Sti Risk Factors Young Adults Peer Review Us
-
Loading metrics
Risk factors associated with sexually transmitted infections and HIV among adolescents in a reference clinic in Madrid
- Oskar Ayerdi Aguirrebengoa,
- Mar Vera Garcia,
- Montserrat Rueda Sanchez,
- Giovanna D´Elia,
- Belén Chavero Méndez,
- María Alvargonzalez Arrancudiaga,
- Sandra Bello León,
- Teresa Puerta López,
- Petunia Clavo Escribano,
- Juan Ballesteros Martín
10
- Published: March 16, 2020
- https://doi.org/10.1371/journal.pone.0228998
Figures
Abstract
Introduction
Adolescents have a college incidence of sexually transmitted infections (STIs) than persons of older historic period groups. The WHO emphasises the demand to prefer specific and comprehensive prevention programmes aimed at this age group. The objective of this piece of work was to analyse the prevalence of HIV/STIs amid adolescents and to identify the sociodemographic, clinical and behavioural markers associated with these infections, in order to promote specific preventive strategies.
Methodology
Retrospective descriptive study of adolescents, anile 10–xix years, who were attended to for the starting time consultation between 2016 and 2018 in a reference STI clinic in Madrid. All adolescents were given a structured epidemiological questionnaire where data on sociodemographic, clinical and behavioural characteristics was collected. They were screened for human being inmmunodeficiency virus (HIV) and other sexually transmitted infections (STIs). The processing and analysis of the data was done using the STATA 15.0 statistical packet.
Results
The frequency of HIV/STIs detected amid all adolescents was: gonorrhoea 21.7%, chlamydia 17.1%, syphilis 4.viii% and HIV 2.iv%. After conducting a multivariate analysis, the independent and statistically significant variables related to the presence of an STI were having kickoff sexual relations at a immature historic period and having a history of STIs. Latin American origin was just below the level of statistical significance (p = 0.066).
Give-and-take/Conclusions
Adolescents who brainstorm sexual relations at an early on age or those who accept a history of HIV/STIs are at higher risk of acquiring STIs. Comprehensive prevention programmes aimed specifically at adolescents should be implemented, especially before the age of 13 years.
Citation: Ayerdi Aguirrebengoa O, Vera Garcia M, Rueda Sanchez M, D´Elia G, Chavero Méndez B, Alvargonzalez Arrancudiaga M, et al. (2020) Take a chance factors associated with sexually transmitted infections and HIV among adolescents in a reference dispensary in Madrid. PLoS ONE 15(3): e0228998. https://doi.org/10.1371/journal.pone.0228998
Editor: Remco PH Peters, University of Pretoria, SOUTH AFRICA
Received: December 2, 2019; Accepted: January 27, 2020; Published: March 16, 2020
Copyright: © 2020 Aguirrebengoa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are inside the manuscript and its Supporting Information files.
Funding: There was no funding for this study.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Adolescence is considered to be the transitional age betwixt childhood and adulthood, from ten to 19 years [1]. Adolescents are at higher risk of acquiring sexually transmitted infections (STIs) compared to adults and they should be considered a special population in terms of STIs [2]. Many are having sexual relations at increasingly young ages and using alcohol and drugs during sexual activity [3]. They may as well face barriers of access to the healthcare system due to lack of awareness and knowledge, incompatibility of their schedule or concerns for their anonymity and confidentiality [4]. This carries an elevated risk of contracting an STI, including the human being immunodeficiency virus (HIV). In addition, at that place are no guidelines relating to the frequency of STI screenings in adolescents.
Worldwide, it is estimated that 357.4 million cases of the four almost common curable STIs occur annually: chlamydia (130.9 million cases), gonorrhoea (78.iii million), syphilis (v.6 million) and trichomoniasis (142.6 meg) [5,6]. The annual epidemiological written report by the European Center for Disease Control (ECDC) reports that, in the twelvemonth 2016, 403,807 cases of chlamydia infection were reported in Europe, primarily amongst women aged 15–25 years, 2,043 cases of lymphogranuloma venereum (LGV), peculiarly in men who take sex with men (MSM) older than 25 years, 75,349 episodes of gonorrhoea, which mainly affected MSM aged xx–34 years and women aged 15–nineteen years, and 29,365 cases of syphilis mostly in MSM older than 25 years[7]. In Spain, the reported STI incidence during 2017 for chlamydia was 24,55 cases per 100.000 people/year, gonorrhoea 18,74 cases per 100.000 people/twelvemonth and syphilis ten,61 cases per 100.000 people/year, comparable to those described in Europe [8].
