health Centre, Parramatta, NSW, Australia.

⁸Gold Cost Sexual Health Centre, Gold Coast, Qld, Australia.

⁹Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Background: Clinical trials are underway to confirm the efficacy of potential vaccines for gonorrhoea prevention. The UK have recommended the 4CMen B vaccine, particularly among GBM with a recent history of gonorrhoea or other bacterial sexually transmitted infections (STI) diagnoses or reporting multiple partners. We report GBM sub-populations who might most benefit from vaccination.

Methods: GBM who attended one of the 23 participating clinics of the ACCESS network and had at least two gonorrhoea tests recorded in 2019 were eligible. A history of STIs was defined as a diagnosis of gonorrhoea, chlamydia, or syphilis in the previous two years. Eligible sub-populations were identified using composite grouping of risk factors associated with gonorrhoea incidence.

Results: A total of 15,941 GBM were included, median age 31 (IQR: 26–39), 1547 (9.7%) being HIV-positive. Over 6746.7 person-years of follow-up, 3,022 episodes of gonorrhoea were diagnosed, an incidence of 44.8 per 100 person-years (95% CI: 43.2–46.4). Risk factors associated with the highest incidence were: injecting drug use (90.9), being a contact of STI (88.6), reporting 10 or more recent (last 3 months) sexual partners (81.9), and a history of syphilis (76.2), gonorrhoea (69.9), and chlamydia (65.5). The sub-population of those with a history of any STIs consisted of 37.0% of the total sample, who accumulated 1781(58.9%) episodes of diagnoses. Combining these with STI contacts covered 40.2% of the total sample, who accumulated 1893 (62.6%) of total diagnoses. Further inclusion of those reporting 10 or more recent partners consisted of 44.2% of the total sample, who accumulated 2029 (67.1%) of total diagnoses.

Conclusions: We found the criterion which reached the largest number of gonorrhoea diagnoses relative to population size was GBM with a history of bacterial STIs. This information should inform future guidelines to maximise vaccination impact and reduce costs, particularly if regular vaccinations are needed.

Disclosure of interest statement: None.

152. Mother-to-child transmission of Chlamydia trachomatis and Neisseria gonorrhoeae: cohort study in Papua New Guinea

Low N.¹, Riddell M. A.^2,3, Mengi A.², Vallely L. M.^2,3, Wand H.³, Spycher B. D.¹, Pomat W. S.³, Laman M.³ and Vallely A. J.^2,3

¹Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

²Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.

³The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can be transmitted from mother-to-child during labour, causing ophthalmia neonatorum (CT and NG) and neonatal pneumonia (CT). The objective of this study was to assess mother-to-child transmission of CT and NG, using nucleic acid amplification tests (NAAT).

Methods: This study was nested in the Women and Newborns Trial of Antenatal Interventions and Management in Papua New Guinea. Women in the control phase collected a urine sample at 34–36 weeks of pregnancy, with post-natal treatment if CT/NG were detected (Xpert CT/NG, Cepheid). All newborns had eye swabs taken within 72 h and at 1–2 weeks and 4–6 weeks if they had signs of conjunctivitis, with treatment if CT or NG were detected. All newborns had a nasal swab taken at 1–2 and 4–6 weeks, tested using Xpert CT/NG or Cobas PCR (Roche). We calculated proportions (with 95% confidence intervals, CI) of positive swabs among babies of mothers with CT or NG.

Results: Of 961 mother-baby pairs, 57 mothers had CT and 25 had NG at 34–36 weeks. Among newborns of these mothers, 17/57 (29.8%, 95% CI 18.4–43.4) had CT and 7/25 (28.0%, 12.1–49.4) had NG detected in eye swabs at birth. Of those with clinical signs of conjunctivitis at 1–2 weeks, 9 babies of 15 infected mothers had CT (60.0%, 32.3–83.7); 2 babies remained CT-positive at 4–6 weeks. No baby had NG detected subsequently. CT prevalence in nasal swabs was 23.6% (13.2–37.0, 13/55) among babies with a visit at 1–2 weeks and 24.6% (14.1–37.8, 14/57) at 4–6 weeks.

Conclusions: Mother-to-child CT and NG transmission are frequent. Proportions of NAAT-detected CT or NG in eye swabs at birth were similar to previously published studies using culture. Nasal carriage persists up to 6 weeks in about a quarter of babies of mothers with CT.

Disclosure of interest statement: Cepheid (Sunnyvale, CA, USA) contributed diagnostic consumables at subsidised cost. No authors have any other interests to disclose. This study was funded by the Swiss National Science Foundation Research for Development award (number IZ07Z0_160909), Joint Global Health Trials award from the UK Department of Health and Social Care, UK Foreign Commonwealth and Development Office, UK Medical Research Council and Wellcome Trust (number MR/N006089/1) and Australian National Health and Medical Research Council (number GNT1084429).

153. Muslim adolescents’ sexual and reproductive health knowledge including STI/HIV, attitudes and educational needs: a qualitative study

AL Zaabi O.¹, Heffernan M.² and Holroyd E.³

¹Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman.

²College of Business, RMIT University, Melbourne, Vic, Australia.

³Auckland University of Technology, Auckland, New Zealand.

Background: Young people are at a greater risk of acquiring STI/HIV. However, in the Middle East, there is currently no formal sexual and reproductive health (SRH) education or STI services offered specifically for adolescents.

Methods: This qualitative-descriptive study aimed to explore SRH knowledge, attitudes, and educational needs among adolescents in Oman. Eighty first-year undergraduate university students, aged 18–19 years, comprising 40 boys and 40 girls, participated in 16 focus group discussions and 16 in-depth individual interviews. We employed a convenience sampling approach, selecting students from four major universities located across four governorates in Oman.

Results: Thematic analysis revealed four major themes and nine subthemes. Both boys and girls interviewed demonstrated a lack of SRH knowledge, including awareness of STIs/HIV, and reported not receiving SRH education in school. They expressed a desire for comprehensive, age-appropriate SRH education starting from primary school to high school, covering topics such as child sexual abuse, puberty changes, contraception, and STI/HIV. Moreover, adolescents indicated that they mainly sought SRH information from friends, social media, and the Internet, as opposed to communicating with parents, school teachers, or school nurses about their SRH concerns. The socio-cultural taboo surrounding sexual discussion was identified as a primary factor discouraging open communication about sexuality. Additionally, participants expressed a preference for receiving SRH education from school teachers and nurses, emphasizing the importance of school policies supporting these educators with adequate resources, skills, and training to deliver effective SRH education.

Conclusions: The study findings highlight the lack of SRH knowledge among Muslim adolescents in Oman and their desire to receive comprehensive, age-appropriate SRH education. Therefore, this provides implications for school curriculum decision-makers and school healthcare providers to establish SRH education policies, enhancing adolescents’ SRH and well-being in Middle Eastern countries and other regions with similar religious beliefs or socio-cultural contexts.

Disclosure of interest statement: No potential conflict of interest was reported by the authors. All authors contributed to finalising the manuscript. The authors do not have any financial or nonfinancial competing interests for this review. Acknowledgement is given to Sultan Qaboos University (SQU), who supported this study. We also thank the undergraduate university students who participated in this study. Human subjects approval statement. Ethical approval was obtained from the Deanship of Research and the Ethical Committee of the College of Nursing at Sultan Qaboos University (SQU). Funding Sources: This study was funded by Sultan Qaboos University, Oman (Grant Number: RC/URG- CON/AHCC/23/01).

154. Sexual practices and health seeking behaviour of women who have sex with women (WSW): a cross-sectional study

Salamanca C.¹, Yang G.¹, Angeles C.¹, Jamisola L.¹ and Buenviaje J.¹

¹Section of Dermatology, Department of Medicine, University of the East Ramon Magsaysay Memorial Medical Center, Incorporated, Quezon City, Philippines.

Background: Individuals of the LGBTQI+ community encounter important health issues relevant to dermatologists, especially infectious diseases. Women who have sex with women (WSW) specifically are understudied in literature as few sources of sexual health information are available for this population. Hence, this study aims to obtain essential information regarding the sexual health of women who have sex with women in the local setting.

Methods: This study is an analytical cross-sectional study with a general objective of determining the sexual practices and health seeking behaviour of women who have sex with women. This included Filipino females, 18 years old and above, and are women with previous or current sexual relations with women with responses acquired using an online and printed questionnaire. Respondents were obtained through personal contacts via snowball technique, through organizations, and online.

Results: Among 304 respondents, oral sex (98%), and digital penetration of the vagina (91%) were common sexual practices; however, barrier methods were not commonly utilised (89%). Women who had male partners are more likely to utilise barrier methods (90% vs 8%, P < 0.0001) as compared to women who exclusively had female partners. They are also more likely to seek consultation (74% vs 43%, P < 0.0001), avail of testing for sexually transmitted infection (STI) (60% vs 31%, P < 0.0001) human papillomavirus (HPV) vaccination (63% vs 24%, P < 0.0001), papanicolaou smear (32% vs 12%, P < 0.0001), and are also more open to state their sexual orientation to their physicians (96% vs 86%, P = 0.002).

Conclusion: Despite growing awareness of the LGBT community, there remains insufficient research on WSW, making them a neglected minority. Engagement in risky sexual behaviours and reluctance to seek healthcare services makes them vulnerable to sexually transmitted infections. Therefore, raising awareness could pave the way to developing targeted and suitable health programs to ensure this population is not overlooked.

Disclosure of interest statement: None.

155. Review of neurosyphilis cases in a regional local health district in New South Wales, Australia, reflects higher proportions of heterosexuals and females

Lim Y. L.^1,2

¹Port Kembla Sexual Health Service (PKSHS), Illawarra Shoalhaven Local Health District (ISLHD), Port Kembla, NSW, Australia.

²The Albion Centre, South Eastern Sydney Local Health District (SESLHD), Sydney, NSW, Australia.

Background: Illawarra Shoalhaven Local Health District (ISLHD), NSW, comprises a regional and rural population of approximately 420,000. Demographics of ISLHD syphilis notifications differ other Local Health Districts (LHD) with higher proportion of heterosexuals and females. This is reflected in neurosyphilis diagnoses. The purpose of audit was to elucidate the unique characteristics of neurosyphilis cases in ISLHD and review strategies for improved screening and treatment.

Methods: A retrospective audit of syphilis notifications from 1 Jan 2021 to 31 Dec 2023 at ISLHD was conducted to identify neurosyphilis diagnoses. assess demographics, symptoms, treatment, outcomes and review opportunities to improve diagnosis and treatment options.

