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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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2
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Li J, Armon C, Palella FJ, Novak RM, Ward D, Purinton S, Durham M, Buchacz K. Chlamydia and Gonorrhea Incidence and Testing Among Patients in the Human Immunodeficiency Virus Outpatient Study (HOPS), 2007-2017. Clin Infect Dis 2021; 71:1824-1835. [PMID: 31689341 DOI: 10.1093/cid/ciz1085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although chlamydia (CT) and gonorrhea (GC) infections are increasing in the United States, there are limited data on their incidence, testing rates, and associated risk factors among persons living with HIV (PLWH), including by anatomic site among men who have sex with men (MSM). METHODS We analyzed 2007-2017 medical records data from Human Immunodeficiency Virus (HIV) Outpatient Study (HOPS) participants in care at 9 HIV clinics. We calculated CT (and GC) incidence and testing rates and assessed associations with sociodemographic and clinical factors using log-linear regression. RESULTS Among 4727 PLWH, 397 had 881 CT infections and 331 had 861 GC infections, with an incidence of 2.95 and 2.88 per 100 person-years, respectively. From 2007 to 2017, incidence and testing rates increased by approximately 3.0- and 1.9-fold for CT and GC, respectively. Multivariable factors associated with incident CT (GC) included younger age, MSM, and prior diagnoses of sexually transmitted diseases (STDs). Among 1159 MSM, 583 (50.3%) had 844 CT and 843 GC tests during 2016-2017, and 26.6% of tests were 3-site (urethra, rectum, and pharynx), yielding the highest rates of CT (GC) detection. Multivariable factors associated with CT (GC) testing included younger age, non-Hispanic/Latino black race, and having prior STDs. CONCLUSIONS Recent CT and GC incidence and testing increased among PLWH; however, only half of MSM were tested for CT or GC during 2016-2017 and less than a third of tests were 3-site. To promote sexual health and STD prevention among PLWH who are MSM, research regarding the added value of CT and GC testing across 3 anatomic sites is needed.
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Affiliation(s)
- Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard M Novak
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, District of Columbia, USA
| | | | - Marcus Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, Ladner RA, Trepka MJ. Predictors of chlamydia or gonorrhea among people with HIV in Miami-Dade County Ryan White Program in 2017. AIDS Care 2021; 34:615-620. [PMID: 33576239 PMCID: PMC8357847 DOI: 10.1080/09540121.2021.1883510] [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: 10/22/2022]
Abstract
The purpose of this study was to assess the prevalence of chlamydia or gonorrhea and factors associated with the diagnoses among people with HIV (PHIV) in the Ryan White Program Part A (RWP) in Miami-Dade County, Florida. We used 2017 calendar year data to identify factors associated with a chlamydia or gonorrhea diagnoses using logistic regression. About 50% of the 7110 PHIV who were ≥18 years old in active Ryan White care in 2017 reported being screened for chlamydia or gonorrhea. Of those screened, 2.3% reported diagnoses of chlamydia, gonorrhea or both. In the adjusted model, compared to PHIV ≥40 years-old, PHIV aged 18-24 and 25-39 years reported higher odds of diagnoses (adjusted odds ratio [aOR] 4.29; 95% confidence interval [CI]: 1.73-10.63 and aOR 4.58; 95% CI; 2.62-7.99 respectively). Those with multiple sexual partners in the last 12 months reported higher odds of diagnoses (aOR 1.67; (95% CI; 1.04-2.69)). Screening rates for chlamydia or gonorrhea are low, relative to CDC guidelines. Interventions are needed to increase rates of screening and targeted behavioral risk reduction techniques are highly recommended among those 18-39 years of age and those who have multiple sexual partners.
