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Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline GCO), an internet based testing service in British Columbia (BC).We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016-2017 was matched to two STI clinic cases by diagnosis, gender, age group, and specimen collection date. Data was collected through chart review with outcomes compared using appropriate statistical tests.Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254/257, 98.9%) and clinic (513/514, 99.8%) cases, as was engagement in partner notification (250/257 (97.2%) vs. 496/514 (96.5%)). There was no difference in the proportion of notified partners between GCO (159/270, 58.9%) and clinic cases (253/435, 58.2%) although a greater proportion of partners reported by clinic cases were notified by STI nurses (43/435, 9.9%) vs. GCO cases (6/270, 2.2%).GCO clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for partner notification among clinic clients may be related to having had an initial in-person testing visit.

Background Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. Methods We recruited GBM aged 16–30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12–13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. Results Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24–1.31) for cumulative incidence and 0.53 (95% CI, .25–1.14) for persistence. PRs were 0.23 (95% CI, .05–1.03) and 0.08 (95% CI, .01–.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03–.68) and 0.12 (95% CI, .03–.54) among participants who were sexually active for ≤5 years before vaccination. Conclusions Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.

Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic.In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p 0.01).Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a "bubble", and not having sex).Sexual health service clients in BC with 2+ partners during the initial phases of BC's pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic.RéSUMé: OBJECTIFS: Les premières directives de santé publique sur les rapports sexuels et l’infection par la COVID-19 portaient sur la réduction du nombre de partenaires. Nous avons caractérisé les personnes ayant eu de nombreux partenaires au cours des phases initiales de la pandémie. MéTHODE: En Colombie-Britannique, la première vague de cas de COVID-19 a déferlé du 14 mars au 19 mai 2020, puis a été suivie d’une levée progressive des restrictions sanitaires. Nous avons administré un sondage par courriel auprès d’usagers existants des services de santé sexuelle entre le 23 juillet et le 4 août 2020. Nous avons procédé par régression logistique bivariée pour examiner l’association entre le nombre déclaré de partenaires sexuels depuis le début de la pandémie et certaines variables clés (seuil de signification p 0,01). RéSULTATS: Sur les 1196 usagers de notre échantillon final, 42 % ont dit avoir eu 2 partenaires ou plus depuis le début de la pandémie, avec une probabilité plus élevée chez les participants qui étaient des hommes ayant des relations sexuelles avec des hommes et ceux qui étaient célibataires ou dans une relation ouverte avant la pandémie. Ce groupe était plus susceptible de percevoir une stigmatisation des relations sexuelles durant la pandémie, et il a présenté l’utilisation la plus élevée de stratégies pour réduire le risque de contracter la COVID-19 lors de rapports sexuels (principalement en réduisant partiellement ou à zéro le nombre de partenaires, p. ex. en se masturbant, en limitant ses partenaires aux membres de sa « bulle» ou en s’abstenant de tout rapport sexuel). CONCLUSION: Les usagers des services de santé sexuelle de la Colombie-Britannique ayant eu 2 partenaires ou plus durant les premières phases de la pandémie dans la province ont employé des stratégies pour réduire leur risque de contracter la COVID-19 durant les rapports sexuels. Notre étude confirme la validité d’une approche de réduction des méfaits dans les directives sur le risque de contracter la COVID-19 durant les rapports sexuels et souligne le besoin de pousser la recherche sur la stigmatisation des rapports sexuels durant la pandémie de COVID-19.

