Risk Factors for Chlamydia Among Young Women in a Northern California Juvenile Detention Facility: Implications for Community Intervention

Increasing Chlamydia and Gonorrhea Infections among Female Juveniles: The Need for Collaboration to Improve Treatment

BACKGROUND

 Youth in juvenile detention centers are at a high risk for sexually transmitted disease (STD). The current study assesses the trends of chlamydia and gonorrhea (GC) infections and treatment among females within a single county's juvenile correctional facilities.

METHODS

This is a retrospective review of aggregate data of female adolescents between 12 and 18 years old who underwent STD screening from 2009 to 2016 in San Bernardino County.

RESULTS

Chlamydia infections among adolescent females increased from 11.8% in 2009 to 17.0% in 2016 (p = 0.0002), and GC infections increased from 1.3% in 2009 to 6.0% in 2016 (p < 0.0001). Treatment rates of chlamydia were stable, ranging from 66.7% to 70.8% of positive female adolescents were treated between 2009 and 2016 (p=0.1752). The treatment rate for GC increased from 33% in 2009 to 78.3% in 2016, but annual trends were not statistically significant (p=0.8419).

CONCLUSIONS

Chlamydia and GC infections among female adolescents discovered during routine screening upon booking into a county juvenile detention system increased over the study time period. Effective collaboration between public health and various community organizations is needed to improve awareness and prevention of STDs amongst at-risk adolescents.

Bacterial Sexually Transmitted Disease Screening Outside the Clinic--Implications for the Modern Sexually Transmitted Disease Program

BACKGROUND

The development of noninvasive nucleic acid amplification tests for chlamydia and gonorrhea has facilitated innovation in moving sexually transmitted disease (STD) screening to nonclinical settings. However, limited data are available to inform local STD programs on evidence-based approaches to STD screening in nonclinical settings in the United States.

METHODS

We conducted a systematic review of the literature published since 2000 related to chlamydia, gonorrhea, and syphilis screening in US correctional settings, bathhouses and sex venues, self-collected at-home testing, and other nonclinical sites.

RESULTS

Sixty-four articles met eligibility criteria and were reviewed. Although data on testing volume and positivity were available, there were scarce data on the proportion of new positives treated and the programmatic costs for the various screening programs. Screening in correctional settings identified a sizable amount of asymptomatic infections. The value and sustainability of screening in the other nonclinical settings examined was not clear from the published literature.

CONCLUSIONS

Local and state health departments should explore the development of sustainable jail and juvenile detention screening programs for STDs. Furthermore, local programs should pilot outreach and home-based STD screening programs to determine if they are identifying asymptomatic persons who would not have otherwise been found. Local programs are encouraged to present and publish their findings related to non-clinic-based screening to enhance the limited body of literature; data on the proportion of new infections treated and the local program costs are needed.

Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

We aim to assess if heterosexual anal intercourse (AI) is commonly practiced and how frequently it is practiced by young people. We searched PubMed for articles published 1975 to July 2014 reporting data on the proportion of young people (mean age <25) practicing heterosexual AI (AI prevalence) and on number of AI acts (AI frequency). Stratified random-effects meta-analysis and meta-regression were used to produce summary estimates and assess the influence of participant and study characteristics on AI prevalence. Eighty-three and thirteen of the 136 included articles reported data on lifetime AI prevalence and monthly AI frequency, respectively. Estimates were heterogenous. Overall summary estimates of lifetime AI prevalence were 22 % (95 % confidence interval 20-24) among sexually active young people, with no statistically significant differences by gender, continent or age. Prevalence increased significantly with confidentiality of interview method and, among males and in Europe, by survey year. Prevalence did not significantly differ by recall period. An estimated 3-24 % of all reported sex acts were AI. Reported heterosexual AI is common but variable among young people worldwide. To fully understand its impact on STI spread, more and better quality data on frequency of unprotected AI, and trends over time are required.

Predictors identifying those at increased risk for STDs: a theory-guided review of empirical literature and clinical guidelines

SummarySexually transmitted diseases (STDs) are leading causes of substantial morbidity worldwide. Identification of risk factors for estimating STD risk provides opportunities for optimising service delivery in clinical settings, including improving case finding accuracy and increasing cost-efficiency by limiting the testing of low-risk individuals. The current study was undertaken to synthesise the evidence supporting commonly cited chlamydia and gonorrhoea risk factors. The level of empirical support for the following predictors was strong/moderate: age, race/ethnicity, multiple lifetime sexual partners, sex with symptomatic partners and concurrent STD diagnosis. The following predictors had weak evidence: socio-economic status, transactional sex, drug/alcohol use, condom use and history of STD diagnosis. The most frequently listed predictors among nine clinical guidelines were younger age and multiple sexual partners; the least consistently listed predictor was inconsistent condom use. We found reasonably good concordance between risk factors consistently listed in the recommendations and predictors found to have strong empirical support in the literature. There is a need to continue building the evidence base to explicate the mechanisms and pathways of STD acquisition. We recommend periodic reviews of the level of support of predictors included in clinical guidelines to ensure that they are in accordance with empirical evidence.

Pediatric emergency department provider perceptions of universal sexually transmitted infection screening

The purpose of this study was to describe the perceptions of pediatric emergency care providers in relation to implementing a universal sexually transmitted infection screening process for adolescent female patients in a pediatric emergency department. A descriptive qualitative design was used with a convenience sample of pediatric emergency physicians and nurses working in a large urban, pediatric teaching hospital. Participants were individually interviewed using a standard interview guide. Verbatim transcripts were analyzed using a modified constant comparative analysis method. Three overriding themes were identified that describe the perceptions of providers in relation to a universal screening process in a pediatric emergency department: Attitudes, Barriers, and Solutions. Universal sexually transmitted infection screening is one strategy that may help with early identification and treatment of adolescent female patients with undiagnosed sexually transmitted infections, and the pediatric emergency department is a potential site for such screening.

