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Public health · 2025
Chemsex, the use of psychoactive substances to enhance sexual experiences, is increasingly recognized as a public health concern, particularly among men who have sex with men (MSM). This behavior is associated with risky sexual practices, including condomless sex, multiple partners, and prolonged sexual sessions, which may elevate the risk of sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis. This systematic review and meta-analysis aim to quantify the association between chemsex and these bacterial STIs. Systematic review and meta-analysis. A systematic search of PubMed, Embase, and Web of Science was conducted to identify studies reporting associations between chemsex and chlamydia, gonorrhea, or syphilis until November 10, 2024. Eligible studies included observational designs with chemsex participants and STI outcomes. Random-effects meta-analyses were performed to estimate pooled odds ratios (ORs) with 95 % confidence intervals (CIs). Statistical analysis was performed by using R software version 4.4. A total of 13 studies were included across multiple countries. The meta-analysis revealed a significant association between chemsex and syphilis (pooled OR: 1.741, 95 % CI: 1.337-2.267), gonorrhea (pooled OR: 1.784, 95 % CI: 1.428-2.228), and chlamydia (pooled OR: 1.429, 95 % CI: 1.195-1.710). Two studies reporting hazard ratios for gonorrhea (pooled HR: 1.699, 95 % CI: 1.361-2.121) and chlamydia (pooled HR: 1.202, 95 % CI: 0.972-1.487) showed consistent findings. Heterogeneity across studies was minimal for most outcomes (I2 = 0 %), and prediction intervals supported stable effect sizes. This study confirms that chemsex is significantly associated with an increased risk of bacterial STIs, particularly syphilis and gonorrhea. The findings highlight the urgent need for interventions addressing chemsex behaviors, including harm reduction strategies, STI prevention programs, and culturally competent healthcare services. Future research should focus on standardizing definitions of chemsex, expanding investigations to low- and middle-income countries, and addressing publication bias to ensure global relevance and reliability of evidence.
PloS one · 2025
Successful implementation of oral pre-exposure prophylaxis (PrEP) requires retention in PrEP care among those with an increased likelihood of HIV. This study aimed to estimate the proportion of retention on PrEP and extent to which variability in PrEP retention is associated with population-, program-, and study-specific characteristics among men who have sex with men (MSM) and transgender persons (TGP). We performed a systematic review and meta-analysis examining PrEP studies and conference abstracts retrieved from the PubMed and Ovid online databases, capturing demonstration projects or observational studies published from January 1, 2010 to March 24, 2021. We included 84 studies (totaling 90 study "cohorts" analyzed) that reported on the retention of oral PrEP for HIV and included predominantly MSM and TGP. The proportion of retained participants was obtained from each study and used to estimate the cumulative probability of being retained on PrEP and the loss of PrEP retention rate over time via a random-effects meta-analysis survival model. We examined sources of heterogeneity by including study-level covariates in this model. The pooled cumulative probability of PrEP retention was 77.0%, 64.7%, 48.5%, and 24.1% at 6, 12, 24, and 60 months, respectively. Loss of PrEP retention rates were significantly (p < 0.05) lower in studies from Europe, Australia and multiple regions (vs. North America), and with ≥3-monthly follow-up (vs. < 3). Rates were significantly higher in studies from Africa (vs. North America), with lower median age, higher proportions of non-MSM/TGP participants, higher proportions of participants with unspecified (vs. mixed) ethnicity, with unspecified (vs. daily) PrEP regimen, free-of-charge (vs. unspecified) STI testing, whose data were from conference abstracts (vs. peer-reviewed papers), and that were more recent. In conclusion, oral PrEP retention decreased over time and differed across population-, program-, and study-specific characteristics. The heterogeneity across studies highlights PrEP implementation challenges and the need for tailored retention strategies.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Critical gaps exist in our understanding of the progression from anal human papillomavirus (HPV) infection to same-type HPV-associated anal disease in human immunodeficiency virus (HIV)-negative men who have sex with men (MSM). We conducted a post hoc analysis of a phase 3 randomized 4-valent HPV vaccine trial (NCT00090285) to assess the natural progression of anal HPV infections to associated anal lesions among MSM. A total of 602 HIV-negative MSM aged 16-27 years. HIV-negative MSM aged 16-27 years enrolled in the placebo arm from 18 countries were included. We estimated the distribution of 9-valent HPV (9vHPV) vaccine types in intra-anal lesions (anal condyloma and anal intraepithelial neoplasia [AIN] 1-3), proportions and rates of progression from incident-persistent (no associated anal disease at baseline) intra-anal HPV infections to the same-type HPV-associated anal lesion, and cumulative incidence over 30 months. Predominant 9vHPV types detected were HPV6 (55.7%) and HPV11 (25.3%) in MSM with anal condyloma/AIN1, and HPV6 (30.5%), HPV16 (22.0%), and HPV11 (15.3%) in those with pooled AIN2/3. Progression from incident-persistent intra-anal 9vHPV infection to anal disease was driven primarily by HPV6, HPV11, and HPV16/18 infections for MSM with anal condyloma/AIN1 (63.0%, 85.7%, and 16.3%, respectively) and AIN2/3 (25.9%, 14.3%, and 32.4%, respectively). Cumulative incidence of anal condyloma/AIN1 and AIN2/3 in MSM with incident-persistent infection was 43.1% and 34.4%, respectively. A high proportion of unvaccinated HIV-negative MSM with a new intra-anal 9vHPV infection developed same-type HPV-associated anal disease. These findings support HPV vaccination of young HIV-negative MSM to prevent anal HPV infection and associated anal disease. ClinicalTrials.gov, NCT00090285.