The aim of this study was to explore the acceptability of bacterial STI vaccines among young HPV-vaccinated Canadian women to inform future vaccine program implementation.A 20-item cross-sectional questionnaire was administered from June 2019 to June 2020 to HPV-vaccinated participants of the pan-Canadian QUEST cohort. Multivariable logistic regression models assessed interest in chlamydia, syphilis, and gonorrhea vaccines using a priori variables and factors significant in bivariate analysis.Of the 1092 respondents analyzed, 82% indicated interest in receiving one or more future STI vaccines. Respondents had a median age of 19.6 years (range 16.9-23.4), and 75% of respondents identified as white/European descent. In adjusted analyses, intent to engage in positive health behaviours was associated with vaccine interest for syphilis (OR = 5.76, 95% CI 4.03-8.27), chlamydia (OR = 5.27, 95% CI 3.66-7.63), and gonorrhea (OR = 5.96, 95% CI 4.15-8.60). Willingness to pay for an STI vaccine was also associated with vaccine interest for syphilis (OR = 2.02, 95% CI 1.29-3.19), chlamydia (OR = 2.41, 95% CI 1.50-3.90), and gonorrhea (OR = 2.29, 95% CI 1.44-3.63). Ever having sexual intercourse and identifying as LGBTQ were significantly associated with vaccine interest for all infections, while age and ever being immunosuppressed were not significant in any adjusted models.Findings indicate over 80% of participants in a cohort of young HPV-vaccinated Canadian women are interested in receiving future bacterial STI vaccines. Further exploration of STI vaccine acceptability among diverse populations is required to inform future bacterial STI vaccine program implementation.RéSUMé: OBJECTIF: Cette étude visait à explorer l’acceptabilité des vaccins contre les ITS bactériennes chez les jeunes Canadiennes vaccinées contre le VPH pour éclairer la mise en œuvre de futurs programmes de vaccination. MéTHODE: Un questionnaire transversal de 20 questions a été administré entre juin 2019 et juin 2020 aux participantes de la cohorte QUEST pancanadienne ayant été vaccinées contre le VPH. Des modèles de régression logistique multivariée ont permis d’analyser l’intérêt pour les vaccins contre la chlamydia, la syphilis et la gonorrhée à l’aide de variables a priori et des facteurs significatifs dans l’analyse bivariée. RéSULTATS: Sur les 1 092 répondantes analysées, 82 % ont manifesté l’intérêt de recevoir un ou plusieurs futurs vaccins contre les ITS. L’âge médian des répondantes était de 19,6 ans (intervalle 16,9–23,4), et 75 % s’identifiaient comme étant blanches/d’ascendance européenne. Dans les analyses ajustées, l’intention de s’adonner à des comportements de santé positifs était associée à l’intérêt pour les vaccins contre la syphilis (RC = 5,76, IC de 95 % 4,03–8,27), la chlamydia (RC = 5,27, IC de 95 % 3,66–7,63) et la gonorrhée (RC = 5,96, IC de 95 % 4,15–8,60). La volonté de payer pour un vaccin contre les ITS était aussi associée à l’intérêt pour les vaccins contre la syphilis (RC = 2,02, IC de 95 % 1,29–3,19), la chlamydia (RC = 2,41, IC de 95 % 1,50–3,90) et la gonorrhée (RC = 2,29, IC de 95 % 1,44–3,63). Le fait d’avoir déjà eu des rapports sexuels et le fait de s’identifier comme une personne LGBTQ présentaient une corrélation significative avec l’intérêt pour les vaccins contre toutes les infections, mais l’âge et le fait d’avoir déjà subi un traitement immunodépresseur n’étaient des facteurs significatifs dans aucun des modèles ajustés. CONCLUSION: Selon nos constatations, plus de 80 % des participantes d’une cohorte de jeunes Canadiennes vaccinées contre les VPH sont intéressées à recevoir de futurs vaccins contre les ITS bactériennes. Une exploration plus poussée de l’acceptabilité des vaccins contre les ITS dans des populations à forte mixité est nécessaire pour éclairer la mise en œuvre de futurs programmes de vaccination contre les ITS bactériennes.

Using observational data, human papillomavirus vaccination was associated with a lower anal prevalence of vaccine-preventable types among young, sexually active gay and bisexual men soon after implementation of publicly funded vaccination programs. Supplemental digital content is available in the text., Background Starting in 2015, human papillomavirus (HPV) vaccine has been publicly funded for gay, bisexual, and other men who have sex with men (GBM) 26 years or younger in Canada. Methods Self-identified GBM who reported having sex with another man within the past 6 months were enrolled using respondent-driven sampling (RDS) between February 2017 and August 2019 in Montreal, Toronto, and Vancouver, Canada. Men aged 16 to 30 years self-collected anal specimens for HPV-DNA testing. Prevalence was estimated using RDS-II weights. We compared the prevalence of quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types between GBM who self-reported HPV vaccination (≥1 dose) and those reporting no vaccination using a modified Poisson regression for binary outcomes. Results Among 645 GBM who provided a valid anal specimen (median age, 26 years; 5.9% HIV positive), 40.3% reported receiving ≥1 dose of HPV vaccine, of whom 61.8% received 3 doses. One-quarter were infected with ≥1 quadrivalent type (crude, 25.7%; RDS weighted, 24.4%). After adjustment for potential confounders, vaccinated GBM had a 27% lower anal prevalence of quadrivalent types compared with unvaccinated GBM (adjusted prevalence ratio [aPR], 0.73; 95% confidence interval [CI], 0.54–1.00). Lower prevalence ratios were found among vaccinated participants who were vaccinated >2 years before enrollment (aPR, 0.47; 95% CI, 0.25–0.86) or received their first vaccine dose at age ≤23 years (aPR, 0.64; 95% CI, 0.42–0.99). Point estimates were similar for ≥2 or 3 doses and 9-valent types. Conclusions Human papillomavirus vaccination was associated with a lower anal prevalence of vaccine-preventable HPV types among young, sexually active GBM. Findings will help inform shared decision making around HPV vaccination for GBM and their healthcare providers.

