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  • ChatGPT could be an effective tool to help reduce vaccine hesitancy

    ChatGPT could be an effective tool to help reduce vaccine hesitancy

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    New research being presented at this year’s ESCMID Global Congress (formerly ECCMID) in Barcelona, Spain (27-30 April) suggests that the free-to-use, widely accessible ChatGPT could be an effective tool to help reduce vaccine hesitancy among the general public, as well as providing helpful advice on sexually transmitted infections (STIs) in conjunction with sexual health clinics, by improving knowledge and access to care.

    Our findings showed that ChatGPT displayed a remarkable ability to accurately respond to a wide breadth of commonly asked questions, encompassing topics such as misconceptions around mRNA vaccination and the importance of testing for STIs. In the majority of instances, ChatGPT performed at the level of advice provided by professional organizations and guidelines.”

    Dr Matthew Koh,lead author from the National University Health System (NUHS) in Singapore

    Since its unveiling in November 2022, millions of people have used AI (artificial intelligence) chatbots like ChatGPT for everything from making music to answering trivia to helping with homework. But ChatGPT has been mired in issues around its accuracy.

    Vaccines have stopped epidemics and almost eradicated deadly diseases in the past such as polio, but vaccine hesitancy, directly linked to misinformation-;false, inaccurate information promoted as factual-;is on the rise, resulting in lower vaccine uptake. Since the public debut of ChatGPT, individuals with mistrust of health professionals may be using the technology to address their concerns.

    Similarly, for individuals trying to access information on sexual health, or those worried about the stigma and embarrassment of attending a clinic, or with limited access to healthcare, could find using ChatGPT is a good way to get answers about STIs.

    To find out more, researchers from the NUHS in Singapore tested ChatGPT to see whether it could successfully provide answers to common questions about vaccination and STIs.

    A team of physicians who run infectious disease clinics asked ChatGPT to answer 15 commonly asked questions on vaccine hesitancy, including questions on doubts about the efficacy of vaccines, concerns about adverse effects, and cultural concerns relating to vaccines (see table in notes to editors).

    They also asked ChatGPT 17 common questions on STIs based on general risk factors, access to care and diagnosis, and management and post-exposure prophylaxis (see table in notes to editors).

    The AI-generated responses on vaccine hesitancy were then assessed by two independent infectious disease experts against recommendations from the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP), and the chatbot answers on STIs were assessed against the 2021 US CDC STI Treatment Guidelines. All responses were evaluated for their completeness, quality, and accuracy.

    Factual responses to vaccine hesitancy concerns

    The researchers found that overall ChatGPT’s output provided factual responses and reassurance to vaccine hesitancy concerns.

    For example, ChatGPT accurately highlighted the indication for measles vaccination in low incidence settings, and discussed the potential benefits of male human papillomavirus (HPV) vaccination. However, the AI chatbot failed to acknowledge the suggested ACIP age cut-offs for HPV vaccination, or account for a specific individual’s situation such as how sexually active they are.

    In addition, ChatGPT provided reassurances for people with an egg allergy and influenza vaccination, and addressed misconceptions around mRNA vaccination and permanent alterations in DNA with high accuracy. However, it did not offer the non-mRNA vaccine options for COVID-19, but did encourage further discussions with healthcare professionals.

    ChatGPT also appropriately acknowledged the complexity of religious issues around vaccination and directed individuals to have further discussions with religious leaders. Importantly, however, the researchers found that without specific details of the religious concern and the specific vaccine, ChatGPT’s advice was generic and it did not provide a more detailed risk-benefit discussion.

    “Overall, ChatGPT’s responses to vaccine hesitancy were accurate and may help individuals who have vaccine-related misconceptions”, says Dr Koh, who is also an infectious diseases physician at the National University Hospital in Singapore. “Our results demonstrate the potential power of AI models to assist in public health campaigns and aid health professionals in reducing vaccine hesitancy.”

    STI responses generally accurate and concise

    The researchers also found that overall, ChatGPT’s responses on STIs were mostly accurate and concise.