Results: From 2021–2023, there were 130 syphilis diagnoses (mean 43/year) with 33.1% primary syphilis, 22.3% secondary syphilis, 16.2% early latent and 26.1% late latent. 81.% were male and 18.5% female. 10% individuals identified as Aboriginal. There were 11 (8.5%) neurosyphilis diagnoses. Ten had no previous syphilis diagnosis/treatment. Six (54.5%) were male and five (45.5%) were female (all non-pregnant). Six (54.5%) identified as Aboriginal. There were eight heterosexuals, two men who have sex with men (MSM) and one bisexual. 7 had regular partners. One was HIV positive and one took daily pre-exposure prophylaxis. Symptoms included chancre, rash, visual changes, tinnitus, hearing and sensory loss. Eight were treated with benzylpenicillin 1.8g IV Q4h (or 10.8g by Baxter infusor/24 h) for 14–15 days. Three received ceftriaxone 2g IV daily due to penicillin allergy/anaphylaxis. None were treated with oral doxycycline. Four had oral steroid prior to treatment. All completed the prescribed treatments.

Conclusion: A greater proportion of ISLHD neurosyphilis diagnoses were heterosexuals and/or females with regular partners. Preliminary audit of 2024 data confirmed four neurosyphilis diagnoses with two treated with oral doxycycline, one with benzylpenicillin and ones yet untreated. Flexible oral treatment options are needed due to stigma or preference. Consideration of other screening strategies may be required to reduce infectious syphilis in women of child-bearing age and congenital syphilis rates.

Disclosure of interest statement: The authors have no conflicts of interest to declare.

156. A Southeast Queensland evaluation of ATLAS Indigenous STI and BBV surveillance system

White A.^1,2, Field E.¹ and Butler D.^1,2

¹National Centre for Epidemiology and Population Health.

²Institute for Urban Indigenous Health.

Background: The ATLAS Indigenous Primary Care Health Surveillance and Research Network (ATLAS) is a national sentinel surveillance system of Aboriginal primary healthcare services. The network is currently made up of 40 Aboriginal Community Controlled Health Services (ACCHS) collecting deidentified primary care data relating to sexually transmissible infections (STIs) and blood-borne viruses (BBVs) testing and management. An early evaluation occurred in 2019. We used the CDC Updated Guidelines for Evaluating Public Health Surveillance Systems and assessed the attributes of acceptability, simplicity, flexibility, timeliness, stability, and data quality, from the perspective of the Institute for Urban Indigenous Health (IUIH), an ATLAS network clinical hub member.

Methods: The evaluation included yarns, surveys, and workshops with members from the ATLAS project team and the IUIH clinical hub, IUIH Continuous Quality Improvement (CQI) sessions, analysis of an ATLAS/IUIH subset dataset (Hepatitis C), and document review.

Results: The evaluation found that ATLAS has expanded its operations since 2019 to include near real-time dashboards for authorised users, timely feedback and support mechanisms, a research network, a behavioural surveillance survey, and is developing additional measures for addressing vaccine preventable diseases. A strength of ATLAS is the creation of the dashboard allowing users to access, interrogate and display their data to meet individual users’ priorities and needs in a timely manner. A further strength is its responsiveness to feedback from users via surveys, workshops, and dashboard feedback widgets.

Conclusion: The establishment and growth of ATLAS throughout Australia is providing a formidable tool to reduce the burden of disease in the Aboriginal and Torres Strait Islander community. Promoting greater awareness of the dashboard and encouraging higher participation rates from ACCHS in ATLAS will enhance the system’s ability to meet its objectives of providing Aboriginal and Torres Strait Islander STI and BBV testing, treatment, and management data for and on behalf of the community.

Disclosure of interest statement: The National Centre for Epidemiology and Population Health, the Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Primary Health Care Surveillance Network: ATLAS acknowledges the considerable contribution that industry partners make to professional and research activities. We recognise the need for transparency of disclosure of potential conflicts of interest by acknowledging these relationships in publications and presentations.

Acknowledgement of Funding: The author is a recipient of the Aboriginal Community Controlled Health Services (ACCHS) Master of Philosophy in Applied Epidemiology (MAE) scholarship. This scholarship allows the author to participate in the MAE program and apply this knowledge in her field placement at the Institute of Urban Indigenous Health (IUIH, a not-for-profit regional community controlled health organisation). The Aboriginal and Torres Strait Islander Primary Health Care Surveillance Network: ATLAS is funded through the National Health and Medical Research Council, Medical Research Future Fund and Commonwealth Department of Health.

157. Viral genitourinary infections associated with RVVC among women of reproductive age in Nigeria

Fayemiwo S. A.^1,2, Novak-Frazer L.^2,3, Adewole I. F.⁴ and Rautemaa-Richardson R.^2,3

¹Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

²Division of Evolution, Infection and Genomics, FBMH, University of Manchester, Manchester, United Kingdom.

³Mycology Reference Centre Manchester (MRCM), Manchester University NHS Foundation Trust.

⁴Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Background: Recurrent vulvovaginal candidiasis (RVVC) is a clinical condition defined by a history of four or more acute inflammatory and culture-positive symptomatic episodes of vulvovaginal candidiasis (VVC) in 12 months. There is a lack of evidence on the burden of viral STIs among women with RVVC in Nigeria. This study aimed to map the frequency of viral aetiologic agents of STIs associated with RVVC among women in Nigeria.

Methods: A prospective population-based cross-sectional study was conducted in all six geopolitical zones of Nigeria. Women of childbearing age (18–55) were recruited in two randomly selected local government areas of the selected states in Nigeria. The participants were given pre-tested, standardised symptoms, health, and lifestyle questionnaires. After pelvic examinations, high vaginal swabs were collected from the sides of the vaginal wall. The DNAs were extracted from the swabs using Quick-DNA mini–prep ZYMO kits and analysed by CFX-96 Real-time PCR using the AllplexTM Assay system (Seegene, Seoul, Korea). Data were analysed using IBM and SPSS version 26.0.

Results: The mean age was 33.0 years ± 9.0 (range = 18–55, IQR = 12). Of the enrolled 1198 women, 63.5% (761/1198) were symptomatic. About a third (37.5%, 449/1198) were in their thirties, while 73.2% (877/1198) were married. Overall, the most common viral agents discovered were Hepatitis B virus (6.5%, 78/1198), HIV infection (4.6%, 55/1198), cytomegalovirus (CMV) (1.8%, 21/1198) and varicella-zoster virus (VZV) (0.6%, 7/1198). Others included herpes simplex virus type 2 (HSV2) (0.5%, 6/1198) and HSV1 (0.17%, 1/1198). Viral aetiological agents strongly associated with RVVC include HIV infection (OR 1.7, 95% CI = 1.0–2.8; 5.9% vs 2.7%; P = 0.021).

Conclusions: The most common viral agent associated with RVVC in Nigeria was HIV infection. Routine testing for viral agents of STI is advocated in women seeking care for gynaecological infections.

Disclosure of interest statement: No pharmaceutical grants were received in the development of this study. We declared no conflicts of interest.

158. Knowledge of cognitive disorder and attitude towards cognitive function screening in people living with HIV in China: a cross-sectional study

Xin X.^1,2 and Huachun Z.^1,3,4,5

¹School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.

²Department of science, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.

³School of Public Health, Fudan University, Shanghai, PR China.

⁴School of Public Health, Southwest Medical University, Luzhou, PR China.

⁵Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

Background: Gradually increasing evidence showed that cognitive disorder was high prevalent in people living with HIV (PLWH) in worldwide, which account for 30–50% in PLWH. However, the data on the knowledge of cognitive disorder and attitude towards cognitive disorder screening were scarce. This study aimed to assess cognitive disorder knowledge and attitude towards cognitive disorder screening in PLWH in China.

Methods: A cross-sectional survey was conducted from August to December in 2023. We collected participants’ demographic and clinical characteristics and knowledge with 16 knowledge items related to cognitive disorder. Modified Bloom’s cut-off points of 75% (total score > 12) was considered as having “adequate knowledge”. Multivariable logistics regression analysis was used to assess factors of cognitive disorder knowledge and attitude towards cognitive function screening.

Results: A total of 314 eligible PLWH were selected for data analysis (age: median = 46, interquartile range, IQR = 24). Of the 314 PLWH, 18.2% (57/314) had adequate knowledge of cognitive disorder, and 58.3% (183/314) were willing to be screening of cognitive disorder. We found that adequate knowledge was associated with age [adjusted odds ratio (AOR) = 0.97, 95% confident interval (CI) (0.94–0.99)], anxiety [2.20, 0.88–5.25] and HIV transmission methods [1.70, 1.28–2.36]. Willingness to get screened was related to HUKOU [1.72, 0.97–3.13] and HIV transmission methods [1.37, 1.07–1.85].

Conclusions: We found that PLWH in China had relatively lower cognitive disorder knowledge and a suboptimal willingness to be screened for cognitive disorder. PLWH who are anxiety and HIV transmission methods may have adequate knowledge of cognitive disorder. These findings underscore the importance of providing health education on cognitive disorder and cognitive function screening among PLWH in China.

Disclosure of interest statement: No conflicts of interest.

159. The implementation of a molecular diagnostic network for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Brazil: first results

Amanda Krummenauer¹, Mayra G. Aragón¹,álisson Bigolin ¹, Ana Roberta P. Pascom¹, José A. V. Morais¹, Isabella M. C. D. DE Souza¹, Amanda A. C. Morais¹, Luiz Fernando A. Júnior¹, Angélica E. B. Miranda¹, Draurio B. Cravo Neto¹ and Pâmela C. Gaspar¹

¹Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health of Brazil, Brazil.

Background: The Ministry of Health (MoH) of Brazil implemented a laboratory diagnostic network for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Diagnostics are now carried out in public laboratories, and initial outcomes of this initiative, starting from September 2022, are presented below.

Methods: Analysed data entered into the national laboratory management platform. The collection of material was carried out in public health services, mainly HIV/ISTs services, with national testing recommendations: people living with HIV, PrEP/PEP users and people with STI symptoms. Samples consisted of urine, cervical/vaginal, anal and/or oropharyngeal extragenital material.

Results: The database revealed that 17,023 individuals were tested for CT/NG, of which 1,044 (6.1%) tested positive for CT and 975 (5.7%) for NG. There were 356 cases of co-infections detected. The profile of individuals who tested positive revealed that the most affected age groups were between 20 and 34 years old (61.1% for CT and 64.8% for NG), with median ages of 26 years (CT) and 27 years (NG). The most frequent racial/ethnic group was mixed race (37.4% for NG and 36.9% for CT). Throughout Brazil, 146 municipalities conducted sample collection for tests, in 20 federative units out of 27. The Southern and Southeastern regions of the country had a higher number of individuals tested and healthcare facilities conducting sample collection. Additionally, these regions exhibited the highest number of positive cases. The number of tests per month demonstrates an increase throughout the entirety of the year 2023.