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Affiliation(s)
- Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Sandra G Jones
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, FL, USA
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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4
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Gottwald C, Schwarz NG, Frickmann H. Sexually Transmitted Infections in Soldiers - A Cross-Sectional Assessment in German Paratroopers and Navy Soldiers and a Literature Review. Eur J Microbiol Immunol (Bp) 2019; 9:138-143. [PMID: 31934366 PMCID: PMC6945994 DOI: 10.1556/1886.2019.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction The study was performed to estimate the prevalence and determinants of occurrence of sexually transmitted infections (STIs) in paratroopers and navy soldiers by anonymously analyzing medical records from the medical departments of two large German barracks in order to assess the need for medical STI prevention. Methods Medical records from 80 paratroopers and 80 navy soldiers were screened for records of STI. Results were anonymously collected next to information on risk factors, as well as diagnostic and therapeutic management, and comparatively assessed. Results Proportions of suspected STIs were 17.5% and 20%, and proportions of diagnosed STIs were 13.9% and 11.3% for paratroopers and navy soldiers, respectively. Chlamydia trachomatis, human papillomavirus, and genital scabies were observed in paratroopers and navy soldiers, while Gardnerella vaginalis, herpes simplex virus, Molluscum contagiosum virus, Neisseria gonorrhoeae, and Trichomonas vaginalis were additionally identified in navy soldiers. Conclusions Although clinical hints for STIs were frequently observed, clinical management was usually restricted to syndrome-based antibiotic treatment without detailed diagnostic workup, leaving room for procedural improvement. Ongoing need for medical STI prevention in the military could be confirmed.
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Affiliation(s)
- Carina Gottwald
- Bundeswehr Military Medical Department Wilhelmshaven, Wilhelmshaven, Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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5
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Braun DL, Marzel A, Steffens D, Schreiber PW, Grube C, Scherrer AU, Kouyos RD, Günthard HF. High Rates of Subsequent Asymptomatic Sexually Transmitted Infections and Risky Sexual Behavior in Patients Initially Presenting With Primary Human Immunodeficiency Virus-1 Infection. Clin Infect Dis 2019; 66:735-742. [PMID: 29028966 DOI: 10.1093/cid/cix873] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/03/2017] [Indexed: 12/19/2022] Open
Abstract
Background Knowledge of the risk factors of individuals with an asymptomatic sexually transmitted infection (STI) is essential for implementation of targeted STI screening strategies. Methods Between June 2015 and January 2017, an STI screening was offered to all participants in the Zurich Primary human immunodeficiency virus (HIV)-1 Infection study. Patients were tested for gonorrhea, chlamydia, syphilis, and hepatitis C virus (HCV). Results Of 214 participants, 174 (81%) were screened at least once. Most patients were men who have sex with men (MSM) (87.4%). Presenting with a primary HIV infection was associated with higher odds for later risky sexual behavior, as compared with presenting in the chronic phase (odds ratio [OR], 5.58; 95% confidence interval [CI], 3.68-8.8). In total, 79 STIs were detected, reflecting a high period prevalence of 33.3% (58 of 174 patients). Sixty-six percent of patients (52 of 79) were asymptomatic. Most common STIs were chlamydia (50.6%; 40 of 79 patients), gonorrhea (25.3%; 20 of 79), and syphilis (19%; 15 of 79). In a multivariable model, engaging in insertive (OR, 6.48; 95% CI, 1.14-36.76) or both insertive and receptive (4.61; 1.01-20.96) anal intercourse, STI symptoms (3.4; 1.68-6.89), and condomless sex (2.06; 1.14-3.74) were positively correlated with a positive screening result. The hazard of an incident STI increased with the presence of STI symptoms (hazard ratio, 3.03; 95% CI, 1.17-7.84) and any recent drug use (2.63; 1-6.9). Conclusions A trimonthly STI screening including asymptomatic individuals should be considered in this population, particularly in MSM who report sexual risk behavior. Clinical Trial Registration NCT 00537966.