Sexually transmitted infections (STIs) are a global epidemic; although screening programs reduce transmission, barriers, including access and stigma, hinder success. The World Health Organization highlights the ability to maintain health without the direct support of a health care provider as one form of self-care, which can be applied to STI testing. Self-care through non-clinic-based self-collection for STI testing can address barriers while providing comprehensive care. Before implementation of innovative changes to screening approaches, it is important to understand if communities who rely on in-person care will self-collect outside of the clinic setting. This study investigated willingness to use non-clinic-based self-collection for STI testing among STI clinic attendees in British Columbia, Canada.Participants (n = 446) were recruited from STI clinics offering clinic-based self-collection for STI testing and completed a survey assessing self-care attitudes, including willingness to self-collect urine samples, throat swabs, and anogenital swabs outside of the clinic setting. Descriptive statistics, bivariable analyses, and multivariable models were conducted to investigate willingness to use non-clinic-based STI self-collection methods and associated correlates.This population reported high willingness to use non-clinic-based self-collection methods for STI testing (urine samples, 73%; throat swabs, 67%; anogenital swabs, 65%). Those aged 35 to 54 years compared with 15 to 34 years were more likely to be willing (adjusted odds ratio, 1.87; 95% confidence interval, 1.03-3.50); those identifying as straight/mostly straight compared with gay/lesbian were less likely to be willing (adjusted odds ratio, 0.39; 95% confidence interval, 0.23-0.65).Non-clinic-based self-collection for STI testing can address barriers to testing while maintaining quality care. Those currently receiving in-person care find these methods highly acceptable. These findings reinforce that self-collection for STI testing used in British Columbia clinics is acceptable to clients and may be extended to collection performed outside of the clinical setting.

We estimated the effectiveness of COVID-19 vaccines against laboratory-confirmed SARS-CoV-2 infection among people living with HIV (PLWH) and compared estimates with a matched HIV-negative cohort.We used the British Columbia COVID-19 Cohort, a population-based data platform which integrates COVID-19 data on SARS-CoV-2 tests, laboratory-confirmed cases, and immunizations with provincial health services data. Vaccine effectiveness (VE) was estimated with a test-negative design using multivariable logistic regression.Adjusted VE against SARS-CoV-2 infection was 79.2% (52.5, 90.9%) 7-59 days after two doses, rising to 91.6% (75.2, 97.2%) between 60-89 days. VE was preserved four to six months following receipt of 2 doses after which slight waning was observed (72.7% [39.1, 87.8%]). In the matched cohort (n=375 043), VE peaked at 91.0% (90.5, 91.5%) 7-59 days after 2 doses and was sustained for up to four months after which evidence of waning was observed, dropping to 83.8% (82.9, 84.7%) between four to six months.Receipt of two COVID-19 vaccines doses was effective against SARS-CoV-2 infection among PLWH pre-Omicron. VE estimates appeared to peak later in PLWH compared to the matched HIV-negative cohort and the degree of waning was relatively quicker in PLWH; however, overall estimates were comparable in both populations.

Introduction In 2015/2016, Canada’s largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. Methods Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. Results Across the three cities, 26–35% and 14–21% of men ≤ 26 years and 7–26% and 2–9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06–4.36; ≥27: PR = 2.73, 95%CI 1.14–6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64–5.05; ≥27: PR = 2.03, 95%CI 1.07–3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. Conclusions Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.

