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Obafemi OA, Rowan SE, Nishiyama M, Wendel KA. Mycoplasma genitalium: Key Information for the Primary Care Clinician. Med Clin North Am 2024; 108:297-310. [PMID: 38331481 DOI: 10.1016/j.mcna.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..
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Affiliation(s)
- Oluyomi A Obafemi
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Masayo Nishiyama
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA
| | - Karen A Wendel
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
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Higgins DM, Riba A, Alderton L, Wendel KA, Scanlon J, Weise J, Gibson N, Obafemi O. Evaluation of the Impact and Outcomes of a Rapid Transition to Telehealth PrEP Delivery at a Sexual Health Clinic During the COVID-19 Pandemic. Sex Transm Dis 2023; 50:816-820. [PMID: 37820240 PMCID: PMC10668045 DOI: 10.1097/olq.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Increasing human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) use is a critical part of ending the HIV epidemic. In response to the COVID-19 pandemic, many PrEP services transitioned to a telehealth model (telePrEP). This report evaluates the effect of COVID-19 and the addition of telePrEP on delivery of PrEP services at the Denver Sexual Health Clinic (DSHC), a regional sexual health clinic in Denver, CO. METHODS Before COVID-19, DSHC PrEP services were offered exclusively in-clinic. In response to the pandemic, after March 15, 2020, most PrEP initiation and follow-up visits were converted to telePrEP. A retrospective analysis of DSHC PrEP visits compared pre-COVID-19 (September 1, 2019 to March 15, 2020) to post-COVID-19 (March 16, 2020 to September 30, 2020) visit volume, demographics, and outcomes. RESULTS The DSHC completed 689 PrEP visits pre-COVID-19 and maintained 96.8% (n = 667) of this volume post-COVID-19. There were no differences in client demographics between pre-COVID-19 (n = 341) and post-COVID-19 PrEP start visits (n = 283) or between post-COVID-19 in-clinic (n = 140) vs telePrEP start visits (n = 143). There were no differences in 3- to 4-month retention rates pre-COVID-19 (n = 17/43) and post-COVID-19 (n = 21/43) ( P = 0.52) or between in-clinic (n = 12/21) and telePrEP clients (n = 9/22) in the post-COVID-19 window ( P = 0.37). Also, there were no significant differences in lab completion rates between in-clinic (n = 140/140) and telePrEP clients (n = 138/143) ( P = 0.06) and prescription fill rates between in-clinic (n = 115/136) and telePrEP clients (n = 116/135) in the post-COVID-19 window ( P = 0.86). CONCLUSIONS Implementation of TelePrEP enabled the DSHC to sustain PrEP services during the COVID-19 pandemic without significant differences in demographics, engagement, or retention in PrEP services.
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Affiliation(s)
- David M. Higgins
- Public Health Institute at Denver Health, Denver, CO
- Department of Preventive Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Adrean Riba
- Public Health Institute at Denver Health, Denver, CO
| | - Lucy Alderton
- Public Health Institute at Denver Health, Denver, CO
| | - Karen A. Wendel
- Public Health Institute at Denver Health, Denver, CO
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Julia Weise
- Public Health Institute at Denver Health, Denver, CO
| | - Nathan Gibson
- Public Health Institute at Denver Health, Denver, CO
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Higgins DM, Moore M, Alderton L, Weinberg L, Hickok AM, Yale A, Wendel KA. Evaluation of a Statewide Online, At-Home Sexually Transmitted Infection and Human Immunodeficiency Virus Screening Program. Clin Infect Dis 2023; 76:2148-2153. [PMID: 36757359 DOI: 10.1093/cid/ciad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Innovative approaches such as online, at-home programs may address important barriers to sexually transmitted infection (STI) and human immunodeficiency virus (HIV) screening in the United States. This study evaluated the first year of an online, at-home program offering HIV and triple-site (urogenital, rectal, and pharyngeal) gonorrhea (GC) and chlamydia (CT) testing in Colorado. METHODS Test Yourself Colorado (TYC) is an online, at-home program that provides free mailed HIV tests and/or GC/CT tests to Colorado adults. Program use and outcomes between 1 June 2021 and 31 May 2022 were analyzed. RESULTS A total of 1790 unique clients utilized TYC. Of 1709 clients who ordered HIV tests, 508 (29.7%) were men who have sex with men (MSM), and 41.3% (210/508) of these clients reported having never been tested for HIV before or were not tested in the prior year. Hispanic clients had lower STI test return rates (37.1%; 134/361) compared with non-Hispanic clients (45.9%; 518/1128) (P = .003). Positive STI tests were identified in 9.6% (68/708) of clients. Positive STI tests were more common in MSM clients (15.7%; 34/216) compared with all other sexual orientations (6.9%; 34/492) (P < .001). STI treatment was confirmed in 80.9% (55/68) of clients. CONCLUSIONS The TYC online, home testing portal is a scalable tool that reaches clients at risk of STIs and HIV and navigates those with positive STI tests to treatment. HIV/STI home testing programs need to further assess and address utilization and outcomes for disparities by race and ethnicity to assure programs equitably benefit all at-risk communities.
