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Considerations for Research on Sexually Transmitted Infections (STIs): Reflections of an STI Clinician–Researcher

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Abstract

Sexually transmitted infections (STIs) have been explored in various sexual subgroups. While excellent, these analyses have primarily occurred from uniquely biologic, epidemiologic, or sociologic perspectives. Missing from these discussions has been in-depth presentations of the dynamics of STI transmission from all three viewpoints simultaneously. In this paper, I present information about STI transmission for each STI, including considerations of prevalence, and then review the STI research and of the concept of risk. I then apply these three considerations to a fictitious case study to show their importance and utility. I close by arguing that this information could strengthen future sociologic reviews of STIs and sexual health by helping such researchers include more nuanced understandings about STIs.

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Notes

  1. In the jurisdiction where I work, nurse practitioners can autonomously order all medications and testing related to STI diagnosis, treatment, and management, including referrals and consultations. Nurse practitioners are thus equal in scope of practice to family physicians and can work independently in their practice, without needing to collaborate with physicians.

References

  • Akobeng, A. K. (2007). Understanding diagnostic tests 1: Sensitivity, specificity, and predictive values. Acta Paediatrica,96, 338–341.

    Article  PubMed  Google Scholar 

  • Alexander, P. (1996). Bathhouses and brothels: Symbolic sites in discourse and practice. In Dangerous Bedfellows (Eds.), Policing public sex (pp. 221–250). Boston: South End Press.

  • Anderson, R. M., & May, R. M. (1991). Infectious diseases of humans: Dynamics and control. Oxford, England: Oxford University Press.

    Google Scholar 

  • Barker, M., & Langdridge, D. (2010). Introduction. In M. Barker & D. Langdridge (Eds.), Understanding non-monogamies (pp. 3–8). New York: Routledge.

    Chapter  Google Scholar 

  • Berube, A. (2003). The history of gay bathhouses. Journal of Homosexuality,44(3–4), 33–53.

    Article  PubMed  Google Scholar 

  • Beuhler, J. W. (2008). Surveillance. In K. J. Rothman, S. Greenland, & T. L. Lash (Eds.), Modern epidemiology (3rd ed., pp. 459–480). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  • Brandt, A. M. (1978). Racism and research: The case of the Tuskegee syphilis study. The Hastings Center Report,8(6), 21–29.

    Article  PubMed  Google Scholar 

  • Buechner, S. A. (2002). Common skin disorders of the penis. British Journal of Urology International,90, 498–506.

    Article  Google Scholar 

  • Calabrese, S. K., & Mayer, K. H. (2019). Providers should discuss U = U with all patients with HIV. The Lancet HIV,6(4), E211–E213. https://doi.org/10.1016/S2352-3018(19)30030-X.

    Article  PubMed  Google Scholar 

  • Celada, M. T., Merchant, R. C., Waxman, M. J., & Sherwin, A. M. (2011). An ethical evaluation of the 2006 Centers for Disease Control and Prevention recommendations for HIV testing in health care settings. American Journal of Bioethics,11(4), 31–40.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention [CDC]. (2018a). Sexually transmitted disease surveillance 2017. https://www.cdc.gov/std/stats17/natoverview.htm.

  • Centers for Disease Control and Prevention [CDC]. (2018b). Antibiotic-resistant gonorrhea. https://www.cdc.gov/std/gonorrhea/arg/default.htm.

  • Centers for Disease Control and Prevention [CDC]. (2018c). Sexually transmitted disease surveillance 2017Syphilis. https://www.cdc.gov/std/stats17/syphilis.htm.

  • Chan, P. A., Robinette, A., Montgomery, M., Almonte, A., Cu-Uvin, S., Lonks, J. R., et al. (2016). Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A review of the literature. Infectious Diseases in Obstetrics and Gynecology. https://doi.org/10.1155/2016/5758387

    Article  PubMed  PubMed Central  Google Scholar 

  • Choudhri, Y., Miller, J., Sandhu, J., Leon, A., & Aho, J. (2018). Infectious and congenital syphilis in Canada, 2010–2015. Canadian Communicable Disease Report,44(2), 43–48.

