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Htet KZ, Lindrose AR, O'Connell S, Marsh J, Kissinger P. The burden of chlamydia, gonorrhea, and syphilis in older adults in the United States: A systematic review. Int J STD AIDS 2023; 34:288-298. [PMID: 36626249 DOI: 10.1177/09564624221149770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Increases in life expectancy, the availability of sexual performance enhancing medication, and changes in sexual partnering suggest that sexually transmitted infections (STIs) among older persons could be on the rise, yet there have been relatively few studies examining STIs in this demographic. Our systematic review aimed to further characterize the incidence and prevalence of chlamydia, gonorrhea, and syphilis, along with associated risk factors among older adults (45 years or older) in the United States. METHODS We searched five electronic databases (PubMed, Embase, Cinahl, Web of Science, and Global Health) for data published from inception to January 2021. The retrieved articles were screened based on eligibility criteria, and subsequent review of relevant article bibliographies was conducted. RESULTS Of 4748 articles identified, 23 studies met our inclusion criteria and one additional article was identified through bibliography review. Of the 23 included articles, only 3 (11.5%) were focused exclusively on evaluating STIs in an older population. We found prevalence to be the following ranges: syphilis (0-18%), chlamydia (0-14.2%) and gonorrhea (0-15%). Few studies specifically investigated risk factors in this demographic. CONCLUSIONS The understudied burden of STIs in the older adult population substantiates the need to recognize issues surrounding sexuality in this demographic.
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Affiliation(s)
- Kyaw Zin Htet
- 12255Tulane University - School of Medicine, 2339 Saint Thomas St New Orleans LA 70112-2632, US
| | - Alyssa R Lindrose
- 25812Tulane University - School of Public Health and Tropical Medicine, New Orleans, LA US
| | - Samantha O'Connell
- 25812Tulane University - School of Public Health and Tropical Medicine, New Orleans, LA US
| | - James Marsh
- 12255Tulane University - School of Medicine, 2339 Saint Thomas St New Orleans LA 70112-2632, US
| | - Patricia Kissinger
- 25812Tulane University - School of Public Health and Tropical Medicine, New Orleans, LA US
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2
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Yabes J, Lamb CC, Hakre S, Scott PT, Mika W, Okulicz JF. Provider uptake of extragenital screening for gonorrhea and chlamydia in a cohort of Air Force members with incident HIV diagnosis. Medicine (Baltimore) 2022; 101:e31209. [PMID: 36281093 PMCID: PMC9592302 DOI: 10.1097/md.0000000000031209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. Although national guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. All USAF members with incident HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016 to 2018 (n = 98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Patients were predominantly male (98%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis. A previous history of STIs was reported in 53 (54%) patients and the majority of males self-identified as MSM (66%) or bisexual (23%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62%) patients. EG-STI screening was conducted in 3 (3%) patients overall and in (3%) MSM/bisexuals. A total of 31 (32%) patients had missed STIs; the majority due to EG-STIs of the rectum (59%) and pharynx (19%). All EG-STIs would have been missed by urethral GC/CT screening alone. EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored.
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Affiliation(s)
- Joseph Yabes
- Infectious Disease Service, Brooke Army Medical Center, San Antonio, TX, USA
- *Correspondence: Joseph Yabes, Infectious Disease Service, Brooke Army Medical Center, San Antonio, TX, USA (e-mail: )
| | - Christian C. Lamb
- Department of Internal Medicine, Brooke Army Medical Center, JBSA, San Antonio, TX, USA
| | - Shilpa Hakre
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Paul T. Scott
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Walter Mika
- Infectious Disease Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Jason F. Okulicz
- Infectious Disease Service, Brooke Army Medical Center, San Antonio, TX, USA
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3
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Geba M, Powers S, Williams B, Dort KR, Rogawski McQuade ET, McManus KA. A Missed Opportunity: Extragenital Screening for Gonorrhea and Chlamydia Sexually Transmitted Infections in People with HIV in a Southeastern Ryan White HIV/AIDS Program Clinic Setting. Open Forum Infect Dis 2022; 9:ofac322. [PMID: 35899288 PMCID: PMC9310267 DOI: 10.1093/ofid/ofac322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines recommend annual screening for gonorrhea/chlamydia in sexually active people with HIV at multiple sites (urogenital, oropharyngeal, rectal). In the first year of multisite screening at our Ryan White HIV/AIDS Program clinic, we studied (1) sexual history documentation rate, (2) sexually transmitted infection (STI) screening rate, (3) characteristics associated with STIs, (4) the percentage of extragenital STIs that would have been missed without multisite screening.
Methods
Participants were ≥14 years old with ≥1 in-person medical visit at our clinic in 2019. Descriptive analyses were performed, and adjusting for number of sites tested, a log-binomial model was used to estimate the association between characteristics and STI diagnosis in men.