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Affiliation(s)
- David M Higgins
- Public Health Institute at Denver Health, Denver, Colorado, USA
- Preventive Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Prevention Training Center, Division of HIV/STI Prevention, Public Health Institute at Denver Health, Denver, Colorado, USA
| | - MaShawn Moore
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Lucy Alderton
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Laura Weinberg
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Andrew M Hickok
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Andrew Yale
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Karen A Wendel
- Public Health Institute at Denver Health, Denver, Colorado, USA
- Denver Prevention Training Center, Division of HIV/STI Prevention, Public Health Institute at Denver Health, Denver, Colorado, USA
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Dalton AF, Diallo AO, Chard AN, Moulia DL, Deputy NP, Fothergill A, Kracalik I, Wegner CW, Markus TM, Pathela P, Still WL, Hawkins S, Mangla AT, Ravi N, Licherdell E, Britton A, Lynfield R, Sutton M, Hansen AP, Betancourt GS, Rowlands JV, Chai SJ, Fisher R, Danza P, Farley M, Zipprich J, Prahl G, Wendel KA, Niccolai L, Castilho JL, Payne DC, Cohn AC, Feldstein LR. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:553-558. [PMID: 37200229 DOI: 10.15585/mmwr.mm7220a3] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
As of March 31, 2023, more than 30,000 monkeypox (mpox) cases had been reported in the United States in an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and transgender persons (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) was approved by the Food and Drug Administration (FDA) in 2019 for the prevention of smallpox and mpox via subcutaneous injection as a 2-dose series (0.5 mL per dose, administered 4 weeks apart) (2). To expand vaccine access, an Emergency Use Authorization was issued by FDA on August 9, 2022, for dose-sparing intradermal injection of JYNNEOS as a 2-dose series (0.1 mL per dose, administered 4 weeks apart) (3). Vaccination was available to persons with known or presumed exposure to a person with mpox (postexposure prophylaxis [PEP]), as well as persons at increased risk for mpox or who might benefit from vaccination (preexposure mpox prophylaxis [PrEP]) (4). Because information on JYNNEOS vaccine effectiveness (VE) is limited, a matched case-control study was conducted in 12 U.S. jurisdictions,† including nine Emerging Infections Program sites and three Epidemiology and Laboratory Capacity sites,§ to evaluate VE against mpox among MSM and transgender adults aged 18-49 years. During August 19, 2022-March 31, 2023, a total of 309 case-patients were matched to 608 control patients. Adjusted VE was 75.2% (95% CI = 61.2% to 84.2%) for partial vaccination (1 dose) and 85.9% (95% CI = 73.8% to 92.4%) for full vaccination (2 doses). Adjusted VE for full vaccination by subcutaneous, intradermal, and heterologous routes of administration was 88.9% (95% CI = 56.0% to 97.2%), 80.3% (95% CI = 22.9% to 95.0%), and 86.9% (95% CI = 69.1% to 94.5%), respectively. Adjusted VE for full vaccination among immunocompromised participants was 70.2% (95% CI = -37.9% to 93.6%) and among immunocompetent participants was 87.8% (95% CI = 57.5% to 96.5%). JYNNEOS is effective at reducing the risk for mpox. Because duration of protection of 1 versus 2 doses remains unknown, persons at increased risk for mpox exposure should receive the 2-dose series as recommended by the Advisory Committee on Immunization Practices (ACIP),¶ regardless of administration route or immunocompromise status.
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Obafemi OA, Leichliter JS, Maravi M, Alfonsi GA, Shlay JC, Wendel KA, Rietmeijer CA. Successful Provision of Long-Acting Reversible Contraception in a Sexual Health Clinic. Sex Transm Dis 2022; 49:443-447. [PMID: 35608098 PMCID: PMC9951185 DOI: 10.1097/olq.0000000000001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women who attend sexual health clinics are at high risk for sexually transmitted infections and unintended pregnancy. Long-acting reversible contraceptives (LARC) are very effective contraceptive methods, but the provision of LARC in such clinics is not well described in the literature. METHODS We conducted a retrospective chart review of women who presented to Denver Sexual Health Clinic for any reason and received family planning services between April 1, 2016, and October 31, 2018. We assessed demographic and clinical factors associated with contraceptive method received and conducted a subanalysis of those with intrauterine device (IUD) insertions on the same-day versus delayed insertion. Among those who received an IUD, we assessed rates of pelvic inflammatory disease (PID) 30 days after insertion. RESULTS Of the 5064 women who received family planning services in our clinic, 1167 (23%) were using a LARC method at the time of their visit. Of the 3897 who were not using a LARC, fewer women, 12.6%, chose LARC (IUD and progestin implant), compared with 33.3% who chose new short-acting reversible contraceptives. Further analysis of the 270 IUD initiators revealed 202 (74.8%) received the IUD on the same day, whereas 68 (25.2%) had delayed IUD insertion. There were 9 incident cases of gonorrhea or chlamydia in those who received same-day IUD and 1 incident case among those who had delayed IUD insertion. There were no cases of PID at 30 days after insertion in either group. CONCLUSIONS Study findings support IUD provision in a sexual health clinic on the day of initial visit without increased risk of PID.
