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Solnick RE, López LH, Martinez PM, Zucker JE. Sexually Transmitted Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:335-368. [PMID: 38641394 DOI: 10.1016/j.emc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
As the United States faces a worsening epidemic of sexually transmitted infections (STIs), emergency departments (EDs) play a critical role in identifying and treating these infections. The growing health inequities in the distribution and disproportionate impact of STIs add to the urgency of providing high-quality sexual health care through the ED. Changes in population health are reflected in the new Centers for Disease Control recommendations on screening, diagnostic testing, and treatment of STIs. This review covers common, as well as and less common or emerging STIs, and discusses the state-of-the-art guidance on testing paradigms, extragenital sampling, and antimicrobial treatment and prevention of STIs.
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Affiliation(s)
- Rachel E Solnick
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA.
| | - Laura Hernando López
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Patricia Mae Martinez
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Jason E Zucker
- Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, Box 82, New York, NY 10032, USA
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Martin EG, Ansari B, Gift TL, Johnson BL, Collins D, Williams AM, Chesson HW. An Interactive Modeling Tool for Projecting the Health and Direct Medical Cost Impact of Changes in the Sexually Transmitted Diseases Prevention Program Budgets. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:221-230. [PMID: 38271104 DOI: 10.1097/phh.0000000000001868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CONTEXT Estimating the return on investment for public health services, tailored to the state level, is critical for demonstrating their value and making resource allocation decisions. However, many health departments have limited staff capacity and expertise to conduct economic analyses in-house. PROGRAM We developed a user-friendly, interactive Excel-based spreadsheet model that health departments can use to estimate the impact of increases or decreases in sexually transmitted infection (STI) prevention funding on the incidence and direct medical costs of chlamydia, gonorrhea, syphilis, and STI-attributable HIV infections. Users tailor results to their jurisdictions by entering the size of their population served; the number of annual STI diagnoses; their prior annual funding amount; and their anticipated new funding amount. The interface was developed using human-centered design principles, including focus groups with 15 model users to collect feedback on an earlier model version and a usability study on the prototype with 6 model users to finalize the interface. IMPLEMENTATION The STI Prevention Allocation Consequences Estimator ("SPACE Monkey 2.0") model will be publicly available as a free downloadable tool. EVALUATION In the usability testing of the prototype, participants provided overall positive feedback. They appreciated the clear interpretations, outcomes expressed as direct medical costs, functionalities to interact with the output and copy charts into external applications, visualization designs, and accessible information about the model's assumptions and limitations. Participants provided positive responses to a 10-item usability evaluation survey regarding their experiences with the prototype. DISCUSSION Modeling tools that synthesize literature-based estimates and are developed with human-centered design principles have the potential to make evidence-based estimates of budget changes widely accessible to health departments.
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Affiliation(s)
- Erika G Martin
- Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, Albany, New York (Dr Martin); Department of Organization, Work, and Leadership, Queen's Business School, Queen's University Belfast, Belfast, United Kingdom (Dr Ansari); Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (Drs Gift, Williams, and Chesson and Mr Collins), and Division of Workforce Development, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce (Ms Johnson), Centers for Disease Control and Prevention, Atlanta, Georgia
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Fang J, Silva RM, Tancredi DJ, Pinkerton KE, Sankaran D. Examining associations in congenital syphilis infection and socioeconomic factors between California's small-to-medium and large metro counties. J Perinatol 2022; 42:1434-1439. [PMID: 35739308 DOI: 10.1038/s41372-022-01445-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate differences in congenital syphilis (CS) infection between California's small-to-medium and large metropolitan counties and the socioeconomic mechanisms behind these differences. STUDY DESIGN County-level data from 2019 and 2020 on CS infection and other socioeconomic covariates were obtained from the California Department of Public Health and the United States Census Bureau. Counties were stratified into small-to-medium or large metropolitan counties by the National Center for Health Statistics Urban-Rural Classification Scheme and analyzed using simple and multiple Poisson regression models. RESULTS California's small-to-medium metropolitan counties reported significantly higher rates of CS incidence, female poverty, and uninsured females, and significantly lower rates of English-language speaking ability and female education level compared to large metropolitan counties. CS infection was significantly associated with female poverty and education level. CONCLUSION Rates of CS infection in the California counties are more dependent on socioeconomic indicators than county classification itself.
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Affiliation(s)
- Juliet Fang
- Center for Health and the Environment, University of California, Davis, CA, USA
| | - Rona M Silva
- Center for Health and the Environment, University of California, Davis, CA, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California, Davis, CA, USA.,Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA, USA.,Western Center for Agricultural Health and Safety, University of California, Davis, CA, USA
| | - Deepika Sankaran
- Western Center for Agricultural Health and Safety, University of California, Davis, CA, USA.