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Affiliation(s)
- Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Daniela Steffens
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Christina Grube
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Switzerland
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Krieger D, Abe C, Pottorff A, Li X, Rich J, Nijhawan AE. Sexually Transmitted Infections Detected During and After Incarceration Among People with Human Immunodeficiency Virus: Prevalence and Implications for Screening and Prevention. Sex Transm Dis 2019; 46:602-607. [PMID: 31415042 PMCID: PMC6702963 DOI: 10.1097/olq.0000000000001023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incarceration and human immunodeficiency virus (HIV) are associated with sexually transmitted infections (STIs); however, little is known about STI prevalence among people living with HIV (PLWH) during and after incarceration. METHODS Electronic medical records from the Dallas County Jail and community HIV clinics were reviewed to determine the frequency and results of testing for gonorrhea, chlamydia, syphilis, and hepatitis B virus (HBV) among PLWH incarcerated in Dallas County Jail between 2010 and 2013. HIV viral loads (VL) and evidence of STI symptoms and treatment were also collected. RESULTS During 2473 incarcerations, 6 (3%) of 190 tests were positive for gonorrhea, 7 (4%) of 190 for chlamydia, 231 (21%) of 1082 for syphilis, of which 53 (23%) were new diagnoses, and 48 (5%) of 1005 for HBV surface antigen. Among 1631 releases to the community, 808 followed up in community clinics, where 21 (4%) 553 tests were positive for gonorrhea, 23 (4%) of 555 for chlamydia, 150 (19%) of 808 for syphilis, of which 31 (21%) were new diagnoses, and 24 (6%) of 421 for HBV surface antigen. The majority of new STI cases, 51 (80%) of 64 in jail and 43 (77%)of 56 in the community, had a concurrent detectable (>200 copies/mL) HIV VL. CONCLUSIONS Testing for gonorrhea and chlamydia was low, particularly in jail, which was attributed to testing protocols. High proportions of PLWH tested positive for syphilis and HBV infection in both settings. The majority of patients with active STIs had a detectable HIV VL. Routine, opt-out screening for STIs for PLWH during and after incarceration has the potential to identify a high proportion of STIs and improve secondary HIV prevention.
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Affiliation(s)
- Demi Krieger
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caroline Abe
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Xilong Li
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Josiah Rich
- Department of Internal Medicine and Epidemiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ank E. Nijhawan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital Systems, Dallas, TX, USA
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7
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Budkaew J, Chumworathayi B, Pientong C, Ekalaksananan T. Prevalence and factors associated with gonorrhea infection with respect to anatomic distributions among men who have sex with men. PLoS One 2019; 14:e0211682. [PMID: 30943191 PMCID: PMC6447148 DOI: 10.1371/journal.pone.0211682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/19/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Gonorrhea (GC) infection caused by Neisseria gonorrhoeae has been steadily increasing in Thailand over the last decade. Men who have sex with men (MSM) are at high risk for gonorrhea infection. MATERIALS AND METHODS In this study, we determined the prevalence of and risk factors associated with gonococcal infections by three anatomical sites among MSM. We have conducted a cross-sectional analysis of a sexually transmitted disease (STD), gonorrhea among MSM attending two STD clinics in Khon Kaen, Thailand. We included 358 MSM over 18 years of age. Data were collected using self-administered questionnaire. In each participant, an oropharyngeal, anorectal, and endourethral swab were tested with culture and nucleic acid amplification test (NAAT). However, 267 urine samples were tested by both methods. Factors associated with gonorrhea infections were assessed using univariate and multivariate logistic regression. RESULTS One hundred and ninety-five out of 358 (54.47%) MSM tested were found to be positive for gonorrhea using a porA gene targeted NAAT by Real-time PCR with TaqMan probes, but there was no positive result by culture. The gonorrheal prevalence for male genital site, anal, and oropharyngeal, were 34.73% (95%CI 33.07, 45.08), 29.01% (95%CI 24.61, 34.33), and 27.93% (95%CI 23.35, 32.89), respectively, while 5.9% (21/355) were positive for gonococcal infection in all anatomic sites (oropharynx + anus + urethra) of one participant. Previous history of diagnosed STDs was a significant factor associated urethral gonorrhea (odds ratio = 3.52, 95%CI 1.87-6.66, P Value< 0.001). In addition, having more than one partner was increased urethral gonorrhea (adjusted odds ratio = 2.26, 95%CI 1.10-4.68, P Value = 0.026). 100% of condom use was found decreasing urethral infection (adjusted odds ratio = 0.39, 95%CI 0.15-0.99, P Value = 0.046). CONCLUSIONS The most common anatomic site of gonorrhea infection was male genital site, and the independent risk factors were having history of diagnosed STDs and having more than one partner in the past 3 months, but 100% condom use was a protective factor of this infection.
