Current News about Sexually Transmitted Disease

Background Doxycycline post-exposure prophylaxis (doxy-PEP) reduces chlamydia, gonorrhea, and syphilis infections among men who have sex with men (MSM) and transwomen (TW). Perspectives of health care providers (HCPs) regarding doxy-PEP can inform implementation efforts. Methods From August 2022 to January 2023, HCPs were recruited from 13 cities with high sexually transmitted infection (STI) rates for semi-structured, in-depth interviews about their awareness of and attitudes toward doxy-PEP for STI prevention. Health care providers were purposively sampled to include people with experience prescribing PrEP and provision of care to MSM. Interviews were conducted virtually via Zoom. Transcripts and debrief reports were analyzed using a directed content analysis approach to explore knowledge, attitudes, and beliefs about doxy-PEP. Results Among 30 HCPs, almost half (47%) were between 31–40 years of age, 53% identified as male, and 47% reported their sexual orientation as gay or queer. Half (53%) of participants practiced in the South, 43% had >100 MSM in their clinic panel, and 17% had previously prescribed doxy-PEP. We identified four overarching themes: 1) HCPs expressed positive attitudes toward doxy-PEP; 2) antimicrobial resistance concerns limit enthusiasm for some HCPs; 3) additional data about the long-term safety of doxy-PEP would improve their confidence; and 4) development of guidelines would facilitate the prescription of doxy-PEP, including eligibility, dosing instructions, and treatment management. Conclusion HCPs were motivated to prescribe doxy-PEP with almost 20% already having prescribed it. Guidelines and data about long-term safety, especially antimicrobial resistance, would facilitate introduction of doxy-PEP into clinical practice. 10/31/2024 01:00 AM
 

Background The incidence of syphilis among cisgender women and heterosexual men in the United States has risen sharply. Public Health – Seattle & King County implemented a voluntary, opt-in syphilis screening program in a jail to reach disproportionately affected populations outside the health care system. Methods Public Health – Seattle & King County disease intervention specialists conducted syphilis screening 4 days per week in a regional jail. All persons screened January 2022 to March 2023 were included in the analysis. Disease intervention specialists performed point-of-care treponemal-specific tests, collected demographic and risk factor data, worked with jail medical providers to coordinate empiric treatment and confirmatory testing, and determined syphilis history and stage. We categorized persons with reactive rapid tests as “confirmed,” “presumed,” “possible,” or “not new” cases based on confirmatory testing and syphilis history. We compared the characteristics of confirmed cases to overall King County syphilis cases using χ2 tests and examined treatment completion by diagnosis category. Results A total of 1371 persons completed screening; 69 (5.0%) had positive results, of whom 51 (73.9%) had confirmatory testing, and 33 had confirmed infections (2.4% of screened persons). Compared with all King County syphilis cases, confirmed cases were more likely to be cisgender women (30.3% vs. 21.9%) or cisgender heterosexual men (66.7% vs. 20.6%), people living homeless (66.7% vs. 24.3%), or people who use methamphetamine (90.9% vs. 20.3%; P < 0.001 for all comparisons). Among 33 persons with confirmed syphilis, 29 (87.8%) started and 18 (54.5%) completed treatment. Conclusions Jail screening reached persons at disproportionate risk for syphilis, but treatment was often incomplete. 11/27/2024 01:00 AM
 

No abstract available 11/25/2024 01:00 AM
 

Background Developments in natural language processing and unsupervised machine learning methodologies (e.g., clustering) have given researchers new tools to analyze both structured and unstructured health data. We applied these methods to 2019 Ohio disease intervention specialist (DIS) syphilis records, to determine whether these methods can uncover novel patterns of co-occurrence of individual characteristics, risk factors, and clinical characteristics of syphilis that are not yet reported in the literature. Methods The 2019 disease intervention specialist syphilis records (n = 1996) contain both structured data (categorical and numerical variables) and unstructured notes. In the structured data, we examined case demographics, syphilis risk factors, and clinical characteristics of syphilis. For the unstructured text, we applied TF-IDF (term frequency multiplied by inverse document frequency) weights, a common way to convert text into numerical representations. We performed agglomerative clustering with cosine similarity using the CLUTO software. Results The cluster analysis yielded 6 clusters of syphilis cases based on patterns in the structured and unstructured data. The average internal similarities were much higher than the average external similarities, indicating that the clusters were well formed. The factors underlying 3 of the clusters related to patterns of missing data. The factors underlying the other 3 clusters were sexual behaviors and partnerships. Notably, 1 of the 3 consisted of individuals who reported oral sex with male or anonymous partners while intoxicated, and one comprised mainly of males who have sex with females. Conclusions Our analysis resulted in clusters that were well formed mathematically, but did not reveal novel epidemiological information about syphilis risk factors or transmission that were not already known. 10/31/2024 01:00 AM
 