A clinical prediction rule can be used to predict asymptomatic chlamydia/gonorrhea infections among women and heterosexual men using an Internet-based testing service in British Columbia, Canada (GetCheckedOnline.com). Supplemental digital content is available in the text., Background Clinical prediction rules (CPRs) can be used in sexually transmitted infection (STI) testing environments to prioritize individuals at the highest risk of infection and optimize resource allocation. We previously derived a CPR to predict asymptomatic chlamydia and/or gonorrhea (CT/NG) infection among women and heterosexual men at in-person STI clinics based on 5 predictors. Population differences between clinic-based and Internet-based testers may limit the tool's application across settings. The primary objective of this study was to assess the validity, sensitivity, and overall performance of this CPR within an Internet-based testing environment (GetCheckedOnline.com). Methods We analyzed GetCheckedOnline online risk assessment and laboratory data from October 2015 to June 2019. We compared the STI clinic population used for CPR derivation (data previously published) and the GetCheckedOnline validation population using χ2 tests. Calibration and discrimination were assessed using the Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating curve, respectively. Sensitivity and the fraction of total screening tests offered were quantified for CPR-predicted risk scores. Results Asymptomatic CT/NG infection prevalence in the GetCheckedOnline population (n = 5478) was higher than in the STI clinic population (n = 10,437; 2.4% vs. 1.8%, P = 0.007). When applied to GetCheckedOnline, the CPR had reasonable calibration (Hosmer-Lemeshow, P = 0.90) and discrimination (area under the receiver operating characteristic, 0.64). By screening only individuals with total risk scores ≥4, we would detect 97% of infections and reduce screening by 14%. Conclusions The application of an existing CPR to detect asymptomatic CT/NG infection is valid within an Internet-based STI testing environment. Clinical prediction rules applied online can reduce unnecessary STI testing and optimize resource allocation within publicly funded health systems.

Background Our objective was to quantify the extent of anal cancer screening among men receiving HIV specialty care in Ontario, Canada, and evaluate factors associated with screening. Setting Cross-sectional questionnaire within a multisite clinical HIV cohort. Methods A questionnaire assessing knowledge and experience with human papillomavirus-associated diseases and their prevention was administered in 2016-2017 to 1677 men in the Ontario HIV Treatment Network Cohort Study. We used logistic regression to identify factors associated with having discussed screening with a health care provider and self-reported receipt of screening [digital anal rectal examinations (DARE); anal cytology or anoscopy]. Results reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results Forty percent of men reported ever having had anal cytology/anoscopy, and 70% had ever had DARE. After accounting for differences in age, sexual orientation, years since HIV diagnosis, previous diagnosis with AIDS, knowing someone with human papillomavirus-associated cancer, comfort discussing anal health, education, and income, the proportion screened differed by self-identified race. Compared with white men, Asian men were less likely to have discussed screening with a health care provider (aOR = 0.48; 95% CI: 0.29 to 0.80) or to have been screened by DARE (aOR = 0.27; 95% CI: 0.17 to 0.44) or anal cytology/anoscopy (aOR = 0.51; 95% CI: 0.31 to 0.83), and African, Caribbean, or black men (aOR = 0.47; 95% CI: 0.31 to 0.70) were less likely to have had DARE. Results were consistent when restricting the analyses to gay, bisexual, and other men who have sex with men. Conclusion Our findings highlight the potential for disparities in anal cancer screening that need to be considered when developing guidelines and screening programs to reduce the burden of anal cancer among men living with HIV and ensure health equity.

This study assessed gay, bisexual, and other men who have sex with men's (GBMSM) awareness of and intention to use GetCheckedOnline, an online sexually transmitted and blood-borne infection (STBBI) testing service.A cross-sectional study was conducted two years after launch among GBMSM 18 years of age in British Columbia, Canada. Participants were recruited through community venues, clinics, websites, and apps.Of 1272 participants, 32% were aware of GetCheckedOnline. Gay identity, regularly testing at an STBBI clinic, being out to one's healthcare provider, attending GBMSM community venues, and frequent social media use were associated with awareness. Among participants who were aware but had not used GetCheckedOnline, knowing GetCheckedOnline users, using social media, not knowing where else to test, and not wanting to see a doctor were associated with intention to use GetCheckedOnline.Early promotion of GetCheckedOnline resulted in greater awareness among those connected to GBMSM.RéSUMé: OBJECTIFS: Évaluer chez les hommes gais, bisexuels et les hommes ayant des relations sexuelles avec des hommes (gbHARSAH) la connaissance de GetCheckedOnline, un service de dépistage en ligne des infections transmissibles sexuellement et par le sang (ITSS), et l’intention d’utiliser ce service. MéTHODE: Deux ans après le lancement du service, une étude transversale a été menée auprès d’hommes gbHARSAH de plus de 18 ans en Colombie-Britannique, au Canada. Les participants ont été recrutés dans les milieux associatifs, les cliniques, sur des sites Web et au moyen d’applications. RéSULTATS: Sur 1 272 participants, 32 % connaissaient GetCheckedOnline. L’identité gaie, le dépistage périodique à une clinique d’ITSS, le fait d’avoir dévoilé son orientation sexuelle à son dispensateur de soins de santé, la fréquentation de milieux associatifs pour hommes gbHARSAH et l’utilisation fréquente des médias sociaux étaient associés à la connaissance du service. Chez les participants qui connaissaient GetCheckedOnline mais qui ne l’avaient pas utilisé, le fait de connaître des utilisateurs de GetCheckedOnline, l’utilisation des médias sociaux, le fait de ne pas savoir où se faire tester ailleurs et le fait de ne pas vouloir voir un médecin étaient associés à l’intention d’utiliser GetCheckedOnline. CONCLUSION: La promotion précoce de GetCheckedOnline a rehaussé la visibilité de ce service dans les milieux en lien avec les hommes gbHARSAH.