A systematic review and meta-analysis of the prevalence of chlamydia, gonorrhoea and syphilis in incarcerated persons

Communicable diseases are common in people who are incarcerated. We aimed to define the prevalence of chlamydia, gonorrhoea and syphilis in people who are incarcerated and to identify subgroups with the highest risk of infection. We searched for prevalence studies of chlamydia, gonorrhoea or syphilis in incarcerated populations. Pooled estimates were generated, and meta-regression was conducted. Random effects models yielded pooled prevalence estimates of 5.75% (95% confidence interval [CI] 5.01, 6.48) and 12.31% (95% CI 10.61, 14.01) for chlamydia in men and women, 1.4% (95% CI 1.09, 1.70) and 5.73% (4.76, 6.69) for gonorrhoea in men and women, and 2.45% (95% CI 2.08, 2.82) and 6.10% (95% CI 4.75, 7.46) for syphilis in men and women, respectively. Each infection was associated with female gender in meta-regression models. Chlamydia, gonorrhoea and syphilis are highly prevalent in these populations. Primary and secondary prevention efforts could improve individual and population health.

Reaching youth with out-of-facility HIV and reproductive health services: a systematic review

PURPOSE

Many young people, particularly those who are marginalized and most at risk for HIV and reproductive health-related problems, cannot or will not seek traditional facility-based health services. Policies and programs are being implemented to provide them with these health services in the community. We sought to review the effectiveness of such approaches in increasing HIV and reproductive health service use.

METHODS

A systematic literature review was undertaken to identify policies promoting or programs delivering HIV or reproductive health services in the community. We reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analyzed.

RESULTS

Twenty studies met inclusion criteria, including 10 containing comparative data (e.g., before and after study or control study design). The studies generally demonstrated positive impact, although results varied across settings and approaches. The most successful approaches included mail-based chlamydia screening in the Netherlands, condom distribution via street outreach in Louisiana, home-based HIV counseling and testing in Malawi, and promotion of over-the-counter access to emergency contraception in various countries.

CONCLUSION

Overall, this review suggests that out-of-facility approaches can be important avenues to reach youth. Continued evaluation is necessary to better understand specific approaches that can successfully deliver health services.

Methamphetamine use and high-risk sexual behaviors among incarcerated female adolescents with a diagnosed STD

Juvenile detention settings provide an important venue for addressing the health-related needs of adolescent populations, who often have high rates of sexually transmitted diseases (STDs) and concomitant drug use. This study examines factors associated with methamphetamine use and risky sexual behaviors among 539 incarcerated female adolescents between ages 12-18 years with an STD diagnosis. Data were obtained from interviews with detainees receiving STD case management services within a California juvenile detention facility in January 2006-June 2007. High-risk behaviors characterized the sample, such as low use of condoms consistently (43.3%), prior STD infection (25%), pregnancy history (26%), arrest charge for prostitution or drug use (23%), and a history of prostitution (18%). Half of the sample reported weekly alcohol or drug use; most commonly used drugs were marijuana (37%), alcohol (21%), and methamphetamine (16%). In multivariate analysis, African Americans had a lower odds of methamphetamine use (odds ratio [OR] = .163) compared with whites. Detainees who reported inconsistent condom use had over twice the odds of methamphetamine use (OR = 2.7) compared with consistent condom users. In addition, those who reported alcohol use had twice the odds of methamphetamine use (2.0). There was a significant interaction between Latina ethnicity and having an arrest charge for drugs or prostitution; Latinas who had this charge had over 11 times the odds of using methamphetamine compared with those with other arrest charges (OR = 11.28). A better understanding of the relationship between drug use and sexual risk behaviors of STD-positive incarcerated female adolescents can inform the development of appropriate corrections and community-based interventions serving this segment of high-risk adolescents.

Phenotypic and molecular characterization of Acinetobacter clinical isolates obtained from inmates of California correctional facilities

Acinetobacter spp. increasingly have been wreaking havoc in hospitals and communities worldwide. Although much has been reported regarding Acinetobacter isolates responsible for nosocomial infections, little is known about these organisms in correctional facilities. In this study, we performed species identification, examined the antibiotic resistance profiles, and determined the mechanisms of resistance and clonal relationships of 123 Acinetobacter isolates obtained from inmates of 20 California correctional facilities (CCFs). We found that 57.7% of the isolates belong to A. baumannii, followed by isolates of Acinetobacter genomic species 3 (gen. sp. 3; 23.6%) and of Acinetobacter gen. sp. 13TU (10.6%). Multidrug-resistant (MDR) CCF isolates were found in only six CCFs. Additionally, DNA sequences of gyrA and parC genes were consistent with fluoroquinolone (FQ) susceptibility phenotypes. Furthermore, the presence of class 1 integrons was detected in 15 CCF isolates, all of which are MDR. Integron-associated gene cassettes encode several aminoglycoside modification enzymes, which correlate with most of the aminoglycoside-resistant phenotypes. Antimicrobial susceptibility testing in the presence of Phe-Arg-β-naphthylamide dihydrochloride and 1-(1-naphthylmethyl)-piperazine indicated the involvement of efflux pumps in the FQ resistance of only a few CCF isolates. Finally, genetic profiling showed that there was no evidence of A. baumannii outbreaks in CCFs. Instead, our analyses revealed only limited clonal dissemination of mostly non-MDR A. baumannii strains in a few facilities. This study represents the first report to characterize phenotypic and molecular features of Acinetobacter isolates in correctional facilities, which provides a baseline for monitoring the antimicrobial resistance changes and dissemination patterns of these organisms in such specialized institutions.