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Affiliation(s)
- Oluyomi A. Obafemi
- Public Health Institute at Denver Health, Denver
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
| | | | | | - Grace A. Alfonsi
- Public Health Institute at Denver Health, Denver
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver
| | - Judith C. Shlay
- Public Health Institute at Denver Health, Denver
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver
| | - Karen A. Wendel
- Public Health Institute at Denver Health, Denver
- Department of Infectious Diseases, University of Colorado School of Medicine, Aurora
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McWhirter L, Lou Y, Reingold S, Warsh S, Thomas-Gale T, Haynes C, Rinehart D, Wendel KA, Frost HM. Rates of Appropriate Treatment and Follow-Up Testing After a Gonorrhea and/or Chlamydia Infection in an Urban Network of Federally Qualified Health Center Systems. Sex Transm Dis 2022; 49:319-324. [PMID: 35001017 PMCID: PMC9018487 DOI: 10.1097/olq.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reinfection and partner transmission are common with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT). We assessed treatment and follow-up laboratory testing for GC and CT and evaluated associations with patient- and system-level factors. METHODS The analysis included positive GC and/or CT nucleic acid amplification test results from patients aged 14 to 24 years at a federally qualified health center system site in Denver, CO, from January 2018 to December 2019. Outcomes assessed include treatment within 14 days, HIV/syphilis testing within 6 months, and repeat GC and CT testing within 2 to 6 months. Bivariate and multivariable regression modeling assessed associated factors. RESULTS Among 27,168 GC/CT nucleic acid amplification tests performed, 1.8% (484) were positive for GC and 7.8% (2125) were positive for CT. Within the assessed time frames, 87% (2275) of patients were treated, 54.1% (1411) had HIV testing, 50.1% (1306) had syphilis testing, and 39.9% (1040) had GC and CT retesting. Older patients were more likely to receive treatment (adjusted odds ratio 1.13; 95% confidence interval, 1.00-1.27; P = 0.05) than younger patients, whereas males were less likely to receive GC and CT retesting (adjusted odds ratio, 0.19; 95% confidence interval, 0.11-0.33; P < 0.001) than females. Patients treated on the day of testing were less likely to receive follow-up laboratory tests than those treated 2 to 14 days after. CONCLUSIONS Although most patients received antibiotic treatment, only about half received HIV/syphilis testing and less than half received GC and CT retesting. It is critical to find innovative strategies to improve treatment and follow-up management of these infections to decrease complications, reduce transmission, and combat the rising rates of sexually transmitted infections.
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Affiliation(s)
| | - Yingbo Lou
- Denver Health Medical Center, Community Health Services, Denver, CO
| | - Sarah Reingold
- University of Colorado School of Medicine, Department of Internal Medicine-Pediatrics, Aurora, CO
| | - Sarah Warsh
- Denver Health Medical Center, Community Health Services, Denver, CO
| | - Tara Thomas-Gale
- Denver Health Medical Center, Community Health Services, Denver, CO
| | - Christine Haynes
- Denver Health Medical Center, Department of Internal Medicine, Denver, CO
- University of Colorado School of Medicine, Department of Medicine, Division of General Internal Medicine, Aurora, CO
| | | | - Karen A. Wendel
- Denver Health Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Denver, CO
- University of Colorado School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Aurora, CO
| | - Holly M Frost
- Denver Health Medical Center, Office of Research, Denver, CO
- Denver Health Medical Center, Department of Pediatrics, Denver, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
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Hauschild BC, Burnside HC, Gray BA, Johnston C, Neu N, Park IU, Reno HEL, Rompalo A, Van Wagoner N, Wendel KA, Coor A, Tromble E, Rietmeijer CA. Characteristics of the Audience Reached by the National Network of Sexually Transmitted Disease Clinical Prevention Training Centers and Correlation With Sexually Transmitted Infection Rates, 2015 to 2020. Sex Transm Dis 2022; 49:313-317. [PMID: 35312669 DOI: 10.1097/olq.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC) trains clinical providers to diagnose and treat sexually transmitted infections (STIs) in the United States. The purpose of this study was to examine the demographics of clinical providers and to correlate the number of training episodes with STI rates at the county level. METHODS Registration data were collected between April 1, 2015, and March 31, 2020, in a custom Learning Management System from clinical providers taking NNPTC training. Using the 2018 STI surveillance data, counties were divided into quartiles based on reportable STI case rates and the number of county-level training events was compared per quartile. Univariate and multivariate analyses were conducted in IBM SPSS Statistics 23 (Armonk, NY) and SAS Enterprise Guide 7.1 (Cary, NC). RESULTS From 2015 to 2020, the NNPTC trained 21,327 individuals, predominantly in the nursing professions and working in a public health environment. In multivariate analysis, the number of training events was significantly associated with higher STI rates at the county level (P < 0.0001) and the state where a prevention training center is located (P < 0001). CONCLUSIONS The analysis suggests that NNPTC trainings are reaching the clinical providers working in geographic areas with higher STI rates.