Conclusion: Despite disparities in distribution, the expansion of the laboratory diagnostic network appears to be gradually achieving its goal of facilitating diagnosis nationwide. It was observed that areas with a higher number of tests conducted also had more cases, reflecting a potential silent epidemic. Continuous monitoring of data is crucial for better understanding infection trends and ensuring that public health interventions are effective and appropriately targeted.

160. Preferences for attributes of an artificial intelligence-based risk assessment tool for HIV and sexually transmitted infections: a discrete choice experiment

Phyu M. Latt^1,2, Nyi N. Soe^1,2, Alicia J. King^2,3, David Lee³, Tiffany R. Phillips^2,3, Xianglong Xu^1,4, Eric P. F. Chow^2,3,5, Christopher K. Fairley^2,3, Lei Zhang^6,1,2,* and Jason J. Ong^2,3,7,*

¹Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁴School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

⁵Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

⁶Clinical Medical Research Center, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.

⁷Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.

^*Authors contribute to supervision equally.

Background: Early detection and treatment of HIV and sexually transmitted infections (STIs) are crucial to their effective control. We developed MySTIRisk, an artificial intelligence (AI)-based risk self-assessment tool that predicts an individual’s risk of HIV and STIs. We examined the attributes of MySTIRisk that encourage potential users to use the tool.

Methods: Between January and March 2024, we sent text message invitations to the Melbourne Sexual Health Centre (MSHC) attendees to participate in an online survey. We also advertised the survey on social media platforms, the clinic’s website, and posters in affiliated general practice clinics. This anonymous survey used a discrete choice experiment (DCE) to examine which attributes of MySTIRisk would encourage potential users to use the tool. We analysed the data using random parameters logit (RPL) and latent class analysis (LCA) models.

Results: The median age of 415 participants was 31 years (interquartile range, 26–38 years), with a proportion of participants identifying as lesbian, gay or homosexual (41.0%, n = 170). The choice to use MySTIRisk was most influenced by two attributes: cost and accuracy, followed by the provision of a pathology request form, level of anonymity, speed of receiving results, and whether the tool was a web or mobile application. LCA revealed two classes: “The Precisionists” (66.0% of respondents), who demanded high accuracy and “The Economists” (34.0% of respondents), who prioritised low cost. Simulations predicted a high uptake (97.7%) for a tool designed with the most preferred attribute levels, contrasting with lower uptake (22.3%) for the least preferred design.

Conclusions: Participants were more likely to use MySTIRisk if it was free, highly accurate, and could send pathology request forms. Tailoring the tool to meet the needs of distinct user segments could further enhance its uptake and effectiveness in promoting early detection and prevention of HIV and STIs.

Disclosure of interest statement: None declared.

Acknowledgement of Funding: EPFC is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873), CKF by an NHMRC Leadership Investigator Grant (GNT1172900), and JO by an NHMRC Emerging Leadership Investigator Grant (GNT1193955).

161. Assessing the effectiveness of HIV/STI risk communication displays among Melbourne Sexual Health Centre attendees: a cross-sectional, observational, and vignette-based study

Phyu M. Latt^1,2, Nyi N. Soe^1,2, Christopher K. Fairley^2,3, Xianglong Xu^1,4, Alicia King^2,3, Rashidur Rahman^2,3, Jason J. Ong^2,3, Tiffany R. Phillips^2,3,* and Lei Zhang^1,2,5,*

¹Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

³Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁴School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

⁵China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, PR China.

^*Authors contribute to supervision equally.

Background: Increasing rates of sexually transmitted infections (STI) over the past decade underscore the need for early testing and treatment. Communicating HIV/STI risk effectively can promote individuals’ intention to test, which is critical for the prevention and control of HIV/STIs. We aimed to determine which visual displays of risk would be the most likely to increase testing or use of prevention strategies.

Methods: A vignette-based cross-sectional survey was conducted with 662 clients (a median age of 30 years (IQR: 25–36), 418 males, 203 females, 41 other genders) at a sexual health clinic in Melbourne, Australia, between February and June 2023. Participants viewed five distinct hypothetical formats, presented in a randomised order, designed to display the same level of high risk for HIV/STIs: icon array; colour-coded risk meter; colour-coded risk bar; detailed text report; and guideline recommendation. They reported their perceived risk, concern, and intent to test for each risk display. Associations between the format of the risk display and the intention to test for HIV/STI were analysed using logistic regression.

Results: About 378 (57%) of participants expressed that the risk meter was the easiest to understand. The risk meter (Adjusted Odds Ratio (AOR) = 2.44, 95% confidence interval (CI) = 1.49–4.01) and risk bar (AOR = 2.08, CI = 1.33–3.27) showed the greatest likelihood of testing compared to the detailed text format. The icon array was less impactful (AOR = 0.73, CI = 0.57–0.94). The risk meter also elicited the most concern but was the most preferred and understood. High-risk perception and concern levels were strongly associated with their intention to have an HIV/STI test.

Conclusions: Displaying risk differently affects an individual’s perceived risk of an HIV/STI and influences their intention to test.

Disclosure of interest statement: None declared.

Acknowledgement of Funding: CKF is supported by an NHMRC Leadership Investigator Grant (GNT1172900), and JO by an NHMRC Emerging Leadership Investigator Grant (GNT1193955).

162. Characteristics of neurosyphilis diagnoses at a sexual health clinic in Sydney’s Inner West, 2021–2024

Madhara N. Weerasinghe¹, Yen Li Lim^2,3, Linda Garton¹, David J. Templeton¹, Rachael Thomas¹ and Rachel M. Burdon¹

¹Department of Sexual Health Medicine, Community Health, Sydney Local Health District, NSW, Australia.

²Port Kembla Sexual Health Service, Illawarra Shoalhaven Local Heath District, NSW, Australia.

³The Albion Centre, South Eastern Sydney Local Health District, NSW, Australia.

Background: Sydney Local Health District (SLHD) has consistently had one of the highest syphilis notification rates in NSW. We observed an increase in neurosyphilis cases presenting to RPA Sexual Health (RPASH) since 2021 and sought to understand clinical, epidemiological, diagnostic and treatment characteristics of these cases.

Methods: Between August 2021 and May 2024, neurosyphilis diagnoses were identified by retrospective chart review. Electronic medical records were reviewed for gender, age, transmission mode, HIV status including pre-exposure prophylaxis use (PrEP) or antiretroviral treatment (ART), clinical stage of syphilis, neurological symptoms, investigations, and treatment.

Results: 23 neurosyphilis cases were identified. 83% of cases were male (n = 19). Median age at diagnosis was 39 years (IQR: 19–63). Most acquired syphilis through male-to-male sexual contact (70%) and presented with secondary syphilis (n = 20). Almost half (n = 11) had otosyphilis, 3 had ocular syphilis and 9 had another neurological syndrome. Serum rapid plasma reagin (RPR) titres ranged from 1:8 to 1:2048. Lumbar puncture was performed in 15 patients. The majority of those with neurosyphilis were HIV negative (n = 18), with only one-third taking PrEP. Of 5 patients living with HIV, 3 were taking ART. 70% received IV Benzylpenicillin as treatment, 2 received IV Ceftriaxone, 4 received high-dose doxycycline and 1 received IM procaine penicillin with probenecid. 43% were diagnosed at RPASH (n = 10), 13% were referred from an inpatient speciality and 43% were referred by GPs.

Conclusion: A high index of suspicion and systematic enquiry of neurological symptoms in all cases of syphilis may facilitate the identification and appropriate management of early neurosyphilis. Improving awareness of neurosyphilis especially in primary care and emergency departments is important given rising notifications of infectious syphilis nationally.

Disclosure of interest statement: The authors declare no conflict of interests.

163. Geographical distribution and prevalence of urogenital chlamydia and trachoma: an ecological study

Ferguson M.¹, Hocking J. S.², Low N.³, Solomon A.⁴, Marks M.¹, Kaldor J.⁵, Hooper P. J.⁶, Bakhtiari A.⁶, van Gemert C.⁷, Molefi T.⁸, Epée E.⁹, Bella A.¹⁰, Trujillo-Trujillo J.^11,12, Makangila F.¹³, Watitu T.¹⁴, Honorio-Morales H.¹⁵, Muñoz Carrillo C.¹⁶, Kabona G.¹⁷, Midzi N.¹⁸, Phiri I.¹⁹ and Harding-Esch E.¹

¹London School of Hygiene and Tropical Medicine, London, United Kingdom.

²The University of Melbourne, Melbourne, Vic, Australia.

³University of Bern, Bern, Switzerland.

⁴World Health Organization, Geneva, Switzerland.

⁵Kirby Institute, Sydney, NSW, Australia.

⁶International Trachoma Initiative, Task Force for Global Health, Decatur, USA.

⁷Burnet Institute, Melbourne, Vic, Australia.

⁸Ministry of Health and Wellness, Gaborone, Botswana.

⁹Department of Ophthalmology, University of Yaoundé, Yaoundé, Cameroun.

¹⁰Programme National De Lutte Contre La Cécité, Ministère De La Santé Publique, Yaoundé, Cameroun.

¹¹Ministerio de Salud y Protección Social, Bogotá, Colombia.

¹²Universidad Nacional Abierta y a Distancia (UNAD), Colombia.

¹³Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo.

¹⁴Ministry of Health, Nairobi, Kenya.

¹⁵Technical Manager of the Eye Health and Blindness Prevention Component, General Directorate of Strategic Interventions in Public Health, Ministry of Health of Peru, Lima, Peru.

¹⁶Eye Health and Blindness Prevention Component, General Directorate of Strategic Interventions in Public Health, Ministry of Health of Peru, Lima, Peru.

¹⁷Neglected Tropical Disease Control Program, Ministry of Health, Dodoma, United Republic of Tanzania.

¹⁸National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe.

¹⁹Epidemiology and Disease Control Department, Ministry of Health and Child Care, Harare, Zimbabwe.

Background: Urogenital Chlamydia trachomatis (CT, serovars D-K) is the most common bacterial STI worldwide. Trachoma, caused by repeated ocular CT infection (serovars A-C) is the leading infectious cause of blindness. Partial protective immunity may exist. We conducted an ecological study, hypothesising that trachoma prevalence will be inversely associated with adult urogenital CT prevalence.

Methods: A systematic review identified urogenital CT population prevalence data, which were matched to the geographically closest trachoma baseline (pre-mass antibiotic treatment) prevalence survey. Trachoma data included trachomatous trichiasis (TT) prevalence in ≥15-year-olds and trachomatous inflammation—follicular (TF) prevalence among 1–9-year-olds. We examined trends, with tertiles (low, medium, high) of TT and TF prevalence.