In 2017, in that location were 1.viii million adolescents living with HIV worldwide, which represents 5% of the total prevalence. Of those adolescents, 85% resided in sub-Saharan Africa [9]. In the same year, 250,000 new infections were diagnosed among persons aged xv–19 years, 16% of the total of new cases, the bulk existence in women of sub-Saharan Africa. In developed countries, new cases amidst adolescents are mostly diagnosed in men [10]. There were 25,353 new cases in the European union, the majority in men, 38.2% were in MSM and 11.1% were between fifteen–24 years erstwhile [11]. In Spain, 3,381 new diagnoses of HIV were reported in 2017, 84.6% in men and the majority aged 25–34 years [12].
The World Health Arrangement (WHO) highlights the need to adopt a comprehensive package of essential preventive interventions confronting HIV and other STIs [13]. Therefore, it is necessary to know updated epidemiological data in order to develop specific preventive strategies regarding sexual health[14].
The aim of this study was to analyse the prevalence of STIs/HIV among adolescents and to identify the sociodemographic, clinical and behavioural markers associated with these pathologies, in social club to establish specific preventive measures.
Methodology
Study design and analysed population
Retrospective descriptive study in adolescents, aged 10–19 years, who were attended to for the kickoff time between 1st of Jan of 2016 and 31thursday of December 2018 in a free and easily attainable STI clinic located in Madrid. During this period, a full of 12,474 persons, with issues related to HIV / STIs, were seen to for the offset consultation, aged i–84 years, of which 3% (374) were adolescents.
Variables
The data were obtained through a structured epidemiological questionnaire where information on sociodemographic, clinical and behavioural characteristics was collected: sex (men or women), historic period, sexual beliefs (heterosexual men, men who accept sexual activity with men, women), origin (Spain, Latino America, Europe, Africa, Asia, N America), number of sexual partners year (0–five, half-dozen–fifty, >fifty), number of sexual partners lifetime (1–10, 11–25, 26–100, >100), age of start sexual relations (≤13, 14–xvi, 17–19), type of sexual practices (oral sexual practice, vaginal sexual practice, insertive anal intercourse, receptive anal intercourse), frequency in the systematic use of condom (0%, <l%, ≥50%, 100%) or other preventive measures (post-exposure prophylaxis, pre-exposure prophylaxis), history of STIs, diagnoses of STIs at the fourth dimension of first consultation (gonorrhea, chlamydia, syphilis, HIV), toxic habits (use of each drug, unprotected sexual practice that occurred nether each effect: alcohol, tabacco, cannabis, cocaine, poppers, MDMA/ecstasy, ketamine, metanfetamine/crystal/tina, GHB, mephedrone), use of mobile applications in the search for sexual contacts and others (sexual practice workers, victims of sexual abuse).
The post-obit diagnostic tests were carried out based on the risk of acquiring HIV/STIs. HIV serologies (CMIA and Western Blot confirmation), syphilis (night field microscopy, RPR, Environmental impact assessment and TPPA) and hepatotropic viruses: hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) through chemiluminescent microparticle immunoassay (CMIA), Architect (Abbott). By HBV infection is characterized past the presence of HBcAc and HBsAc with absenteeism of HBsAg. Astute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM). During the initial phase of infection, patients are besides seropositive for hepatitis B due east antigen (HBeAg). Chronic infection is characterized by the persistence of HBsAg for at to the lowest degree 6 months (with or without concurrent HBeAg). Genital and actress-genital exudates were taken for the detection of: Neisseria gonorrhoeae (NG) by Gram staining, culture in Thayer Martin medium, NH API and PCR, and Chlamydia trachomatis (CT), PCR, and genotyped for lymphogranuloma venereum (LGV).
Statistical analysis
The qualitative variables are shown with their frequency distribution. The quantitative variables are summarised with the average and standard deviation or with the median and interquartile range (IQR) if they do not fit within a normal distribution. The association betwixt qualitative variables and the presence of an STI was carried out using the chi-squared examination or Fisher'due south exact test, if necessary. A logistic regression model was adjusted with the objective of identifying the factors that are independently associated with the presence of an STI. The factors that were introduced in the logistic regression model were those that presented a p <0.10 in the bivariate clarify and/or clinically relevant. A significance level of 5% was accepted for all variables. The processing and assay of the data was done using the STATA 15.0 statistical package.