    For example, when asked about how to prevent STIs, the chatbot recommended safe sex practices HPV vaccinations as well as abstinence, but it failed to provide guidance on other key elements such as HIV pre-exposure prophylaxis.

    In addition, the AI chatbot was able to provide general reassurance about STI symptoms, such as noting that other possibilities exist, and recommended going for testing. It also consistently communicated the importance of partner testing and follow-up testing.

    However, when asked about chlamydia treatment, ChatGPT suggested either azithromycin or doxycycline, although the CDC favors doxycycline as the first-line treatment. It also failed to highlight the importance of testing for other STIs.

    “ChatGPT provided good general advice about STIs, but it lacked specificity and could not tailor its advice to individual’s risk of acquiring STIs”, says Dr Koh. “The goal of this project is to empower the general public. The hope is that individuals can educate themselves with ChatGPT by making accurate advice more accessible and increase vaccine uptake and protection from STIs.”

    He continues “We believe that ChatGPT should be used in conjunction with, or in addition to, a physician consultation-;the human response is still needed to contextualize the advice that is given to a specific individual’s situation and for it to make the most sense and be the most helpful for the patient.”

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  • Managing the rise in STIs among older adults

    Managing the rise in STIs among older adults

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    A new research review presented at a pre-congress day for this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024, Barcelona, 27-30 April) will look at how to manage the rise in sexually transmitted infections (STIs) in older people, such as gonorrhea, syphilis, and genital warts. It will focus on the importance of sex, intimacy, and sexual health to the Baby Boomer generation, especially given that 1 in 6 individuals worldwide will be aged 60 and older by 2030. The presentation will be given by Professor Justyna Kowalska from the Medical University of Warsaw, Hospital for Infectious Diseases in Warsaw, Poland-;who will highlight the need for conversations around older people and sexual health to be normalized.

    Data from the US Centers for Disease Control and Prevention (CDC) indicate that rates of chlamydia, gonorrhea, and syphilis among US adults aged 55 and older have more than doubled over the past 10 years. For example, rates of gonorrhea among those aged 55 to 64 years rose from around 15 cases per 100,000 people in 2015 to 57 per 100,000 in 2019 [1]. In England, 31,902 new STIs were recorded in the over 45s in 2015, which rose to 37,692 in 2019 – an increase of 18%, with the majority of new diagnoses in men who have sex with men [2]. High STI prevalence estimates have also been reported more broadly in older adults around the world, including China, Korea, Kenya, and Botswana.

    Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities, and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over 50s. These data likely underestimate the true extent of the problem as limited access to sexual health services for the over 50s, and trying to avoid the stigma and embarrassment both on the part of older people and healthcare professionals, is leading to this age group not seeking help for STIs.”


    Professor Justyna Kowalska from the Medical University of Warsaw

    Compounding the problem are the many misconceptions around sexuality and sexual activity in older adults, and the importance of sex and intimacy to older people’s happiness and wellbeing. As Professor Kowalska explains, “People do not become asexual with age. In fact, with preventive medicine and improved lifestyles people are enjoying a healthy life and sex life for longer. Older people often find greater satisfaction in their sex lives due to experience and known expectations. We need more role models like Samantha Jones in the TV show Sex and the City to challenge stereotypes around older sexuality.”

    Although the frequency of sexual activity tends to decline with age, older adults are still having lots of sex. In a study in England, half of men and almost a third of women aged 70 and over reported being sexually active. Similarly, in a Swedish study, 46% of individuals aged 60 years and older reported being sexually active, as did 10% of those aged 90 years or older.

    Studies show higher levels of sexual desire, greater sexual frequency, and more sexual partners among older men than women. A retrospective study from the USA involving 420,790 couples aged 67 to 99 years, found that widowhood was associated with an increased risk of STIs in older men, but not women. And the effects in men were larger after sildenafil (Viagra), the first phosphodiesterase type 5 inhibitor (PDE5 inhibitor), hit the market. Professor Kowalska says, “These findings indicate that sexual risk taking is common among older adults, particularly men. Given that the number of people aged 60 years and older is set to double worldwide by 2050 and the widespread availability of drugs to enhance sexual activity, health professionals must be proactive in discussing sexual concerns and making sexual health a routine part of general health care for older adults.”