Objective To characterize the trends and explore the demographics, ophthalmic manifestations, and outcomes of ocular syphilis cases in British Columbia. Design Retrospective chart review. Participants Ocular syphilis cases reported to the British Columbia Centre for Disease Control (BCCDC) between January 2013 and December 2016. Methods The demographic and clinical data were extracted from the BCCDC's centralized sexually transmitted infection database and the ophthalmologists’ clinical charts. Results There was a steady increase in the rate of syphilis infection per 100 000 population, from 3.4 in 2010 to 18.4 in 2018. There were 39 ocular syphilis cases identified from January 2013 to December 2016. The median age was 50 years (interquartile range: 40–59.5 years); 82.1% were male and 51.3% were HIV positive. The clinical charts belonging to 32 patients were available for review, 14 of which (43.8%) presented with bilateral ocular complaints (46 affected eyes). The most commonly noted ocular presentations were uveitis (93.5%), including retinal vasculitis in 54.3%, and optic nerve involvement in 65.2% (which included papillitis, optic nerve swelling, or pallor). Panuveitis was the most frequent type of uveitis (52.2% of all eyes); 77.8% of affected eyes with best-corrected visual acuity (BCVA) ≤20/50 on presentation had an improvement of 2 or more Snellen lines of visual acuity at their final assessment. At presentation, 37.0% of eyes had BCVA ≤20/200, which decreased to 17.1% at final assessment. Conclusion Ocular syphilis, although rare, is on the rise globally and can result in serious ocular sequelae. A high index of suspicion is required for proper diagnosis and treatment.

There is considerable interest in syphilis preexposure (44.1%) and postexposure (60.1%) prophylaxis among gay, bisexual, and other men who have sex with men attending Toronto/Vancouver sexual health clinics., Background We assessed the acceptability of doxycycline-based syphilis pre-exposure and post-exposure prophylaxis (PrEP/PEP) as well as human immunodeficiency virus (HIV) PrEP/PEP in gay, bisexual, and other men who have sex with men (gbMSM). Methods We recruited gbMSM from Toronto and Vancouver sexually transmitted infection (STI) clinics during routine visits from June 2018 to August 2018. We analyzed data using descriptive statistics and constructed multivariable logistic regression models for willingness to use syphilis and HIV PrEP and PEP respectively. Results Among 424 participants (56.4% Toronto, 43.6% Vancouver), median (interquartile range [IQR]) age was 31.0 years (26.0–39.0 years), 61.7% had completed postsecondary education and 54.4% were white. Median (IQR) number of male partners in the past 6 months was 6.0 (3.0–13.0), and 18.2% had 1 or more prior syphilis diagnosis. 60.1%/44.1% indicated willingness to use syphilis PEP/PrEP; 36.6% were unwilling to use either. Among HIV-negative participants, 74.0% and 75.2% were willing to use HIV PrEP and PEP, respectively. Most participants were familiar with antibiotic resistance (89.0%) and agreed that syphilis rates are rising in Canada (68.2%), but only 55.4% believed they were at risk for syphilis. Agreement with the latter statement was associated with willingness to use syphilis PrEP (adjusted odds ratio [aOR], 1.6; 95% confidence interval [95%CI], 1.0–2.5), as was previous/existing HIV PrEP use (aOR, 2.2; 95% CI, 1.1–4.3) and being “very concerned” about STI acquisition (aOR, 1.9; 95% CI, 1.0–3.4). Odds of being willing to use syphilis PEP were higher in Toronto versus Vancouver (aOR, 2.0; 95% CI, 1.2–3.4) and increased with the number of different STIs previously diagnosed (aOR, 1.4; 95% CI, 1.2,1.7). Conclusions There is considerable interest in syphilis PrEP/PEP in gbMSM attending Toronto/Vancouver STI clinics.