    Article  Google Scholar 

  • Chu, L. F., Utengen, A., Kadry, B., Kucharski, S. E., Campos, H., Crockett, J., … Clauson, K. A. (2016). “Nothing about us without us”—Patient partnership in medical conferences. British Medical Journal,354, i3883. https://doi.org/10.1136/bmj.i3883

    Article  PubMed  Google Scholar 

  • Conley, T. D., Perry, M., Gusakova, S., & Piemonte, J. L. (2019). Monogamous halo effects: The stigma of non-monogamy within collective sex environments [Commentary]. Archives of Sexual Behavior,48, 31–34.

    Article  PubMed  Google Scholar 

  • Deeks, S. G., Overbaugh, J., Phillips, A., & Buchbinder, S. (2015). HIV infection. Nature Reviews,1, 15035. https://doi.org/10.1038/nrdp.2015.35.

    PubMed  Google Scholar 

  • Dicker, R. C. (1992). Principles of epidemiology (2nd ed.). Atlanta, GA: U.S. Department of Health and Human Services. http://www.ciphi.ca/hamilton/Content/documents/principles.pdf.

  • Fleming, D. T., & Wasserheit, J. N. (1999). From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV. Sexually Transmitted Infections,75(1), 3–17.

    Article  PubMed  PubMed Central  Google Scholar 

  • Foucault, M. (1977). Discipline and punish: The birth of the prison. New York: Vintage Books.

  • Frank, K. (2019a). Rethinking risk, culture, and intervention in collective sex environments. Archives of Sexual Behavior,48, 3–30.

    Article  PubMed  Google Scholar 

  • Frank, K. (2019b). Response to commentaries. Archives of Sexual Behavior,48, 69–77.

    Article  PubMed  Google Scholar 

  • Frank, K., & DeLamater, J. (2010). Deconstructing monogamy: Boundaries, identities, and fluidities across relationships. In M. Barker & D. Langdridge (Eds.), Understanding non-monogamies (pp. 9–20). New York: Routledge.

    Google Scholar 

  • Friedman, D. S., & O’Byrne, P. (in press). Extragenital testing increases case detection of gonorrhea and chlamydia: The impact of implementing nucleic acid amplification testing. Canadian Communicable Disease Report.

  • Garnett, G. P. (2008). The transmission dynamics of sexually transmitted infections. In K. K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, & M. Cohen (Eds.), Sexually transmitted diseases (4th ed., pp. 27–39). New York: McGraw Hill.

    Google Scholar 

  • Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., et al. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine,363(27), 2587–2599.

    Article  PubMed  Google Scholar 

  • Grov, C., & Parsons, J. T. (2006). Bug chasing and gift giving: The potential for HIV transmission among barebackers on the Internet. AIDS Education and Prevention,18(6), 490–503.

    Article  PubMed  Google Scholar 

  • Hanssens, C. (2007). Legal and ethical implications of opt-out HIV testing. Clinical Infectious Diseases,45(Suppl. 4), S232–S239.

    Article  PubMed  Google Scholar 

  • Hollingsworth, T. D., Anderson, R. M., & Fraser, C. (2008). HIV-1 transmission, by stage of infection. Journal of Infectious Diseases,198(5), 687–693.

    Article  PubMed  Google Scholar 

  • Holmes, D., O’Byrne, P., Murray, S. J., Hammond, C., & Mercier, M. (2018). Transgressive assemblages: An ethnography of gay group sex. In D. Holmes, S. J. Murray, & T. Foth (Eds.), Radical sex between men: Assembling desiring-machines (pp. 153–176). New York: Routledge.

    Google Scholar 

  • Huffam, S., Chow, E. P. F., Leeyaphan, C., Fairley, C. K., Hocking, J. S., Phillips, S., et al. (2017). Chlamydia infection between men and women: A cross-sectional study of heterosexual partnerships. Open Forum of Infectious Diseases,4(3), ofx160. https://doi.org/10.1093/ofid/ofx160.