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Lim S, Pintye J, Seong H, Bekemeier B. Estimating the Association Between Public Health Spending and Sexually Transmitted Disease Rates in the United States: A Systematic Review. Sex Transm Dis 2022; 49:462-468. [PMID: 35312659 DOI: 10.1097/olq.0000000000001627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Public health spending is important for managing increases in sexually transmitted diseases (STDs) in the United States. Although previous studies suggest that a beneficial link exists between public health spending and changes in STD rates, there have been no systematic reviews synthesizing existing evidence regarding the association for STDs at the population level. The objective of this study was to synthesize evidence from studies that assessed the associations between general and STD-specific public health spending and STD rates. We conducted a systematic review using Ovid-Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and EconLit for relevant studies that examined the association between public health spending and gonorrhea, syphilis, chlamydia, and chancroid rates following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 5 articles (2 regarding general public health spending and 3 regarding STD-specific public health spending) met our inclusion criteria. There was a significant decrease in gonorrhea, syphilis, chlamydia, and chancroid rates associated with increased public health spending. We also found that STD-specific public health spending has a greater effect on STD rates compared with general public health spending. Our review provides evidence that increases in general and STD-specific public health spending are associated with a reduction of STD rates. Such research regarding estimates of the impact of STD prevention spending can help policy makers identify priority funding areas and inform health resource allocation decisions.
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Affiliation(s)
- Sungwon Lim
- From the Departments of Child, Family, and Population Health
| | - Jillian Pintye
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA
| | - Hohyun Seong
- School of Nursing, University of Maryland, Baltimore, MD
| | - Betty Bekemeier
- From the Departments of Child, Family, and Population Health
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Schlanger K, Learner ER, Pham CD, Mauk K, Golden M, Wendel KA, Amsterdam L, McNeil CJ, Johnson K, Nguyen TQ, Holderman JL, Hasty GL, St. Cyr SB, Town K, Nash EE, Kirkcaldy RD. Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae. Sex Transm Dis 2021; 48:S97-S103. [PMID: 34475362 PMCID: PMC10275356 DOI: 10.1097/olq.0000000000001545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2016, Centers for Disease Control and Prevention initiated Strengthening the US Response to Resistant Gonorrhea (SURRG) in multiple jurisdictions to enhance antibiotic resistant gonorrhea rapid detection and response infrastructure and evaluate the impact of key strategies. METHODS Eight jurisdictions were funded to establish or enhance local gonococcal culture specimen collection in sexually transmitted disease and community clinics, conduct rapid antimicrobial susceptibility testing (AST) in local laboratories, modify systems for enhanced data collection and rapid communication of results, and initiate enhanced partner services among patients with gonorrhea demonstrating elevated minimum inhibitory concentrations (MICs) to ceftriaxone, cefixime or azithromycin. RESULTS Grantees incorporated genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018 to 2019, grantees collected 58,441 culture specimens from 46,822 patients and performed AST on 10,814 isolates (representing 6.8% [3412] and 8.9% [4883] of local reported cases in 2018 and 2019, respectively). Of isolates that underwent AST, 11% demonstrated elevated azithromycin MICs; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs. Among patients whose infections demonstrated elevated MICs, 81.7% were interviewed for partner elicitation; however, limited new cases were identified among partners and contacts. CONCLUSIONS As a public health model to build capacity to slow the spread of emerging resistance, SURRG successfully expanded culture collection, implemented rapid AST, and implemented an enhanced partner services investigation approach in participating jurisdictions. Findings from SURRG may enhance preparedness efforts and inform a longer-term, comprehensive, and evidence-based public health response to emerging gonococcal resistance. Continued development of innovative approaches to address emerging resistance is needed.
