The Sexual Health 2024 thematic days of the SFLS, SPILF and Public Health France were an opportunity to finally know new figures of prevalence Number of people affected by a given infection or other disease in a given population. bacterial sexually transmitted infections, thanks to the preliminary results of the PrévIST survey, based on part of the cohort of the Context of Sexuality in France (CFS) survey.
The CFS survey, carried out by Inserm with the support of the ANRS-MIE, aimed to study the sexual and preventive practices of the general population in France. A random sample of 20,000 people aged 15 to 89 was interviewed via two questionnaires, one by telephone and the other online, from November 2022 to December 2023. Some of the participants, people aged 18-59 who declared having already had sexual intercourse during their life, also were invited to participate in the PrévIST study: they were offered screening for sexually transmitted infections (STIs) and received a home self-screening kit for three STI Sexually transmitted infections. Bacterial —Infections Chlamydia trachomatis (Ct), Neisseria gonorrhoeae (Ng) and Mycoplasma genitalium (Mg)—to which is added the search for a possible human papillomavirus (HPV) infection for 18-29 year olds. These criteria made it possible to enroll 13,600 of the more than 21,000 CFS.
The samples – urine, vaginal sample or penile sample – had to be returned to the National Reference Center (CNR) for bacterial STIs in Bordeaux and to the CNR HPV in Besançon. These centers also took care of communicating the results to the participants, regardless of the result for Ct and Ng. For Mg, positive results were only reported if the person had reported symptoms. Indeed, for Mg, the national recommendations – SPILF, HAS, CNR, SFD – only recommend its screening in the event of a symptomatic form, essentially to avoid an increase in the pressure of selection of antibiotic treatments (macrolides in particular), Mg being already largely concerned by the issue of antibiotic resistance. As treatment is only recommended in the presence of symptoms, the authors did not want to unnecessarily worry those affected. For the same reasons, HPV results were not communicated.
The overall acceptance rate of the study is good, at 36%: 4872 people out of 13,686 returned their samples to the CNR.
Low numbers
These preliminary results, which concern France exclusively, show very (too?) low figures: the prevalence of Chlamydia infection was 0.58% in men and 0.93% in women (10 cases for men and 22 for women), with a higher concentration among those under 30.
About the Mycoplasma genitalium, the prevalence was 1.25% among men and 3.06% among women (30 cases among men and 41 among women), with a higher concentration among 30-39 year olds. These results are slightly below the prevalences observed in other countries and as already reported more precisely in Great Britain and by the European Center for Disease Prevention and Control (ECDC).
Public health France, SFLS 2024
As expected, prevalence varies depending on sexual orientation and number of sexual partners: thus, people identifying as homosexual or bisexual had higher prevalences and women who reported having two or more partners over the 12 recent months had a prevalence of 13.23% for Mg. We also found a higher prevalence of Ct in homo- or bisexual women compared to homo- or bisexual men (7.44 versus 4.10).
For gonorrhea, only one positive case was detected, making it impossible to estimate prevalence. This result, more than surprising, highlights both the difficulty of knowing the prevalence of Ng in the general population and the probable anchoring of existing cases in targeted populations. At this stage, according to Claire Sauvage (SPF), we do not have data on the history of treated gonorrhea which could have dissuaded the people concerned from being re-screened.
Long-awaited final results
What are the limits of these results? The first is that the study did not provide for an anal or throat sample, only the first stream of urine and a penile sample. The choice of penile samples may be surprising, as they are no longer carried out in centers treating STIs (CeGIDD or outside CeGIDD). SPF explains this decision by the request of the CNRs involved. The absence of prevalence of oropharyngeal carriage is notable, especially if we consider that the French population has become accustomed, with the Covid-19 Coronavirus disease, sometimes referred to as coronavirus disease, is an illness caused by a coronavirus (CoV). The term may refer to the following diseases: severe acute respiratory syndrome (SARS) caused by the SARS-CoV virus, Middle East respiratory syndrome (MERS) caused by the MERS-CoV virus, coronavirus disease 2019 ( Covid-19) caused by the SARS-CoV-2 virus. to carry out ENT self-samples repeatedly and that the good acceptability of these self-samples among patients is taken into account. MSM Man having sex with other men. in the “MémoDépistages” study, also from SPF. In any case, it is possible that this non-discovery of Ng cases is due, at least in part, to the fact that the sampling sites were unsuitable.
Finally, for the moment, we do not know the correlation of prevalence with sexual practices. However, it is easy to anticipate the fact that oral-genital intercourse will be increasing or at least at a high rate, as noted in all general population surveys for years.
Claire Sauvage reminded us that the data presented were the very first extracted and more in-depth analyzes are essential to refine these results, better understand the risk factors for STIs and evaluate the use of screening. The HPV data, not presented to the SFLS, should also be enlightening. To do this, we will have to wait until the end of 2024, and the official publication of the CFS 2023 results.
SISTR’S study: STI screening in women, one site or 3?
To screen for the main bacterial STIs, a single vaginal self-sampling is taken from women. In men who have sex with other men (MSM), however, it is recommended to take samples from the 3 sites (urine, anus, throat).
Should these same recommendations be extended to women? This is the question that the study will attempt to answer. SISTR’S, presented by Thierry Prazuck (CHU Orléans) during the 2024 Sexual Health Days. This multicenter French study aims to question screening strategies in women and evaluate the number of STIs that would have remained unrecognized by relying on a single vaginal sample. To date, the authors have included 1,347 people out of the 1,500 searched, and we have the first screening figures. As a result, taking 3 samples instead of just one made it possible to diagnose 38% of additional patients carrying an STI (in whom, therefore, the vaginal sample was negative). To be continued.