Background Ensuring patients receive appropriate (Centers for Disease Control and Prevention–recommended) and prompt (≤14 days of specimen collection) treatment is critical to decrease gonorrhea and early syphilis (ES) incidence. The objectives were to (1) quantify treatment performance among community health care providers (CHPs), (2) compare CHP treatment performance to local health department goals, and (3) describe variation in treatment performance by CHP characteristics in Baltimore City, Maryland. Methods Surveillance data for gonorrhea and ES diagnoses reported between January 2018 and December 2019 were used. Treatment performance measures were calculated for each CHP (gonorrhea: 171 CHPs; ES: 122 CHPs). Measures were (1) percent treated among all diagnoses (goal: ≥90%), (2) percent appropriately treated among diagnoses treated (goal: ≥90% gonorrhea, ≥95% ES), and (3) percent promptly treated among diagnoses appropriately treated (goal: ≥85%). Treatment performance measures and achievement of goals were compared across CHP characteristics. Results For gonorrhea, median percent treated, appropriately treated, and promptly treated were 71.4%, 95.0%, and 100.0%, respectively; 29.8% met treated goals. The majority achieved appropriately treated (62.9%) and promptly treated (76.8%) goals. Community health care practices reporting high (vs. low) volume of gonorrhea diagnoses less frequently achieved percent-treated goals (12.2% vs. 35.4%, P = 0.008). Median value for all ES treatment performance measures was 100.0%. Most achieved treated (90.2%) and appropriately treated (95.9%) goals. Less than half (49.2%) achieved the promptly treated goal. Community health care practices reporting high (vs. low) volumes of ES less frequently achieved promptly treated goals (33.3% vs. 54.4%, P = 0.045). Conclusions Substantial gaps in reporting gonorrhea treatment and prompt ES treatment were observed. Practice-level interventions to facilitate reporting gonorrhea treatment and provide prompt ES treatment are needed. 11/07/2024 01:00 AM
 

Background The 2030 United Nations Agenda for Sustainable Development includes targets to end sexually transmitted infections (STIs) as a major public health threat. Prevalence data of STIs to inform strategies toward this goal are lacking in middle- and low-income countries, especially among men. Methods Data from Seroprevalence and Behavioral Epidemiology Risk Surveys conducted among militaries in Cameroon, Chad, Democratic Republic of the Congo (DRC), Ethiopia, Liberia, Malawi, Republic of the Congo, and Sierra Leone during 2013–2018 were used to estimate the prevalence of presumed active syphilis among active-duty military men. Associations of active syphilis infection with age, education, marital status, and rank for each country were assessed. Results The prevalence of active syphilis was less than 1% among men in Cameroon (2018), Ethiopia (2018), Liberia (2018), Malawi (2013), Republic of the Congo (2014), and Sierra Leone (2013). In Chad (2014), 6.2% (95% confidence interval, 5.2%–7.4%; n = 121/1949) of men tested positive for active syphilis. In DRC (2014), the prevalence of active syphilis was 15.5% (95% confidence interval, 14.1%–16.9%; n = 404/2611) among men. Active syphilis was associated with older age in DRC (P < 0.01), with less education in Chad (P = 0.03) and DRC (P < 0.01), and with rank in DRC (P = 0.048). Conclusions These data help address a paucity of information on prevalence of STIs in sub-Saharan Africa and demonstrate the need for improved surveillance among men. 11/08/2024 01:00 AM
 

Introduction Lymphogranuloma venereum (LGV) caused by L-serovars of Chlamydia trachomatis (CT) is a sexually transmitted infection (STI) causing asymptomatic infection, and anogenital disease. Epidemiologically, LGV has been strongly associated with human immunodeficiency virus (HIV) infection. Methods Using a retrospective longitudinal study design, we first described unadjusted and adjusted associations between demographic and sociobehavioral characteristics and rectal (r) CT (rCT) and rLGV in sexual health clinic attendees in Baltimore, MD, between 2009 and 2016 at baseline visits. Rectal samples that tested positive for CT with the Aptima AC2 assay underwent DNA extraction and in-house L-serovar PCR analysis. Then, patients were followed over 24 months and incident STIs were described using multivariable Cox-proportional hazard regression models. Results In 292/391 (73.4%) patients who were male-assigned at birth (MAB), LGV prevalence was 20/292 (6.8% (95% confidence interval, 4.2%–10.4%)). In the final multivariable regression model, LGV was significantly associated with age greater than 25 years, transgender identity, and a history of syphilis. Baseline LGV was not associated with incident HIV or gonorrhea, but after adjusting for age, race, HIV status, and history of syphilis, LGV was marginally associated with a new syphilis diagnosis (hazard ratio 2.35 (95% confidence interval, 0.96–5.73), P = 0.06) over 24 months follow-up. Conclusion Lymphogranuloma venereum accounted for almost 7% of rCT in patients MAB attending sexual health clinics in Baltimore between 2009 and 2016. Lymphogranuloma venereum was not associated with prevalent or incident HIV as in other studies. FDA-cleared tests and better surveillance measures are required to understand changes in the epidemiology of LGV in the United States. 03/01/2025 01:00 AM
 

Introduction Follow-up testing is recommended 3 months after patients initially test positive with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Follow-up testing adherence in the United States has been reported below one-third of women, even in universally insured populations. We assessed both the positivity of CT and GC infections in female basic military trainees and the rates of follow-up testing for those who tested positive. Methods Between January 1, 2006, and December 31, 2021, female Air Force Basic Military Trainees were universally screened with urinary nucleic acid amplification testing for CT and GC. Those who tested positive were evaluated to determine demographic information as well as follow-up testing rates. Patients who were evaluated with a repeat CT/GC nucleic acid amplification test within 12 months after a positive CT/GC test result were considered to have received appropriate follow-up. Results A total of 5022 (5.2%) of 97,168 trainees tested positive for only CT (4749 [4.8%]), only GC (138 [0.1%]), or both CT/GC (135 [0.1%]) during the study period. Those at increased risk of infection were those <24 years of age, Hispanic and Black individuals, those with high school education level, and single women. Of the 4687 still in the military at 3 months after diagnosis, 3268 (69.7%) had repeat testing within 12 months. There was no significant difference in follow-up testing by age, race, educational level, marital status, or organism causing original infection. Conclusions Follow-up testing among female United States Air Force basic military trainees is higher than in other universally insured populations. This study demonstrates remaining barriers to adherence to recommended guidelines. 11/07/2024 01:00 AM