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Affiliation(s)
- Benjamin C Hauschild
- From the Denver Prevention Training Center, Public Health Institute at Denver Health, Denver, CO
| | - Helen C Burnside
- From the Denver Prevention Training Center, Public Health Institute at Denver Health, Denver, CO
| | - Barbara A Gray
- Sylvie Ratelle STD/HIV Prevention Training Center, Massachusetts Department of Public Health, Jamaica Plain, MA
| | - Christine Johnston
- University of Washington Prevention Training Center, Department of Medicine, University of Washington, Seattle, WA
| | - Natalie Neu
- New York City STD Prevention Training Center, Colombia University Mailman School of Public Health, New York, NY
| | - Ina U Park
- California Prevention Training Center, University of California at San Francisco, San Francisco, CA
| | - Hilary E L Reno
- St. Louis HIV/STI Prevention Training Center, Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Anne Rompalo
- Prevention Training Center at Johns Hopkins, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Nicholas Van Wagoner
- Southeast HIV/STD Prevention Training Center, Division of Infectious Diseases, University of Alabama, Birmingham, AL
| | - Karen A Wendel
- From the Denver Prevention Training Center, Public Health Institute at Denver Health, Denver, CO
| | - Alexandra Coor
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin Tromble
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Rowan SE, McCormick DW, Wendel KA, Scott T, Chavez-van de Hey J, Wilcox K, Stella SA, Kamis K, Burman WJ, Marx GE. Lower Prevalence of SARS-CoV-2 Infection Among People Experiencing Homelessness Tested in Outdoor Encampments Compared with Overnight Shelters - Denver, Colorado, June - July 2020. Clin Infect Dis 2022; 75:e157-e164. [PMID: 35040947 PMCID: PMC8807271 DOI: 10.1093/cid/ciac039] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A better understanding of the risk for COVID-19 that people experiencing homelessness (PEH) face in congregate shelters versus unsheltered encampments is critical for an effective pandemic response. METHODS We analyzed factors associated with current and past SARS-CoV-2 infection among PEH in day and overnight shelters and encampments in Denver, Colorado, during June 2-July 28, 2020, and constructed multivariable logistic regression models to examine risk factors for SARS-CoV-2 RNA and seropositivity with age, race/ethnicity, testing location, testing month, and symptom status as predictor variables. RESULTS A total of 823 participants were tested for SARS-CoV-2 RNA, and 276 individuals were tested for SARS-CoV-2 antibodies. A greater percentage of PEH at overnight shelters tested positive for SARS-CoV-2 RNA (8.6% vs 2.5%, p<0.01) and antibodies (21.5% vs 8.7%, p=0.03) compared to encampments. In regression models, testing at an overnight shelter compared to testing at encampments (OR=3.03, 95% CI 1.16-9.02) had increased odds of a positive SARS-CoV-2 RNA result. Age >60 years compared to age <40 years (OR=5.92, 95% CI 1.83-20.3), Hispanic ethnicity (OR=3.43, 95% CI 1.36-8.95) and non-Hispanic Black race compared to non-Hispanic White race (OR=3.07, 95% CI 1.16-8.26), and testing at an overnight shelter compared to testing at encampments (OR=2.45, 95% CI 1.04-6.17) had increased odds of a positive antibody result. CONCLUSIONS Our findings support the need for continuing assessment of mitigation strategies in shelters, increasing access to individual rooms and linkage to housing options for PEH, and supporting people to remain in encampments when these options are not available.
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Affiliation(s)
- Sarah E Rowan
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - David W McCormick
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Karen A Wendel
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Tracy Scott
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | | | - Kay Wilcox
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Public Health Associate Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Stella
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Kevin Kamis
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - William J Burman
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Grace E Marx
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA.,National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Rietmeijer CA, Hauschild BC, Burnside HC, Wendel KA. Medicaid Expansion and Rates of Reportable Sexually Transmitted Infections in the United States: A County-Level Analysis. Sex Transm Dis 2021; 48:e190-e191. [PMID: 34110744 DOI: 10.1097/olq.0000000000001422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chlamydia, gonorrhea, and primary/secondary syphilis rates in 2018 were significantly higher in counties located in states without Medicaid expansion compared with those with Medicaid expansion. For sexually transmitted infections combined, 59.9% of counties without Medicaid expansion were in the highest 2 sexually transmitted infection rate quartiles compared with 42.2% of counties with Medicaid expansion (P < 0.0001).
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Affiliation(s)
| | | | | | - Karen A Wendel
- the Denver Public Health Department, Denver Health and Hospital
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11
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Wendel KA, Mauk K, Amsterdam L, McNeil CJ, Pfister JR, Mobley V, Mettenbrink C, Nishiyama M, Terrell E, Baldwin T, Pham CD, Nash EE, Kirkcaldy RD, Schlanger K. Enhancing Gonococcal Antimicrobial Resistance Surveillance in Cisgender Women, Strengthening the US Response to Resistant Gonorrhea, 2018 to 2019. Sex Transm Dis 2021; 48:S104-S110. [PMID: 34475358 PMCID: PMC10261999 DOI: 10.1097/olq.0000000000001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cisgender women have been underrepresented in antibiotic-resistant gonorrhea (ARGC) surveillance systems. Three of 8 project sites (City of Milwaukee [MIL], Guilford County [GRB], Denver County [DEN]), funded under the Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG), focused efforts to better include cisgender women in ARGC surveillance. METHODS MIL, GRB, and DEN partnered with diverse health care settings and developed gonorrhea culture criteria to facilitate urogenital specimen collection in cisgender women and men. Regional laboratories within the Antibiotic Resistance Laboratory Network performed agar dilution antibiotic susceptibility testing (AST) of gonococcal isolates. Data from 2018 and 2019 were analyzed. RESULTS In SURRG, 90.5% (11,464 of 12,667) of the cisgender women from whom urogenital culture specimens were collected were from MIL, GRB, and DEN. Of women in SURRG whose gonococcal isolates underwent AST, 70% were from these 3 sites. In these 3 sites, a substantial proportion of cisgender women with positive urogenital cultures and AST were from health care settings other than sexually transmitted disease (STD) clinics (non-STD clinics; MIL, 56.0%; GRB, 80.4%; and DEN, 23.5%). Isolates with AST were obtained from 5.1%, 10.2%, and 2.4% of all diagnosed gonorrhea cases among cisgender women in MIL, GRB, and DEN, respectively, and were more often susceptible to all antibiotics than those from cisgender men from each of these sites. CONCLUSIONS With focused efforts and partnerships with non-STD clinics, 3 SURRG sites were able to include robust ARGC surveillance from cisgender women. These findings may guide further efforts to improve gender equity in ARGC surveillance.