Starting in 2015/16, most Canadian provinces introduced publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) aged ≤ 26 years. We estimated 12-month changes in HPV vaccine coverage among community-recruited GBM from 2017 to 2021 and identified baseline factors associated with vaccine initiation (≥1 dose) or series completion (3 doses) among participants who were unvaccinated or partially vaccinated at baseline.We recruited sexually-active GBM aged ≥ 16 years in Montreal, Toronto, and Vancouver, Canada, from 02/2017 to 08/2019 and followed them over a median of 12 months (interquartile range = 12-13 months). We calculated the proportion who initiated vaccination (≥1 dose) or completed the series (3 doses) by 12-month follow-up. Analyses were stratified by city and age-eligibility for the publicly-funded programs at baseline (≤26 years or 26 years). We used multivariable logistic regression to identify baseline factors associated with self-reported incident vaccine initiation or series completion.Among 165 unvaccinated participants aged ≤ 26 years at baseline, incident vaccine initiation (≥1 dose) during follow-up was 24.1% in Montreal, 33.3% in Toronto, and 38.9% in Vancouver. Among 1,059 unvaccinated participants aged 26 years, incident vaccine initiation was 3.4%, 8.9%, and 10.9%, respectively. Higher education and trying to access pre-exposure prophylaxis for HIV were associated with incident vaccination among those aged ≤ 26 years, while younger age, residing in Vancouver (vs. Montreal), being diagnosed with anogenital warts, having both government and private extended medical insurance, and being vaccinated against influenza were associated with incident vaccination among those aged 26 years.We observed substantial gains in HPV vaccine coverage among young GBM within 5 + years of targeted program implementation, but gaps remain, particularly among older men who are ineligible for publicly-funded programs. Findings suggest the need for expanded public funding or insurance coverage for HPV vaccines.

Objectives There is interest in doxycycline as prophylaxis against sexually transmitted infections (STIs), but concern about antimicrobial resistance (AMR). We conducted a systematic review (CRD42021273301) of the impact of oral tetracycline-class antibiotics on AMR in normal flora. Methods We searched MEDLINE, EMBASE, the Cochrane Library (1940–2021) and conference proceedings (2014–21) for randomized controlled trials in adults comparing daily oral tetracycline-class antibiotics to non-tetracycline controls. The primary outcome was AMR to tetracyclines; secondary outcomes included resistance to non-tetracyclines. Data were inappropriate for meta-analysis, so we analysed findings descriptively. Results Our search yielded 6265 abstracts of which 7 articles fulfilled inclusion criteria. Most were at moderate/high risk of bias, generally due to inadequate methodologic reporting. Studies used doxycycline, tetracycline, oxytetracycline or minocycline for 2–18 weeks. Most observed an increased burden of tetracycline resistance, including in subgingival (n = 3 studies), gastrointestinal (n = 2) and upper respiratory tract (n = 1) flora; one study of skin flora found no change in tetracycline-resistant Propionibacterium species after 18 weeks of oxytetracycline/minocycline. Four studies reassessed AMR at 2–50 weeks post-intervention and reported varying degrees of resistance. Three articles reported on the prevalence of non-tetracycline AMR after doxycycline prophylaxis, of which one found a transient increase among gastrointestinal Escherichia coli; the other two showed no difference from control. Conclusions Although the effects are modest and transient, limited data from small prospective studies may suggest that oral tetracyclines for 2–18 weeks increase resistance in subgingival, gastrointestinal and upper respiratory tract flora. STI prophylaxis trials should include AMR in commensal bacteria as study outcomes.