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Affiliation(s)
- Jiratha Budkaew
- Family Physician, Department of Social Medicine, Khon Kaen Center Hospital, Khon Kaen Province, Thailand
| | - Bandit Chumworathayi
- Gynecologic Oncologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Thailand
| | - Chamsai Pientong
- Generalist, Department of Microbiology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Thailand
| | - Tipaya Ekalaksananan
- Family Physician, Department of Microbiology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Thailand
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Refugio ON, Klausner JD. Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care. Expert Rev Anti Infect Ther 2018; 16:321-331. [PMID: 29489420 DOI: 10.1080/14787210.2018.1446828] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Syphilis continues to be a growing epidemic among men who have sex with men (MSM), particularly for those living with the human immunodeficiency virus (HIV). In 2016, MSM accounted for 80% of primary and secondary syphilis diagnoses in men in the United States; almost half of who were also HIV-infected. The synergistic relationship between HIV and syphilis has significant implications not only for HIV patient management, but also for sexually transmitted infection (STI) control among MSM. Areas covered: We review the literature on STI screening and treatment barriers at the patient-, provider-, and health system-levels, and present strategies to incorporate STI prevention into HIV care settings. Expert commentary: Integration of STI prevention into HIV care is paramount to stop the epidemic of not only syphilis, but also other curable STIs like gonorrhea and chlamydia. Although guidelines have been established for STI testing in HIV-infected MSM, screening rates continue to be lower than desired. Gonorrhea and chlamydia screening is below 50% in HIV-infected MSM; interventions that improve testing of those two infections must be implemented. For syphilis control, other additional strategies such as chemoprophylaxis should be considered given syphilis screening is above 50% in HIV-infected MSM.
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Affiliation(s)
- Oliver N Refugio
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , California , USA
| | - Jeffrey D Klausner
- b Division of Infectious Diseases, Department of Medicine , UCLA , Los Angeles , California , USA
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9
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Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004-2014. J Acquir Immune Defic Syndr 2018; 76:409-416. [PMID: 28777262 DOI: 10.1097/qai.0000000000001514] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Annual screening for gonorrhea [Neisseria gonorrhoeae (NG)] and chlamydia [Chlamydia trachomatis (CT)] is recommended for all sexually active persons living with HIV but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004-2014, a period of expanding testing. METHODS We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women, and women. RESULTS Among 15,614 patients (50% MSM, 26% men who have sex exclusively with women, and 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 [adjusted odds ratio (AOR) per year 1.22 (1.21-1.22)]. Despite the increase in testing, test positivity also increased [AOR per year 1.10 (1.07-1.12)], and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 [AOR per year 1.20 (1.17-1.22)]. Case detection was highest among MSM but increased over time among all 3 groups. CONCLUSIONS NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among persons living with HIV to decrease transmission and complications of NG/CT and of HIV.
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Lucar J, Hart R, Rayeed N, Terzian A, Weintrob A, Siegel M, Parenti DM, Squires LE, Williams R, Castel AD, Benator DA. Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort. Open Forum Infect Dis 2018; 5:ofy017. [PMID: 29479550 PMCID: PMC5804762 DOI: 10.1093/ofid/ofy017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/16/2018] [Indexed: 11/14/2022] Open
Abstract
Background Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission. Methods We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk. Results Six point seven percent (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STIs was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5-4.1); age 18-34 years, 10.8 (95% CI, 9.7-12.0); transgender women, 9.9 (95% CI, 6.9-14.0); Hispanics, 9.2 (95% CI, 7.2-11.8); and men who have sex with men (MSM), 7.7 (95% CI, 7.1-8.4). Multivariate Poisson regression showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable VL within 1 month of STI diagnosis, and 14.6% had a VL ≥1500 copies/mL. Conclusions STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.