JAMA network open · 2025
HIV self-testing (HIVST) with online real-time support by human administrators (HIVST-OIC) is an evidence-based HIV intervention for men who have sex with men (MSM) but requires intensive resources to implement. To investigate whether a novel HIVST service using a chatbot to deliver online real-time instruction and counseling support (HIVST-chatbot) is noninferior to the HIVST-OIC in increasing HIVST uptake and counseling support for MSM. A partially blinded, parallel-group, and noninferiority randomized clinical trial was conducted between April 16, 2023, and May 31, 2024, in Hong Kong, China. Eligible participants were Hong Kong-based, Chinese-speaking MSM 18 years or older who reported anal intercourse with men in the past 6 months and had access to WhatsApp. Participants were recruited via gay venues, online recruitment, and peer referrals and then randomized to the HIVST-chatbot or HIVST-OIC groups. Both intention-to-treat (ITT) and complete case analyses were performed. The noninferiority margin was set at 10 percentage points. Standard-of-care pretest and posttest counseling was delivered by a chatbot for the HIVST-chatbot group and by trained human administrators in the HIVST-OIC group. Both groups received free HIVST kits. Primary outcomes included self-reported HIVST uptake and receiving any counseling support along with HIVST, validated by the research team. A total of 531 participants (mean [SD] age, 34.8 [9.3] years) were randomized to either the HIVST-chatbot (n = 266) or HIVST-OIC (n = 265) groups. In ITT analysis, the HIVST-chatbot was noninferior to the HIVST-OIC in increasing HIVST uptake (216 [81.2%] vs 227 [85.7%]; proportion difference, -4.5 percentage points; 95% CI, -9.8 to 0.8 percentage points; 1-sided P = .10) and proportion of HIVST users who received counseling support (197 [91.2%] vs 142 [62.6%]; proportion difference, 28.7 percentage points; 95% CI, 22.5 to 34.8 percentage points; 1-sided P < .001) at month 6. The HIVST-chatbot was more cost-effective than HIVST-OIC. In this randomized clinical trial, the HIVST-chatbot was noninferior to the HIVST-OIC in increasing HIVST uptake and counseling among HIVST users. These results suggest that the HIVST-chatbot might be an alternative to the evidence-based HIVST-OIC service for MSM. ClinicalTrial.gov Identifier: NCT05796622.
