Current News about Sexually Transmitted Disease

Objectives Women who report sex with women are thought to have a lower risk of Chlamydia trachomatis (CT) infection than women who report sex with men only (WSM-only), but comparisons of lifetime burden are limited. Methods Among 1418 sexually experienced women aged 18 to 39 years participating in the National Health and Nutrition Examination Survey (2013–2016), we estimated weighted CT seroprevalence and Wald-based 95% confidence intervals (CIs) in women who reported ever having sex with a woman (all reported having sex with men also) (WSWM) compared with WSM-only. We defined seropositivity as detection of Pgp3 antibodies and used stratified Poisson regression with robust standard errors to estimate prevalence ratios (PRs). Results More than half (58.3%) were White non-Hispanic; 16.2% were WSWM. Women who had sex with women and men were somewhat younger (mean, 27.8 vs. 29.0 years; P = 0.07), were younger at sexual debut (mean, 15.6 vs. 17.5 years; P < 0.001), and had more lifetime male sexual partners (mean, 15.9 vs. 6.4; P < 0.001) than WSM-only. Weighted CT seroprevalence was 38.9% (95% CI, 30.4%–47.4%) in WSWM and 28.6% (95% CI, 24.4%–32.9%) in WSM-only. Correlates of higher CT seroprevalence in both groups were Black non-Hispanic race/ethnicity, Hispanic ethnicity, and CT infection in the prior year. Having ≥5 lifetime male partners compared with 1 to 2 partners was associated with higher seroprevalence among WSWM (PR, 4.5; 95% CI, 1.77–11.44) and WSM-only (PR, 2.7; 95% CI, 1.87–3.69). Among WSWM, bisexual identity was associated with lower seroprevalence. Among WSM-only, low income and younger age at sexual debut were associated with higher seroprevalence. Conclusion Lifetime CT burden was higher in WSWM than WSM-only. Number of lifetime male partners was the strongest predictor of seropositivity for WSWM. 12/24/2024 01:00 AM
 

Background Infection with Chlamydia trachomatis (CT) can have distinct clinical presentations, such as trachoma, or lymphogranuloma venereum (LGV). Certain populations are at greater risk for LGV acquisition and transmission, which may require a longer duration of therapy than other urogenital CT sexually transmitted infections (STIs). Commercial assays are not available in the United States to distinguish LGV from non-LGV genovars. Methods Lymphogranuloma venereum real-time polymerase chain reaction was performed on rectal CT-positive samples (N = 93) obtained from men (N = 80) who ordered from a mail-in self-collection STI service between April 2021 and February 2024. pmpH gene sequencing was performed on all samples to confirm LGV versus non-LGV, and multilocus sequence typing was performed on LGV-positive samples (n = 7) for additional confirmation. Results Lymphogranuloma venereum was detected in 7.5% (7 of 93) of samples by real-time polymerase chain reaction, with pmpH sequencing and multilocus sequence typing confirming 100% (7 of 7) of these results. Overall, pmpH sequencing data were obtained for 92% (86 of 93) of samples with the following genovar distribution based on BLAST analysis: 54% (47 of 86) J, 28% (24 of 86) F, 9% (8 of 86) E, and 8% (7 of 86) L. No individual had more than 1 LGV-positive sample. No statistically significant associations with demographic factors were identified. Conclusions Lymphogranuloma venereum was detected in CT-positive rectal swabs from users of an online, mail-in, self-collect STI testing platform in Maryland. These data suggest that increased LGV reflexive testing may be warranted to better understand the cotemporary epidemiology of LGV. These data also illustrate that mail-in programs for routine STI testing may be leveraged for public health surveillance purposes. 12/24/2024 01:00 AM
 