    Article  Google Scholar 

  • Knox, J., Yi, H., Reddy, V., Maimane, S., & Sandfort, T. (2010). The fallacy of intimacy: Sexual risk behavior and beliefs about trust and condom use among men who have sex with men in South Africa. Psychology, Health & Medicine,15(6), 660–671.

    Article  Google Scholar 

  • Lotringer, S. (2007). Overexposed: Perverting perspectives. Los Angeles: Semiotext(e).

    Google Scholar 

  • Luiken, G. P. M., Joore, I. K., Taselaar, A., Schuit, S. C. E., Geerlings, S. E., Govers A., et al. (2017). Non-targeted HIV screening in emergency departments in the Netherlands. Netherlands Journal of Medicine,75(9), 386–393.

    PubMed  Google Scholar 

  • Lupton, D. (1995). The imperative of health: Public health and the regulated body. London: Sage.

    Google Scholar 

  • Lupton, D. (1999). Risk. London: Routledge.

    Google Scholar 

  • Mays, V. M., Coles, C. N., & Cochran, S. D. (2012). Is there a legacy of the U.S. Public Health syphilis study at Tuskegee in HIV/AIDS-related beliefs among heterosexual African Americans and Latinos? Ethics & Behavior,22(6), 461–471.

    Article  Google Scholar 

  • McGough, L. J. (2008). Historical perspectives on sexually transmitted diseases: Challenges for prevention and control. In K. K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, & M. Cohen (Eds.), Sexually transmitted diseases (4th ed., pp. 3–11). New York: McGraw Hill.

    Google Scholar 

  • McGough, L. J., & Handsfield, H. H. (2007). History of behavioral interventions in STD control. In S. O. Aral & J. M. Douglas (Eds.), Behavioral interventions for prevention and control of sexually transmitted diseases (pp. 3–22). New York: Springer.

    Chapter  Google Scholar 

  • Mertz, G. J. (2008). Asymptomatic shedding of herpes simplex virus 1 and 2: Implications for prevention and transmission. Journal of Infectious Diseases,198(8), 1098–1100.

    Article  PubMed  Google Scholar 

  • Meunier, E., Escoffier, J., & Siegal, K. (2019). Rethinking risks and interventions beyond HIV: The importance of contextualizing collective sex [Commentary]. Archives of Sexual Behavior,48, 51–56.

    Article  PubMed  Google Scholar 

  • Moores, A., Phillips, J. C., O’Byrne, P., & MacPherson, P. A. (2015). Anal cancer screening knowledge, attitudes, and experiences among men who have sex with men in Ottawa, Ontario. Canadian Journal of Human Sexuality,24(3), 228–236.

    Article  Google Scholar 

  • Moors, A. C. (2019). Moving past the rose-tinted lens of monogamy: Onward with critical self-examination and (sexually) healthy science. Archives of Sexual Behavior,48, 57–61.

    Article  PubMed  Google Scholar 

  • Morris, M., Goodreau, S., & Moody, J. (2008). Sexual networks, concurrency, and STD/HIV. In K. K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, & M. Cohen (Eds.), Sexually transmitted diseases (4th ed., pp. 109–125). New York: McGraw Hill.

    Google Scholar 

  • O’Byrne, P. (2008). The dissection of risk: A conceptual analysis. Nursing Inquiry,15(1), 30–39.

    Article  PubMed  Google Scholar 

  • O’Byrne, P. (2012). Population health and social governance: Analyzing the mainstream incorporation of ethnography. Qualitative Health Research,22(6), 859–867.

    Article  PubMed  Google Scholar 

  • O’Byrne, P. (2019a). Population health and social governance: A review, an update, some clarifications, and a response. Qualitative Health Research,29(5), 731–738.

    Article  PubMed  Google Scholar 

  • O’Byrne, P. (2019b). HIV PEP and nursing scholarship: A review of critical theory and social justice. Witness: The Canadian Journal of Critical Nursing Discourse,1(1), 28–38.