mSystems · 2025
This study aimed to assess the impact of a high-fiber/low-fat agrarian diet (AD) on inflammation and metabolic outcomes in HIV-positive men who have sex with men (MSM). Since the gut microbiomes of MSM resemble those of individuals in agrarian cultures, including being Prevotella-rich and Bacteroides-poor, we hypothesized that they would have particularly strong health benefits from consumption of a diet matched to their microbiome type. Sixty-six participants, including 36 HIV-positive MSM [HIV(+)MSM], 21 HIV-negative MSM, and 9 HIV-negative men who have sex with women, were randomized to either an AD or a high-fat/low-fiber western diet (WD) for 4 weeks. Plasma, fecal, and colonic biopsy samples were obtained. Metabolic and inflammatory markers were measured in plasma. 16S ribosomal RNA sequencing was performed on fecal and biopsy samples, and shotgun metagenomic sequencing was performed on fecal samples. The AD reduced plasma low-density lipoprotein cholesterol (LDL-C) in HIV(+)MSM, with median reductions of 0.4138 mmoL/L at 2 weeks and 0.2845 mmol/L at 4 weeks. Greater LDL-C reductions were predicted by Prevotella-rich/Bacteroides-poor microbiomes with increased starch utilization potential, emphasizing the importance of personalized microbiome-dietary matching. The AD also reduced T cell exhaustion and pro-inflammatory intermediate monocytes and altered host transcription in the colonic mucosa. Our findings suggest tailoring diet interventions to baseline microbiome types can promote metabolic health in Prevotella-rich/Bacteroides-poor MSM, a significant portion of people living with HIV at risk for metabolic syndrome.This study was registered at NCT02610374.
BMC infectious diseases · 2025
Syphilis has re-emerged in China in recent decades, particularly among men who have sex with men (MSM). We aimed to assess the prevalence, incidence, and associated factors of syphilis among MSM in China. We systematically searched major English (MEDLINE via PubMed, Web of Science, Embase, Scopus, Cochrane Library) and Chinese (CNKI, Wanfang, CBM, VIP, Airiti Library) databases for studies on syphilis prevalence or incidence among MSM in China published from January 1, 2013 to March 1, 2025. Study qualities were evaluated using the Hoy et al.'s risk-of-bias tool and the Newcastle-Ottawa Scale. Random-effects meta-analysis models were used to estimate pooled syphilis prevalence (%) and incidence (per 100 person-years, PYs) with 95% confidence intervals (CIs). Meta-regression analyses were performed to assess differences across subgroups. A total of 441 studies (429 prevalence and 33 incidence) were included. The pooled syphilis prevalence among general MSM was 8.8% (95% CI: 8.3-9.4). Study location (R²=0.13) and study year (R²=0.11) each contributed significantly to the high heterogeneity observed (I² = 98.5%) among the general MSM prevalence studies. MSM with high-risk sexual behaviors or related risk factors exhibited higher prevalence. The pooled incidence among all MSM was 7.8 per 100 PYs (95% CI: 6.0-9.8), with similarly high heterogeneity (I² = 96.4%). Both syphilis prevalence and incidence declined over time. Syphilis prevalence and incidence remain high among high-risk MSM subgroups in China. More rigorous studies and targeted interventions are needed to obtain more accurate estimates and to further reduce syphilis infection rates.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP · 2025
This paper aimed to identify the facilitators, barriers, and recommendations for overcoming challenges to HIV self-testing (HIVST) uptake among men who have sex with men (MSM) and transgender (TG) people in Asia. Using a systematic search strategy, databases including PubMed, OCLC, EBSCOhost, Google Scholar, SABINET Online, Union Catalogue of Theses and Dissertations, WorldCat Dissertations, and ERIC were searched. The Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach was used to analyse the findings. The results suggest that HIVST is perceived as a more confidential and easier method compared to traditional HIV testing among MSM and TG individuals. HIVST can increase the reach of HIV testing services for MSM and TG individuals in Asia. Community-based organisations and community workers can facilitate HIVST among MSM and TG in Asia. However, the cost of test kits is a significant barrier to HIVST uptake. Additionally, counselling services make traditional HIV testing preferable than HIVST method among these populations. Overall, there is a lack of policy for supporting HIVST for MSM and TG in many Asian countries. There are concerns among users and stakeholders that HIVST may lead to mental distress, promoting recommendations to link mental health services in a way that protects users' privacy. Key Words: HIV self-testing, Uptake, Health system, Multi-stakeholder, Men who have sex with men.