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Affiliation(s)
- Karen A. Wendel
- Public Health Institute at Denver Health, Denver
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Kerry Mauk
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers of Disease Control and Prevention, Atlanta, GA
| | - Lori Amsterdam
- Wisconsin Division of Public Health STI Unit, Madison
- City of Milwaukee Health Department, Milwaukee, WI
| | - Candice J. McNeil
- Section on Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Winston Salem
- Guilford County Department of Health, Greensboro, NC
| | - John R. Pfister
- Health Care Education & Training (HCET) Epi Consultant, Madison, WI
| | | | | | | | | | | | - Cau D. Pham
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers of Disease Control and Prevention, Atlanta, GA
| | - Evelyn E. Nash
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers of Disease Control and Prevention, Atlanta, GA
| | - Robert D. Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers of Disease Control and Prevention, Atlanta, GA
| | - Karen Schlanger
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers of Disease Control and Prevention, Atlanta, GA
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Marx GE, Biggerstaff BJ, Nawrocki CC, Totten SE, Travanty EA, Burakoff AW, Scott T, De Hey JCV, Carlson JJ, Wendel KA, Harcourt JL, Tamin A, Thomas JD, Rowan SE. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 on Self-Collected Saliva or Anterior Nasal Specimens Compared With Healthcare Personnel-Collected Nasopharyngeal Specimens. Clin Infect Dis 2021; 73:S65-S73. [PMID: 33912930 PMCID: PMC8135412 DOI: 10.1093/cid/ciab330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nasopharyngeal specimens (NPS) are commonly used for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing but can be uncomfortable for patients. Self-collected saliva specimens (SS) or anterior nasal specimens (ANS) for SARS-CoV-2 detection are less invasive, but the sensitivity of these specimen types has not been thoroughly evaluated. METHODS During September-November 2020, 730 adults undergoing SARS-CoV-2 testing at community testing events and homeless shelters in Denver provided self-collected SS and ANS before NPS collection and answered a short survey about symptoms and specimen preference. Specimens were tested for SARS-CoV-2 by means of real-time reverse-transcription polymerase chain reaction (rRT-PCR); viral culture was performed on a subset of specimens positive by rRT-PCR. The sensitivity of SS and ANS for SARS-CoV-2 detection by rRT-PCR was measured against that of NPS. Subgroup analyses included test outcomes by symptom status and culture results. RESULTS Sensitivity for SARS-CoV-2 detection by rRT-PCR appeared higher for SS than for ANS (85% vs 80%) and higher among symptomatic participants than among those without symptoms (94% vs 29% for SS; 87% vs 50% for ANS). Among participants with culture-positive SARS-CoV-2 by any specimen type, the sensitivities of SS and ANS by rRT-PCR were 94% and 100%, respectively. SS and ANS were equally preferred by participants; most would undergo NPS collection again despite this method's being the least preferred. CONCLUSIONS SS were slightly more sensitive than ANS for SARS-CoV-2 detection with rRT-PCR. With both SS and ANS, SARS-CoV-2 was reliably detected among participants with symptoms. Self-collected SS and ANS offer practical advantages, are preferred by patients, and might be most useful for testing people with coronavirus disease 2019 symptoms.
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Affiliation(s)
- Grace E Marx
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.,Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,University of Colorado Denver, Aurora, Colorado, USA
| | | | - Courtney C Nawrocki
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Sarah E Totten
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Emily A Travanty
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Alexis W Burakoff
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Tracy Scott
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | | | - Jesse J Carlson
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Karen A Wendel
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,University of Colorado Denver, Aurora, Colorado, USA
| | | | - Azaibi Tamin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Sarah E Rowan
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,University of Colorado Denver, Aurora, Colorado, USA
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13
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Kamis KF, Marx GE, Scott KA, Gardner EM, Wendel KA, Scott ML, Montgomery AE, Rowan SE. Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care. Open Forum Infect Dis 2019; 6:ofz310. [PMID: 31341933 PMCID: PMC6641790 DOI: 10.1093/ofid/ofz310] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Strategies to increase pre-exposure prophylaxis (PrEP) uptake are needed. We hypothesized that same-day PrEP initiation in a sexually transmitted diseases (STD) clinic would be acceptable, feasible, and safe, and that individuals would engage in ongoing PrEP care. Method Individuals aged ≥ 18 years were evaluated for PrEP. Exclusion criteria were HIV, history of renal dysfunction or chronic hepatitis B infection, pregnancy, indications for HIV post-exposure prophylaxis, or positive screen for acute HIV symptoms. One hundred individuals received a free 30-day PrEP starter pack and met with a patient navigator to establish ongoing care. Bivariate analysis and multivariable logistic regression were used to compare individuals who did and did not attend at least 1 PrEP follow-up appointment within 180 days of enrollment. Client satisfaction surveys were given 3 months after enrollment. Results The majority (78%) of participants completed at least 1 PrEP follow-up appointment, and 57% attended at least 2 follow-up appointments. After adjusting for race and ethnicity, age, health insurance status, and annual income, only income was associated with follow-up appointment attendance. Each additional $10,000 increase in income was associated with a 1.7-fold increase in the odds of attending a PrEP follow-up appointment (95% confidence interval, 1.07–2.66, P = .02). The majority (54%) of individuals completed the satisfaction survey and all respondents liked the option of same-day PrEP initiation. Conclusions Our study suggests STD clinic-based, same-day PrEP initiation is acceptable, feasible, safe, and links a high proportion of individuals into ongoing PrEP care. Additional resources may be needed to support low-income individuals’ retention in care.