POINTS CLES On assiste actuellement a une epidemie mondiale d’infections bacteriennes transmissibles sexuellement (ITS), telles que syphilis, chlamydia et gonorrhee; l’Organisation mondiale de la sante estime a pres d’un million par jour le nombre d’ITS qu’il est possible de

Background Implementation of anal cancer screening requires the procedure to be acceptable to the target population. Our objective was to assess the beliefs of men living with HIV regarding anal cancer screening and identify factors associated with their willingness to participate in screening. Methods We developed a cross-sectional questionnaire using the Theory of Planned Behavior to examine beliefs regarding prevention of human papillomavirus (HPV)-related diseases, administered to men living with HIV in 2016–2017 in a multi-site HIV clinical cohort. Correspondence analysis was used to examine the interrelationships between men’s beliefs and willingness to undergo anal cancer screening. We used multivariable proportional odds models to identify factors associated with increasing willingness. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Among 1677 male participants, the vast majority (90%) would be willing to undergo screening by “anal Pap test”; willingness clustered with positive beliefs (e.g. confident they can get screened; disagree that they will feel pain) in the correspondence analysis. Higher self-perceived risk for anal cancer and positive beliefs regarding screening were associated with higher willingness to be screened. Gay, bisexual and other men who have sex with men had higher willingness (aOR = 1.62; 95% CI: 1.15, 2.29) than heterosexual men. Racialized men reported lower willingness (aOR = 0.68; 95% CI: 0.54, 0.89) than white men. Conclusions Men generally had positive beliefs and were willing to undergo screening, though there were differences by sexual orientation and racial identity. Tailored community-led initiatives could focus on men’s understanding of their risk and expectations of anal cancer screening to facilitate participation.

Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC.We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing.Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p = 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93).gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.RéSUMé: OBJECTIFS: Les taux de syphilis ont augmenté en Colombie-Britannique et affectent de manière disproportionnée les hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec des hommes (gbHARSAH). Une campagne de marketing social (Syphistory) a été mené de janvier à septembre 2017 avec pour objectif principal d’informer sur la syphilis et pour objectif secondaire d’augmenter le dépistage de la syphilis chez les gbHARSAH en Colombie-Britannique. MéTHODES: Nous avons réalisé deux sondages, l’un avant et l’autre après la campagne, sur un échantillon de convenance constitué de patients fréquentant des cliniques ITS, pour évaluer les changements dans les connaissances sur la syphilis à l’aide de tests t unilatéraux. Nous avons utilisé les mesures Piwik en ligne pour examiner la portée de la campagne et les données provinciales sur les tests pour examiner les tendances quant au dépistage de la syphilis. Nous avons utilisé les données de l’étude Engage à Vancouver, pour identifier les facteurs associés à la sensibilisation lors de la campagne et les associations avec le dépistage de la syphilis. RéSULTATS: Sur les 2 155 visiteurs du site Web Syphistory dont la position géographique était connue, 79,4 % provenaient de la Colombie-Britannique. De plus, les participants aux cliniques ITS ayant vu la campagne ont démontré une meilleure connaissance de la syphilis (9,7/12, 80,8 %) par rapport à ceux n’ayant pas vu la campagne (moyenne 8,9/12, 74 %) (p0,001). Les taux provinciaux de dépistage de la syphilis étaient de 8 764 et 9 749 au cours des 12 mois précédant et suivant la campagne; cependant, nous n’avons pas trouvé de tendance globale à la hausse des dépistages suite à la campagne (p=0,147). Parmi les participants Engage, 12,7 % ont déclaré avoir vu la campagne en ligne et nous avons trouvé une association entre l’exposition à la campagne et le dépistage récent de la syphilis (RCa=2,73; IC à 95 %=1,51, 4,93). CONCLUSION: Les gbHARSAH qui ont vu la campagne étaient plus susceptibles de déclarer avoir été testés pour la syphilis au cours des six derniers mois. Les participants aux cliniques ITS qui ont déclaré avoir vu la campagne avaient également une meilleure connaissance de la syphilis que ceux qui ne l’ont pas vue.

Background In response to the COVID-19 pandemic, sexual health services have started to implement alternative service delivery methods that reduce in-person contact (e.g., telemedicine, virtual health). We sought to understand acceptability of alternative service delivery methods among sexual health service clients in BC, Canada. Methods We used data from an online anonymous survey administered from 21/07/2020–04/08/2020 to clients (aged ≥16 years) who had used the BC Centre for Disease Control’s sexually-transmitted infection (STI) clinic and/or the GetCheckedOnline testing service in the year prior to COVID-19 public health responses (03/2020). We described participants’ likelihood of using potential alternative sexual health service delivery methods, and conducted bivariate analysis to examine its association with experiencing any sexual health service access barriers during the pandemic. Results Of the 1198 survey participants (aged 17–76 years), 48% identified as men, 47% as women, and 5% as another gender; 71% identified as White, 24% as racialized minorities, and 4% as Indigenous. Overall, support for using alternative STI testing models was high, with 88% likely to use at-home self-collection kits and 79% likely to use an express testing model (i.e., phone/video triage prior to specimen collection at a clinic). More participants were likely to discuss sexual health with a healthcare provider over the phone (64%), compared with video visits (53%) and text (49%). Text messaging to receive STI test results and reminders were of high interest (71% and 63% likely to use, respectively). Likelihood of using alternative service delivery methods did not differ by participants’ experience of access barriers, where 66% of total participants reported having avoided/delayed seeking services during 03/2020–07/2020. Conclusion Likelihood of using potential alternative sexual health service delivery methods was high overall, including among participants who did not avoid/delay seeking services. Sustaining and expanding such services would facilitate access during and beyond the COVID-19 pandemic.