Research in nursing & health · 2026
Men who have sex with men (MSM) in Thailand continue to experience a disproportionate HIV burden, with persistent challenges related to antiretroviral therapy (ART) adherence, quality of life, and self-management. Stigma and the scarcity of culturally adapted interventions further hinder sustained engagement in care. This study evaluated the effectiveness of the HIV/AIDS Self-Management Education Program-Thai (HASMEP-T), a culturally adapted, nurse-delivered, peer-supported intervention, on immunologic and patient-reported outcomes among Thai MSM living with HIV. A randomized controlled trial with a pretest-posttest design was conducted at a tertiary HIV clinic, where 64 MSM living with HIV were randomized to either the intervention or control group (n = 32 each). The intervention included four biweekly, 3 h group sessions over 7 weeks, in addition to routine services, while the control group received routine care only. Outcomes measured at baseline, immediately post-intervention, and at the 12-week follow-up included CD4 count, ART adherence, quality of life (WHOQOL-BREF), and HIV self-management. Paired and independent t-tests and repeated-measures ANOVA were employed. At 12 weeks, the intervention group showed significantly greater improvements than the controls in CD4 count (+84.5 cells/mm³), ART adherence (+8.9%), quality of life (+14.7 points), and self-management (+9.1 points) (all p < 0.05). No adverse events were observed. The findings indicate that HASMEP-T is effective in enhancing immunologic, behavioral, and psychosocial outcomes among Thai MSM living with HIV and has the potential to be integrated into routine HIV care to strengthen ART adherence, reduce stigma, and improve quality of life in resource-limited settings.
The Journal of infectious diseases · 2026
The global prevalence of and risk factors associated with same-type HPV infection across multiple anogenital sites among men has not been quantified. Men aged 16-27 years participating in a multi-country 4-valent HPV vaccine trial (NCT00090285) were assessed at baseline for prevalent HPV infection at penile/scrotal and perineal/perianal sites (heterosexual men [HM] and men who have sex with men [MSM]) and additionally at intra-anal sites (MSM). Concordant infection with 9-valent HPV (9vHPV) vaccine types (6/11/16/18/31/33/45/52/58) was defined as same-type 9vHPV infection at 2 or 3 sites. 3363 HM and 595 MSM were included. Prevalence of concordant 9vHPV infection at 2 anogenital sites was 3.7% among HM and 9.1% among MSM, and 8.2% at 3 sites (including the intra-anal site) among MSM. HPV6 and HPV16 were most likely to occur at multiple anogenital sites in HM and MSM, with strong agreement observed between perineal/perianal and anal sites among MSM for HPV6 (Cohen's kappa, 0.78; 95% CI, .69-.87) and HPV16 (0.61; 95% CI, .50-.73). Concordant anogenital 9vHPV infection was more common among MSM than HM, which is consistent with evidence that MSM are at increased risk of HPV-related cancer across multiple anogenital sites. Clinical Trial Registration:  ClinicalTrials.gov, NCT00090285.
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Waning immunity and reduced vaccine effectiveness among people with HIV (PWH) raise concerns about optimal HBV revaccination dosing. This study compared double-dose versus standard-dose HBV revaccination among men who have sex with men (MSM) born in the neonatal HBV vaccination era in Taiwan. In this multicenter randomized trial, 526 participants negative for all HBV seromarkers received either standard-dose (20 µg) or double-dose (40 µg) aluminum-adjuvanted recombinant vaccine at Weeks 0, 4, and 24. The primary outcome was seroprotection response (SPR, ≥10 mIU/mL) at Week 28; secondary outcomes included SPR at Week 48 and high-level seroprotection response (HSPR, ≥100 mIU/mL) at Weeks 28 and 48. In the per-protocol analysis, SPRs at Week 28 were 92.2% in the standard-dose group vs 96.7% in the double-dose group (difference 4.5%, 95% CI: 0.5-8.4%, P = 0.029), not meeting the superiority threshold. At Week 48, HSPR was higher with double-dose vaccination (74.8% vs 62.8%; difference 11.9%, 95% CI: 3.9-20.0%, P = 0.004). Among PWH, the double-dose group achieved higher HSPR at Weeks 28 (difference 9.0%, 95% CI: 1.0-16.9%) and 48 (difference 11.7%, 95% CI: 1.5-21.9%). Both dosing regimens were highly effective. Double-dose HBV revaccination provided stronger and durable high-level protection.
