1
|
Parreira de Andrade B, Pereira A, Bandeira Santos A, Fonseca P. Adolescence and Sexually Transmitted Infections: A Portuguese Single-Center Report. ACTA MEDICA PORT 2024; 37:570-571. [PMID: 38950622 DOI: 10.20344/amp.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/16/2024] [Indexed: 07/03/2024]
Affiliation(s)
| | - Adriano Pereira
- Serviço de Pediatria. Unidade Local de Saúde do Médio Ave. Vila Nova de Famalicão. Portugal
| | - Ana Bandeira Santos
- Serviço de Pediatria. Unidade Local de Saúde do Médio Ave. Vila Nova de Famalicão. Portugal
| | - Paula Fonseca
- Serviço de Pediatria. Unidade Local de Saúde do Médio Ave. Vila Nova de Famalicão. Portugal
| |
Collapse
|
2
|
Tomcho MM, Lou Y, O’Leary SC, Rinehart DJ, Thomas-Gale T, Penny L, Frost HM. Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care. J Prim Care Community Health 2022; 13:21501319221131382. [PMID: 36300428 PMCID: PMC9619876 DOI: 10.1177/21501319221131382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis and Neisseria gonorrhea are the most reported sexually transmitted infections in the United States. Testing rates remain suboptimal and may be subject to implicit bias. We evaluated the effectiveness of an opt-out chlamydia and gonorrhea testing program for adolescents and young adults in improving testing rates and promoting equity. METHODS An opt-out testing program that standardized testing to once annually for 14 to 24-year-old patients was implemented across 28 federally qualified health centers spanning 4 specialties. A quasi-experimental design using interrupted time series analyses evaluated testing and infection rates between baseline, intervention, and pandemic-associated test shortage periods. Reduction in testing inequities based on sex, race, ethnicity, insurance, and language preference were also examined. RESULTS A total of 57 452 encounters during the baseline, 17 320 during the intervention, and 26 993 during the test supply shortage periods were included. Testing increased from 66.8% to 81.0% (14.2% absolute increase) between baseline and intervention periods. Pediatric clinics demonstrated the largest improvement compared to other settings (absolute increase 30.9%). We found significant reductions in testing inequities for language preference (P < .001), and un-insured and public insured individuals (P < .001). More cases of chlamydia and gonorrhea were detected in the intervention period (chlamydia-29.7; gonorrhea-7.4 per 1000 patients) than in the baseline period (chlamydia-20.7; gonorrhea-4.4 per 1000 patients; P < .001). CONCLUSIONS An opt-out approach increased testing, reduced inequities between some groups and detected more infections than a risk-based approach. Opt-out testing should be considered as an approach to increase detection of chlamydia and gonorrhea and promote equity.
Collapse
Affiliation(s)
- Margaret M. Tomcho
- Denver Health and Hospital Authority,
Denver, CO, USA,University of Colorado School of
Medicine, Aurora, CO, USA
| | - Yingbo Lou
- Denver Health and Hospital Authority,
Denver, CO, USA
| | - Sonja C. O’Leary
- Denver Health and Hospital Authority,
Denver, CO, USA,University of Colorado School of
Medicine, Aurora, CO, USA
| | - Deborah J. Rinehart
- Denver Health and Hospital Authority,
Denver, CO, USA,University of Colorado School of
Medicine, Aurora, CO, USA
| | | | - Lara Penny
- Denver Health and Hospital Authority,
Denver, CO, USA,University of Colorado School of
Medicine, Aurora, CO, USA
| | - Holly M. Frost
- Denver Health and Hospital Authority,
Denver, CO, USA,University of Colorado School of
Medicine, Aurora, CO, USA,Holly M. Frost, Department of General
Pediatrics, Denver Health and Hospital Authority, 601 Broadway Ave, Denver, CO
80004, USA.
