963. Extragenital Chlamydia and Gonorrhea Among Females Visiting an STD Clinic

Abstract Background Rates of chlamydia (CT) and gonorrhea (GC) are increasing in the United States. Annual screening for urogenital infection is recommended for sexually active females less than 25 years and older females at risk. CT and GC can be detected at pharyngeal and rectal sites and are commonly asymptomatic. Currently, extragenital screening is only recommended in men who have sex with men (MSM). Data among females on extragenital CT and GC are limited. Methods We reviewed all females presenting to a sexually transmitted diseases (STD) clinic in Providence, Rhode Island from May 2014 to December 2018. During this time, urogenital, pharyngeal, and rectal screenings were offered to all females presenting for care. We evaluated demographics, behaviors, and laboratory data on urogenital, pharyngeal and rectal CT/GC. Univariate and bivariate analyses were performed to determine the characteristics of demographic and behavioral variables associated with extragenital infection. Results During the study period, 2,672 females presented for STD screening. Median age was 26 years (interquartile range [IQR]: 33–22). Most patients (95%) reported engaging in sex with male partners. More than half (59%) had at least one extragenital (pharyngeal or rectal) test performed (77% pharyngeal only, 0.4% rectal only, 23% both). During the study period, there were 334 CT and 66 GC infections identified across all three anatomical sites. Of individuals with a positive CT result (N = 273), 85% (N = 233) had a positive urogenital, 19% (N = 53) a positive pharyngeal, and 18% (N = 48) a positive rectal specimen. Of individuals with a positive GC result (N = 50), 62% (N = 31) had a positive urogenital, 54% (N = 27) a positive pharyngeal, and 16% (N = 8) a positive rectal specimen. Among individuals with a positive CT or GC result, (N = 315), 17% (N = 55) had an extragenital infection in the absence of a positive urogenital result. No single risk factor was statistically associated with an extragenital CT or GC infection. Most individuals (82%) were asymptomatic at presentation. Conclusion In an STD clinic setting, a significant number of pharyngeal and rectal CT/GC infections may be missed in the absence of extragenital screening. Settings which engage at-risk females should consider implementation of routine CT/GC extragenital screening. Disclosures All Authors: No reported Disclosures.

Download Full-text

Association between intensity of STI screening and development of antimicrobial resistance in N. gonorrhoeae in 12 cities in the USA: An ecological study

F1000Research ◽

10.12688/f1000research.15569.3 ◽

2018 ◽

Vol 7 ◽

pp. 1237

Author(s):

Chris R. Kenyon

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Ecological Study ◽

Geometric Mean ◽

The United States ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Antimicrobial Sensitivity ◽

The Usa ◽

Sex With Men

In this study, we assessed if there was a city-level association between sexually transmitted infection (STI) screening intensity in men who have sex with men and antimicrobial sensitivity in Neisseria gonorrhoeae in the United States, 2007 to 2013. We found positive associations between STI screening intensity and increases in minimum inhibitory concentrations for cefixime and azithromycin, but not ceftriaxone when using change in city geometric mean N. gonorrhoeae MIC between 2005 and 2013.

Download Full-text

Optimizing Screening for HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa024 ◽

2020 ◽

Cited By ~ 1

Author(s):

Antoine Chaillon ◽

Martin Hoenigl ◽

Lorri Freitas ◽

Haruna Feldman ◽

Winston Tilghman ◽

...

Keyword(s):