    Although the incidence of STIs among the over 50s is small compared to younger age groups, it is rising, and Prof Kowalska will call for raising awareness about sexual health in older adults, explaining that they came of age at a time when sex education in school did not exist. “Sexual health campaigns are focused on young people and overlook the needs and experiences of those aged 50 and older”, she says. “Health promotion messages give the impression that condoms and concerns about STIs only apply to young people. But the dangers of undiagnosed and untreated STIs such as HPV-related cancers and onwards transmission are very real, particularly in this age group who are more likely to have underlying conditions such as heart disease and stroke.”

    Prof Kowalska will also highlight the lack of evidence for using communication to promote positive behaviors to reduce the spread of STIs in older adults, particularly outside the USA and for infections other than HIV. “Increasing older adults’ knowledge of the risk of STIs and how to engage in safer sex is crucial to tackling record levels of STIs”, says Professor Kowalska. “Tailoring education programs to the over 50s and including peer support and ensuring they are located within existing community settings is vital to their success.” Ultimately she says, “Older people have a right to good sexual health, so let’s normalize conversations around sex and older people, and change the narrative on aging.”

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  • Advancing sexual medicine through collaborative European efforts

    Advancing sexual medicine through collaborative European efforts

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    Timeliness and purpose

    Sexual medicine covers a wide range of issues related to sexual health and well-being at different stages of life. When there are problems in sexual life, it doesn’t just affect the bedroom – it has broader impacts. Dealing with issues like low sexual desire, premature ejaculation, and pain during sex involves looking at the bigger picture – not just the medical side but also the psychological and relational aspects. The media can influence how younger generations view and behave in terms of sex, sometimes leading to behaviors outside societal norms. That’s why education that helps people critically understand media messages about sex is so important. Addressing sexual health in older people means taking into account changes related to menopause, erectile function, chronic illness and emotional factors. Overall, dealing with these complexities requires open communication, understanding and personalizing interventions that recognize the diversity of human sexuality at different stages of life and in different circumstances.

    The COST Action ‘European Sexual Medicine Network’ (ESMN) was established to address sexual health issues through a collaborative platform for European experts and researchers. Focusing on standardizing practices, sharing resources and advocating for sexual health policies, ESMN prioritized the training of healthcare professionals to advance research and improve patient care. In this interview with Action Chair Dr Marianne Greil-Soyka of the Austrian Academy of Sexual Medicine, we discuss the impact of ESMN in breaking the silence, and why this is not just a choice but a societal necessity. 

    Collaborative triumphs and discoveries

    Dr Marianne Greil-Soyka explains that the Action has brought together medical professionals and social scientists specializing in sexual health through conferences, workshops and events, such as one at the University of Novi Sad in Serbia, which set the stage for innovative approaches to global health. These approaches, based on a deeper understanding of the mechanisms that influence sexual function and dysfunction, have the potential to develop diagnostic tools, therapies and treatments for sexual health disorders. The identification of markers of mitochondrial dynamics in peripheral blood mononuclear cells (PMBC) offers valuable insights, which will be tested in practice through bilateral collaboration between Turkey and Serbia. This collaboration aims to integrate medical expertise with social, psychological and cultural perspectives to provide a more comprehensive understanding of sexual health issues. The groundwork laid by the Psychophysiology Sex Research Group meeting has paved the way for future collaboration between medical and social scientists. One output of the ESMN was an educational animated video on ‘The Dual Control Model of Sexual Response’: The role of sexual inhibition and excitation in sexual arousal and behavior

    Advocating inclusivity and shaping policies

    The network’s fusion of medical and social scientists enables it to advocate for policies that address not only medical aspects but also the social and cultural factors that affect sexual health, well-being and pleasure, with the aim of better serving diverse populations. In particular, the Action has started a cooperation with WAS (World Association of Sexual Health) and its educational group to jointly reach the goal of establishing Sexual Medicine as its own subject.