Ethic statement
The data were obtained through a structured epidemiological questionnaire systematically filled during the usual clinical practice. For the study, all data of the medical history were obtain fully anonymized before accessed them and the ethics committee waived the requirement for informed consent. The protocol was approved by the CEIC Infirmary Clínico San Carlos, approving Number: xix/469 (S2).
Results
Between Jan of 2016 and Dec of 2018, a total of 374 adolescents came to a reference STI clinic in Madrid for the first consultation. In 2016, 119 (31.8%) were attended to; in 2017, 111 (29.7%) and in 2018, 144 (38.5%).
Of the total number, 62.6% (234) were men. According to sexual behavior, 39.8% (149) were MSM, 22.7% (85) heterosexual men (HTX) and 37.4% (140) women (Due west) who had sex with men. Of these women, 5% (7) also had sex with women. The average age, of the three categories of manual, was 17.9 years (± 1.ane) with a minimum age of 13 years (Table 1).
Fig ane. Blazon of sexual practices and use of condom according to sexual behavior (North = 374).
Abbreviations: OS: oral sex; VS: vaginal sexual practice; IAI: insertive anal intercourse and RAI: receptive anal intercourse.
https://doi.org/10.1371/journal.pone.0228998.g001
Amongst the adolescents analysed, 42.8% (IQ95%:37.vii–48.0) were diagnosed with an STI at the time of the first consultation, a full of 160. In that location were 110 adolescents with i STI, 41 with two and nine with three concomitant infections. Table 1 illustrates the frequencies of STIs according to sexual behavior. In adolescents diagnosed with STIs, l.6% (81) had a gonorrhoea infection. There were 52 cases in MSM, of which 40.4% (21) were rectal, 38.5% (xxx) pharyngeal and 21.ane% (xi) urethral. In HTX, 100% were urethral. Among women, in that location were 21 cases, of which 66.7% (xiv) were cervical, 23.8% (5) pharyngeal and 9.5% (2) rectal. Of the 160, 40.0% (64) had chlamydia. Among MSM, at that place were eighteen cases, 61.i% (eleven) were rectal, 27.8% (5) pharyngeal and 11.1% (2) urethral. All chlamydia in the HTX were urethral. In women, there were 28 cases, 85.7% (24) in the cervix and 14.three% (4) in the pharynx. There were no cases of LGV. In add-on, 11.3% (18) presented syphilis: 21.1% (15) amongst MSM with STIs, 2.6% (1) of HTX and 4% (2) of women. Of those diagnosed with syphilis, 27.8% were detected in the primary phase, 38.nine% secondary, 27.8% early latent and 5.6% late latent.
Regarding other STIs, eleven.3% (18) had condyloma acuminatum, 7.5% (12) Ureaplasma urealyticum urethritis and 7.5% (12) anogenital canker: 75% (9) genital and 25% (iii) perianal. At that place were two cases of vaginal trichomoniasis (one.iii%).
The prevalence of HIV among adolescents was two.4% [ix/372(IQR95%:1.1–4.15)], all MSM aged 18–19 years, with the exception of i who was xv. The prevalence of HIV among MSM was 7.four% (nine/149). Two MSM who came to the first consultation with a previous diagnosis of HIV were not included, both in antiretroviral therapy (ART). The temporal development of the prevalence of HIV, amid MSM, was: viii% (4/l) in 2016, viii.seven% (four/46) in 2017 and 1.9% (1/53) in 2018. In 77.viii%, information on the CD4 lymphocyte count was available upon diagnosis. The median CD4 count was 659 cells/ml (IQR: 626.v–669). In that location were no tardily diagnoses (<350 cells/ml CD4). Three of the ix diagnosed had no previous serologies. Of all MSM, two received postexposure prophylaxis (PEP) and ane pre-exposure prophylaxis (PrEP) throughout their lives.
Regarding hepatitis B, 1.iii% (4) had serological markers of a by hepatitis infection, 0.3% (i) acute and 0.3% (1) chronic; 16.7% (44) past hepatitis A and i hepatitis C cured. According to vaccination, 90.4% (281) vaccinated for HBV and 3.0% (viii) for HAV.
Of all adolescents with STIs, 28.i% (45) were asymptomatic. Of genital gonorrhoea and chlamydia infections, 23.ane% were asymptomatic equally well every bit 55.7% of the extra-genital cases.