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Affiliation(s)
- Kevin F Kamis
- Denver Public Health, Denver Health and Hospital Authority, Colorado
| | - Grace E Marx
- University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora.,Colorado School of Public Health, Department of Epidemiology, Aurora
| | - Kenneth A Scott
- Denver Public Health, Denver Health and Hospital Authority, Colorado
| | - Edward M Gardner
- Denver Public Health, Denver Health and Hospital Authority, Colorado.,University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora
| | - Karen A Wendel
- Denver Public Health, Denver Health and Hospital Authority, Colorado.,University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora
| | | | | | - Sarah E Rowan
- Denver Public Health, Denver Health and Hospital Authority, Colorado.,University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora
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Abstract
Acyclovir (Zovirax) was approved for the treatment of herpesvirus infections almost two decades ago. It was the first agent in a novel group of antiviral medications that now include valacyclovir (Valtrex), penciclovir (Denavir and famciclovir (Famvir). These agents have made a dramatic impact on the morbidity associated with herpes simplex virus infections and herpes zoster. Topical and oral antiviral use have shown modest but statistically significant efficacy in treating herpes labialis with most studies demonstrating a significant reduction in episode length and/or healing time. Oral acyclovir, valacyclovir and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes and are useful as suppressive therapy for individuals with frequent genital herpes recurrences. In addition, high doses of oral acyclovir, valacyclovir and famciclovir have been shown to speed the healing of herpes zoster, and data suggests that these agents also decrease associated acute and chronic pain in people of 50 years of age or older. Further research is required to clarify the safety of these agents in pregnant women with genital herpes, the role of antiviral therapy in decreasing the sexual transmission of genital herpes, and the efficacy and cost-effectiveness of these agents in treating herpes zoster in people below the age of 50 years.
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Affiliation(s)
- Michelle D Moomaw
- Oklahoma University Health Science Center Department of Internal Medicine, Section Infectious Diseases, Oklahoma City, OK, USA
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15
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Abstract
Trichomonas vaginalis infection is a common cause of vaginal irritation in women and is the most common nonviral sexually transmitted disease in the world. It has been associated with serious sequelae, the most notable of which are prematurity, low birth weight, and increases in human immunodeficiency virus transmission. We review advances in diagnosis and treatment and the current controversies regarding management.
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Affiliation(s)
- Karen A Wendel
- Division of Infectious Diseases, University of Colorado Health Science Center, Denver, CO, USA.
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16
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Abstract
Trichomonas vaginalis has long been recognized as a cause of infectious vaginitis in women. More recently, studies have demonstrated a significant burden of disease in men with urethritis or men at high risk for sexually transmitted diseases. There is increasing interest in this pathogen as more data accumulates linking it to HIV transmission and perinatal morbidity. New diagnostic methods have emerged that may increase sensitivity of diagnosis or improve point-of-care access to testing. Nitroimidazoles remain the mainstay of therapy. Metronidazole and tinidazole are highly effective as single-dose therapy. Unfortunately, despite the link between T. vaginalis infection and perinatal morbidity, nitroimidazole therapy during pregnancy remains controversial. Although metronidazole resistance is currently uncommon, pharmacological features and nitroimidazole resistance patterns suggest that tinidazole may be more effective in treating patients with metronidazole treatment failure. Alternatives to nitroimidazole therapy are few, and most have limited efficacy and significant toxicity.
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Affiliation(s)
- Neha Nanda
- Department of Medicine, Oklahoma University Health Science Center, Oklahoma City, OK, USA
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17
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Huppert JS, Batteiger BE, Braslins P, Feldman JA, Hobbs MM, Sankey HZ, Sena AC, Wendel KA. Use of an immunochromatographic assay for rapid detection of Trichomonas vaginalis in vaginal specimens. J Clin Microbiol 2005; 43:684-7. [PMID: 15695664 PMCID: PMC548056 DOI: 10.1128/jcm.43.2.684-687.2005] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trichomonas vaginalis infection is estimated to be the most widely prevalent nonviral sexually transmitted infection in the world. Wet-mount microscopy is the most common diagnostic method, although it is less sensitive than culture. The OSOM Trichomonas Rapid Test (Genzyme Diagnostics, Cambridge, Mass.) (referred to here as OSOM) is a new point-of-care diagnostic assay for T. vaginalis that uses an immunochromatographic capillary flow (dipstick) assay and provides results in 10 min. The purpose of this study was to determine the test characteristics of OSOM compared to those of a composite reference standard (CRS) comprised of wet-mount microscopy and T. vaginalis culture. This multicenter cross-sectional study enrolled sexually active women > or =18 years of age who presented with symptoms of vaginitis, exposure to T. vaginalis, or multiple sexual partners. Vaginal-swab specimens were obtained for T. vaginalis culture, wet mount, and rapid testing. The prevalence of T. vaginalis in this sample was 23.4% (105 of 449) by the CRS. The sensitivity and specificity of OSOM vaginal-swab specimens were 83.3 and 98.8%, respectively, while wet mount had a sensitivity and specificity of 71.4 and 100%, respectively, compared to the CRS. OSOM performed significantly better than wet mount (P = 0.004) and detected T. vaginalis in samples that required 48 to 72 h of incubation prior to becoming culture positive. The performance of the rapid test was not affected by the presence of coinfections with chlamydia and gonorrhea. The OSOM Trichomonas Rapid Test is a simple, objective test that can be expected to improve the diagnosis of T. vaginalis, especially where microscopy and culture are unavailable.