At Risk ◽

Screening Program ◽

Demographic Data ◽

The United States ◽

Hiv Prevalence ◽

Screening Tests ◽

Transmitted Infection ◽

Sexually Transmitted ◽

At Risk Populations ◽

Zip Code

Abstract Background The HIV epidemic is unevenly distributed throughout the United States, even within neighborhoods. This study evaluated how effectively current testing approaches reached persons at risk for HIV infection across San Diego (SD) County, California. Methods HIV case and testing data, sexually transmitted infection (STI) and socio-demographic data for SD County were collected from the SD Health and Human Services Agency and the ‘Early Test’ community-based HIV screening program between 1998 and 2016. Relationships between HIV diagnoses, HIV prevalence, and STI diagnoses with screening at zip code level were evaluated. Results Overall, 379,074 HIV tests were performed. The numbers of HIV tests performed on persons residing in a zip code or region overall strongly correlated with prevalent HIV cases (R2=0.714), new HIV diagnoses (R2=0.798), and STI diagnoses (R2=0.768 [chlamydia],0.836 [gonorrhea], 0.655 [syphilis]) in those regions. Zip codes with the highest HIV prevalence had the highest number of tests per resident and fewest number of tests per diagnosis. Even though most screening tests occurred at fixed venues located in high prevalence areas, screening of residents from lower prevalence areas was mostly proportional to the prevalence of HIV and rates of new HIV and STI diagnoses in those locales. Conclusion This study supported the ability of a small number of standalone testing centers to reach at-risk populations dispersed across SD County. These methods can also be used to highlight geographic areas, or demographic segments that may benefit from more intensive screening.

Download Full-text

423. Self-Reported Screening for Rectal Sexually Transmitted Infections Among Men Who Have Sex with Men

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.496 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S212-S213

Author(s):

Timothy William. Menza ◽

Lauren Lipira ◽

Amisha Bhattarai ◽

Joseph Ramirez ◽

Roberto Orellana

Keyword(s):

Sexually Transmitted Infections ◽

Multivariable Analysis ◽

Prevalence Ratio ◽

Hiv Positive ◽

Sexually Active ◽

Hiv Status ◽

Sexually Transmitted ◽

Sex With Men ◽

Hiv Negative ◽

Hiv Positive Men

Abstract Background Rectal gonorrhea and Chlamydia are common and predict HIV acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine. Methods In 2017, we recruited sexually-active MSM in the Portland, Oregon metropolitan area through venue-based sampling. Our outcome of interest was self-reported rectal STI screening in the prior 12 months. Stratified by HIV status, we assessed the prevalence and demographic, healthcare, clinical, and behavioral predictors of screening. Results Of 448 participants, 168 (37.5%) reported rectal STI screening. One hundred twenty-seven (35.8%) of 355 HIV-negative men, 41 (58.6%) of 70 HIV-positive men, and none of 23 men who did not know their HIV status reported screening. Among HIV-negative men, having a healthcare provider who offered HIV testing (adjusted prevalence ratio [aPR]=2.09; 95% confidence interval [CI]: 1.43, 3.04), a syphilis diagnosis (aPR=1.32; 95% CI: 1.03, 1.69), use of pre-exposure prophylaxis (aPR=1.57; 95% CI 1.21, 2.04), and condomless anal sex with casual partners in the prior 12 months (aPR=1.74; 95% CI: 1.36, 2.22) independently predicted screening for rectal STI in multivariable analysis. HIV-positive men who reported having a provider who always or often initiates conversations about sex were significantly more likely to report screening compared with men who did not have such a provider (aPR=1.48; 95% CI: 1.06, 2.06). Conclusion Rectal STI screening is not universal in a venue-based sample of sexually-active MSM. Implementing innovative, acceptable, and accessible screening practices and improving provider comfort with talking about sex are paramount to increasing rectal STI screening. Disclosures All authors: No reported disclosures.

Download Full-text

Risky sexual behavior and sexually transmitted infections among men who have sex with men and purchase sex attending an Israeli sexually transmitted infection clinic

International Journal of STD & AIDS ◽

10.1177/0956462419830856 ◽

2019 ◽

Vol 31 (3) ◽

pp. 236-243 ◽

Cited By ~ 1

Author(s):

Rivka S Rich ◽

Alex Leventhal ◽

Rivka Sheffer ◽

Zohar Mor

Keyword(s):