    Marianne Greil-Soyka, now Austrian National Correspondent and Representative of the UNESCO Chair in Sexual Health and Human Rights, actively promotes the importance of sexual health and medicine for people of all ages, sexual identities and ethnicities. ESMN takes a proactive stance on inclusivity, with subgroups dedicated to disability and sexual health and LGBTQ+ issues, many of which are addressed in a video series on sexual health produced by the network. The network has played a key role in shaping policy to promote inclusivity in sexual health in many ways.

    Our next steps are ambitious, and we seek to lobby for the establishment of sexual medicine as a stand-alone discipline.”


    Dr Marianne Greil-Soyka, Chair of ESMN

    One achievement has been the creation and piloting of a comprehensive sexual health curriculum for undergraduate medical students and other health professionals.

    To make this resource more widely available, a mini-MOOC was created in collaboration with the UNESCO Chair on Sexual Health, using text, video, animation and cartoons to promote comprehensive sexuality education in 140 universities. The link to this MOOC will be distributed by the Action shortly.

    ESMN also launched the Open Research Europe Gateway ‘Sexual Health and Sexual Medicine’, a collection of Open Access articles on focusing on sexual health and on sexual medicine as an interdisciplinary science. It encourages the interplay between different disciplines, including medicine, psychology, biology, sociology, pedagogy, and other health sciences.

    Influencing clinical practice

    ESMN’s influence has extended into clinical practice, particularly in areas such as oncosexology, a subgroup within the ESMN, which aims to raise awareness of sexual issues in oncology care. It was important for the Action to address these issues to prevent the development of chronic sexual dysfunction, problems or concerns such as low sexual desire, difficulty becoming aroused, inability to achieve orgasm and body-image concerns. One outcome of this subgroup was an educational video.

    Nurturing young researchers

    According to the Action Chair, “the promotion of early career researchers has been central in the growth of ESMN.” To this end, a sub-group called the ‘Alliance of Early Career Researchers & Innovators in Sexual Health’ has been established, which cuts across all Working Groups. It promotes multidisciplinary and cross-country collaboration among early career researchers in sexual medicine and health. It also aims to increase inclusivity and sustainability in research and practice for young professionals. Young researchers and innovators were given a platform to share and disseminate their research. For example, Tomislav Mestrovic, a young researcher from Croatia, gave a keynote presentation at the Action’s final meeting in Ljubljana. Joke Dupont, a postgraduate researcher, worked with other ESMN members to complete a study entitled ‘Towards a Transnational Sexual Health Research and Policy Agenda: The ESMN Delphi Study’. The study has been published in the journal ‘Sexuality Research and Social Policy’. The ESMN Symposium in Salzburg allowed young researchers to present their research and posters to ESMN members and a wider audience through live streaming of the sessions. Additional funding was secured to provide generous financial awards to young researchers in recognition of high-quality research.

    Future horizons

    Looking to the future, ESMN intends to lobby for the establishment of sexual medicine as a stand-alone discipline. The network, poised to become a leading force in medicine, psychology and the social sciences, aims to define its uniqueness and continue its legacy beyond COST support, establishing Salzburg as a center for sexual medicine teaching, research and scholarship.

    “Our next steps are ambitious, and we seek to lobby for the establishment of sexual medicine as a stand-alone discipline,” concludes Marianne.

    Source:

    European Cooperation in Science and Technology (COST)

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  • Study shows long COVID’s hidden effect on women’s sex lives

    Study shows long COVID’s hidden effect on women’s sex lives

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    From work to school to socializing, COVID-19 has impacted just about every part of our lives-;and now Boston University research has shown that also includes what happens in the bedroom. A study of more than 2,000 cisgender women found the coronavirus disease can impair sexual function, with long COVID having an especially detrimental effect.

    If you’re sick with COVID, you’re probably less interested in sex and maybe your body is less prepared to have sex. But what might be surprising to some folks is that long COVID symptoms really may have a physiological and psychological impact on sexual well-being for women.”