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Affiliation(s)
- Jill S Huppert
- Division of Adolescent Medicine (ML 4000), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
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18
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Wendel KA, McArthur JC. Acute meningoencephalitis in chronic human immunodeficiency virus (HIV) infection: putative central nervous system escape of HIV replication. Clin Infect Dis 2003; 37:1107-11. [PMID: 14523776 DOI: 10.1086/378300] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 06/11/2003] [Indexed: 11/03/2022] Open
Abstract
We describe 3 patients with chronic human immunodeficiency virus (HIV) infection who presented with syndromes compatible with acute meningoencephalitis secondary to HIV; these syndromes were characterized by elevated cerebrospinal spinal fluid (CSF) HIV viral loads and T2-weighted signal abnormalities on magnetic resonance imaging of the brain. After the initiation of or a change in highly active antiretroviral therapy (HAART), each of the patients had significant and rapid improvement in neurologic symptoms and dramatic reductions in CSF HIV viral loads. Although further investigation is needed, these findings suggest that measurement of CSF HIV viral load and treatment with central nervous system-penetrating HAART should be considered for patients with acute neurologic complaints, chronic HIV infection, and no other identifiable cause of neurologic illness.
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Affiliation(s)
- Karen A Wendel
- Division of Infectious Diseases, Oklahoma University Health Science Center, Oklahoma City, OK 73104, USA.
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19
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Wendel KA, Erbelding EJ, Gaydos CA, Rompalo AM. Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic. Sex Transm Infect 2003; 79:151-3. [PMID: 12690140 PMCID: PMC1744621 DOI: 10.1136/sti.79.2.151] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the prevalence and clinical features of Trichomonas vaginalis (TV) infection in men. METHODS Men attending a public STD clinic in Baltimore, Maryland, were evaluated between March and July 2000. Clinicians recorded a standardised history and clinical examination. Urethral swab specimens were collected for Gram stain and Neisseria gonorrhoeae culture. First fraction urine samples were evaluated with TV culture and chlamydia and TV polymerase chain reaction (PCR). True positive TV was defined as a positive TV culture or a positive TV PCR confirmed with a second primer set. RESULTS 355 men were evaluated in 363 visits. The prevalence of gonorrhoea, TV, and chlamydia were 19%, 13%, and 11%, respectively. In men over 28 years, the prevalence of TV was significantly higher than chlamydia. Age and urethritis by Gram stain were associated with a positive result on TV culture (p=0.03 and p=0.02, respectively) but not associated with TV infection as defined by a positive TV culture or a confirmed TV PCR. Discharge or dysuria was reported in 47% and 22% of men with TV, respectively. CONCLUSIONS TV prevalence in an urban STD clinic setting was high. Older age and urethritis were not significantly associated with TV infection as defined by a positive TV culture or a confirmed TV PCR.
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Affiliation(s)
- K A Wendel
- Division of Infectious Diseases, Oklahoma University Health Science Center, Oklahoma, USA
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20
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Abstract
Trichomonas vaginalis is the most common nonviral sexually transmitted disease in the world. Recent research has elucidated several virulence factors that allow T. vaginalis to adhere to extracellular host proteins and evade the host immune system. Further investigation is needed to determine the mechanisms responsible for the perinatal morbidity associated with trichomoniasis and to evaluate the interactions between trichomoniasis and HIV infection. An effort to decrease T. vaginalis associated with perinatal morbidity by metronidazole treatment in pregnancy was unsuccessful. However, more sensitive tools for diagnosis such as polymerase chain reaction may further facilitate future understanding of the epidemiology and risk factors of disease and improve approaches to control this widespread infection. Treatment has remained highly efficacious with single-dose metronidazole, although concern regarding drug resistance has led to more systematic evaluations of the prevalence of metronidazole resistance and alternatives to metronidazole treatment.
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Affiliation(s)
- Karen A. Wendel
- Division of Infectious Diseases, Oklahoma University Health Science Center, 921 NE 13th Street (111C), Oklahoma City, OK 73104, USA.
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Alderete JF, Wendel KA, Rompalo AM, Erbelding EJ, Benchimol M, Chang TH. Trichomonas vaginalis: evaluating capsid proteins of dsRNA viruses and the dsRNA virus within patients attending a sexually transmitted disease clinic. Exp Parasitol 2003; 103:44-50. [PMID: 12810045 DOI: 10.1016/s0014-4894(03)00068-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Some isolates of Trichomonas vaginalis, the number one, non-viral sexually transmitted disease agent, are infected with one or several distinct double stranded (ds)-RNA virus. Immune rabbit anti-capsid serum (IRS) reacted with the capsid protein of purified dsRNA virus of a subset of the virus-infected T. vaginalis isolates. A monoclonal antibody (mAb) that recognized the capsid protein reactive with the IRS was generated. Analysis of the virus capsid protein of virus-infected isolates by probing nitrocellulose blots with mAb revealed diversity among immunoreactivity and in the size of the reactive capsid protein. Despite difficulties in visualizing virus within parasites by cross-section electron microscopy, gold-conjugated mAb readily labeled the cytoplasm of virus-positive trichomonads. Finally and importantly, isolates infecting patients attending an STD clinic, 75% of which were virus-positive isolates, had capsid protein of the same size detected by mAb present in all dsRNA viruses.