| |
Collapse
|
3
|
Marks LR, Reno H, Liang SY, Schwarz ES, Liss DB, Jiang L, Nolan NS, Durkin MJ. Value of Packaged Testing for Sexually Transmitted Infections for Persons who Inject Drugs Hospitalized With Serious Injection-Related Infections. Open Forum Infect Dis 2021; 8:ofab489. [PMID: 34926711 PMCID: PMC8675536 DOI: 10.1093/ofid/ofab489] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background Persons who inject drugs (PWID) are frequently admitted for serious injection-related
infections (SIRIs). PWID are also at risk for sexually transmitted infections (STIs). Methods We conducted a multicenter quality improvement project at 3 hospitals in Missouri. PWID with
SIRI who received an infectious diseases consultation were prospectively identified and placed
into an electronic database as part of a Centers for Disease Control and
Prevention–funded quality improvement project. Baseline data were collected from
8/1/2019 to 1/30/2020. During the intervention period (2/1/2020–2/28/2021), infectious
diseases physicians caring for patients received 2 interventions: (1) email reminders of best
practice screening for HIV, viral hepatitis, and STIs; (2) access to a customized EPIC
SmartPhrase that included checkboxes of orders to include in assessment and plan of
consultation notes. STI screening rates were compared before and after the intervention. We
then calculated odds ratios to evaluate for risk factors for STIs in the cohort. Results Three hundred ninety-four unique patients were included in the cohort. Initial screening
rates were highest for hepatitis C (88%), followed by HIV (86%). The bundled intervention
improved screening rates for all conditions and substantially improved screening rates for
gonorrhea, chlamydia, and syphilis (30% vs 51%, 30% vs 51%, and 39 vs 60%, respectively;
P < .001). Of patients who underwent screening, 16.9% were
positive for at least 1 STI. In general, demographics were not strongly associated with
STIs. Conclusions PWID admitted for SIRI frequently have unrecognized STIs. Our bundled intervention improved
STI screening rates, but additional interventions are needed to optimize screening.
Collapse
Affiliation(s)
- Laura R Marks
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Hilary Reno
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Evan S Schwarz
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of Medical Toxicology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David B Liss
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of Medical Toxicology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Linda Jiang
- Division of Medical Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nathanial S Nolan
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
4
|
Tomcho MM, Lou Y, O'Leary SC, Rinehart DJ, Thomas-Gale T, Douglas CM, Wu FJ, Penny L, Federico SG, Frost HM. An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care. Pediatrics 2021; 148:e2020027508. [PMID: 34675130 PMCID: PMC8972200 DOI: 10.1542/peds.2020-027508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system. METHODS A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment. RESULTS In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic. CONCLUSIONS Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .
Collapse
Affiliation(s)
| | - Yingbo Lou
- Ambulatory Care Services, Denver Health Medical Center, Denver, Colorado
| | - Sonja C O'Leary
- Departments of General Pediatrics
- Departments of General Pediatrics
| | | | - Tara Thomas-Gale
- Ambulatory Care Services, Denver Health Medical Center, Denver, Colorado
| | - Claudia M Douglas
- Departments of General Pediatrics
- Departments of General Pediatrics
- Internal Medicine
| | - Florence J Wu
- Departments of General Pediatrics
- Departments of General Pediatrics
| | - Lara Penny
- Family Medicine
- Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Holly M Frost
- Departments of General Pediatrics
- Center for Health Systems Research, Denver, Colorado
- Departments of General Pediatrics
| |
Collapse
|
5
|
Stanford KA, Hazra A, Friedman E, Devlin S, Winkler N, Ridgway JP, Schneider J. Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations. Sex Transm Dis 2021; 48:347-352. [PMID: 33009277 PMCID: PMC8012396 DOI: 10.1097/olq.0000000000001311] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With syphilis rates rising rapidly in the United States, novel means of reaching high-risk populations for screening and treatment are needed. Building on successful models for emergency department (ED) HIV screening, a routine opt-out syphilis screening program was implemented in a large, urban, tertiary care hospital ED in May 2019. This study aims to assess the prevalence of syphilis in this population and to evaluate the routine, opt-out syphilis screening model. METHODS A retrospective chart review was performed of all patients screened for syphilis in the ED from June to December 2019. Demographic information, HIV status, chief complaint, and follow-up visits were examined. RESULTS During the study period, 9198 people aged 18 to 64 years were screened for syphilis. Of these, 97 (1.1%) had presumed active syphilis infection (PAI), 354 (3.8%) were presumed not to have active syphilis, and 8747 (95.1%) were negative for infection. Patients with PAI were more likely to be male (67%; adjusted odds ratio, 3.5; 95% confidence interval, 2.3-5.3; P < 0.001), although the percentage of women was considerably higher than the nationally reported rate, and most were non-Hispanic Black (93.8%). Among patients with PAI, 23 (23.7%) were HIV positive. Only 18.6% of patients with PAI presented with complaints related to sexually transmitted infections. CONCLUSIONS Syphilis rates in this community are very high, and many infections were found in populations traditionally considered at lower risk by demographic or presenting complaint, indicating that universal screening is needed. Routine ED syphilis screening in high-prevalence communities will be critical to addressing the syphilis epidemic.
Collapse
Affiliation(s)
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Eleanor Friedman
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Samantha Devlin
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Nolan Winkler
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Jessica P. Ridgway
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Skaletz-Rorowski A, Potthoff A, Nambiar S, Wach J, Kayser A, Kasper A, Brockmeyer NH. Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr-area, Germany: PreYoungGo study. J Eur Acad Dermatol Venereol 2020; 35:241-246. [PMID: 32881091 DOI: 10.1111/jdv.16913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time. METHODS In this study, 272 subjects (14-31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time - TAT) and (ii) test to therapy initiation was documented. RESULTS Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h. CONCLUSION Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day.
Collapse
Affiliation(s)
- A Skaletz-Rorowski
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A Potthoff
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - S Nambiar
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - J Wach
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Public Health Department Bochum, Bochum, Germany
| | - A Kayser
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Aids Service Organization Bochum e. V., Bochum, Germany
| | - A Kasper
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - N H Brockmeyer
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| |
Collapse
|
7
|
Bergquist EP, Trolard A, Kuhlmann AS, Loux T, Liang SY, Stoner BP, Reno H. Undertreatment of chlamydia and gonorrhea among pregnant women in the emergency department. Int J STD AIDS 2019; 31:166-173. [PMID: 31865863 DOI: 10.1177/0956462419880379] [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: 11/16/2022]
Abstract
The objective of this study is to evaluate whether pregnant women receive appropriate treatment, undertreatment, or overtreatment in the emergency department (ED) when they are tested for chlamydia and gonorrhea as compared to non-pregnant women. In a retrospective cohort study, we analyzed visits made to an urban ED from 1 July 2012 to 30 June 2014, with testing for chlamydia and gonorrhea (n = 3908). Using multiple logistic regression, we compared undertreatment and overtreatment in women controlling for pregnancy, age, race, and sexually transmitted infection International Statistical Classifications of Diseases (ICD)-9 coded diagnosis. Pregnant women were significantly more likely to be undertreated when positive for infection as compared to non-pregnant women (OR 2.94; 95% CI, 1.47–5.95) and significantly less likely to be overtreated when negative for infection (OR 0.40; 95% CI, 0.31–0.53) as compared to non-pregnant women. Pregnant women may not be receiving appropriate treatment when they present to the ED with chlamydia or gonorrhea. Attention should be paid to this group when administering chlamydia and gonorrhea treatment to ensure appropriate care and follow-up.
Collapse
Affiliation(s)
- Eleanor P Bergquist
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Anne Trolard
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne S Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Travis Loux
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Stephen Y Liang
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley P Stoner
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.,Department of Anthropology, Washington University in St. Louis, St. Louis, MO, USA
| | - Hilary Reno
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|