Sexually Transmitted Diseases

BACKGROUND: Syphilis in Florida increased 49% from 2016-2020. Moreover, many serological tests for syphilis (STS) do not indicate current infection. Traditionally, syphilis surveillance systems used reactor grids, a method for prioritizing STS for investigation based on age, non-treponemal titer, and/or sex. In 2022, Florida's STD surveillance system implemented an automated method for processing electronically reported STS (eSTS), expanding upon the reactor grid, using an individual's current STS (treponemal and non-treponemal), treatment history, and historical STS results aiming for more efficiently processing eSTS...

BACKGROUND: Previous studies have suggested that vitamin D may possess anti-infection properties, but the relationship between vitamin D and Trichomonas vaginalis infection remains unexplored. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES) between 2013-2016, we conducted multivariate regression analyses and subgroup analyses to investigate the association between 25(OH)D levels and Trichomonas vaginalis infection, ensuring the robustness of our results...

BACKGROUND: Many adolescents and young adults (AYA, 10-24 years old) are excluded from HIV research due to social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). METHODS: We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs...

BACKGROUND: Promptly recognizing mpox can facilitate earlier diagnosis and appropriate treatment. How accurately clinicians can diagnose mpox based on clinical data and before receiving molecular test results is not known. METHODS: Leveraging public health and clinical data collected in Seattle-King County's Sexual Health Clinic (SHC) from 7/29/22 to 9/30/22, we analyzed the proportion of patients who received presumptive vs results-based tecovirimat when clinicians had a high, intermediate or low suspicion for mpox after clinical evaluation...

BACKGROUND: Sexually transmitted infections (STIs) have a high incidence in the US Armed Forces and can adversely impact service members' ability to perform their duties. Better knowledge of Mycoplasma genitalium (MG) epidemiology in the military is needed to understand the potential impact of this emerging pathogen on force readiness. METHODS: We conducted cross-sectional analyses of data from US Army service members and other Military Health System beneficiaries participating in a trial of an STI/HIV behavioral intervention at Fort Liberty, NC and Joint Base Lewis-McChord, WA...

BACKGROUND: Before the early 2000s, the sexually transmitted infection lymphogranuloma venereum (LGV) was rare in high-income countries. Initially, most cases in these countries were among symptomatic men who have sex with men (MSM) living with HIV. In the context of widespread HIV pre-exposure prophylaxis (PrEP), LGV's epidemiology may be changing. We aim to characterize the epidemiology and clinical presentation of LGV in the PrEP era. METHODS: A retrospective chart review was performed on all LGV cases occurring between 11/2004-10/2022 in British Columbia (BC), Canada...

We conducted a retrospective cohort study of PrEP patients at the municipal Sexual Health Clinic in Seattle-King County, Washington from 2019-2021 to determine whether monthly check-in text messages impacted 4- and 6-month PrEP retention. Monthly check-ins did not appear to improve retention above and beyond open-ended texting and appointment reminders.

BACKGROUND: How often mpox causes asymptomatic infections, particularly among persons who have received the Modified Vaccinia Ankara (MVA) vaccine, is unknown. METHODS: We performed mpox PCR testing on rectal and pharyngeal specimens collected from symptomatic and asymptomatic patients at a sexual health clinic in Seattle, WA, USA between May 2022 and May 2023. Analyses evaluated the prevalence of asymptomatic or subclinical infection and, among persons with PCR positive tests, the association of MVA vaccination status with the symptomatic infection...

BACKGROUND: Reproductive age females comprise the fastest growing segment of Veterans Health Administration patients, but little is known about rates of reproductive health outcomes among those with chlamydia or gonorrhea infections. Our aim was to estimate the risk of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain in female Veterans tested for chlamydia or gonorrhea. METHODS: We performed a retrospective cohort analysis of female Veterans tested for chlamydia or gonorrhea between January 1, 2010 and December 31, 2020...

Rates of STIs in the United States including chlamydia and gonorrhea are rising. Point-of-care (POC) testing could increase access to testing and treatment. This evaluation found POC STI testing to be concordant with the results of traditional laboratory testing for 100% of patients who were tested. Ninety-five percent of patient reported being satisfied with the experience, and 66% preferred it to traditional laboratory testing. The most commonly reported reason for preferring the test was the short amount of time it took to receive results...