Results: We identified 57 urogenital CT studies from 55 districts across 20 countries. Six had trachoma data in the same or a nearby district (<20 km away); 23 had trachoma data <150 km away; and 26 had trachoma data ≥150 km away. Districts in the low TT prevalence tertile had higher mean urogenital CT prevalence (10.9%, 95% CI 8.7–13.0%) than medium (7.9%, 2.8–13.0%) and high (8.1%, 4.8–11.3%) TT prevalence tertiles. Districts in the low TF tertile had lower urogenital CT prevalence (7.6%, 5.5–9.8%) than medium (9.2%, 6.6–11.8%) and high (12.1%, 8.2–16.1%) tertiles. These findings suggest an inverse association between TT and urogenital CT, and a positive association between TF and urogenital CT. The overlapping 95% CI between urogenital CT prevalence estimates in adjacent tertiles indicates poor precision.

Conclusion: The potential inverse relationship between TT and urogenital CT is consistent with a hypothesis that frequent reinfections with ocular CT throughout life protect against urogenital CT during adulthood, but the potential positive association between TF and urogenital CT does not. The ecological study design limits interpretation about causality and individual-level associations. Further research and modelling are required to explore these possible associations.

Disclosure of interest statement: AB and PJH are employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research funds from Pfizer Inc., the manufacturers of Zithromax® (azithromycin), used for trachoma elimination. EMHE receives salary support from the International Trachoma Initiative. AWS is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this abstract and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

164. Exploring associations of the vaginal microbiome and STI co-infections with spontaneous clearance of urogenital Chlamydia trachomatis

Carter K. A.¹, Brown S. E.^1,2, Tuddenham S.³, Shardell M. D.^1,2, Ghanem K. G.³, Ravel J.^1,4 and Brotman R. M.^1,2

¹Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.

²Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.

³Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

⁴Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA.

Background: Urogenital Chlamydia trachomatis (CT) spontaneously clears (without antibiotics) in up to 44% of women between screening and treatment initiation; underlying mechanisms are poorly understood. We investigated relationships of clinical and microbiome characteristics with CT persistence versus spontaneous clearance.

Methods: From 1999 to 2003, the Longitudinal Study of Vaginal Flora followed reproductive-age women every three months for one year. CT screening for asymptomatic participants started after ligase chain reaction became available mid-study; unscreened endocervical swabs were tested after study completion. We identified CT persistence and clearance events between consecutive visits without CT-active antibiotic use, and we characterised the vaginal microbiome by metagenome sequencing at CT-positive index visits in these events. We used mixed-effects logistic regression to estimate associations between exposures at CT-positive visits and CT persistence versus clearance at subsequent visits.

Results: This analysis includes 310 persistence and 301 spontaneous clearance events from 425 participants. In univariable models, CT persistence at the following visit was associated with Black race, age ≤25, bacterial vaginosis (Nugent score ≥7), prescription of metronidazole/clindamycin, and Mycoplasma genitalium co-infection (all P < 0.05). CT persistence was also associated with Candidatus Lachnocurva vaginae-dominated and Gardnerella-dominated vaginal microbiomes, compared to Lactobacillus crispatus, gasseri, and jensenii-dominated microbiomes (all P < 0.05). M. genitalium co-infection remained significantly associated with persistence when adjusting for race, bacterial vaginosis, and metronidazole/clindamycin prescription (OR = 1.72, 95% CI: 1.04–2.82). Ca. L. vaginae dominance (OR = 4.86, 95% CI: 2.04–11.57) and Gardnerella dominance (OR = 2.65, 95% CI: 1.32–5.33) remained significantly associated with persistence when adjusting for age, race, and metronidazole/clindamycin prescription. Hormonal contraception, smoking, douching, baseline CT history, and Neisseria gonorrhoeae and Trichomonas vaginalis co-infections were not associated with CT persistence versus clearance.

Conclusion: An optimal vaginal microbiome during CT infection may reduce CT persistence. The association between M. genitalium co-infection and CT persistence should be interrogated further as co-infection may uniquely contribute to adverse sequelae.

Disclosure of interest statement: ST has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UPTODATE; has received speaker honoraria from Roche Molecular Diagnostics and Medscape; and has received in-kind donation of sexually transmitted infection (STI) test kits to her institution through Hologic. JR is a cofounder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutic drugs for women’s health. RMB has received in-kind donation of STI test kits to her institution through Hologic. All other authors report no potential conflicts.

165. Comparing stages of new syphilis infections before, during and after the COVID-19 lockdowns in Melbourne, Australia

Aung E. T.^1,2, Kelly H.¹, Fairley C. K.^1,2, Chen M. Y.^1,2 and Chow E. P. F.^1,2,3

¹Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

³Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: Studies have shown reductions in asymptomatic HIV and sexually transmitted infections (STIs) testings during COVID-19 lockdowns in Melbourne, Australia, although there was no reduction in diagnoses of syndromic STIs. Syphilis stages vary by specific signs and symptoms and the frequency of testing. We hypothesise that reduced access to sexual health during COVID-19 may potentially decrease asymptomatic syphilis presentations. We aim to examine the impact of COVID-19 on syphilis presentations at a sexual health service in Melbourne.

Methods: We included persons aged over 18 years who had at least one syphilis serology between 2018 and 2023, attending the Melbourne Sexual Health Centre (MSHC). We compared the syphilis stages (primary, secondary, early latent (<2 years and non-primary or non-secondary), and late syphilis (>2 years or unknown duration)) over pre-COVID (2018–2019), COVID (2020–2021), and COVID-normal (2022–2023) periods.

Results: There were 93,715 persons (223,044 consultations) attended MSHC in 2018–2023. A total of 3055 syphilis cases were diagnosed: 25% (n = 777) primary, 19% (n = 588) secondary, 36% (n = 1103) early latent, and 19% (n = 587) late syphilis cases. There were no changes in syphilis stages across the three periods. The proportion of primary syphilis did not change over time (26% [n = 266] in pre-COVID, 27% [n = 244] in COVID, and 24% [n = 267] in COVID-normal (P_trend = 0.31). Similarly, the proportion of secondary syphilis did not change (19% [n = 199], 18% [n = 163], and 20% [n = 226], respectively; P_trend = 0.56). The proportion of early latent syphilis followed the same trend (35% [n = 361], 36% [n = 331], and 37% [n = 411], respectively; P_trend = 0.38). Lastly, the proportion of late syphilis diagnoses remained stable (20% [n = 203], 19% [n = 174], and 19% [n = 210], respectively; P_rend = 0.61).

Conclusion: The proportion of syphilis diagnoses across different stages remained consistent throughout the pre-COVID, COVID, and COVID-normal periods. This suggests that the access to sexual health services during the pandemic did not significantly affect the distribution of syphilis stages among diagnosed.

Disclosure of interest statement: All authors declared no conflict of interest.

166. Epidemiology of infectious syphilis in the Illawarra Shoalhaven Local Health District (ISLHD) 2009–2021

Lam M.¹, Rutherford A.¹, Little A.² and Rowling D.³

¹Illawarra Shoalhaven Sexual Health Service, Port Kembla, NSW, Australia.

²Illawarra Shoalhaven Public Health Unit, Warrawong, NSW, Australia.

³Qld Syphilis Surveillance Service, Metro North Public Health Unit, Brisbane, Qld, Australia.

Background: Infectious syphilis notification rates have been increasing in NSW. This project aimed to identify trends and patterns in our local health district to guide development of a local Syphilis Action Plan.

Methods: Descriptive study analysing infectious syphilis notification data extracted from the Notifiable Conditions Information Management System (NCIMS) for ISLHD residents from 1 January 2009 to 31 December 2021.

Results: Over the 12-year study period, the number of infectious syphilis notifications steadily increased to a peak in 2020 of 50 cases per year (11.7 cases per 100,000 population). There were 332 total notifications; 91% (302/332) in males and 8.7% (29/332) in females, with highest notifications in the 20–39 year age bracket. 8.4% (28/332) of notifications were in people who identified as Aboriginal or Torres Strait Islander. There were 7 cases of syphilis in pregnancy during the study period but no confirmed cases of congenital syphilis. Of the males with syphilis, 63% (190/302) reported sexual exposure with males only, 14% (42/302) with females only, and 8.9% (27/302) with both males and females. 47% (156/332) of diagnosis were made by GPs and 37% (123/332) by the sexual health clinic. The surveillance data quality improved substantially over time.

Conclusion: Consistent with NSW trends, ISLHD is seeing an increase in total infectious syphilis notifications. In collaboration with local stakeholders, we are developing a local Syphilis Action Plan which includes implementation of state-wide strategies to prevent congenital syphilis.

Disclosure of interest statement: None.

Prevention abstracts

167. Measuring the readiness of health facilities to provide sexually transmitted infection services in Bangladesh: evidence from Bangladesh health facility survey

Jahan E.¹, Saha A.¹, Hasan M.¹ and Rahman A. E.¹

¹Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.

Background: STI represent a global public health burden. The World Health Organization’s global strategy on STI states the objective of reducing incidence of syphilis and gonorrhoea by 90% by 2030. Bangladesh is adhering to the strategy as mentioned in the “National Guidelines for Management of STI 2019”. The objective is to assess the readiness of health facilities to provide STI services in Bangladesh.

Methods: Secondary analysis was done using the nationally representative BHFS 2017 and 2014. A total of 1524 and 1548 facilities were surveyed in 2017 and 2014 respectively. Analysis was done for three components – training of healthcare providers, availability of diagnostic facilities and availability of medicines and commodities.

Results: In terms of training, capacity have decreased among health providers. Regarding diagnostics, syphilis testing capacity has increased in all facilities except district hospitals and MCWC’s. For individual tests, there has been an increase in RDT, VDRL, TPHA. Notably, there was no provision of STI testing in union level as highlighted in the surveys. Regarding availability of medicines and commodities, there has been a reduction in availability of medications in all health facilities except for private facilities and NGO’s.

Conclusion: There has been an overall decline in the readiness of health facilities to provide STI services. The BHFS does not have questions regarding gonorrhea diagnosis. Urgent action is required to upgrade the condition of health facilities in providing STI services in order to meet the global strategy’s timeline by 2030.

Disclosure of interest statement: None.

168. Significant obstacles to women commercial sex workers’ (WCSWS) access to HIV and STD programs during the COVID-19 epidemic in Rajshahi, Bangladesh

Kalam M. A.¹

¹Quick Health Service Centre (QHSC).

Background: Women Commercial Sex Workers (WCSWs) who engage in hazardous sexual activity run a much higher risk of contracting HIV and other STDs. Testing and counseling are essential components of behaviour change, treatment admission, and aftercare for WCSWs. This exploratory study aimed to record how the nation addressed the need for people living with HIV/STD and vulnerable to risk during the COVID-19 epidemic, as well as to look into obstacles that WCSWs faced in accessing, using, and staying in treatment.

Methods: During the height of the COVID-19 epidemic, the study was conducted in Rajshahi, Bangladesh, from July 2021 to June 2022. The study comprised the following: a review of official statements and orders from the Government of Bangladesh; in-person interviews with 650 WCSWs; 24 service providers; 14 key informants; and a one-day negotiation workshop with 40 participants from the WCSW and service provider groups.