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Affiliation(s)
- Jose Lucar
- Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC.,Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC.,Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | | | - Amy Weintrob
- Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC.,Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
| | - Marc Siegel
- Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC
| | - David M Parenti
- Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC
| | - Leah E Squires
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC.,Department of Psychology, The George Washington University, Washington, DC
| | - Rush Williams
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC.,Columbia Health, Columbia University in the City of New York, New York, New York
| | | | - Debra A Benator
- Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC.,Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
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11
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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12
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Hoover KW, Tao KL, Peters PJ. Nationally representative prevalence estimates of gay, bisexual, and other men who have sex with men who have served in the U.S. military. PLoS One 2017; 12:e0182222. [PMID: 28763487 PMCID: PMC5538666 DOI: 10.1371/journal.pone.0182222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To estimate the number of men in the U.S. military who are gay, bisexual, or other men who have sex with men (MSM) to inform the development of military and other federal policies. Study design We analyzed data from the National Surveys of Family Growth to estimate the number of U.S. men who were gay, bisexual, or MSM, and who had served in the military, compared to those who did not serve. We stratified using hierarchical categories of gay, bisexual, and other MSM to compare proportions in the military and general population. Results We found that 4.23% of men self-reported as gay, bisexual, or other MSM among men who served in the military, compared to 4.14% among men who had not served (p = 0.93). When stratified, we found that 0.78% self-reported as gay among men who served in the military, compared to 2.12% among men who had not served (p<0.001). Conclusions The proportion of men who identified as a gay was lower in the military than in the general population. This finding might have been influenced by historical military policies related to sexual orientation.
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Affiliation(s)
- Karen W. Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- * E-mail:
| | - Kevin L. Tao
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Philip J. Peters
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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13
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Iwata A, Shimuta K, Ohnishi M. Conjunctivitis Caused by a Strain of Neisseria gonorrhoeae That Was Less Susceptible to Ceftriaxone. Intern Med 2017; 56:1443-1445. [PMID: 28566614 PMCID: PMC5498215 DOI: 10.2169/internalmedicine.56.7656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 20-year-old man presented with bilateral ocular discharge and conjunctival injection. An ocular culture revealed Neisseria gonorrhoeae with decreased susceptibility to multiple drugs, including ceftriaxone. The patient was successfully treated with doxycycline (100 mg), which was administered orally, twice a day, for 7 days.
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Affiliation(s)
- Akira Iwata
- Department of Infectious Disease, Rakuwakai Otowa Hospital, Japan
| | - Ken Shimuta
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
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14
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Kugblenu RK, Paulin PS, Tastad KJ, Okulicz JF. HIV testing patterns for United States Air Force personnel, 2008-2012. Public Health 2016; 133:91-8. [PMID: 26795677 DOI: 10.1016/j.puhe.2015.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 11/24/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study evaluated 3rd generation human immunodeficiency virus (HIV) test patterns and HIV infection rates in the United States Air Force (USAF). STUDY DESIGN Retrospective database study. METHODS HIV enzyme-linked immunoassay (ELISA) and Western blot tests were analysed for all USAF personnel from 2008 to 2012. For new HIV cases, unadjusted and adjusted annual rates were calculated per 100,000 persons. RESULTS In total, 1,608,665 tests were performed in 626,298 individuals, with a reactive ELISA observed in 809 (0.001%) persons. Western blot (n = 1949) results included 378 (19.4%) positive, 1283 (65.8%) negative, and 288 (15.0%) indeterminate (WBi). Unadjusted annual HIV rates were between 16.7 and 20.6 per 100,000 persons during the study period. The overall age-adjusted rate was 14.8 cases per 100,000 persons tested. Blacks/African Americans had the highest risk of HIV (risk ratio 7.9 [95% confidence interval 5.78, 9.95] compared to Whites). CONCLUSIONS WBi results, which can cause delays in determining HIV status, were relatively common with the 3rd generation assay. However, this will be mitigated by a planned transition to a 4th generation assay. Although the overall rate of HIV in the USAF is lower than US civilian adults, HIV prevention efforts targeting young Blacks/African Americans may help to reduce HIV incidence in the USAF.