High Risk ◽

Sexually Transmitted Infections ◽

Sexual Behaviors ◽

Risky Sexual Behavior ◽

Laboratory Data ◽

Cross Sectional Study ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted ◽

Sex With Men

Men who have sex with men (MSM) and purchase sex (MPS) are a sub-group potentially at high risk for acquiring and transmitting sexually transmitted infections (STIs). This is a hard-to-reach population resulting in a scarcity of studies covering the issue. This cross-sectional study aimed to assess the association between purchasing sex and high-risk behaviors related to HIV/STI transmission and appraise the STI prevalence among MSM. All MSM who attended the STI clinic in Tel Aviv between 2003 and 2010 were included. Demographics, behavioral, clinical, and laboratory data were compared between MPS and non-MPS to identify high-risk sexual behaviors and STI prevalence associated with purchasing sex. Of the first visits of 2694 MSM who attended the STI clinic during the study period, 151 (5.6%) paid for sex. MPS were more commonly older and married than non-MPS. MPS were more likely to engage in behaviors associated with high risk for HIV/STI transmission, including infrequent condom use during anal sex, substance use during sex, and selling sex themselves. MPS had a higher STI prevalence than non-MPS, although this was not statistically significant ( p = 0.05). These findings highlight the need to establish culturally tailored interventions for MPS addressing the potential risks associated with purchasing sex.

Download Full-text

Sexually transmitted infections and sexual behaviors of men who have sex with men in an American Deep South PrEP clinic

International Journal of STD & AIDS ◽

10.1177/0956462419886228 ◽

2020 ◽

Vol 31 (2) ◽

pp. 127-135 ◽

Cited By ~ 1

Author(s):

Ronnie M Gravett ◽

Andrew O Westfall ◽

Edgar T Overton ◽

Kachina Kudroff ◽

Christina A Muzny ◽

...

Keyword(s):

High Risk ◽

Sexually Transmitted Infections ◽

Incidence Rate ◽

Sexual Behaviors ◽

The United States ◽

Sexual Partners ◽

Deep South ◽

Multiple Sexual Partners ◽

Sexually Transmitted ◽

Sex With Men

HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75–32.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. High-risk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.

Download Full-text

Syphilitic hepatitis and neurosyphilis: an observational study of Danish HIV-infected individuals during a 13-year period

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053921 ◽

2019 ◽

Vol 95 (6) ◽

pp. 416-418

Author(s):

Kirsten Salado-Rasmussen ◽

Maria Wessman ◽

Susan A Cowan ◽

Jan Gerstoft ◽

Terese Lea Katzenstein

Keyword(s):

Laboratory Data ◽

Personal Identification ◽

Neurological Symptoms ◽

Sexually Active ◽

Facial Paresis ◽

Motor Weakness ◽

Unexplained Pain ◽

Secondary Stage ◽

Sex With Men ◽

Active Patients

ObjectiveSyphilis is an STI that potentially affects any organ. Syphilitic hepatitis and neurosyphilis have been reported in both HIV-uninfected and HIV-infected individuals. The aim of this study was to investigate syphilitic hepatitis and neurosyphilis among HIV-infected individuals during a 13-year period.MethodsThis retrospective study included all HIV-infected individuals ≥18 years diagnosed with syphilis between 1 May 2004 and 31 December 2016 in Copenhagen, Denmark. We used the unique 10-digit personal identification number assigned to all individuals in Denmark to link data from two nationwide registers to identify the patients. Patient files were revised to obtain clinical and laboratory data.ResultsA total of 509 episodes of syphilis were diagnosed in 427 HIV-infected individuals attending three hospitals in Copenhagen, Denmark. The majority of the patients were men (99.5%), and the majority of men were men who have sex with men (96%). Twenty-seven patients (6%) met the criteria for neurosyphilis, and the neurological symptoms included ocular and auditory abnormalities, headache, paraesthesia, vertigo, facial paresis, motor weakness and unexplained pain in the legs. The patients with neurosyphilis were diagnosed in the secondary stage (84%) and in the early latent (8%) or late latent (8%) stage. Among the patients tested for liver affection, 41% met the criteria for syphilitic hepatitis. The patients with syphilitic hepatitis were diagnosed in the secondary stage (82%), primary stage (10%), and in the early latent (5%) or late latent (3%) stage.ConclusionsThe study emphasises that patients with syphilis, also those seen at STI clinics, should undergo a thorough clinical examination and questioning to reveal neurological symptoms. Identification of patients with neurosyphilis is crucial since these patients undergo a different treatment. The study also emphasises that syphilis should be considered as a diagnosis in sexually active patients with liver .