Results: During the pandemic’s peak, WCSWs reported that they were denied access to medical facilities for almost 18 months, that they were not given any tests or treatments, and that people’s attitudes toward them were extremely hostile and intolerant. Nearly 94% of WCSWs, reported facing obstacles in obtaining social services and health treatment. However, for those who are currently at continuous risk of infection, annual HIV/STD testing is advised. More than 90% of the group as a whole said they had never had an HIV or STD test. The government’s failure to apply a justice lens in implementing its response to the nation’s inept healthcare systems was pointed up by the key informant interviews and service providers.

Conclusions: Public health experts and HIV/STD service providers need to be aware of how the COVID-19 pandemic is affecting HIV/STD care and be ready for any rises in HIV/STD-related morbidity and mortality in the upcoming years.

169. Enhancing consent education for Year 9 boys: a pilot program in Perth, Western Australia

Thompson V.^1,2 and Rason K.^1,2

¹University of Curtin, Perth, WA, Australia.

²We Are Womxn, Perth, WA, Australia.

Background: This research evaluates the impact of a consent education pilot program targeting Year 9 male students in diverse school settings, aligning with the nationwide mandate for consent education. The initiative addresses the pressing need highlighted by the Australian Institute of Health and Welfare regarding the increased risk of sexual violence among young people. The program aims to instill nuanced concepts of sexual consent and communication before sexual activity begins, drawing on evidence-based practices.

Methods: Four schools with varied socioeconomic backgrounds were engaged, involving 30 male students each. The program featured 2-h sessions with a focused consent workshop, complemented by pre- and post-evaluations. Despite budget constraints, the program showcased adaptability, leveraging existing resources to deliver impactful sessions.

Results: The program yields substantial positive effects on students’ knowledge, attitudes, skills, and consent awareness. Key outcomes feature a remarkable 63% overall increase in comprehending the consent cycle, achieving a 93% knowledge acquisition rate. Positive attitudes toward consent rose by 14%, accompanied by commendable enhancements in communication skills. A notable 40% improvement in students’ decision-making capacity is also observed. In the short term, the program induces positive changes in sexual behaviours, attitudes, skills, and decision-making among students. Medium-term impacts encompass sustained post-workshop discussions, increased skill application, and heightened awareness of consent-related issues. Long-term objectives focus on reducing sexual violence rates among Australian students and influencing future curricula based on research insights from this program.

Conclusions: Despite initial challenges, this pilot program showcases adaptability and garners positive feedback, making it a potential model for broader implementation across Western Australia. Its unique blend of evidence-based consent education and a tailored workshop for Year 9 male students not only yields immediate positive changes but also provides crucial insights for crafting effective and culturally sensitive programs. The program’s multifaceted impact, fostering positive behaviours, attitudes, and skills, positions it as a transformative force in reshaping consent education. Beyond short-term successes, it aims to contribute to long-term goals, reducing sexual violence rates among Australian students and influencing future curricula based on ground-breaking research. This initiative stands as a beacon in the ongoing pursuit of comprehensive and impactful consent education.

Disclosure of interest statement: The authors declare no conflicts of interest. This research received no external funding, and the authors have no financial relationships with any organisations that might have an interest in the submitted work.

170. A community-based approach in ending sexual gender-based violence against adolescents in Kono District, Sierra Leone

Mawindo B.¹ and Dumbuya I.¹

¹Partners In Health Sierra Leone, Sierra Leone.

Background: The DHS 2019 shows that adolescents aged 15–19 in Sierra Leone continue to experience physical (54.2%) and sexual (3.4%) violence. This has put them at risk of being excluded by society, gets early pregnancy and sexually transmitted infections. The No woman or Girl left behind project carried out a 3-year (2021–2024) intervention project to address SGBV challenges facing adolescents in Kono District. The project outcomes were to increase awareness about SGBV among adolescents and strengthen referral pathways of survivors to healthcare and legal support.

Methods: The project goal was to improve provision of quality health services to SGBV adolescent survivors. The project desired outcomes included a reduction in violence against adolescents, reduction in unwanted pregnancies and STIs and increase number of SGBV adolescent survivors referred for healthcare services. The project targets adolescent girls and boys aged 10 to 19 years. The project is being implemented by community police units, CHWs, the legal support team and school teachers and peers. The project also trained these stakeholders on SGBV issues. A virtual one-stop-centre platform to strengthen the referral pathway was created. Performance indicators are monitored monthly against set quarterly targets.

Results: The monitoring and evaluation report for the past 2 years (2021–2023) show that the project has reached 5047 adolescents with SGBV messages in 15 communities. An end of second year survey also showed that 76% (3836) of adolescents possess basic knowledge regarding attitudes, knowledge, and practices related to SGBV. The report also showed that to date 635 SGBV survivors (females) were reported of which 62% (395) were sexually assaulted and 38% (241) were physically assaulted. Of reported survivors, 125 contracted STIs and 35 got pregnancies and majority of them were referred to Kono Rainbo Center for medical, psychosocial and legal support services.

Conclusions: There is underreporting of male SGBV survivors due to cultural norms. The virtual one-stop centre (OSC) approach, together with school clubs formulation, community outreach and training of key stakeholders has contributed to an increase in SGBV referrals for support.

171. Empowerher: a quantitative exploration of trauma-informed education’s impact on adolescent well-being

Raston K.¹ and Beard N.¹

¹We Are Womxn, Perth, WA, Australia.

Background: This abstract presents the transformative outcomes of a 6-week program conducted by We Are Womxn at Belridge Secondary College with a focus on Year 9 students. Covering topics such as consent, relationships, social media, sex education, and mental health, our trauma-informed approach aimed to empower girls, providing them with knowledge and skills while fostering confidence and agency. The inclusion of an art project, resulting in a mural, became a pivotal element of our program.

Methods: Our approach employed a pre- and post-survey methodology, ensuring a robust evaluation. Engaging discussions, informative activities, and a collaborative art project led by artist Maddy Fisk constituted our intervention. The mural, strategically placed near the student services building, serves as both an artistic expression and a tangible representation of the transformative journey undertaken by the participants.

Results: A total of 10 Year 9 students participated, exhibiting a 100% response rate. In social media education, there was a significant 90% increase in awareness of issues associated with sexting. “It’s Complicated” demonstrated an 80% increase in identifying signs of unhealthy relationships. Consent: “How to: CONSENT” showcased a 40% increase in correctly identifying the legal age of consent, and a 55% increase in understanding consenting language.

Impacts and Testimonials: The impacts of our program extend beyond statistics. Maria, a participating student, expressed, “Whenever I walk past, I just feel proud that I was a part of it. It makes my day whenever I walk past it.” Sarah echoed this sentiment, saying, “I was really excited about coming to school to see everyone and paint the mural and see how it would be after it finished.” These testimonials highlight the emotional resonance and sense of accomplishment our program instilled in the participants, emphasising the holistic impact on their well-being.

Conclusion: This program’s innovation lies in its integration of research-driven methods, evidenced by statistically significant improvements across multiple domains. The mural, adorned with positive affirmations such as ’I’m brave’ and ’I am strong,’ serves as a daily source of empowerment and positivity. It acts as both an aesthetic expression and a therapeutic intervention, contributing to the program’s multifaceted impact. The significance of our findings indicates a nuanced and informed shift in students’ understanding, empowering them to navigate complex issues and fostering a culture of respect and understanding.

Disclosure of interest statement: We Are Womxn operates independently, without external funding.

172. Empowering young women in regional Western Australia: We Are Womxn’s Business

Raston K.^1,2 and Beard N.^1,2

¹University of Curtin, Perth, WA, Australia.

²We Are Womxn, Perth, WA, Australia.

Background: In the Pilbara region of Western Australia, ‘We Are Womxn’s Business’ initiated a targeted project for 320 young women in years 5–12, acutely aware of the nuanced intricacies and resource disparities prevalent in regional Australia. The Pilbara region is approximately 1300 kms north of Perth and covers an area of 500,000 km². Recognising critical gaps in the existing school curriculum compounded by limited access to resources, health education, and preventive programs in regional settings, the initiative aimed to address these specific challenges. The project sought to comprehensively educate on menstrual health, sexual health, healthy relationships, and social media use, establishing a robust platform for open dialogue in a region where such initiatives are scarce.

Methods: The project employed a strategic three-tiered workshop series: “It’s Complicated,” delving into healthy relationships; “The Social Dilemma,” emphasising responsible social media use; and “The Period. Program,” delivering extensive knowledge on menstrual health. Methodologically, the project hinged on rigorous pre- and post-surveys to systematically analyse shifts in cognition, attitudes, and decisional judgment. The tailored approach considered the regional context, ensuring content relevance and applicability.

Results: It’s Complicated: A substantial 70% increase in discernment regarding toxic relationships. A noteworthy 60% augmentation in understanding the intricate concept of gaslighting. A remarkable 85% increase in acumen regarding avenues for support in instances of domestic violence.

The Social Dilemma: A consummate 100% enhancement in discerning manipulated images in advertising. A robust 94% escalation in understanding the pervasive culture of social comparison. A substantive 80% augmentation in cognisance of legal nuances governing social media conduct such as sexting and pornography.

The Period. Program: A 100% escalation in comprehension of female anatomical structures.

A substantial 98% rise in knowledge pertaining of the menstrual cycle.

An impressive 95% augmentation in self-assurance in discussing menstrual health.

Conclusion: This project unveils a blueprint for addressing gaps in adolescent education, especially pertinent in the unique regional Australian context. The success of our tailored workshops signifies the urgent need for an enriched and comprehensive integration of content within school curricula in regions facing resource disparities. Specifically tailored to empower young women in regional Australia, this initiative represents a pioneering step in navigating the intricate tapestry of their health and relationships amid challenging circumstances.

Disclosure of interest statement: The authors declare no conflicts of interest. This research received no external funding, and the authors have no financial relationships with any organisations that might have an interest in the submitted work.

173. Exploring relationships between dating applications use and sexual activity among young adult college students

Reeves J. M.^1,2, Griner S. B.³, Johnson K. C.³, Jones E. C.¹ and Shangani S.⁴

¹University of Texas at Arlington, TX, USA.

²Yale University School pf Public Health Research Fellow, USA.

³University of North Texas Health Science Center School of Public Health, TX, USA.

⁴Boston University School of Public Health, Boston, MA, USA.

Background: Sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infections are significant global and public health problems resulting from risky sexual behaviour. Among young adults in the U.S., the use of dating applications is prevalent; however, there is limited research on its impact on sexual behaviours. We examined the relationship between the use of dating applications and risky sexual behaviours among college students.

