{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:33:05Z","timestamp":1781533985767,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,11,12]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective population-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Catalonia, Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>42\u2009283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34\u2009600 individuals, reported to the Catalan HIV\/STI Registry in 2017\u20132019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100\u2009000 population between 2017 and 2019 (p&lt;0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017\u20132019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30\u201339 years (versus &lt;20 years, aOR 18.58; 95%\u2009CI 8.56 to 52.13), having 5\u20137 STI episodes (vs 1 episode, aOR 5.96; 95%\u2009CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95%\u2009CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95%\u2009CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052817","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T11:32:53Z","timestamp":1639395173000},"page":"e052817","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017\u20132019: a retrospective population-based cohort study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8132-5645","authenticated-orcid":false,"given":"Alexis","family":"Sent\u00eds","sequence":"first","affiliation":[{"name":"Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain"},{"name":"Pompeu Fabra University (UPF), Barcelona, Spain"},{"name":"Epidemiology Department, Epiconcept, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Montoro-Fernandez","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain"},{"name":"Fundaci\u00f3 Institut d'Investigaci\u00f3 Germans Trias i Pujol (IGTP), Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelin","family":"Lopez-Corbeto","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain"},{"name":"Fundaci\u00f3 Institut d'Investigaci\u00f3 Germans Trias i Pujol (IGTP), Badalona, Spain"},{"name":"Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Egea-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain"},{"name":"Fundaci\u00f3 Institut d'Investigaci\u00f3 Germans Trias i Pujol (IGTP), Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K","family":"Nomah","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain"},{"name":"Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesika","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain"},{"name":"Fundaci\u00f3 Institut d'Investigaci\u00f3 Germans Trias i Pujol (IGTP), Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Garcia de Olalla","sequence":"additional","affiliation":[{"name":"Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilas","family":"Mercuriali","sequence":"additional","affiliation":[{"name":"Epidemiology Service, Public Health Agency of Barcelona, Barcelona, 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