JMIR formative research · 2025
HIV self-testing is an important strategy in the US Ending the HIV Epidemic initiative. To facilitate uptake of self-testing, we developed the mLab app, which complements existing self-test options to support the potential for higher uptake of the HIV self-test. Syphilis, a sexually transmitted infection with currently rising prevalence and overlap in risk profiles with HIV, could similarly benefit from the advantages of companion diagnostic mobile apps such as mLab. Due to the success of the mLab app in promoting HIV self-testing during a randomized controlled trial and the scientific evidence of need for at-home syphilis testing, our team developed the mLab+ app, which supports both HIV and syphilis testing through an image processing algorithm that incorporates a duplex HIV and syphilis point-of-care test. We conducted a pilot study to assess the feasibility and usability of the mLab+ app for HIV and syphilis testing. We recruited participants who were assigned male sex at birth and reported sex with another man. Participants came to the Nurse Practitioner Group clinic for baseline and follow-up visits. Participants rated the usability of the app using the Health Information Technology Usability Evaluation Scale and the Post-Study System Usability Questionnaire at their 3-month follow-up visit. The primary outcome was the number of participants who were able to self-administer the DPP HIV-Syphilis test with the assistance of the mLab+ app. Feasibility was measured through recruitment pace, retention over 3 months, app usability, and paradata. Of the 20 participants, 19 identified as male and 1 identified as nonbinary. Most participants (n=16) were able to complete the DPP HIV-Syphilis test with facilitation support from the mLab+ app. The average duration of an app session, from after authentication until log-out or abandonment, was 30 minutes and 33 seconds (SD 21 minutes and 40 seconds). Apart from the 27% (13/48) of sessions that were 5 minutes or less, the distribution of session durations was approximately normal. Users spent the longest time viewing testing screens (ie, timer screens, initial testing screen, test guided walkthroughs, test results, and picture and result upload). The overall mean scores on the Post-Study System Usability Questionnaire (2.65, SD 1.06) and Health Information Technology Usability Evaluation Scale (3.62, SD 1.07) indicated medium to high usability. The retention rate for the 3-month trial was 80% (16/20). The findings support the use of the mLab+ app as a tool for assisting consumers in self-testing for HIV and syphilis. The limitations of the study design warrant further examination outside of clinic settings to better understand the utility of these tools for improving consumer health outcomes.
AIDS (London, England) · 2026
The Global AIDS Strategy 2021-2026 calls for equitable access to HIV services for all populations. Transgender people have been marginalized and experience disproportionate risk of HIV infection in sub-Saharan Africa (SSA) and data to guide HIV programmes are severely limited. Surveillance data among cisgender men who have sex with men (cis-MSM) are comparatively abundant. We assessed whether HIV prevalence among cis-MSM was correlated with HIV prevalence among transgender women. Data from key population surveys conducted in SSA between 2010 and 2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence data among both transgender women and cis-MSM populations were analysed with random effect meta-analysis to estimate the ratio of HIV prevalence among cis-MSM:transgender women. Twenty-one studies were identified encompassing 8476 transgender women and 24 102 cis-MSM. Median HIV prevalence among transgender women was 23.5% [interquartile range (IQR) 11.5-39.8%] and 16.2% (IQR 8.1-26.8%) among cis-MSM. HIV prevalence among transgender women was 50% higher than in cis-MSM [prevalence ratio 1.48, 95% confidence interval (CI) 1.25-1.76]. HIV prevalence among transgender women was highly correlated with year/province-matched HIV prevalence among cis-MSM ( R2  = 0.60), but poorly correlated with year/province-matched total population HIV prevalence ( R2  = 0.01). Transgender women experience a significantly greater HIV burden than cis-MSM in SSA, underscoring the need for HIV services addressing the disproportionate vulnerability experienced by transgender women. Further bio-behavioural surveys focused on determinants of HIV infection, treatment uptake, and risk behaviours among transgender people, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities.
Frontiers in cellular and infection microbiology · 2025
The recent mpox outbreaks have brought challenges to the global health system. We aimed to study the epidemiological and clinical differences between patients with mpox and patients without mpox among suspected cases during and after 2022. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our meta-analysis included a total of 22 articles regarding 12,850 suspected cases of mpox. The prevalence of mpox was 54%. We found that the proportion of men among the mpox patients was much greater than that among the non-mpox patients (odds ratio (OR)=9.94, 95% confidence interval (CI): 4.37-22.58), and the same trend was also observed (OR = 11.52, 95% CI: 6.22-21.33) for men who have sex with men (MSM). Sexual intercourse (OR = 4.02, 95% CI: 2.63-6.13), multiple sexual partners (OR = 3.36, 95% CI: 1.99-5.68), and anal sex (OR = 2.40, 95% CI: 1.53-3.77) were more common among mpox patients than non-mpox patients. Sexual contact was more strongly associated with mpox infection (OR = 4.39, 95% CI: 1.77-10.92), whereas nonsexual contact (OR = 0.72, 95% CI: 0.63-0.83) and transmission through health services (OR = 0.55, 95% CI: 0.33-0.93) showed weaker associations. Furthermore, there were significant differences between the two patient groups in terms of sexually transmitted infections, symptoms, complications, lesion locations and types of lesions. Our findings provide a reference for clinicians in the diagnosis and differentiation of mpox. By scientifically understanding these epidemiological and clinical differences, healthcare workers can not only address this epidemic more effectively but also be more fully prepared for the inevitable challenges of future emerging infectious diseases. https://www.crd.york.ac.uk/prospero/, identifier CRD420251141869.