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Affiliation(s)
- R K Kugblenu
- United States Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, Epidemiology Consult Service, Wright-Patterson AFB, OH, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - P S Paulin
- United States Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, Epidemiology Consult Service, Wright-Patterson AFB, OH, USA
| | - K J Tastad
- United States Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, Epidemiology Consult Service, Wright-Patterson AFB, OH, USA
| | - J F Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
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15
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Fuchs W, Kreuter A, Hellmich M, Potthoff A, Swoboda J, Brockmeyer NH, Wieland U. Asymptomatic anal sexually transmitted infections in HIV-positive men attending anal cancer screening. Br J Dermatol 2016; 174:831-8. [PMID: 26577338 DOI: 10.1111/bjd.14288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV-positive men who have sex with men (HIV+MSM) have an increased risk for anal dysplasia and for sexually transmitted infections (STIs). OBJECTIVES We determined the positivity rates of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), Mycoplasma genitalium (MG) and syphilis in HIV+MSM participating in an anal cancer screening programme. METHODS In total, 852 intra-anal swabs were collected from 503 HIV+MSM between 2012 and 2014. Anal cytology and polymerase chain reaction assays for human papillomavirus (HPV), CT, NG and MG detection were performed. The syphilis status was determined serologically. Risk factors for STIs were explored by multiple logistic regression analysis. RESULTS In total 20·7% (104 of 503) of the patients had an STI other than HPV within the study period. The most common was CT, found in 10·9%, followed by NG (8·9%) and MG (4·2%). Early syphilis was detected in 4·6% and past syphilis in 44·5% of the HIV+MSM. Eighteen patients (3·6%) had more than one STI episode, and 90·6% of the 127 cases of STIs were asymptomatic. Age, anal HPV infection, abnormal anal cytology and previous syphilis were risk factors for STI. CONCLUSIONS Anal STIs are frequent and mostly asymptomatic in HIV+MSM participating in anal cancer screening. STI screening should be incorporated into anal cancer screening programmes for HIV+MSM.
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Affiliation(s)
- W Fuchs
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - A Kreuter
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50924, Köln, Germany
| | - A Potthoff
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - J Swoboda
- Institute of Cytology, Koblenzer Straße 121-123, 53177, Bonn, Germany
| | - N H Brockmeyer
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - U Wieland
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, Uniklinik Köln, University of Cologne, Fuerst-Pueckler-Straße 56, 50935, Köln, Germany
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16
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A Cross Sectional Analysis of Gonococcal and Chlamydial Infections among Men-Who-Have-Sex-with-Men in Cape Town, South Africa. PLoS One 2015; 10:e0138315. [PMID: 26418464 PMCID: PMC4587970 DOI: 10.1371/journal.pone.0138315] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 08/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men-who-have-sex-with-men (MSM) are at high risk of HIV and sexually transmitted infection (STI) transmission. Asymptomatic STIs are common in MSM and remain undiagnosed and untreated where syndromic management is advocated. Untreated STIs could be contributing to high HIV rates. This study investigated symptomatic (SSTI) and asymptomatic STIs (ASTIs) in MSM in Cape Town. METHODS MSM, 18 years and above, were enrolled into this study. Participants underwent clinical and microbiological screening for STIs. Urine, oro-pharyngeal and anal swab specimens were collected for STI analysis, and blood for HIV and syphilis screening. A psychosocial and sexual questionnaire was completed. STI specimens were analysed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection. RESULTS 200 MSM were recruited with a median age of 32 years (IQR 26-39.5). Their median number of sex partners within the last year was 5 (IQR 2-20). 155/200 (78%) reported only male sex partners while 45/200 (23%) reported sex with men and women. 77/200 (39%) reported transactional sex. At enrolment, 88/200 (44%) were HIV positive and 8/112 (7%) initially HIV-negative participants seroconverted during the study. Overall, 47/200 (24%) screened positive for either NG or CT. There were 32 MSM (16%) infected with NG and 7 (3.5%) of these men had NG infections at two anatomical sites (39 NG positive results in total). Likewise, there were 23 MSM (12%) infected with CT and all these men had infections at only one site. Eight of the 47 men (17%) were infected with both NG and CT. ASTI was more common than SSTI irrespective of anatomical site, 38 /200 (19%) versus 9/200 (5%) respectively (p<0.001). The anus was most commonly affected, followed by the oro-pharynx and then urethra. Asymptomatic infection was associated with transgender identity (OR 4.09 CI 1.60-5.62), ≥5 male sex partners in the last year (OR 2.50 CI 1.16-5.62) and transactional sex (OR 2.33 CI 1.13-4.79) but not with HIV infection. CONCLUSIONS Asymptomatic STI was common and would not have been detected using a syndromic management approach. Although molecular screening for NG/CT is costly, in our study only four MSM needed to be screened to detect one case. This supports dual NG/CT molecular screening for MSM, which, in the case of confirmed NG infections, may trigger further culture-based investigations to determine gonococcal antimicrobial susceptibility in the current era of multi-drug resistant gonorrhoea.