BackgroundGetCheckedOnline is a publicly-funded internet-based testing service for sexually-transmitted and blood borne infections (STBBI) offered in British Columbia (BC), Canada since 2014. GetCheckedOnline has remained accessible since the beginning of the COVID-19 pandemic response, despite many in-person sexual healthcare services having been reduced or stopped. GetCheckedOnline users complete an online risk assessment to inform STBBI test recommendations, auto-generating a lab requisition which can be used at any participating laboratory location, with results available online or by phone. Our objective was to describe GetCheckedOnline program utilization and selected risk factors before and during the COVID-19 pandemic.ApproachWe used linked GetCheckedOnline program and laboratory testing data for this analysis. We compared the mean of selected monthly program measures during the COVID-19 pandemic (March 2020 – December 2020) to the same time period the previous year, defined as pre-pandemic (March 2019 – December 2019). Descriptive statistics are presented.OutcomesThe median number of monthly test episodes completed was higher during the pandemic (median=1088;n=9470 total episodes completed), compared to pre-pandemic (median=824, n=8237 total episodes completed), despite a sharp decline and rapid recovery in March-May 2020. During the pandemic, the mean proportion of test episodes completed by those using GetCheckedOnline for the first time was 57%;an increase from pre-pandemic (51%). We observed an increase in the percent positivity during the pandemic compared to pre-pandemic (6.44% vs. 5.72%), as well as in the mean proportion of those reporting symptoms (20.3% vs 19.4%) or being a contact to someone with an STBBI (11.0% vs 9.3%).Innovation and SignificanceThe increase in first time GetCheckedOnline testers, percent positivity, and those reporting symptoms or being a contact to an STBBI during the COVID-19 pandemic suggest the program has filled a gap in STBBI testing services, and remains a critical service for accessing sexual healthcare.

BackgroundThe COVID-19-pandemic impacts on sexual health services access have not been fully examined. We sought to describe characteristics associated with unmet sexual health needs and access barriers during the initial pandemic phases in BC, Canada.MethodsAn anonymous online survey about sexual health service needs and access was administered from July 21-August 4, 2020 to clients ≥ 16 years old who had visited the BC Centre for Disease Control’s sexually transmitted infections (STI) clinic and/or GetCheckedOnline testing service in the year prior to March 2020. Using logistic regression, we reported univariate odds ratios (OR) with 95% confidence intervals [95% CI] for characteristics associated with unmet sexual health needs (i.e., not accessing needed services) during March–July 2020.ResultsOf 1198 respondents, 59% (n=706;median age: 32 years, 71% White, 47% women, 27% men having sex with men only (MSM)) reported needing sexual health services since March 2020, of which 52% (365/706) did not access needed services. Women (OR=1.37 [1.01–1.86]) were more likely to have unmet sexual health needs, while MSM (OR=0.37 [0.23–0.61]) were less likely to. Participants needing routine STI testing were more likely to report not accessing services (OR=2.49 [1.64–3.79]), whereas those needing birth control (OR=0.48 [0.30–0.75]), HIV pre-exposure prophylaxis (OR=0.39 [0.22–0.66]), or treatment for a new STI (OR=0.40 [0.21–0.76]) were less likely to report not accessing services. Most common reasons for avoiding/delaying service access were: concern about getting COVID-19 while at or traveling to a clinic/lab (249/689, 36%), public messaging against seeking non-urgent healthcare (239/689, 35%), and closure of usual place of service (182/689, 26%).ConclusionBC sexual health service clients experienced numerous barriers in accessing needed sexual health services during the initial pandemic phases. Offering alternative service delivery methods and more nuanced public health messaging may help address the identified barriers to improve access.