BMC medical ethics · 2026
Ethical safeguards are critical in HIV research involving minors, especially vulnerable groups such as men who have sex with men (MSM) under 18 years. This systematic review explores how informed assent and consent practices are reported, guided by the 2016 Council for International Organizations of Medical Sciences (CIOMS) guidelines. A systematic review was conducted of peer-reviewed studies from 2010 to 2023 involving MSM under 18 years, using PubMed, Embase, and Scopus databases. Key ethical components were extracted and synthesized thematically. Of 410 articles screened, 65 met inclusion criteria. All included studies reported informed consent, but only 20% (n = 13) included informed assent. Most were conducted in high-income countries (64%), with no representation from low-income settings. Only 7% involved minors living with HIV. Quantitative methods were predominant (82%), and 20% used online platforms. Waivers of parental permission were reported in 27% of studies, while only 3% obtained parental permission. Four studies described tailored consent/assent approaches, such as simplified language, comprehension checks, and involvement of minor advocates. This review highlights inconsistencies in how informed assent is addressed in HIV research involving MSM minors. Only one in five studies described ethically appropriate, youth-tailored processes. Limited use of waivers and adapted assent procedures points to ongoing gaps in aligning research with ethical standards. Future studies should adopt clearer, age-appropriate consent practices, ensure transparent reporting, and strengthen researcher training in ethics involving vulnerable minors.
Journal of acquired immune deficiency syndromes (1999) · 2026
Circumcision reduces HIV risk for men who have sex with women, but for men who have sex with men (MSM), prior meta-analyses were ambiguous because of inconsistent, highly confounded data suggesting regional differences. This has left the weight of evidence unclear even after a small 2024 trial in primarily insertive MSM (PI-MSM) in China showed protection. Any protection would be for PI-MSM and could have substantial impact given high incidence. No restrictions. We performed an updated literature search on the association of male circumcision with HIV among MSM. We conducted descriptive analyses, and a random-effects meta-analysis among PI-MSM. To isolate the protective effect of circumcision from confounders, we then performed a confounder-adjusted meta-analysis, comparing the effect of circumcision on HIV status among PI-MSM versus other MSM, testing for publication bias (funnel plot asymmetry) and regional heterogeneity (United States/Canada/Europe/Australia vs. Asia/Africa/Latin America). Forty-nine studies were included in the descriptive analysis, 13 in the unadjusted meta-analysis, and 10 in the confounder-adjusted meta-analysis. In the unadjusted meta-analysis, circumcision was associated with a lower HIV risk among PI-MSM (odds ratio (OR) = 0.57, 95% CI: 0.33 to 0.98); publication bias and heterogeneity were present. In the confounder-adjusted analysis, the additional effect of circumcision in the PI-MSM group-a ratio of ORs-was 0.53 (95% CI: 0.34 to 0.83), a significant, substantial protective association. Regional heterogeneity ( P = 0.65) and publication bias ( P = 0.34) were not present. Among PI-MSM, circumcision was protective against HIV. Findings support male circumcision as an effective HIV prevention method for PI-MSM.