Methods: From August to December 2022, we conducted an online cross-sectional survey with 122 college students aged 18–35 years old college students in Northern Texas. The survey covered topics such as demographics, dating app use, sexual behaviours, and utilisation of healthcare services. Associations between the variables were estimated using bivariate and multivariate logistic regression analyses.

Results: Among the 122 participants (overall mean age, 23.3 [SD = 3.5], 56% were male, 77% were undergraduates, and 78% were single). Two-thirds used dating apps (67%), 71% reported multiple sexual partners, and approximately 50% reported inconsistent condom use. Adjusting for demographic variables, students with multiple sexual partners [(adjusted odds ratio [aOR) = 5.44; 95% confidence interval (CI) 1.31–22.54, P = 0.02], those who had ever had HIV/STI testing [aOR = 7.39, 95% CI = 1.40–38.97, P = 0.02], and those who utilised the student clinic [AOR = 5.99, 95% CI = 1.48–24.31, P = 0.02] were more likely to use dating apps. However, small-town residents reported lower odds of using dating apps [aOR = 0.11, 95% CI = 0.03–0.47, P = 0.003].

Conclusion: Universities and colleges should offer workshops with “sex-positive” strategies that will improve safer sex practices and promote sexual responsibility (e.g., consistent condom use, STI/HIV testing, screening, and prevention methods) among college students, particularly acknowledging the role of dating apps. It is essential to foster students’ entire development and well-being as they navigate through their academic and personal life experiences. These findings can inform STI/HIV risk-reduction programs on college campuses by adding information related to the social context in which these behaviours occur.

Disclosure of interest statement: The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met ethical guidelines, adherence to the legal requirements of the United States. This study was funded by American Sexually Transmitted Diseases Association (ASTDA). No pharmaceutical grants were received in the development of this study.

174. Broadening scope to improve practice in clinical sexual health education: from vanilla to rocky road

Olivia T. Van Gerwen^1,2, Chidimma Anunobi¹, Nicholas Kummer¹, Erica Mann¹, Aiesha Gentry² and Nicholas J. Van Wagoner^1,2

¹University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.

²Southeast STD/HIV Prevention Training Center, Birmingham, Alabama, USA.

Background: The hot and heavy subject of sex often goes cold in clinical settings. Despite sexually transmitted infection (STI) rates rising annually, particularly in the US Deep South, less than a quarter of physician encounters document sexual history. Eliciting comprehensive sexual health histories is essential to tackle the STI epidemic, but nuances of sexuality, sexual behaviors, and gender identity are rarely taught effectively. We aimed to improve clinician understanding of sexual dysfunction, communicable infections, preventative measures, gender identity, and sexuality through the development and implementation of standardised patient simulations (SIMs).

Methods: We developed SIMs to address training gaps identified by medical students during an immersive sexual health internship at the University of Alabama at Birmingham. Objectives included inclusive language, nonverbal communication, collection of gender identity and sexual behavior data, STI clinical manifestations, elucidation of sexual health concerns, and sexual health counseling. We generated six adaptable simulations to train students and clinicians alike.

Results: SIMs were piloted in September 2023 at the Southeast STD/HIV Prevention Training Center’s Foundations of STI/HIV Clinical Intensive. Five senior level nurses from the Florida Department of Health participated in six SIMs, which were video streamed by preceptors. Participants and preceptors then debriefed, reviewed the recordings, and provided performance reflections and self-assessments. All participants found the SIMs engaging and informative, providing them with skills to collect more complete sexual health histories.

Conclusion: Transdisciplinary work is important for developing meaningful and sustainable educational tools in the sexual health space. Simulation activities cater to the unique needs of adult learners and are especially effective for topics such as sexual health. Future directions include additional simulation launches with follow-up surveys to assess acceptability and the sustainability of improvements in participant confidence and practices following the initial intervention. Follow-up surveys will provide valuable insights into long-term impact.

Disclosure of interest statement: This work was funded in part by the US Centers for Disease Control and Prevention (CDC-RFA-PS20-2004 National Network of STD Clinical Prevention Training Centers (NNPTC)). None of the authors of this abstract have any conflicting interests to disclose related to this work.

175. Poverty leading to selling sex

Nagumba M. J.¹

¹Jajaz In Christ Community Development Group.

Background: Uganda, was the first country in sub-Saharan Africa to reverse its HIV/AIDS epidemic. Long distance drivers, prostitutes and barmaids have been identified as the groups that engage in risky sex, which promotes HIV transmission in Uganda and other countries across the continent. This paper investigates whether and why there were changes of sexual behavior and practices among five risky groups in Uganda as a consequence of HIV/AIDS epidemic.

Methods: The paper is based on data generated from a survey on ’resistance to sexual behavior change in the Ugandan AIDS epidemic’, which was conducted in the districts of Kampala and Lira in 1999. For purposes of this paper, only data from the focus group discussions with high-risk groups have been analysed. These include commercial sex workers, street children, long haul truck drivers, bar maids and adolescents in three towns of Uganda (Kabale, Kampala, Lira).

Results: Results indicate that despite the HIV/AIDS epidemic, these groups had only changed their sexual behavior a little, and they reported to be continuing with multiple sexual partners for a variety of reasons. The adolescents and street children were under peer pressure and a lot of sexual urge; commercial sex workers and bar maids attributed their risky behaviour to the need to survive due to the existing poverty; and the truck drivers reflected on the need for female company to reduce their stress while on the long lonely travels across Africa. Nevertheless, they are all aware and perceive people with multiple sexual partners as being highly vulnerable to contracting HIV and they all reported to have adopted condom use as an HIV preventive strategy. They also observed that married people were at a high risk of contracting HIV due to non-use of condoms in marital relationships and unfaithfulness of spouses.

Conclusions: Females engage in high-risk sexual relations as a means of economic survival, and perceive their acts as a strategy to improve their socio-economic well being. On the contrary, men in these high-risk categories do such acts out of pleasure and as avenues for attaining fulfilled sexual lives. The search for money among women and the constant desire for men to have sexual pleasure, which are greatly facilitated by their financial status are the forces behind reckless sexual behavior among high-risk groups.

176. Efforts made, challenges faced, and recommendations provided by stakeholders involved in mpox prevention and control in China: a qualitative study

Zhang W.^1,#, Qi X.^2,#, Han B.^2,#, Fu L.^1,#, Wang B.^1,#, Wu K.², Hong Z.³, Yang L.⁴, He J.², Zhang Y.², Sun Y.⁵, Chen Y.¹, Liu S.¹, He L.^6,*, Lv F.^7,*, Qian J.^1,*, Luo S.^8,*, Meng X.^9,* and Zou H.^10,*

¹School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.

²Beijing Chaoyang District Center for Disease Prevention and Control, Beijing, China.

³Department of Infectious Diseases, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.

⁴National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern, University of Science and Technology, Shenzhen, Guangdong, China.

⁵The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

⁶Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China.

⁷National Center for AIDS/Sexually Transmitted Disease Control and Prevention, The Chinese Center for Disease Control and Prevention, Beijing, China.

⁸Vanke School of Public Health, Tsinghua University, Beijing, China.

⁹Wuxi Center for Disease Control and Prevention, Wuxi, China.

¹⁰School of Public Health, Fudan University, Shanghai, China.

^#These authors contributed equally to the manuscript.

^*These corresponding authors contributed equally to the manuscript.

Background: Mpox continues to spread in China, stakeholders’ experiences may help inform prevention and control strategies.

Methods: A Qualitative study across 14 Chinese cities recruited stakeholders from CDCs, CBOs, and hospitals involved in curbing mpox. Semi-structured interviews were conducted by telephone and analysed using Colaizzi’s phenomenological method.

Results: 15 CBO workers, 14 CDC staff, and 13 healthcare workers were recruited. Three theme categories were identified: “Efforts to curb mpox epidemic”, including CDCs’ epidemic management and health education, hospitals’ diagnosis, treatment, and care, CBOs’ counseling, publicity, and referrals. “Challenges to curb mpox epidemic”, including negative impacts of hospital-based quarantine, lack of specific antiviral drugs, gay identity disclosure concerns, psychological problems, contact tracing difficulties, and inadequate communication and collaboration. “Recommendations for curbing mpox epidemic”, including prioritizing supervised home-based quarantine, incorporating HIV-related indicators into hospital quarantine criteria, reducing the cost of hospital quarantine, accelerating development of vaccines and drugs, enhancing patient privacy protection, psychological training for stakeholders, establishing a task force that comprises personnel who are experienced in contact tracing and Strengthening communication and collaboration.

Conclusion: Effective control of mpox spread requires strengthening collaboration with CBOs and community healthcare centers (CHCs) and working out a flexible and contextualised mechanism. It also needs to reinforce patient privacy protection and integrate stigma reduction into strategies. Prioritizing supervised home-based quarantine and incorporating HIV-related indicators into the hospital quarantine criteria are also pivotal steps. Additionally, stakeholders, especially CBO workers should be provided with psychological training to help them manage mental health and improve counseling skills.

Keywords: mpox, stakeholders, prevention and control, qualitative study, China

Disclosure of interest statement: This study was supported by the Natural Science Foundation of China Excellent Young Scientists Fund [82022064], the Natural Science Foundation of China International/Regional Research Collaboration Project [72061137001], the Program from Wuxi Science and Technology Bureau [Y20222006], 2021 Beijing Key Specialty Program for Major Epidemic Prevention and Control, National Key Research and Development Program of China (2023YFC2306700), and National Key Research and Development Program of China (2022YFC2603600). All funding parties did not have any role in the design of the study or the explanation of the data.

177. Comfort in answering questions about higher risk sexual behaviours in a gender-neutral risk assessment for blood donation among diverse populations

Mowat Y.¹, Hoad V.³, Haire B.^1,2, Masser B.^3,4, Kaldor J.¹, Heywood A.², Thorpe R.³, McManus H.¹ and McGregor S.¹

¹The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

²School of Population Health, University of New South Wales, Sydney, NSW, Australia.

³Australian Red Cross Lifeblood, Melbourne, Vic, Australia.

⁴School of Psychology, The University of Queensland, Brisbane, Qld, Australia.

Background: Currently in Australia, a man cannot donate blood if he has had sex with another man within the past 3 months. However, Australia is progressing a gender-neutral assessment (GNA) for blood donation eligibility to address perceived inequity. The GNA will include questions for all donors on new or multiple recent partners, and, if applicable, questions on anal sex. Understanding the acceptability of such questions among existing and potential blood donors is paramount. Additionally, having an ethnically diverse donor panel is crucial to meet patient needs, however individuals from minority backgrounds are underrepresented in blood donation. Assessing acceptability of potential GNA questions among minority populations is essential to minimise shortages of rare blood types.

Methods: We used data from a nationally representative survey to estimate comfort in the proposed GNA questions among minority populations. Respondents were aged over 18 and living in Australia. Data were weighted to match the population.