BACKGROUND: In 2021, national Chlamydia trachomatis (CT) treatment guidelines changed from recommending either azithromycin (1 gram; single dose) or doxycycline (100 mg twice daily for 7 days) to recommending only doxycycline as first-line treatment. The distribution and trends in CT prescribing practices prior to the guidelines change is largely unknown. METHODS: We conducted a trends analysis using Washington STD surveillance data. We included all female cases of urogenital CT aged >15 years who resided in King County and were diagnosed between 2010 and 2018...

BACKGROUND: The COVID-19 pandemic impacted sexual behaviors and the HIV continuum-of-care in the United States, reducing HIV testing and diagnosis, and use of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART). We aim to understand the future implications of these effects through a modeling study. METHODS: We first ran our compartmental model of HIV transmission in the US accounting for pandemic-related short-term changes in transmission behavior and HIV prevention and care provision in 2020-2021 only...

BACKGROUND: Syphilis and congenital syphilis rates have increased sharply in Colorado in the past 5 years. Congenital syphilis is passed during pregnancy in utero and can cause lifelong physical, developmental, and neurologic problems for the child, or can lead to miscarriage, stillbirth, or early infant death. Congenital syphilis is easily prevented if the mother receives timely testing, treatment, and prenatal care. Providers can play a key role in preventing congenital syphilis for women with social vulnerabilities, who have a higher likelihood of syphilis and/or congenital syphilis infection...

We present a case of recurrent, cutaneous mpox with co-infection of disseminated varicella zoster in an immunocompromised patient with poorly controlled HIV. This case demonstrates the importance of maintaining a high index of suspicion for mpox despite prior infection and vaccination, as suboptimal immune response is possible in immunocompromised patients, and also noting the potential for co-infection necessitating timely diagnosis and appropriate testing.

BACKGROUND: Adolescents and young adults (AYA) face significant barriers to screening, testing and treatment for sexually transmitted infections (STIs). Expedited partner therapy (EPT) streamlines partner treatment for STIs but use among adolescents is low. We aimed to increase EPT offering and provision at two adolescent medicine clinics (AMC) and the emergency department (ED) in an urban children's hospital. We addressed barriers at provider, pharmacy, and patient levels. We compared EPT offering and provision for chlamydia (CT) and trichomonas (TV) infection at baseline, and across two intervention cycles...

BACKGROUND: Syphilis incidence is increasing among reproductive-aged women, and previous sexually transmitted infections (STIs) are a risk factor for subsequent STIs. This study aimed to determine syphilis incidence following a chlamydia, gonorrhea, or HIV diagnosis, and identify characteristics associated with higher syphilis incidence rates among reproductive-aged women in one mid-Atlantic city. METHODS: A retrospective cohort of 85,113 chlamydia, gonorrhea, and HIV diagnoses occurring between 2009-2021 and among women ages 13-50 was constructed using public health surveillance data...

BACKGROUND: Prostate-specific antigen (PSA), a biomarker of vaginal semen exposure, is less susceptible to bias than self-reported condom use behaviors. We examined the agreement of self-reported recent condomless sex (RCS) within couples and how these reports related to PSA detection. METHODS: We analyzed data from a study conducted in Vietnam, 2017-2020, of 500 different-sex couples using condoms, and no other contraceptive method, to prevent pregnancy for six months...

BACKGROUND: Partner notification and treatment for sexually transmitted infections is critical to prevent reinfection and reduce transmission. However, partner treatment rates are low globally. Expedited Partner Therapy (EPT), in which the patient delivers treatment directly to their partner, may result in more partners treated. We assessed partner notification and treatment outcomes among pregnant women in Gaborone, Botswana, including EPT intent, uptake, and effectiveness. METHODS: The Maduo study was a cluster-controlled trial evaluating the effect of antenatal C...

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the two most common sexually transmitted infections in the United States (US). The Centers for Disease Control and Prevention (CDC) regularly publishes and updates Sexually Transmitted Infection (STI) Treatment Guidelines. The purpose of this study is to measure and compare treatment rates for CT and GC among public and private providers. METHODS: Data from multiple sources, including electronic health records (EHRs) and Medicaid claims, were linked and integrated...

BACKGROUND: HIV testing for Thai MSM is suboptimal, which undermines their linkage to care and subsequent HIV preexposure prophylaxis (PrEP) uptake. METHODS: We analyzed a cross-sectional survey conducted in 2021 among Thai MSM who attended any private sex parties or circuit parties in the past 3 years ("sexualized parties"). RESULTS: Of the 424 men included in our analysis, 47.6% had been recently tested for HIV in the past 1 year, 30.2% had not recently been tested, and 22...