Results
In this cohort (n = 857), 21% had no sexual history recorded. Almost all STI diagnoses were among males (99.3%). 68% (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate oropharyngeal testing, and 69% (72/105) received appropriate rectal testing. In male participants with ≥1 STI test (n = 347), Hispanic ethnicity and detectable HIV viral load were associated with an STI diagnosis. Of those diagnosed with an STI who had multisite testing, 96% (n = 25/26) were positive only at an extragenital site.
Conclusions
Screening rates were similar across all anatomical sites indicating no obvious bias against extragenital testing. In males, STIs were more frequently diagnosed in people who identify as Hispanic and those with detectable viral loads which may indicate more condomless sex in these populations. Based on infections detected exclusively at extragenital sites, our clinic likely underdiagnosed STIs prior to implementation of multisite screening.
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Affiliation(s)
- Maria Geba
- Department of Medicine, University of Virginia , Charlottesville, VA , USA
| | - Samuel Powers
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
| | - Brooke Williams
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
| | - Kathryn R Dort
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
| | - Elizabeth T Rogawski McQuade
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
- Public Health Sciences, University of Virginia , Charlottesville, VA , USA
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
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4
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Menza TW, Berry SA, Dombrowski J, Cachay E, Crane HM, Kitahata MM, Mayer KH. Anatomic site-specific gonorrhea and chlamydia testing and incidence among people with HIV engaged in care at four United States clinical centers, 2014-2018. Open Forum Infect Dis 2022; 9:ofac298. [PMID: 35873303 PMCID: PMC9301651 DOI: 10.1093/ofid/ofac298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022] Open
Abstract
ABSTRACT
Background
The incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is increasing in the United States; however, there are limited data on anatomic site-specific GC/CT among people with HIV (PWH).
Methods
We reviewed records of all PWH in care between January 1, 2014 and November 16, 2018 at four sites in the CFAR Network of Integrated Clinical Systems Cohort (CNICS; N = 8455). We calculated anatomic site-specific GC/CT testing and incidence rates and used Cox proportional hazards models modified for recurrent events to examine sociodemographic and clinical predictors of GC/CT testing and incidence at urogenital, rectal, and pharyngeal sites. We also calculated site-specific number needed to test (NNT) to detect a positive GC/CT test.
Results
Of 8455 PWH, 2460 (29.1%) had at least yearly GC/CT testing at any anatomic site. The rates of urogenital, rectal, and pharyngeal GC were 1.7 (95%CI:1.6, 1.9), 3.2 (95%CI:3.0, 3.5), and 2.7 (95%CI:2.5, 2.9) infections per 100 person-years, respectively. The rates of urogenital, rectal, and pharyngeal CT were 1.9 (95%CI:1.7, 2.1), 4.3 (95%CI:4.0, 4.5), and 0.9 (95%CI:0.8, 1.0) infections per 100 person-years, respectively. PWH 16-39 years old experienced greater GC/CT rates at all anatomic sites while MSM experienced greater rates of extragenital infections. NNTs for urogenital, rectal, and pharyngeal GC/CT were 20 (95%CI:19, 21), 5 (95%CI:5, 5), and 9 (95%CI:8, 9), respectively.
Conclusion
Many PWH are not tested annually for GC/CT and rates of GC/CT infection, particularly rates of extragenital infections, are high. We identified groups of PWH who may benefit from increased site-specific GC/CT testing.
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Affiliation(s)
- Timothy W Menza
- Oregon Health & Science University , Portland, OR , USA
- Oregon Health & Science University , Portland, OR , USA
| | | | | | - Edward Cachay
- University of California – San Diego School of Medicine , San Diego, CA , USA
| | - Heidi M Crane
- University of Washington School of Medicine , Seattle, WA , USA
| | - Mari M Kitahata
- University of Washington School of Medicine , Seattle, WA , USA
| | - Kenneth H Mayer
- Harvard Medical School , Boston, MA , USA
- Fenway Health , Boston, MA , USA
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Zucker R, Gaisa M, Sigel K, Singer I, Adler A, Turner D, Ben Ami R, Nissan I, Chan C, Halperin T. Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: A prospective cohort study. Int J STD AIDS 2021; 33:114-122. [PMID: 34676780 DOI: 10.1177/09564624211047477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are common among men who have sex with men (MSM). Many oropharyngeal and anorectal infections remain asymptomatic. We aimed to evaluate triple-site screening following PrEP introduction. We enrolled a prospective cohort study including 210 asymptomatic MSM during 2019-2020, analyzed by groups: HIV positive (HIV+), HIV-uninfected using PrEP (HIV-/PrEP+), or HIV-uninfected not using PrEP (HIV-/PrEP-). A self-administered questionnaire captured demographic information and sexual risk-taking behaviors. CT/NG testing results were compared between study groups and predictors of infection were evaluated. We included 59 HIV+, 70 HIV-/PrEP+, and 81 HIV-/PrEP- subjects. 30% (n = 62) of participants tested positive for CT/NG. HIV-/PrEP+ group had highest proportion of infections (n = 33, 47%) followed by HIV-/PrEP- (n = 16, 22%) and HIV+ (n=13, 20%; p < .001). Importantly, 98% (80/82) of pharyngeal/anorectal CT/NG infections were missed in genitourinary tract screening alone. PrEP use and previous syphilis infection were the strongest risk factor for CT/NG. Extra-genital asymptomatic CT/NG infections were prevalent among MSM. These data highlight the importance of routine extra-genital CT/NG testing in asymptomatic sexually active MSM. The study describes the consequences for three-site testing lack of implementation in the PrEP era.