Results: A total of 5178 people completed the survey, with 43% male, 57% female, 0.4% non-binary, and 0.1% using a different term. Most were comfortable with answering questions about new partners (73.1%, 95% CI 71.4–74.8%) or anal sex (64.0%, 95% CI 62.1–65.8%) to donate blood. By religion, the least comfortable group was Muslims, with 11.5% (95% CI 3.4–32.8%) and 14.6% (95% CI 5.4–33.9%) saying that being asked questions about new partners and anal sex respectively would stop them donating. By country-of-birth, respondents born in the Middle East were least comfortable with 17.0% (95% CI 4.8–45.7%) and 26.1% (95% CI 10.7–51.1%) saying that being asked questions about new partners and anal sex respectively would stop them donating.

Conclusion: A GNA appears to be broadly acceptable in the study population, however there are some signals that GNA questions may be less acceptable in some population subgroups, suggesting a need for targeted education to address cultural sensitivities.

Disclosure of interest statement: Australian governments fund Australian Red Cross Lifeblood to provide blood, blood products and services to the Australian community. This work was majority funded under a partnership grant from the Australian National Health and Medical Research Council (NHMRC APP1151959).

178. Evaluation of The Gist: a pornography, sex, and relationships education program for young people

Lim M. S. C.^1,2,3, Orozco A.¹, Turvey J.¹ and Evans D.⁴

¹Burnet Institute, Vic, Australia.

²Melbourne School of Population and Global Health, The University of Melbourne, Vic, Australia.

³Department of Epidemiology and Preventive Medicine, Monash University, Vic, Australia.

⁴Centre for Excellence in Rural Sexual Health, University of Melbourne, Vic, Australia.

Background: Online pornography consumption is prevalent among young people and education programs are needed to help young people understand sex and relationships in this context. Based on co-design research with young people, we developed an education package comprising five face-to-face sexual health education sessions in conjunction with a digital resource (thegist.org.au). The Gist is designed to give young people alternative information about sex, relationships, and pornography. This evaluation aimed to determine the effectiveness, feasibility, and acceptability of The Gist.

Methods: The program was delivered in 2023 with 101 young people at 10 services across Victoria. Data sources for the evaluation included website analytics, student surveys, participatory workshop activities, researcher observation notes, facilitators reflection sessions, feedback forms, and semi-structured interviews with service staff.

Results: Knowledge about sex and relationships demonstrated a statistically significant increase from pre- to post-program. Content was seen as highly relevant to the sexual health needs of students, and inclusive of diverse gender identities and sexual orientations. Students demonstrated high levels of engagement with The Gist and felt comfortable to explore sensitive sexual health topics. Teaching staff appreciated the flexible and interactive workshop delivery and noted that the content was very important for their students; “they were definitely tuned i.nd we had lots of relevant conversation that followed”. There was limited engagement with the digital resource, with only 346 visits during the evaluation period.

Conclusions: The Gist education sessions were acceptable and feasible for education services and showed some evidence of efficacy in improving sexual health knowledge. Further work is needed to integrate the digital resource into the sessions, and to ensure a sustainable delivery mechanism for the program.

Disclosure of interest statement: This research was funded by the Office of the eSafety Commissioner.

179. Prevalence and incidence of sexually transmitted infections in young women receiving peer-supported, community-delivered PrEP and other sexual health services in Kisumu, Kenya

Momanyi V.¹, Rono B.¹, Musinguzi N.⁵, Nyerere B.¹, Omollo V.¹, Oware K.¹, Odoyo J.¹, Kiche M.¹, Ochieng L.¹, Juma L.¹, Garrison L.³, Haberer J.^3,4 and Bukusi E.^1,2

¹Kenya Medical Research Institute, Kenya.

²University of Washington, Seattle, WA, USA.

³Massachusetts General Hospital, USA.

⁴Havard Medical School, USA.

⁵Mbarara University, Uganda.

Background: Sexually transmitted infections (STIs) are a major cause of morbidity and have been associated with HIV transmission, yet STI screening tests are rarely provided for or sought by young women in Kenya. We recently developed and evaluated a peer-supported, community-delivered kit for HIV pre-exposure prophylaxis (PrEP), STI testing, and contraceptive options in efforts to improve sexual health in this population.

Methods: In a randomised trial, women aged 16–24 years assigned to the intervention (the kit) were offered testing for gonorrhea and chlamydia through self-sampled vaginal swabs at a preferred location, along with delivery of PrEP and contraceptive options, at Months 1, 3, and 6. Peers provided support in sample collection and transported the vaginal swabs to a centralised clinic for same-day testing (GeneXpert). Results were returned to participants by phone within 24 h; free treatment was offered to the participant and her partner. Controls received standard-of-care (syndromic management). Data for the intervention arm were analysed descriptively; demographic and socio-behavioral factors associated with STI infection were assessed by multivariable logistic regression.

Results: Among 75 AGYW receiving the intervention, median age was 21.6 years (IQR 20.7, 23.1). There were 9 and 40 cases of gonorrhea and chlamydia, respectively, and 13 repeat infections. The mean number of STIs was 0.7/woman (SD 1.0) for an infection rate of 3.2/person-year (49 cases/15.6 total person-years). Factors trending toward an association with any STI prevalence were increasing age (aOR 1.3 per year, 95% CI: 0.9, 1.8; P = 0.07) and use of family planning (aOR 0.3, 95% CI: 0.1, 0.8; P = 0.03). No STI testing occurred in the control arm.

Conclusion: Prevalence and incidence of asymptomatic STIs were high despite availability of free individual testing and partner treatment. These results point to the need for asymptomatic screening of STIs and potential for scale-up of community-delivered services in routine care.

180. Young women’s perspectives on (a risk test for) infertility following chlamydia

Alexiou Z. W.^1,2, Peters C. M. M.^3,4, Hoebe C. J. P. A.^3,4,5, van Benthem B. H.¹ and Hoenderboom B. M.^1,2

¹Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

²Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.

³Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

⁴Department Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, The Netherlands.

⁵Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands.

Background: Chlamydia trachomatis (chlamydia) infection control might be more effective when focusing on morbidity reduction instead of prevalence reduction. A potential prognostic risk test, identifying women with high risk for infertility following chlamydia, might enhance targeted chlamydia control. However, do young women want to know their individual infertility risk?

Methods: In this qualitative study, focus groups were held with young women (YW) eligible for an STI consult. Participants were recruited from April to August 2023 during an STI consult at sexual health centers by purposive sampling. The theory-informed topic list included the following themes: perspectives on chlamydia (-infertility), needs for a risk test and expected benefits and barriers. Focus groups were recorded, transcribed verbatim and thematically analysed using Atlas.ti 23.

Results: Five focus groups were held with in total 19 participants (aged 18–25, median 22) in four cities across the Netherlands. 53% of participants had a theoretical education. Chlamydia was seen as the most common and known STI. Infertility being a complication was a well-known fact, but the actual mechanism and risks were less known. YW see infertility as irrevocable. YW fear having an infection without knowing it, because they could infect others or due to infertility risks. Majority of YW wanted to know their risk for infertility to be able to mentally prepare or take action (e.g. increased condom use). Reasons for not wanting to know the risk included expected long-term concerns about fertility and the potential impact on relationships. YW expect to feel relieved if the test indicates no increased risk for chlamydia-infertility. High reliability of this test was seen as essential for wanting to do the test.

Conclusion: Young women want to know their infertility risk following chlamydia, however expected barriers require serious consideration for the potential prognostic risk test. These needs, barriers and benefits will be further studied quantitively.

Disclosurer of interest statement: Funding was received from the Netherlands Organisation for Health Research and Development (ZonMW Netherlands) and Research Funding from the Ministry of Health, Welfare and Sports.

181. Optimising regional mpox vaccine access in Gippsland

Rachel Pollard¹, Bethany French¹, Rebecca McQuillen¹, Sydnee Skinner¹ and Annelies Titulaer¹

¹Gippsland Region Public Health Unit, Latrobe Regional Health, Traralgon, Vic, Australia.

Background: On July 23, 2022, Mpox was declared a global public health emergency and subsequently a disease of National Significance by the Australian Chief Medical Officer. The implementation of primary preventive vaccination (PPV) and post-exposure preventive vaccination (PEPV) among close contacts of Mpox cases was required to mitigate disease spread and alleviate breakthrough infection symptoms. The Gippsland Region Public Health Unit (GRPHU) coordinated local vaccination points including offering after-hours services to maximise Mpox vaccine availability and accessibility.

Approach: GRPHU initiated service mapping for specialised Sexual Health Clinics in Gippsland to provide PPV, PEPV, and coordinate the Mpox vaccine rollout. Despite collaboration with four Sexual Health Clinics, gaps in coverage, especially in rural areas, were identified. Embedding Mpox vaccination within an existing mobile COVID-19 vaccination program was identified to supplement existing clinics. Access was further increased through recruitment of a Priority Primary Care Centre to provide after-hours PEPV.

Results: Local Sexual Health Clinics in Gippsland served as trusted Mpox vaccination sites. Expansion of access points included additional clinics, pharmacies, and a local university campus. The mobile outreach model extended services to eligible individuals across a wider geographic area, although was limited by funding discontinuation. Feedback from LGBTQI+ community members highlighted the mobile outreach model provided opportunity for a more inclusive and culturally safe experience compared to clinic visits.

Conclusion: The local Mpox vaccine response fostered stronger relationships with key stakeholders. Providing Mpox vaccination services beyond regular hours reduced the necessity for travel outside Gippsland. The Mpox mobile outreach model, complementing fixed clinics, ensured equitable access in rural and remote areas, with positive community feedback potentially enhancing future service attendance. Maximising Mpox PPV and PEPV access in Gippsland required collaboration between services. Ongoing funding for mobile vaccination programs is recommended to ensure greater access in rural and remote areas.

Disclosure of interest statement: None.

182. Is It True, sexual health, lifestyle and relationships program

Lisa Harrison¹, Liz Pearman¹ and Sonya Khwanyuen¹

¹True Relationships & Reproductive Health (formerly known as Family Planning Queensland).

Background: Is it True is a simple and convenient education, information and screening program for important sexually transmitted infections (STIs) such as Chlamydia trachomatis. Research shows that young people are increasingly seeking information about sexuality, sex and sexual health. It is therefore all the more important that they have access to information which is reliable, responsible and professional.

Methods: Is it True makes sexual health education and getting screened for STIs, easier for young students by bringing education sessions and voluntary screening opportunities into Queensland senior secondary schools. Education sessions include information on STIs, blood borne viruses, contraception and relationship information (including pillars of a healthy relationship and consent). Community engagement is a large part of the program. True staff build relationships with local GP clinics and sexual health services so that students are aware these providers are youth friendly and can feel confident to access these services for STI screening in the future.

