Outcomes of Traditional and Enhanced Gonorrhea Partner Services in the Strengthening the US Response to Resistant Gonorrhea Project, 2017 to 2019

INTRODUCTION

The Centers for Disease Control and Prevention implemented Strengthening the US Response to Resistant Gonorrhea (SURRG) to build local detection and response capacity and evaluate responses to antibiotic-resistant gonorrhea outbreaks, including partner services for gonorrhea. We evaluated outcomes of traditional partner services conducted under SURRG, which involved (1) counseling index patients and eliciting sexual partners; (2) interviewing, testing, and treating partners; and (3) providing partner services to partners newly diagnosed with gonorrhea. We also evaluated outcomes of enhanced partner services, which additionally involved interviewing and testing partners of persons who tested negative, and social contacts of index patients and partners.

METHODS

We analyzed partner services investigation data from 8 jurisdictions participating in SURRG from 2017 to 2019. We summed total index patients, partners from traditional partner services, and partners and contacts from enhanced partner services, and calculated partner services outcomes among partners and contacts. We also visualized sexual networks from partner services data.

RESULTS

Of 1242 index patients identified, 506 named at least 1 sexual partner. Traditional partner services yielded 1088 sexual partners, and 105 were newly diagnosed with gonorrhea. Enhanced partner services yielded an additional 59 sexual partners and 52 social contacts. Of those partners and contacts, 3 were newly diagnosed with gonorrhea. Network visualization revealed sparse networks with few complex partnership clusters.

CONCLUSIONS

Traditional partner services for gonorrhea may be useful for eliciting, notifying, and diagnosing partners of index patients in an outbreak setting. Enhanced partner services are unlikely to be effective for eliciting, notifying, and diagnosing a substantial number of additional people.

[A left atrial myxoma. The clinical aspects]

The paper describes a case of left atrial myxoma, which was unidentified for many years after the onset of symptoms, with emphasis on the necessity for instrumental investigations (particularly M-mode and two-dimensional echocardiography) in order to obtain an accurate and prompt diagnosis of these affections when the patient's clinical history justifies the suspicion.

[Syncopal attacks caused by paroxysmal atrioventricular block in patients with systemic lupus erythematosus]

The case is described of a young woman with SLE and lipothymic and syncopal attacks during second degree paroxysmal AVB or low frequency junctional rhythm. The case was cured by the implantation of a permanent multi-programmable pace-maker.

[Considerations on myocardial scintigraphy with 201thallium after stress]

An heterogeneous group of 12 patients has been studied with 201thallium myocardial scintigraphy after stress (MSS); has been used an electronic calculator which made it possible to increase the reliability of the method. Eight patients were males, 4 females; the average age were 52.6 years. The 201thallium (1.7-2 mCi) is injected (through a Teflon cannula inserted in the forearm) 1' before the interruption of the stress test on the cycloergometer. After 10' tests are made in AP-LAO and LL view; a second test is carried out after an hour, and, if necessary, after 4-6 hours time. The results are interpreted as: a) positive: absence (++) or obvious defect in perfusion (+); b) negative: normal perfusion (-); c) questionable: activity not significantly reduced (+/-). In some cases, the authors studied correlations and discordances between MSS and clinical, coronarographic and echocardiographic data. It has been considered moreover, the uptake's and release's variations of the radio-isotope in relation with experimental knowledge of myocardial extraction and clearance. We conclude by emphasizing the interest of this method and suggesting some practical considerations: 1) Patients with negative MSS don't need coronarography. 2) Positive MSS, but restricted deficit, good delayed reperfusion, good clinical pharmacological control would permit a delay of coronarography. 3) Clear multiple deficit need coronarography. 4) Usefulness of the MSS for long-term control of the evolution of coronary disease and of patients operated of aortocoronary bypass.

Myocardial uptake of radiotechnetium in two cases of ventricular aneurysm after infarction

Two very similar cases of persistent positive myocardial scintigraphy with radiotechnetium are described and, in view of agreement of other medical, electrocardiographic, apexcardiographic and radiographic data, this can be ascribed to the presence of a parietal ventricular aneurysm after myocardial infarction.

[Isoproterenol test in the diagnosis of coronary insufficiency]

Coronary performance was evaluated in 18 men and 6 women by i.v. infusion of increasing doses of isoproterenol and minute-by-minute ECG monitoring. The results appeared fully reliable. In some cases where the conditions for effort testing were satisfied a comparison was made with the cycle-ergometer findings. This shown the ISP test to be more precise, more sensitive and easier to perform technically.