Sexual health · 2026
Recent systematic reviews have demonstrated the efficacy of doxycycline prophylaxis in preventing bacterial sexually transmitted infections (STIs) in randomised controlled trials (RCTs). In this review, we updated evidence from RCTs and non-RCTs and compared the effectiveness of doxycycline as pre- (doxy PrEP) and post-prophylaxis (doxy PEP) across different groups. We searched PubMed, Web of Science, Embase, Cochrane Library, and two conference abstract archives for publications from January 2010 to April 2025. Eligible RCT and non-RCT studies on doxy PrEP and doxy PEP to prevent STIs were included in the analysis. Pooled risk ratios were calculated using fixed-effects and random-effects models. This study was registered with PROSPERO (CRD42024568934). Fourteen eligible studies (4 doxy PrEP, 10 doxy PEP) were included for analysis. Participants were primarily men who have sex with men (MSM) and transgender women (TGW). Doxycycline (either PrEP or PEP) reduced the risk of acquiring any STIs by 60% (risk ratio (RR), 0.40; 95% CI, 0.30-0.52) in RCT and non-RCT trials. Doxycycline was associated with fewer incidences of chlamydia (RR, 0.18; 95% CI, 0.11-0.28), gonorrhoea (RR, 0.61; 95% CI: 0.44-0.86), and syphilis (RR, 0.20; 95% CI; 0.12-0.33). Meta-analysis of seven RCTs showed 76% decrease on chlamydia (RR: 0.24; 95% CI: 0.13-0.45), 33% decrease on gonorrhoea (RR, 0.67; 95% CI; 0.45-0.98), and 78% decrease on syphilis (RR, 0.22; 95% CI; 0.14-0.36). HIV-positive and HIV-negative people benefited from using doxy PrEP and PEP regimens prevented bacterial STIs. RCT and non-RCT data demonstrated the effectiveness of doxy PrEP and doxy PEP in reducing STIs among MSM/TGW. Integrating doxy PrEP or doxy PEP as a biomedical tool into STI prevention strategies should be considered.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi · 2026
Objective: To conduct precise health education about mpox in men who have sex with men (MSM) based on internet platforms and evaluate its performance on the improvement of the mpox related knowledge awareness level in this population. Methods: In January 2025, a randomized controlled study was conducted in MSM recruited through the "Sunshine Test" WeChat official account of the Hangzhou Coastal Public Welfare Social Organization. By using a random number table, the MSM were divided into education group and control group at ratio of 1∶1, and all of them completed a baseline electronic questionnaire. Based on the baseline survey results, the MSM in the education group were further divided into 3 awareness level groups, i.e. high awareness level group (≥12 correct answers), medium awareness level group (9-11 correct answers), and low awareness level group (≤8 correct answers). Tailored educational materials were delivered at different frequencies to conduct precise health education for one month. Finally, mpox knowledge awareness level were compared between the two groups. Results: A total of 360 MSM were included in data analysis, including 176 in the education group and 184 in the control group. In the baseline survey, the proportions of MSM with high awareness level in the education group and in control group were 46.0% and 46.7%, respectively, the difference was not significant. After the precise health education, the proportions of the MSM with high awareness levelin the education group and control group were 84.7% and 58.7%, respectively, the difference was significant (P<0.001). Conclusions: The awareness level of mpox related knowledge was relatively low in MSM. The internet-based precision health education can rapidly improve the awareness level of mpox related knowledge in MSM. 目的： 通过互联网平台实施精准宣教，并观察能否提升男男性行为人群（MSM）猴痘知识知晓水平。 方法： 采用随机对照研究设计。2025年1月，以杭州市海岸公益社会组织“阳光测”公众号为平台招募研究对象，使用随机数字表法将研究对象按1∶1分为宣教组和常规组，并完成基线电子问卷调查。根据基线调查结果，将宣教组研究对象分为高（回答正确的题目数≥12道）、中（回答正确的题目数9~11道）、低（回答正确的题目数≤8道）知晓水平组，并以不同频率推送针对性宣教材料，为期1个月。最终对宣教组和常规组研究对象的猴痘知识知晓水平进行评估。 结果： 共纳入360名研究对象进行分析，其中宣教组176名，常规组184名。基线调查中宣教组和常规组研究对象的猴痘知识高知晓水平组构成比分别为46.0%和46.7%，差异无统计学意义。经过精准宣教后，评估调查中宣教组和常规组研究对象的猴痘知识高知晓水平组构成比分别为84.7%和58.7%，差异有统计学意义（P<0.001）。 结论： MSM猴痘知识知晓水平较低，基于互联网平台的精准宣教模式短期内可以有效提高MSM猴痘知识知晓水平。.