Tabular array ii analyses the frequency of drug utilize and unprotected sexual practices (USPs) that occurred under its effect. The 41.7% of MSM utilize psychotropic drugs, the 46.seven% of HTX and 21.4% of women. Alcohol was the most frequent substance under which most USPs occurred. Yet, other substances such as methamphetamine, mephedrone or poppers, were associated with less safety utilise.
Table 3 shows the factors studied with the presence of STIs during the first consultation in the dispensary amongst all adolescents. A multivariate analysis was conducted with the variables that presented a p<0.10 in the bivariate analysis (sexual behavior, origin, historic period of first sexual, number of sexual partners in the previous twelvemonth, history of STIs and USPs nether the effect of drugs). The variable, use of apps to find sexual relations, had not been included taking into account given the high number of unknown data. The independent and statistically significant variables related to the presence of an STI were: having offset sexual relations at a young historic period and a history of STIs. Latin American origin was just below the level of statistical significance (p = 0.066).
Discussion
In this study a high frequency of STIs has been observed in all sexual categories of transmission, mainly gonorrhoea and chlamydia. In the US, more than one-half of STIs occur among persons aged 15–24, despite the fact that they merely represent 25% of the sexually active population [thirteen]. The Centers for Disease Control and Prevention (CDC) reports chlamydia as the nearly prevalent bacterial STI in the United states, its highest rate being in young women, also reflected in the female person adolescents in our report. In our report, gonorrhoea and syphilis were more than frequent amid MSM merely as in other studies [viii]. The incidence of LGV in adolescents is low in other European regions, however in this study there was no cases [ii].
The prevalence of HIV among the adolescents studied is lower than that found in some regions of the globe. In sub-Saharan Africa it is 16%, with two out of three of cases being in women [15]. However, the figures resemble those establish in developed countries and match with those of the most frequent sexual behavior [11]. All HIV-positive cases were MSM. The decline in new diagnoses between 2017 and 2018 is notable. These preliminary data suggest the decreasing trend in the incidence of HIV, as is the case in developed countries where combination HIV prevention programmes have been implemented [16]. In Spain, younger MSM could gain a greater preventive benefit past implementing new boosted strategies such every bit pre-exposure prophylaxis (PrEP) [17].
In this study the use of condom is low in all sexual practices, particularly in oral sex. Some individuals, particularly youth, may engage in oral sex instead of vaginal sex activity considering they believe information technology to be less risky for STIs manual. The run a risk for oral sex is lower compared with vaginal or anal sex, even so unprotected oral sexual practice is also associated with the acquisition and transmission of STDs infection [18].
Despite adolescents being a target population, in that location are no specific recommendations regarding the frequency of STI/HIV screening [nineteen]. The high frequency of asymptomatic STIs makes screening for STIs solely based on clinical symptoms relatively ineffective [20]. Besides as this, adolescents may be reluctant to study their sexual practices or may not consider their symptoms important through lack of awareness [21,22]. For these reasons, an STI/HIV screening should be considered, not only on clinical suspicion, but likewise through the identification of sociodemographic and behavioural markers.
The use of alcohol and drugs with sex reduces the perception of risk and tends toward unprotected sexual practices [23]. Yet, in our study, the utilize of these substances and the number of sexual partners in the previous year have not shown independent or statistically pregnant association with the presence of STIs. All cases of HIV were detected among MSM. Notwithstanding, the sexual behavior has not been associated as a chance indicator for the presence of other STIs, as is the case among adults [sixteen]. Past contrast, Latin American origin was shut to statistical significance every bit an contained cistron associated with the presence of STIs, possibly relating to poor healthcare resources and bereft sexual practice education [24].
Approximately 11% of the world's adolescents commencement having sexual relations before the age of 15 [25]. In our study, 9%-22% had their first sexual relations before the historic period of 14, according to sexual beliefs. Get-go sexual relations at a young age, especially at 13 or younger, and the presence of a history of STIs are factors which have been independently associated with the presence of HIV/STIs, as has also been reported in other publications [26]. These indicators, found in our study, tin can help establish specific prevention programs in this age group. To optimise this preventive try, it should be aimed at persons in the early on phase of adolescence, between x to xiii years, which is considered a critical period for primary intervention, as from this age onwards the preventive messages offered accept shown less impact [27,28].