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Affiliation(s)
- Roy Zucker
- Crusaid Kobler AIDS Center, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Gaisa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Sigel
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilan Singer
- Crusaid Kobler AIDS Center, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amos Adler
- Crusaid Kobler AIDS Center, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Turner
- Crusaid Kobler AIDS Center, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronen Ben Ami
- Crusaid Kobler AIDS Center, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Israel Nissan
- Ministry of Health, 26737National Public Health Laboratory, Tel Aviv, Israel
| | - Courtney Chan
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tamar Halperin
- Crusaid Kobler AIDS Center, 26738Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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6
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Hill LA, Martin NK, Torriani FJ, Jain S, Qin H, Mathews WC, Cachay ER. Screening for Sexually Transmitted Infections During Hepatitis C Treatment to Predict Reinfection Among People With HIV. Open Forum Infect Dis 2020; 8:ofaa643. [PMID: 33553480 PMCID: PMC7850126 DOI: 10.1093/ofid/ofaa643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background Little is known about the risk of hepatitis C virus (HCV) reinfection among people with HIV (PWH) in the direct-acting antiviral (DAA) era. We evaluate HCV reinfection rates in the DAA era and characterize presustained virologic response (SVR) behavioral risk factors associated with reinfection among PWH at the University of California, San Diego (UCSD). Methods Observational longitudinal cohort of PWH treated with DAAs between 2014 and July 2019 who achieved SVR and had at least 1 subsequent HCV viral load measurement. HCV reinfection was defined as new HCV viremia after SVR. We examined whether screening for sexually transmitted infections (STIs) and substance use during the pre-SVR period could identify patients at greater risk for reinfection using exact Poisson regression to compare reinfection incidence rates between those with and without pre-SVR STIs and positive urine drug screens. Results Eight out of 200 PWH were reinfected with HCV a median ~26 weeks after SVR over 328.1 person-years of follow-up (PYFU), for an incidence rate of 2.44/100 PYFU. The observed HCV reinfection rate was highest among men who have sex with men who inject drugs (MSM IDU; 4.63/100 PFYU) and those aged 30-39 years (6.80/100 PYFU). Having a positive gonorrhea/chlamydia test during the pre-SVR period was a predictor of HCV reinfection. Conclusions The HCV reinfection rate in the DAA era is similar to the rate observed in the interferon era in San Diego in PWH. STI screening during HCV treatment may help determine those at higher risk for HCV reinfection.
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Affiliation(s)
- Lucas A Hill
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, California, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego, San Diego, California, USA
| | - Francesca J Torriani
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego, San Diego, California, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - Huifang Qin
- Department of Medicine, UC San Diego, San Diego, California, USA
| | | | - Edward R Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego, San Diego, California, USA
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Willekens R, Sánchez I, Miguel L, Esperalba J, Serra-Pladevall J, Martin M, Navarro J, Falcó V, Burgos J, Ribera E, Caballero E, Curran A. Screening for asymptomatic STIs in HIV-infected men who have sex with men. Sex Transm Infect 2020; 97:170-171. [PMID: 32753480 DOI: 10.1136/sextrans-2020-054560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/27/2020] [Indexed: 11/03/2022] Open
Abstract
We aimed to study the prevalence, characteristics and risk factors of asymptomatic sexually transmitted infections (STIs) in HIV-infected men who have sex with men (MSM). We conducted a prospective cross-sectional study, including asymptomatic HIV-infected MSM attending regular visits between December 2014 and December 2017. Of the 301 patients included, 60 patients (19.9%) presented at least one STI. The most common STI was syphilis (33 of 69 STIs), followed by chlamydia (19 of 69), gonorrhoea (10 of 69), hepatitis C virus (4 of 69) and lymphogranuloma venereum (3 of 69). Illicit drug use during sex was the only variable significantly associated with the presence of an STI on multivariate analysis (OR 2.13; 95% CI 1.17-3.89). We were unable to identify a subgroup of patients where we could potentially avoid STI screening. Our findings support current guidelines that recommend routine screening for all HIV-infected MSM regardless of their self-reported sexual history.
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Affiliation(s)
- Rein Willekens
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Sánchez
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain
| | - Lucía Miguel
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain
| | | | | | - Mario Martin
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain
| | - Jordi Navarro
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Vicenç Falcó
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Burgos
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain
| | - Esteban Ribera
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Adrian Curran
- Department of Infectious Diseases, Vall d'Hebron Hospital, Barcelona, Spain
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