    Google Scholar 

  • O’Byrne, P., & Gagnon, M. (2012). HIV criminalization and nursing practice. Aporia,4(2), 5–34.

    Google Scholar 

  • O’Byrne, P., & Haines, M. (in press). A qualitative exploratory study of consensual non-monogamy: Sexual scripts, stratifications, and charmed circles. Social Theory & Health. https://doi.org/10.1057/s41285-019-00120-1.

  • O’Byrne, P., & Holmes, D. (2008). Researching marginalized populations: Ethical concerns about ethnography. Canadian Journal of Nursing Research,40(3), 144–159.

    Google Scholar 

  • O’Byrne, P., & MacPherson, P. A. (2016). HIV treatment as prevention in men who have sex with men: Examining the evidence. Canadian Medical Association Journal,188(3), 198–203.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Byrne, P., & MacPherson, P. A. (2019). Syphilis. British Medical Journal,365, I4159. https://doi.org/10.1136/bmj.l4159.

    Article  Google Scholar 

  • O’Byrne, P., MacPherson, P. A., Ember, A., Grayson, M. O., & Bourgault, A. (2014). Overview of a gay men’s STI/HIV testing clinic in Ottawa: Clinical operations and outcomes. Canadian Journal of Public Health,105(5), e389–e394.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Byrne, P., & Watts, J. (2011). Exploring sexual networks: A pilot study of swingers’ sexual behaviour and health-care-seeking practices. Canadian Journal of Nursing Research,43(1), 80–97.

    Google Scholar 

  • O’Byrne, P., & Woodyatt, C. (2012). Sexual health nursing assessments: Examining the violence of intimate exposures. In T. Rudge & D. Holmes (Eds.), Re(thinking) violence in health care settings (pp. 189–199). Surrey, England: Ashgate.

    Google Scholar 

  • Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Pucell, D. W., Hoff, C. C., & Gomez, C. A. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS,19(suppl. 1), S13–S25.

    Article  PubMed  Google Scholar 

  • Perron, A., Fluet, C., & Holmes, D. (2005). Agents of care and agents of the state: Bio-power and nursing practice. Journal of Advanced Nursing,50(5), 536–544.

    Article  PubMed  Google Scholar 

  • Pharmaceuticals Research and Manufacturers of America. (PHRMA). (2014). Twenty-five years of progress against hepatitis C: Setbacks and stepping stones. http://phrma-docs.phrma.org/sites/default/files/pdf/Hep-C-Report-2014-Stepping-Stones.pdf.

  • Pisani, E. (2009). The wisdom of whores: Bureaucrats, brothels, and the business of AIDS. London: W.W. Norton & Co.

    Google Scholar 

  • Public Health Agency of Canada (PHAC). (2013). Management and treatment of specific syndromes. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sexually-transmitted-infections/canadian-guidelines-sexually-transmitted-infections-19.html#table-1.

  • Public Health Agency of Canada (PHAC). (2017). Canadian sexually transmitted infection cases. https://www.datawrapper.de/_/rU7ta/.

  • Public Health Agency of Canada (PHAC). (2019). Canadian guidelines on sexually transmitted infections. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sexually-transmitted-infections.html.

  • Rubin, G. (1984). Thinking sex: Notes for a radical theory of the politics of sexuality. In C. Vance (Ed.), Pleasure and danger (pp. 143–178). London: Routledge.

    Google Scholar 

  • Schachter, J., & Stephens, R. S. (2008). Biology of Chlamydia trachomatis. In K. K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, & M. Cohen (Eds.), Sexually transmitted diseases (4th ed., pp. 555–574). New York: McGraw Hill.

    Google Scholar 

  • Scott-Sheldon, L. A. J., & Chan, P. A. (2020). Increasing sexually transmitted infections in the U.S.: A call for action for research, clinical, and public health practice [Guest Editorial]. Archives of Sexual Behavior, 49, 13–17.