In our study, the use of mobile applications in the search for sexual contacts has non been a cistron associated with the presence of STIs [29]. However, the use of social networks for the screening and command of STIs has proven to be a cost-effective measure among adults in regions with a loftier prevalence of STIs. In addition to schoolhouse or family unit education, technological advances may exist ideal additional resources that incorporate preventive measures such every bit contact tracing or mail service-treatment control with a truly beneficial affect. [thirty,31]
The limitations of this piece of work are that information technology is a descriptive and retrospective study carried out in a unmarried STI/HIV heart in Spain and that, despite the heterogeneity of the adolescents analysed, it may not exist possible to extrapolate its results to the general population. On the other manus, there are very few cohorts of adolescents in which studies of this type have been conducted.
Adolescents who take a history of STIs or who begin sexual relations at an early historic period are at college risk of acquiring STI/HIV. Comprehensive prevention programmes aimed specifically at adolescents should be implemented, especially before the age of xiii years.
Supporting data
References
- ane. World Health Organization (WHO). Salud de la madre, el recién nacido, del niño y del adolescente. Desarrollo en la adolescencia. http://world wide web.who.int/maternal_child_adolescent/topics/adolescence/dev/es/
- 2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Atlanta: U.S. Department of Health and Homo Services; 2018. https://www.cdc.gov/std/stats
- 3. Wangu Zoon, Burstein Gale R. Adolescent Sexuality. Pediatric Clinics of North America, 2017-04-01, Volume 64, Effect 2, Pages 389–411 pmid:28292454
- View Article
- PubMed/NCBI
- Google Scholar
- 4. O'Connor CA, Shubkin CD. Adolescent STIs for primary intendance providers. Curr Opin Pediatr 2012;24:647–55. pmid:22954956
- View Commodity
- PubMed/NCBI
- Google Scholar
- 5. Rowley J, Vander Hoorn South, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019 Aug i;97(eight):548–562P. pmid:31384073
- View Article
- PubMed/NCBI
- Google Scholar
- 6. Report on global sexually transmitted infection surveillance, 2018. Geneva: Earth Wellness System; 2018. Bachelor from: https://www.who.int/reproductivehealth/publications/stis-surveillance-2018/en/
- vii. European Centre for Disease Prevention and Control (ECDC). An agency of the European Union. Sexually transmitted infections—presentation on Annual Epidemiological Reports for 2016. 23 Aug 2018.
- 8. Unidad de vigilancia del VIH y conductas de riesgo. Vigilancia epidemiológica de las infecciones de transmisión sexual, 2017. Madrid: Centro Nacional de Epidemiología, Instituto de Salud Carlos 3/Plan Nacional sobre el Sida, Dirección General de Salud Pública, Calidad e Innovación; 2019.
- ix. World Health Organization (WHO). HIV/AIDS 19 July 2018. Bachelor from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids
- ten. UNICEF Data: Monitoring the situation of children and women. Adolescent HIV prevention July 2018.
- 11. European Heart for Disease Prevention and Command (ECDC) An agency of the European Union. HIV/AIDS surveillance in Europe 2018–2017 data. 28 November 2018.
- 12. Área de Vigilancia de VIH y Comportamientos de Riesgo. Vigilancia Epidemiológica del VIH y sida en España 2017: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida. Plan Nacional sobre el Sida—D.G. de Salud Pública, Calidad e Innovación / Centro Nacional de Epidemiología—ISCIII. Madrid; Nov 2018.
- thirteen. World Health Arrangement (WHO). ESTRATEGIA MUNDIAL DEL SECTOR DE LA SALUD CONTRA LAS INFECCIONES DE TRANSMISIÓN SEXUAL, 2016–2021. Junio del 2016.