Background Pelvic inflammatory disease (PID) disproportionately impacts adolescents and young adult women. The Technology-Enhanced Community Health Nursing (TECH-N) trial demonstrated the potential benefit of a novel community health intervention for adolescents with PID. We assess the cost-effectiveness of TECH-N compared with standard care. Methods We constructed a cohort Markov model to assess the cost-effectiveness of TECH-N for adolescents with PID in an urban setting. The model used nine health states: PID; two states for STIs; four states for PID sequelae, recovery, and deceased states. The cohort consisted of 18-year-old female adolescents with mild to moderate PID. Transition probabilities were derived from the TECH-N clinical trial and published literature. Health state utilities were derived from published literature. Intervention costs were estimated using TECH-N data, and health state costs were derived from published literature and public databases. The model took a health system perspective over a 10-year time horizon. Sensitivity analyses were used to assess uncertainty. Cost-effectiveness was estimated using the discounted incremental cost-effectiveness ratio with effects measured in quality-adjusted life years (QALYs). Results Over ten years, the TECH-N cohort generated 8.16 QALYs per individual at a cost of $20,419 compared with standard care with 8.14 QALYs costing $20,492. The resulting incremental cost-effectiveness ratio was negative since the intervention produced more QALYs at a lower cost; suggesting TECH-N is cost-saving. Conclusions Our model suggests the TECH-N intervention yields better outcomes at lower overall costs. In addition, the nature of TECH-N lends itself to being coupled with other home-health/community strategies, which could further improve its value proposition. 02/20/2025 01:00 AM
 

Background Identify opportunities to improve syphilis screening by describing changes in patient characteristics and risk factors among individuals with syphilis and by comparing cases with and without an indication for syphilis screening. Methods This retrospective cohort study used Colorado public health surveillance data to identify 8326 syphilis diagnoses from 2011 to 2020. Demographics, clinical characteristics, and risk factors were compared across 2-year groups and between individuals with and without an indication for screening. Indications for screening were based on national guidelines and included men who have sex with men, persons living with HIV, pregnant individuals, those who test positive for chlamydia, gonorrhea, or HIV, and partners of those who test positive for syphilis. Results Across study years, there was a 234% increase in the proportion of syphilis cases that were females (5.3% to 17.7%; P < 0.01), a 78% increase in the proportion of cases living in rural areas (3.6% to 6.4%; P < 0.01), and a 15% increase in the proportion of cases among non-White individuals (47.9% to 54.9%; P < 0.01). The proportion of patients that had a guideline-recommended indication for screening decreased from 88% in 2011 to 2012 to 59% in 2019 to 2020 (P < 0.01). Females represented 5.5% of cases with an indication for screening and 29.8% of cases without an indication for screening (P < 0.01). Conclusions Syphilis cases increased annually from 2011 to 2020 yet the proportion of cases detected under current screening recommendations decreased. These findings reveal opportunities to expand syphilis screening. 12/24/2024 01:00 AM
 

Background Adult and congenital syphilis rates are rising in the United States. The aim of this pre- and post-implementation study was to determine whether implementation of an opt-out laboratory-based and rapid syphilis point-of-care testing program in the emergency department (ED) improves the detection and treatment of syphilis during pregnancy in a high-prevalence region. Methods This pre- and post-implementation study was conducted at the University of Texas Health Science Center, Houston, TX. During the pre-implementation phase (November 1, 2023–February 29, 2024), pregnant patients presenting to the ED underwent laboratory-based syphilis testing using the reverse algorithm only when clinically indicated. In the post-implementation phase (March 1, 2024–June 25, 2024), pregnant patients without prenatal care or with no documented syphilis result underwent opt-out syphilis testing using the Syphilis Health Check point-of-care test and the laboratory-based reverse syphilis testing algorithm. Patients with positive syphilis test results were treated by providers. All results were confirmed with the laboratory-based test, and patient follow-up was scheduled. Results During the pre-implementation period, 302 pregnant patients presented to the ED, and only 6 (2%) underwent syphilis laboratory-based testing, none of which yielded positive results. In the post-implementation period, 322 pregnant patients presented to the ED and 202 (62.7%) were approached. Of these, 114 (56.4%) were tested using either the Syphilis Health Check or laboratory-based reverse algorithm (P < 0.001). Four patients tested positive for syphilis, indicating a prevalence of 3.5%. Conclusions An opt-out and rapid syphilis testing program for pregnant individuals visiting the ED increased syphilis screening from 2% to 56.4%, and detected syphilis that might have otherwise been missed. 12/24/2024 01:00 AM
 