Journal of medical Internet research · 2026
Deaf individuals often face communication challenges when interacting with those who can hear. Within health care settings, these challenges may pose risks to their safety, potentially resulting in misdiagnoses, treatment errors, and decreased quality of care. This study aims to systematically review the evidence on communication systems reported in the literature that use human-computer interaction techniques to support communication between deaf individuals who use sign language and hearing health professionals in health care settings. The review focuses on systems that are either currently in use or proposed for use in health care and that have been tested using human participants or videos of human users. A comprehensive search was performed via MEDLINE, Web of Science, ACM, IEEE Xplore, Scopus, and Google Scholar in March 2025. The inclusion criteria comprised studies developing a sign language recognition system within a health care context and testing with human users. Eligible studies underwent screening by 2 independent investigators (LRV and LMMSR or LFRdO and GTdSS), with any disagreements resolved by a senior researcher (MSM). The search retrieved 21,778 publications, and screening of reference lists identified 2 additional studies, resulting in a total of 23 studies meeting the eligibility criteria. Most systems (15/23, 65.2%) were image-based, while 34.8% (8/23) relied on sensors (glove-based or depth-sensing). Applications varied across health care settings, including general hospital care (10/23, 43.5%), emergencies (8/23, 34.8%), and primary care (4/23, 17.4%). All systems were in the development and testing stage, with no data on security and psychological impacts. Accuracy ranged from 25% to 100% for image-based and 72% to 99.7% for sensor-based systems. Bidirectionality and facial expression recognition, crucial for effective communication, were largely overlooked. Image-based systems were more common than sensor-based ones, though both showed wide variability in accuracy in recognizing and interpreting signs. Most systems failed to address critical aspects such as bidirectional communication and the recognition of facial expressions, essential for effective communication. None fully addresses the requirements for integration into health care settings. These findings highlight the need for further research on implementation, usability, and impact on the quality of care for deaf patients.
Endocrinology, diabetes & metabolism · 2026
We conducted the diet and diabetes remission (DIREM) study to assess whether an integrated lifestyle intervention would lead to achieving remission in type 2 diabetes. Patients with type 2 diabetes were randomly assigned to calorie-carbohydrate restriction (CCR) group, intermittent fasting with calorie-carbohydrate restriction (IFCCR), or usual care group (control). The total study duration was 6 months, consisting of two phases: a 12-week integrated lifestyle intervention (ILI) phase, followed by a 12-week maintenance and structured monitoring (MSM) phase. The intervention was presented in the form of a structured behavioural model and also emphasised physical activity. One hundred and twenty participants were randomly assigned to the study. Diabetes remission occurred in 9 (22.5%) of 40 participants in the CCR group (OR (CCR vs. Control) = 11.7, 95% CI: 1.4-98.3; p = 0.024), 12 (30.0%) of 40 participants in the IFCCR group (OR (IFCCR vs. Control) = 18.1, 95% CI: 2.2-151.0; p = 0.007) and 1 (2.5%) of 40 participants in the control group. The odds of remission were higher in the IFCCR group compared to the CCR group, but it was not significant (OR (IFCCR vs. CCR) = 1.5, 95% CI: 0.6-4.3; p = 0.4). Both calorie-carbohydrate restriction alone and in combination with intermittent fasting significantly improved glycemic control and induced diabetes remission compared with the control group. No significant difference was found between the two interventions. Larger long-term studies are needed to confirm these findings. This trial was registered in the Iranian Registry of Clinical Trials (IRCT), IRCT20240418061519N1 (https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20240418061519N1).
Current rheumatology reviews · 2025
Temporomandibular joint osteoarthritis (TMJ OA) is a chronic disease that is a consequence of undue occlusal forces and is characterized by irreversible damage to the articular surfaces. Symptomatic slow-acting so-called nutraceutical drugs have been proposed as a treatment for osteoarthritis in comparison to non-steroidal anti-inflammatory drugs (NSAIDs). Oral glucosamine and chondroitin, slow-acting drugs, have been found to reduce pain and increase mouth opening in patients with TMJ OA. However, there is limited scientific evidence to confirm their clinical effectiveness. This systematic review was conducted to bolster the evidence supporting the assessment of the efficacy of glucosamine in the context of temporomandibular joint osteoarthritis (TMJ OA). This review identified four review articles from databases like Medline (via PubMed), Web of Science, Scopus, and EMBASE till September 2023 after screening at the title, abstract, and full-text level. They were assessed for risk of bias with the JBI risk of bias assessment tool. This review with meta-analysis focused on pooled estimate mean differences, revealing non-significant but discernible effects of glucosamine on maximum mouth opening (SMD = 0.288, p = 0.15) and pain reduction (SMD = 0.217, p = 0.476) in TMJ-related disorders. Compared to control groups with ibuprofen and tramadol, glucosamine showed slightly more favourable outcomes. However, the variability in methodology and study characteristics warrants further longitudinal studies to confirm its efficacy.