- xiv. Gibson EJ, Bell DL, Powerful SA. Common sexually transmitted infections in adolescents. Prim Intendance 2014;41:631–50. pmid:25124210
- View Commodity
- PubMed/NCBI
- Google Scholar
- 15. Adolescente HIV prevention–UNICEF DATA July 2019
- 16. Sentís A, Martin-Sanchez M, Arando M, Vall Chiliad, Barbera MJ, Ocaña I, et al. Sexually transmitted infections in young people and factors associated with HIV coinfection: an observational report in a large city. BMJ Open 2019;9:e027245. pmid:31061051
- View Article
- PubMed/NCBI
- Google Scholar
- 17. Recomendaciones sobre Profilaxis Pre-Exposición en adultos para la Prevención de la Infección por VIH en España. AIDS Study Group (GeSIDA) of the Spanish Order of Infectious Diseases and Clinical Microbiology. Available from: http://www.cesida.org/wp-content/uploads/2013/09/gesida-guiasclinicas-2016-profilaxis_pre-exposicionVIH.pdf (Accessed 26 Dec 2018)
- 18. Habel MA, Leichliter JS, Dittus PJ, Spicknall IH, Aral And then. Heterosexual Anal and Oral Sex activity in Adolescents and Adults in the United states, 2011–2015. Sex activity Transm Dis. 2018 Dec;45(12):775–782. pmid:29965947
- View Article
- PubMed/NCBI
- Google Scholar
- xix. Davoren MP, Hayes K, Horgan Thousand, Shiely F. Sexually transmitted infection incidence amidst adolescents in Ireland. J Fam Plann Reprod Health Intendance 2014;40(4):276–82. pmid:24916479
- View Commodity
- PubMed/NCBI
- Google Scholar
- 20. Yavorsky RL Hollman D Steever J Soghomonian C Diaz A Strickler HY avorsky RL, Hollman D, Steever J, Soghomonian C, Diaz A, Strickler H,et al. Prevalence of sexually transmitted infections in at-risk adolescent females at a comprehensive, stand-lone adolescent health center in New York City. Clin Pediatr 2014;53(nine):890–five.
- View Article
- Google Scholar
- 21. Tilson EC, Sanchez V, Ford CL, Smurzynski K, Leone PA, Fox KK, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: Focus group discussions. BMC Public Wellness 2004;iv(1):21.
- View Article
- Google Scholar
- 22. Fernández-Rouco Noelia, Fernández-Fuertes Andrés A., Martínez-Álvarez José Luís, Carcedo Rodrigo J. & Orgaz Begoña. What practice Spanish adolescents know (or not know) nigh sexuality? An exploratory study. Periodical of Youth Studies. 22:nine, 1238–1254.
- View Commodity
- Google Scholar
- 23. Evers YJ, Van Liere GAFS, Hoebe CJPA, Dukers-Muijrers NHTM. Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cantankerous-sectional study in the netherlands. PLoS One. 2019; 14(v): e0216732. pmid:31086390
- View Article
- PubMed/NCBI
- Google Scholar
- 24. Jespers V, Nöstlinger C, van de Wijgert J. Boyish sexual health: time to invest in a salubrious future generation. Sex Transm Infect. 2016 Jun;92(four):248–9. pmid:26884550
- View Commodity
- PubMed/NCBI
- Google Scholar
- 25. Adolescents and young people and HIV. Stop AIDS November 2016.
- 26. Mulhall BP, Wright ST, De La Mata N, et al. Chance factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective accomplice report. HIV Med 2016; 17(8):623–30. pmid:27019207
- View Article
- PubMed/NCBI
- Google Scholar
- 27. Grupo de Expertos del Grupo de Estudio de Sida de la SEIMC (GESIDA), Secretaria del Plan Nacional Sobre el Sida (SPNS), Grupo de Estudio de ITS de la SEIMC (GEITS), Grupo Español para la Investigación de las Enfermedades de Transmisión Sexual de la Academia Española de Dermatología y Venerología y de la Sociedad Española de Infectología Pediátrica (SEIP). Documento de consenso sobre diagnóstico y tratamiento de las infecciones de transmisión sexual en adultos, niños y adolescentes. Marzo 2017.
- 28. Calatrava M., López-del Burgo C, Irala J. Sexual hazard factors among European young people. MedClin (Barc). 2012;138(12):534–40.
- View Commodity
- Google Scholar
- 29. Braunstein SL, Ingabire CM, Kestelyn E, et al. High human immunodeficiency virus incidence in a cohort of Rwandan female sex workers. Sex activity Transm Dis 2011;38(5):385–94. pmid:22256340
- View Article
- PubMed/NCBI
- Google Scholar
- thirty. Lim MS, Hocking JS, Aitken CK, et al. Affect of text and email messaging on the sexual health of young people: a randomised controlled trial. J Epidemiol Community Health 2012;66(one):69–74. pmid:21415232
- View Article
- PubMed/NCBI
- Google Scholar
- 31. Kampman C, Koedijk F, Driessen-Hulshof H, Hautvast J, van den Broek I. Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in kingdom of the netherlands; response to a text bulletin reminder and reinfection rates: a prospective study with historical controls. Sex Transm Infect. 2016 Mar;92(2):124–9. pmid:26404946
- View Article
- PubMed/NCBI
- Google Scholar
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228998
0 Response to "Sti Risk Factors Young Adults Peer Review Us"
Post a Comment