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17
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Lee T, Ganesan A. Results of a pilot screening programme for genital and extragenital gonococcal and chlamydial infections in a military population following the repeal of 'Don't Ask, Don't Tell'. Sex Transm Infect 2015; 91:233. [PMID: 25990779 DOI: 10.1136/sextrans-2014-051793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tida Lee
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Anuradha Ganesan
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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18
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Buono SA, Watson TD, Borenstein LA, Klausner JD, Pandori MW, Godwin HA. Stemming the tide of drug-resistant Neisseria gonorrhoeae: the need for an individualized approach to treatment. J Antimicrob Chemother 2014; 70:374-81. [PMID: 25331059 DOI: 10.1093/jac/dku396] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Drug-resistant Neisseria gonorrhoeae poses a significant public health challenge. In recent years, gonococci resistant to first- and second-line antibiotics have spread worldwide and new strains have developed that are increasingly resistant to third-generation cephalosporins, which are currently our last line of available treatments. Given the timeline required to develop new drugs or an effective vaccine for N. gonorrhoeae, a top priority is to use the drugs that are available as effectively as possible. Currently, clinical management of gonorrhoea is based upon treatment guidelines informed by international gonococcal antimicrobial susceptibility surveillance programmes. This approach, although currently the most practical, is subject to a number of limitations since surveillance data inherently provide population-level information. As a result, basing treatment guidelines on these data can result in the prescription of more aggressive or broader treatment than is needed by individual patients and hence inadvertently contribute to the development and spread of resistance to important drugs. Clearly, methods are needed that provide patient-specific drug susceptibility information in a time frame that would allow clinicians to prescribe individualized treatment regimens for gonorrhoea. Fortunately, in recent years, there have been a number of advances in the development of rapid methods for characterizing both the genotype and the drug resistance phenotype of N. gonorrhoeae strains. Here, we review these advances and propose additional studies that would help facilitate a transition towards an individualized treatment approach for gonorrhoea.
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Affiliation(s)
- Sean A Buono
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA UCLA Global Bio Lab, California Nanosystems Institute, UCLA, 570 Westwood Plaza Building 114, Los Angeles, CA 90095, USA
| | - Tyler D Watson
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - Lee A Borenstein
- UCLA Global Bio Lab, California Nanosystems Institute, UCLA, 570 Westwood Plaza Building 114, Los Angeles, CA 90095, USA Los Angeles County Public Health Laboratory, 12750 Erickson Avenue, Downey, CA 90242, USA
| | - Jeffrey D Klausner
- David Geffen School of Medicine, UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Mark W Pandori
- San Francisco Public Health Laboratory, San Francisco Department of Public Health, 101 Grove Street, Suite 419, San Francisco, CA 94102, USA
| | - Hilary A Godwin
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA UCLA Global Bio Lab, California Nanosystems Institute, UCLA, 570 Westwood Plaza Building 114, Los Angeles, CA 90095, USA Institute of the Environment and Sustainability, UCLA, La Kretz Hall, Suite 300, Box 951496, Los Angeles, CA 90095, USA
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