    Amelia M. Stanton, BU College of Arts & Sciences assistant professor of psychological and brain sciences

    Although previous research has investigated the effect of the pandemic on peoples’ sex lives-;particularly in men-;Stanton says this is the first study to highlight long COVID’s fallout on sexual health in women. An expert on sexual and mental health, she helped lead the study with researchers from Middlebury College, McLean Hospital, and the University of Vermont. The findings were recently published in the Journal of Sexual Medicine.

    Long COVID and sexual dysfunction

    To figure out COVID’s impact on intimacy, Stanton and her colleagues conducted an online survey. Roughly half of the women taking part had reported never having had COVID, the rest said they’d tested positive. Participants were quizzed using the Female Sexual Function Index (FSFI), an established tool that measures factors like arousal and satisfaction with questions such as, “Over the past 4 weeks, how often did you feel sexual desire?” Only women who’d had sex in the previous month were included in the results.

    Among those who’d had COVID, levels of desire, arousal, lubrication, and satisfaction were all lower than in those who hadn’t; orgasm and pain scores weren’t significantly different between the two groups. But while women in the COVID group were still classed within the index’s functional range, participants with long COVID had “an average FSFI full scale score in the dysfunctional range,” according to the researchers. They found women with long COVID-;a broad condition with cognitive and physical symptoms that linger for weeks, sometimes months, after an initial infection-;had markedly worse arousal, lubrication, orgasm, and pain scores.

    “I hope it’s validating. If women type in ‘sex long COVID,’ something will come up now,” says Stanton, who is also a clinical health psychologist at The Fenway Institute, a Boston clinic focused on the health of sexual and gender minorities. “Sex, sexuality, and sexual function are still relatively taboo subjects. But this offers something patients can bring to their providers and say, ‘This is going on for me,’ and maybe create an open dialogue around sex.”

    In their paper, Stanton and her colleagues say the results suggest “that COVID-19 infection may be associated with impairment of both cognitive and physiological aspects of sexual function.” Just as the body and mind might take some time to get back to firing on all cylinders when it comes to work, study, and exercise, the same may apply to sex. They also speculate that wider societal changes caused by the pandemic may be a factor, with fewer social events and kids hanging around at home more reducing opportunities for shared or solo sexual activities.

    Talking about sex

    While a COVID infection might impact women’s sexual health, previous BU research has found vaccination does not cause infertility, reduce pregnancy chances, or have a significant impact on menstruation.

    “COVID-19 vaccination in either partner is unrelated to fertility among couples trying to conceive through intercourse,” Amelia Wesselink, an SPH research assistant professor of epidemiology, told The Brink in 2022 when discussing her study on vaccines and fertility. That same research did, however, find that men who’d tested positive for COVID within the past 60 days had reduced fertility.

    Stanton is the principal investigator of BU’s Sexual, Reproductive, and Mental Health Disparities Program-;an effort to explore sexual and mental health in minoritized and marginalized populations-;and says possible future routes for the latest project would be to expand the study’s sexual and gender minority diversity, talk to women for their qualitative experiences, and design tools to help providers better support their patients.

    “I’m an interventionist, so I always think about intervention design as a next step,” says Stanton. In other research, she’s working to develop new approaches clinicians can use to talk about sex with their patients, as well as studying how to improve sexual well-being and mental health in low-resource communities.

    “I always encourage providers to initiate conversations about sex,” says Stanton. “If they have someone who’s coming in for long COVID, maybe ask, ‘How are you doing sexually?’ Asking that one question could open the door for people to say, ‘You know, I’ve been ashamed to say that this is going on, and I really need help.’ Any way we can iterate to folks that there is hope and there are strategies-;your symptoms are meaningful and relevant, and they’re important to talk about.”

    Source:

    Journal reference:

    Seehuus, M., et al. (2023). The impact of COVID-19 and long COVID on sexual function in cisgender women. The Journal of Sexual Medicine. doi.org/10.1093/jsxmed/qdad155.

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