Background Free-text notes in disease intervention specialist (DIS) records may contain relevant information for sexual transmitted infection control. In their current form, the notes are not analyzable without manual reading, which is labor-intensive and prone to error. Methods We used natural language processing methods to analyze 2019 Ohio DIS syphilis records with nonmissing notes (n = 1987). We identified 21 topics relevant for transmission and case investigations. We manually coded these records to create “gold standard” labels for each topic (0 = topic not present, 1 = topic present), then trained machine learning models to identify the topics in the text. For models to analyze text data, the text must be converted to numbers. We explored 2 approaches to numerically represent words: (1) term frequency, inverse document frequency, which measures importance of words based on how many times they appear in a record and in the dataset as a whole, and (2) GloVe embeddings, which are numerical vectors that were developed by researchers for each word in the English language to encode its semantic meaning. We explored 3 types of statistical models (naive Bayes, support vector machine, and logistic regression) using term frequency, inverse document frequency, and 1 type of neural network model (long short-term memory [LSTM] model) using GloVe. All models were used for binary prediction (i.e., topic not present, topic present). Results For most topics, the LSTM model performed the best overall in identifying topics, and the support vector machine model performed the best among the statistical models. For example, the LSTM model predicted the topic “substance use” with high accuracy (97%), sensitivity (92%), and specificity (98%). No model performed well for uncommon topics (e.g., “alcohol use” or “delays in care”). Conclusions Machine learning models performed well in identifying some topics in 2019 Ohio syphilis records. This analysis is a first step in applying natural language processing methods to making DIS notes more accessible for analysis. 02/11/2025 01:00 AM
 

Background Increased incidence of bacterial sexually transmitted infections including chlamydia, gonorrhea, and syphilis dictates the need for novel prevention strategies. One such strategy, doxycycline prescribed prophylactically, has proven to be effective at reducing transmission among men who have sex with men and transgender women. We assessed awareness, attitudes, and interest in doxycycline preexposure/postexposure prophylaxis (doxyPrEP/doxyPEP) among New York City sexual health clinic patients, including men who have sex with men, other cisgender men, women, transgender persons, and patients identifying as gender nonconforming or nonbinary. Methods A self-administered survey was completed by 280 patients from 5 New York City sexual health clinics between June and August 2023 that collected information assessing their knowledge, concerns, and willingness to use doxyPrEP and doxyPEP. We used Poisson regression models to examine factors associated with willingness to use doxyPEP. Results Of the 280 patients, 73% (205) and 55% (153) reported that they would take doxyPEP and doxyPrEP, respectively, if offered by their provider. Willingness to use doxyPEP was observed across gender groups and significantly associated with history or current use of HIV preexposure prophylaxis (adjusted risk ratio [aRR], 1.17; 95% confidence interval [CI], 1.07–1.27). Compared with non-Hispanic White participants, Hispanic (aRR, 1.27; 95% CI, 1.07–1.52) and non-Hispanic other (Alaskan Native, American Indian, Native Hawaiian, Pacific Islander, multiracial) group (aRR, 1.28; 95% CI, 1.06–1.56) participants were more likely to report willingness to use doxyPEP. Possible antibiotic resistance was of highest concern. Conclusions If offered by a provider, doxyPEP would likely be accepted by patients of all gender groups. Additional research on acceptability in other settings would help guide widespread implementation. 02/17/2025 01:00 AM
 

Background In 2023, Washington state Medicaid eliminated prior authorizations (PAs) for antiretrovirals (ARVs). We estimated the budget impact of this policy change on Medicaid ARV expenditures, 2023 to 2027. Methods Models used 2022 net drug costs reflecting costs minus rebates. Our base case preexposure prophylaxis (PrEP) model assumed changes in the proportions of PrEP users on tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), tenofovir alafenamide/emtricitabine (TAF/FTC), and cabotegravir (CAB) based on 2021–2022 data (before elimination of PAs). We compared base case costs to models assuming changes in PrEP prescribing observed in 2022 to 2023 (first year after elimination of PAs) and models assuming an accelerated increase in TAF/FTC and CAB use. For HIV treatment, models assuming ARV changes based on 2021 to 2022 data (Base Model), changes based on data from 2022 to 2023 (No PA—Stable Increase), and a model based on 2022 to 2023 data but with a declining rate of change in the adoption of bictegravir/TAF/FTC and CAB/rilpivirine (No PA—Declining Increase). We estimated the number of persons with HIV who might be housed using money required to meet new ARV costs using 2023 local Ryan White Program costs for emergency or temporary housing. Results Elimination of PAs will increase Medicaid expenditures for ARVs by an estimated $109.9 to $157.7 million over 5 years. This cost would pay for 5 years of housing for approximately 820 to 1177 people, or 61% to 88% of unstably housed persons with HIV in Washington state. Conclusions Elimination of Medicaid PAs will result in substantial new costs. Changes in drug formulary policy should consider opportunity costs. 02/11/2025 01:00 AM