Results: Is It True allows young people to have access to education and information about their sexual health and an opportunity to access STI screening in a safe, non-judgmental environment. The program is aimed at providing young people with the skills and confidence to access sexual health services in the community.

Conclusion: Is It True has been successfully delivered to senior school students in Central Queensland, Sunshine Beach and in the Darling Downs region. The positive feedback from students has highlighted the importance and need for senior school students to be able to access this education and screening from experts in a non-judgmental and fun learning environment.

Disclosure of Interest statement: True Relationships and Reproductive Health acknowledges that the Is It True program was modelled on the success of SHLiRP (Sexual Health, Lifestyle & Relationship Program. SHLiRP is a collaboration between Sexual Health and Family Planning ACT and the Canberra Sexual Health Centre). We recognise the need for transparency of disclosure of potential conflicts of interest by acknowledging this relationship in publications and presentations. This project is funded by the Darling Downs Public Health Network.

183. Final results of ANRS 174 Doxyvac: a randomised trial to prevent STI in MSM on PrEP

Molina J. M.¹, Bercot B.^1,4, Assoumou L.², Agarte-Genin M.², Rubenstein E.¹, Pialoux G.³, Katlama C.³, Surgers L.³, Bebear C.⁴, Dupin N.⁴, Viard J. P.³, Pavie J.³, Duvivier C.³, Ghosn J.^1,3 and Costagliola D.²

¹University of Paris Cité, Department of Infectious Diseases, Hopital Saint-Louis and lariboisière, APHP, Paris, France.

²INSERM and Sorbonne University.

³Assistance-Publique Hôpitaux de Paris, France.

⁴National Reference center for STIs.

Background: STIs rates are increasing among MSM and new strategies are needed.

Methods: MSM on PrEP with a history of STI, were randomised in an open-label factorial design trial to receive doxycycline PEP (200 mg within 72 h of condomless sex) or no PEP (2:1); and 2 shots of the 4CMenB vaccine or no vaccine (1:1). Participants were tested at baseline, every 3 months and when symptomatic for N. gonorrhoeae (GC) and C. trachomatis (CT) by PCR in throat, anus and urine with serologic tests for syphilis. The co-primary endpoints were: the incidence of first episode of CT or syphilis with Doxy PEP and the incidence of a first episode of GC with the vaccine.

Results: Between 19 January 19 2021 and 19 September 19 2022, 556 MSM were randomised and 545 were analysed. Median follow-up: 14 months. There was no interaction between the two prevention strategies for the primary endpoints. The incidence of a first episode of CT or syphilis was 8.8 per and 53.2 per 100 PY in the Doxy PEP and no PEP arms, respectively (aHR: 0.17; 95% CI: 0.12–0.26). The incidence of a first episode of GC was 45.5 and 68.4 per 100 PY in the Doxy PEP and no PEP arms, respectively (aHR: 0.67; 95% CI: 0.52–0.87) with increasing rates of high-level tetracycline resistance in the Doxy PEP arm. The incidence of a first episode of GC was 58.3 and 77.1 per 100 PY in the vaccine and no vaccine arms, respectively (aHR: 0.78; 95% CI: 0.60–1.01) and the incidence of cumulative episodes was 57 and 64.4 per 1000 PY, respectively (aIRR: 0.89 (0.71–1.11). A single drug-related SAE was reported.

Conclusion: Doxy PEP significantly reduced the incidence of CT and syphilis and to a lesser extent of GC. 4CMenB vaccine did not show a significant impact on the incidence of GC.

Disclosure of Interest Statement: The Doxyvac study has been funded by ANRS/MIE. Roche diagnostic provided the PCR tests for CT and GC. JM Molina has received honoraria for advisory board with Gilead, Merck and ViiV outside this study.

184. Impact and cost-effectiveness of regular self-digital anal rectal examination on the incidence of syphilis in men who have sex with men: a mathematical modeling study

Lai H.^1,2, Fairley C.^3,4, Shen M.² and Zhang L.^1,2,4

¹Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

²China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, China.

³Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁴Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

Background: Syphilis regular self-digital anorectal examination (self-DARE) may reduce the incidence of syphilis among men who have sex with men (MSM) by detecting anorectal syphilis early. This study aimed to evaluate the epidemiological impact and cost-effectiveness of self-DARE among Australian MSM.

Methods: We proposed an integrated transmission-dynamic health-economic model of syphilis, calibrated it using data from the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) system and other published studies. We simulated the intervention for ten years in different scenarios, considering combinations of frequency, coverage, sensitivity, and specificity of self-DARE. We adopted the health-care system’s perspective with a 3% annual discount rate. We calculated the outcomes including the cumulative diagnoses, incremental cost-effectiveness ratio (ICER), etc.

Results: Implementing moderate self-DARE (50% coverage every 30 days with 50% sensitivity and specificity) could reduce the cumulative syphilis diagnoses in Australia over 10 years from 34,295 cases (95% CI: 30,649–39,201) in the base case to 3489 cases (95% CI: 2917–4061). Correspondingly, the ICER of the moderate self-DARE is A$26,269 (95% CI: 23,178–29,360), and the cost to avert one new infection is A$1330 (95% CI: 1124–1536). With self-DARE, the cumulative diagnoses could be reduced to between 1225 and 10,560 depending on the scenarios. In half the self-DARE scenarios, ICER is below A$50,000, and in one third of low-frequency scenarios, averting a new infection is cheaper than treating a late-stage case. Both the epidemic and economic outcomes are primarily influenced by the coverage and frequency of self-DARE, with specificity also playing a role.

Conclusions: Our analysis indicates that self-DARE could be an effective and cost-efficient strategy for reducing syphilis incidence among Australian MSM. Further empirical research is needed to validate its real-world effectiveness and assess the feasibility of achieving the required coverage and frequency at the population level.

Disclosure of interest statement: No conflict of interest.

185. Web-based harm reduction intervention for chemsex in men who have sex with men: a randomised controlled trial

Choi E. P. H.¹, Choi K. W. Y.^1,2, Chau P. H.¹ and Chow E. P. F.^3,4,5

¹School of Nursing, The University of Hong Kong, Hong Kong.

²Sticky Rice Love, Hong Kong.

³Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

⁴Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

⁵Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

Background: Men who have sex with men (MSM) engaged in chemsex are at heightened risk for risky sexual behaviours and increased rates of HIV and other sexually transmitted infections (STIs). This study marks the first randomised controlled trial assessing the impact of a web-based intervention on reducing chemsex-associated sexual risks among MSM.

Methods: The study was a 2-arm, assessor-blinded, randomised, parallel-group trial conducted in Hong Kong with a 3-month follow-up period. Eligible participants were cis-male MSM aged 18 or older who had internet access and were proficient in Chinese. Grounded in the theory of planned behaviour and a harm reduction framework, the intervention incorporated interactive elements and educational content on chemsex. Participants in the control group were provided with concise educational materials regarding sexual violence prevention. Study outcomes included intentions to engage in chemsex, actual chemsex activity, testing for HIV and other STIs, and instances of condomless anal sex within the last three months. We applied the intention-to-treat principle and used generalised linear mixed-effects models with logit links to analyse the outcomes.

Results: A total of 316 participants were recruited and equally randomised into either the intervention (n = 158) or control (n = 158) groups. The intervention group showed a statistically significant reduction in chemsex engagement (time-by-group interaction: OR = 0.23, P < 0.001), intentions to partake in chemsex (time-by-group interaction: OR = 0.37, P = 0.009), and occurrences of condomless anal intercourse (time-by-group interaction: OR = 0.01, P < 0.001) over the last 3 months. This group also experienced a statistically significant increase in HIV testing (time-by-group interaction: OR = 3.08, P < 0.001).

Conclusion: The findings indicate that a web-based intervention, grounded in harm reduction, can effectively decrease chemsex practices and condomless sex while enhancing HIV testing uptake among MSM. This suggests the potential for online interventions to play a critical role in mitigating the sexual health risks associated with chemsex.

Disclosure of interest statement: All authors declare no conflict of interest. The study was sponsored by the Council for the AIDS Trust Fund, reference number: MSS 338 R. This HIV/AIDS prevention part of project/programme is sponsored by the AIDS Trust Fund. The content of this article represents the opinion of our organiSation only. It does not represent the position of the AIDS Trust Fund. AIDS Trust Fund is not responsible for any claims, demands or liabilities whatsoever arising from or in connection with the use of any information contained in this article or the participation of the sponsored project/program. Chow EPF is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grants (GNT1172873) outside the submitted work.

186. Is my husband gay? Health promotion campaign targeting female partners of men who have sex with men

Kyla Lawson¹, Ses Salmond¹, Vanessa Hingston¹, Lara Goulding¹, Ben Mulcahy², Lorraine Jokovic³ and Brooke Dailey⁴

¹Leichhardt Women’s Community Health Centre, NSW, Australia.

²Pink Media Group.

³Loud Communications.

⁴Pozhet, Sydney Local Health District, NSW, Australia.

Background: Women Partners of Men who have Sex with Men (WPMSM) is a NSW only service which aims to reduce heterosexual HIV transmission. Whilst heterosexual transmission within NSW is lower than Men who have Sex with Men (MSM), female partners of MSM are at increased risk of transmission as they are often unaware of the high-risk sexual behaviours their partners are participating in¹ Within NSW, Q3 2023, of the 54 new HIV diagnoses, 10 were heterosexual transmission.¹ As female HIV diagnosis is less prevalent, diagnosis often occurs late.²

Aligning with the NSW HIV Strategy 2021–2025, WPMSM piloted a promotional campaign aimed at reducing heterosexual HIV transmission.³ The campaign aims were: 1) call to action for men to disclose their sexual activities to their female partners, 2) increase visibility of their at-risk female partners and 3) both cohorts were encouraged to complete comprehensive Sexual Health (SH) testing.

Method: LOUD Communications, Pink Media and WPMSM developed a 6-week dual targeted advertising campaign – digital banners ran on Grindr for male targeted ads and women’s lived experience was targeted in Mamamia, Star Observer, broad media targeting plus re-targeting.

Results: The industry standard Click Through Rate (CTR) is 0.05%, any higher percentage demonstrates strong engagement and positive ad placement. The Grindr ad “Isn’t it time she knew?” received 0.7% CTR, Mamamia received 0.32% CTR, The Star Observer 0.08% CTR, broad targeting 0.07% CTR. A retargeting of audience attracted 0.9% CTR.

Conclusion: The campaign successfully met its aims by prompted HIV testing through linking men to the “Ending HIV” landing page and women to the WPMSM website for holistic support including SH testing. The higher-than-average CTR indicates the effectiveness of male/female targeted health promotion within targeted online spaces. Next campaign is utilising META lead generation formats to encourage the priority population of WPMSM to reach out for support.

Disclosure of interest statement: Women Partners of Men who have Sex with Men is exclusively funded NSW Health. No industry grants or funding are received for this project.