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Affiliation(s)
- J F Alderete
- Department of Microbiology, University of Texas Health Science Center, MC7758, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900, USA.
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Wendel KA, Erbelding EJ, Gaydos CA, Rompalo AM. Trichomonas vaginalis polymerase chain reaction compared with standard diagnostic and therapeutic protocols for detection and treatment of vaginal trichomoniasis. Clin Infect Dis 2002; 35:576-80. [PMID: 12173132 DOI: 10.1086/342060] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2002] [Revised: 04/08/2002] [Indexed: 11/03/2022] Open
Abstract
Wet preparation has limited sensitivity for diagnosis of Trichomonas vaginalis (TV) infection. An observational study of 337 women was conducted to evaluate a new polymerase chain reaction (PCR) test for TV. The sensitivities of wet preparation and TV culture were 52% (95% confidence interval [CI], 41-62) and 78% (95% CI, 69-86), respectively. TV PCR had a sensitivity of 84% (95% CI, 75-90) and a specificity of 94% (95% CI, 90-97). Metronidazole was provided to 67 (69%) of 97 women with TV because of TV on wet preparation, exposure to TV, or a diagnosis of bacterial vaginosis or pelvic inflammatory disease; however, if TV PCR had been used for diagnosis, 81 (84%) of 97 women with TV would have been treated (P=.02). TV is significantly undertreated using standard algorithms for metronidazole therapy. Given the association of trichomoniasis with perinatal morbidity and HIV transmission, women in high-risk groups may benefit from TV PCR.
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Affiliation(s)
- Karen A Wendel
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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23
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Wendel KA, Rompalo AM, Erbelding EJ, Chang TH, Alderete JF. Double-stranded RNA viral infection of Trichomonas vaginalis infecting patients attending a sexually transmitted diseases clinic. J Infect Dis 2002; 186:558-61. [PMID: 12195385 DOI: 10.1086/341832] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2002] [Revised: 04/18/2002] [Indexed: 11/03/2022] Open
Abstract
Trichomonas vaginalis (TV) can be infected with double-stranded RNA (dsRNA) viruses that may have important implications for trichomonal virulence and disease pathogenesis. A cross-sectional study was conducted in a sexually transmitted diseases clinic to determine the prevalence and clinical significance of dsRNA viral infection of TV infecting men and women. Overall, dsRNA virus was present in 21 (75%) of 28 TV isolates (95% confidence interval [CI], 55%-89%). dsRNA viral infection of TV was not associated with the presence of discharge, dysuria, genital pruritus, or genital irritation or odor. However, patients with virus-positive isolates were significantly older than patients with virus-negative isolates (median age, 38 vs. 23 years; P=.003), and virus-positive isolates were more prevalent among women (19 [86%] of 22 isolates; 95% CI, 65%-97%) than among men (2 [33%] of 6 isolates; P=.02). The age and sex specificity of virus-positive isolates may aid in understanding the differences in chronicity and clinical presentation of TV in men and women.
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Affiliation(s)
- Karen A Wendel
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Wendel KA, Sterling TR. Tuberculosis and HIV. AIDS Clin Care 2002; 14:9-15. [PMID: 11838043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Wendel KA, Sterling TR. HIV and paradoxical worsening of tuberculosis. Hopkins HIV Rep 2001; 13:8, 12. [PMID: 11727416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
OBJECTIVE To determine the incidence of paradoxical worsening of tuberculosis (TB) in HIV-infected persons. DESIGN Observational cohort study. SETTING Public, urban TB clinic. PATIENTS HIV-infected persons treated for TB between January 1, 1996, and December 31, 1999, and followed through June 30, 2000. INTERVENTION Patients received standard anti-TB therapy. Antiretroviral therapy was provided by primary medical providers. Patients receiving antiretroviral therapy were given nucleoside reverse transcriptase inhibitors alone or highly active antiretroviral therapy (HAART; nucleoside reverse transcriptase inhibitors in combination with a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor). MAIN OUTCOME MEASURE Paradoxical worsening of TB. RESULTS There were 82 TB cases in 76 patients. Paradoxical worsening was identified in 6 of 82 cases (7%; 95% confidence interval, 3 to 15%). Paradoxical worsening occurred in 3 of 28 cases (11%) in patients receiving HAART and in 3 of 44 cases (7%) in patients not receiving antiretroviral therapy (p = 0.67). Cases complicated by paradoxical worsening were more likely to have both pulmonary and extrapulmonary disease at initial diagnosis than cases without paradoxical worsening (83% vs 24%; p = 0.006). TB relapse occurred in 2 of 6 cases (33%) in patients with paradoxical worsening and in 4 of 76 cases (5%) in patients without paradoxical worsening (p = 0.06). CONCLUSIONS Paradoxical worsening of TB occurred less frequently than in previous reports and was not associated with HAART. Paradoxical worsening also appeared to be associated with an increased risk of TB relapse. Further studies are warranted to better characterize the risk factors for paradoxical worsening and the appropriate duration of anti-TB therapy in patients in whom it occurs.
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Affiliation(s)
- K A Wendel
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore 21287, USA.
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