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Affiliation(s)
| | | | - Cau D. Pham
- Centers for Disease Control and Prevention, Atlanta GA
| | - Kerry Mauk
- Centers for Disease Control and Prevention, Atlanta GA
| | - Matthew Golden
- University of Washington/Public Health-Seattle & King County, Seattle, WA
| | | | | | - Candice J. McNeil
- Guilford County Department of Health, Greensboro
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kimberly Johnson
- New York City Department of Health and Mental Hygiene, Long Island City, NY
| | | | - Justin L. Holderman
- Centers for Disease Control and Prevention, Atlanta GA
- Indiana Department of Health, Indianapolis IN
| | | | | | - Katy Town
- Centers for Disease Control and Prevention, Atlanta GA
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Grembowski D, Lim S, Pantazis A, Bekemeier B. Analytic Approaches to Assess the Impact of Local Spending on Sexually Transmitted Diseases. Health Serv Res 2021; 57:644-653. [PMID: 34806188 DOI: 10.1111/1475-6773.13915] [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: 04/01/2021] [Revised: 08/31/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the estimated associations between annual STD (sexually transmitted diseases) expenditures per capita and STD rates among Florida and Washington local health departments (LHDs) from 2001-2017, using two approaches--a longitudinal regression model with lagged STD spending, and a regression model with the Arellano-Bond panel estimator. DATA SOURCES Secondary data for LHDs were obtained from Florida and Washington state government offices and combined with county sociodemographic and health system data from the federal government. STUDY DESIGN We examined LHDs in Florida and Washington using a longitudinal panel study design to estimate ecological relationships between annual STD expenditures per capita and annual STD incidence rates from 2001 to 2017 with LHDs as the unit of analysis. We compared two regression models: generalized estimating equations (GEE) and the Arellano-Bond panel estimator (an instrumental variable approach). DATA COLLECTION The secondary data were combined to build a longitudinal panel database for LHDs in Florida and Washington from 2001 to 2017. PRINCIPAL FINDINGS In the GEE model with both states, greater STD spending in a prior year was associated unexpectedly with greater STD incidence rates in succeeding years. The Arellano-Bond models for both states had the expected inverse associations but were not significant. In the Arellano-Bond models for Florida, a $1 increase in STD spending in previous years was followed by decreases in STD incidence rates ranging between 29 and 59 points in succeeding years (0.09 ≥ p ≥ 0.04). CONCLUSIONS In longitudinal panel data for LHDs in two states, the Arellano-Bond estimator, or other instrumental variable approach, is preferred over conventional regression models to obtain unbiased estimates of the relationship between annual STD spending rates and annual STD rates. Future studies will require accurate, standardized, and detailed longitudinal data and rigorous analytic approaches, such as those illustrated in our study. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David Grembowski
- Department of Health Systems and Population Health, University of Washington, Hans Rosling Center, 3980 15th Avenue NE, Box 351622, Seattle, WA, United States
| | - Sungwon Lim
- Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Box 357263, 1959 NE Pacific Street, Seattle, WA, United States
| | | | - Betty Bekemeier
- Department of Health Systems and Population Health, University of Washington, Hans Rosling Center, 3980 15th Avenue NE, Box 351622, Seattle, WA, United States.,Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Box 357263, 1959 NE Pacific Street, Seattle, WA, United States
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Implementing Insurance Billing in Local Health Department Sexually Transmitted Disease Clinics in Virginia, 2017. Sex Transm Dis 2021; 47:e21-e23. [PMID: 32371721 DOI: 10.1097/olq.0000000000001193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2017, the Virginia Department of Health implemented billing of insurance in local health department sexually transmitted disease clinics. We examined data collected by Virginia Department of Health related to clinic encounters, billing, and revenue from sexually transmitted disease clinics statewide. Implementing insurance billing created a new revenue stream for local health departments.
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Lieberman JA, Cannon CA, Bourassa LA. Laboratory Perspective on Racial Disparities in Sexually Transmitted Infections. J Appl Lab Med 2021; 6:264-273. [PMID: 33247907 PMCID: PMC7799034 DOI: 10.1093/jalm/jfaa163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Rates of sexually transmitted infections (STI) have risen steadily in recent years, and racial and ethnic minorities have borne the disproportionate burden of STI increases in the United States. Historical inequities and social determinants of health are significant contributors to observed disparities and affect access to diagnostic testing for STI. CONTENT Public health systems rely heavily on laboratory medicine professionals for diagnosis and reporting of STI. Therefore, it is imperative that clinicians and laboratory professionals be familiar with issues underlying disparities in STI incidence and barriers to reliable diagnostic testing. In this mini-review, we will summarize contributors to racial/ethnic disparity in STI, highlight current epidemiologic trends for gonorrhea, chlamydia, and syphilis, discuss policy issues that affect laboratory and public health funding, and identify specific analytic challenges for diagnostic laboratories. SUMMARY Racial and ethnic disparities in STI in the US are striking and are due to complex interactions of myriad social determinants of health. Budgetary cuts for laboratory and public health services and competition for resources during the COVID-19 pandemic are major challenges. Laboratory professionals must be aware of these underlying issues and work to maximize efforts to ensure equitable access to diagnostic STI testing for all persons, particularly those most disproportionately burdened by STI.
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Affiliation(s)
- Joshua A Lieberman
- Division of Microbiology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Chase A Cannon
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Lori A Bourassa
- Division of Microbiology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
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