Download Full-text

Superimposing incident sexually transmitted infections on HIV phylogram to investigate possible misclassification of men who have sex with men as heterosexuals in a cohort in Antwerp, Belgium

International Journal of STD & AIDS ◽

10.1177/0956462418821752 ◽

2019 ◽

Vol 30 (5) ◽

pp. 486-495

Author(s):

Kara K Osbak ◽

Conor J Meehan ◽

Sergio G Ribas ◽

Leo Heyndrickx ◽

Kevin K Ariën ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Sexual Behaviour ◽

Hiv Transmission ◽

Phylogenetic Analyses ◽

Laboratory Data ◽

Risk Groups ◽

Transmission Risk ◽

Sexually Transmitted ◽

Sex With Men ◽

Hiv Transmission Risk

In this study, we assessed if the superimposition of incident sexually transmitted infections (STIs) on HIV phylogenetic analyses could reveal possible sexual behaviour misclassifications in our HIV-infected population. HIV-1 sequences collected between 1997 and 2014 from 1169 individuals attending a HIV clinic in Antwerp, Belgium were analysed to infer a partial HIV transmission network. Individual demographic, clinical and laboratory data collected during routine HIV follow-up were used to compare clustered and non-clustered individuals using logistic regression analyses. In total, 438 (37.5%) individuals were identified in 136 clusters, including 76 transmission pairs and 60 clusters consisting of three or more individuals. Individuals in a cluster were more likely to have a history of syphilis, Chlamydia and/or gonorrhoea (P < 0.05); however, when analyses were stratified by HIV transmission risk groups (heterosexual and men who have sex with men [MSM]), this association only remained significant for heterosexuals with syphilis (P = 0.001). Under closer scrutiny, this association was driven by six heterosexual men who were located in six almost exclusively MSM clusters. A parsimonious conclusion is that these six individuals were potentially misclassified as heterosexual. Improving the accuracy of sexual behaviour reporting could improve care.

Download Full-text

Extragenital Infections Caused byChlamydia trachomatisandNeisseria gonorrhoeae: A Review of the Literature

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2016/5758387 ◽

2016 ◽

Vol 2016 ◽

pp. 1-17 ◽

Cited By ~ 90

Author(s):

Philip A. Chan ◽

Ashley Robinette ◽

Madeline Montgomery ◽

Alexi Almonte ◽

Susan Cu-Uvin ◽

...

Keyword(s):

Sexually Transmitted Diseases ◽

Risk Behaviors ◽

The United States ◽

Anatomical Site ◽

Review Of The Literature ◽

Future Directions ◽

Sexually Transmitted ◽

Public Health Burden ◽

Health Burden ◽

Sex With Men

In the United States, sexually transmitted diseases due toChlamydia trachomatisandNeisseria gonorrhoeaecontinue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.

Download Full-text

Prevalence of sexually transmitted infections among men who have sex with men and injecting drug users and validation of audio computer-assisted self interview (ACASI) technique in Abuja, Lagos, and Ibadan, Nigeria: Technical report

10.31899/hiv14.1004 ◽

2011 ◽

Author(s):

Keyword(s):

At Risk ◽

Sexually Transmitted Infections ◽

Risk Behaviors ◽

Drug Users ◽

Injecting Drug Users ◽

Computer Assisted ◽

Sexually Transmitted ◽

Technical Report ◽

Sex With Men ◽

Audio Computer

Most-at-risk populations (MARPS), including men who have sex with men (MSM) and injecting drug users (IDUs), represent 1 percent of Nigeria’s population yet account for 38 percent of new HIV infections. Despite their elevated risk, MSM and IDUs are less likely than the general population to access HIV prevention and sexual health services because of stigmatization. There is a dearth of data on prevalence of HIV and sexually transmitted infections (STIs) among MSM and IDUs because their behaviors make them difficult to be reached programmatically and engaged in research. While the need for HIV and STI prevalence data is clear, there is also a need to improve the quality and reliability of behavioral data collected for national surveillance, where these stigmatized subpopulations may underreport sensitive behaviors that put them most at risk. This technical report provides details of a study that sought to determine the prevalence of HIV and STIs and sexual and injecting risk behaviors in MSM and male IDUs, and determine if Audio Computer-Assisted Self Interviews provide more accurate reporting of risk behaviors than face-to-face interviewing.

Download Full-text