    Article  PubMed  Google Scholar 

  • Shah, C. P. (2003). Public health and preventive medicine in Canada (5th ed.). Toronto: Elsevier.

    Google Scholar 

  • Sparling, P. F. (2008). Biology of Neisseria gonorrhoeae. In K. K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, & M. Cohen (Eds.), Sexually transmitted diseases (4th ed., pp. 607–626). New York: McGraw Hill.

    Google Scholar 

  • Tan, D. H. S., Hull, M., Yoong, D., Tremblay, C., O’Byrne, P., Thomas, R., et al. (2017). Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. Canadian Medical Association Journal,189, 1448–1458.

    Article  Google Scholar 

  • Taylor, M. M., Rotblatt, H., Brooks, J. T., Montoya, J., Aynalem, G., Smith, L., et al. (2004). Epidemiologic investigation of a cluster of workplace HIV infections in the adult film industry: Los Angeles, California, 2004. Clinical Infectious Diseases,44(2), 301–305.

    Article  Google Scholar 

  • UNAIDS. (2017). Confronting discrimination: Overcoming HIV-related stigma and discrimination in health-care settings and beyond. https://www.unaids.org/sites/default/files/media_asset/confronting-discrimination_en.pdf.

  • Unemo, M., & Jensen, J. J. (2017). Antimicrobial-resistant sexually transmitted infections: Gonorrhoea and Mycoplasma genetalium. Nature Reviews,14, 139–152.

    PubMed  Google Scholar 

  • van Liere, G. A., Hoebe, C. J., Niekamp, A. M., Koedijk, F. D., & Dukers-Muijeres, N. H. (2013). Standard symptom- and sexual history-based testing misses anorectal Chlamydia trachomatis and Neisseria gonorrhoeae infections in swingers and men who have sex with men. Sexually Transmitted Diseases,40(4), 285–289.

    Article  PubMed  Google Scholar 

  • Ward, H., & Ronn, M. (2010). The contribution of STIs to the sexual transmission of HIV. Current Opinion in HIV/AIDS,5(4), 305–310.

    Article  Google Scholar 

  • Watts, J., & O’Byrne, P. (2019). ‘I don’t care if you think I’m gay … that won’t make me either promiscuous or HIV-positive’: HIV, stigma, and the paradox of the gay men’s sexual health clinic—An exploratory study. Applied Nursing Research,47, 1–3.

    Article  PubMed  Google Scholar 

  • Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwaddo, D., Li, X., Laeyendecker, O., et al. (2005). Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. Journal of Infectious Diseases,191(9), 1403–1409.

    Article  PubMed  Google Scholar 

  • Whitehead, J., Shaver, J., & Stephenson, R. (2016). Outness, stigma, and primary health care utilization among rural LGBT populations. PLoS ONE,11(1), e0146139. https://doi.org/10.1371/journal.pone.0146139

    Article  PubMed  PubMed Central  Google Scholar 

  • Wong, T., Singh, A., Mann, J., Hansen, L., & McMahon, S. (2004). Gender differences in bacterial STIs in Canada. BMC Women’s Health,4(Suppl 1), S26. https://doi.org/10.1186/1472-6874-4-S1-S26

    Article  PubMed  PubMed Central  Google Scholar 

  • World Health Organization (WHO). (2019a). Sexually transmitted infections (STIs)Fact sheet. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis).

  • World Health Organization (WHO). (2019b). Types of surveillance. https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/en/.

  • Zablotska, I. B., Grulich, A. E., De Wit, J., & Prestage, G. (2011). Casual sexual encounters among gay men: Familiarity, trust, and unprotected anal intercourse. AIDS and Behavior,15(3), 607–612.

    Article  PubMed  Google Scholar 

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Patrick O’Byrne holds a research chair in public health and HIV prevention from the Ontario HIV Treatment Network.

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O’Byrne, P. Considerations for Research on Sexually Transmitted Infections (STIs): Reflections of an STI Clinician–Researcher. Arch Sex Behav 49, 1863–1873 (2020). https://doi.org/10.1007/s10508-020-01726-7

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