STI initiative: Improving testing for sexually transmitted infections in women

Canadian urgent care and walk-in medical clinics provide health care for a population that may be poorly covered by traditional health care structures. Despite evidence suggesting that women with urinary complaints experience a high incidence of sexually transmitted infections (STIs), this population may be under-tested in this particular setting. The aim of this quality improvement initiative was to increase STI testing in women presenting with GU complaints. Implementation of an opt-out method of STI testing for women ages 16 and older was introduced at three walk-in clinics. Women presenting with GU complaints were given the opportunity to provide samples for both conventional urine culture and nucleic acid amplification testing (NAAT) for non-viral STIs. Patients received treatment according to standard of care and public health was notified as per local regulations. Testing rate and STI incidence was tracked via clinic electronic medical records (EMRs). Overall results were tracked using run charts and compared to historical data for the year prior to the start of the project. Over a 1 year period prior to this intervention, only 65 STI tests were performed in over 1100 GU complaints (5.5%). Six STIs were identified during this time. During the 36-week project period, testing increased to 45% of the patient population (320/707). The STI detected incidence increased from 0.51% to 1.4% in all women, and from 0.84% to 3.4% in women aged 16–29 years. An opt-out method was an effective intervention for increasing STI testing within the walk-in clinic setting. With optimisation, significant increases in testing rates can be obtained without substantially increasing clinic workload and at no economic cost to the clinic. As expected, detected incidence rates of STIs were higher than the recognised population prevalence.

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168. Testing, Diagnosis, and Incidence of Sexually Transmitted Infections Among People with Substance Use Disorders in the Veterans Health Administration, 2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.168 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S101-S101

Author(s):

Holly Villamagna ◽

Lauren Beste ◽

Joleen Borgerding ◽

Elliott Lowy ◽

Ronald Hauser ◽

...

Keyword(s):

Substance Use ◽

Sexually Transmitted Infections ◽

Substance Use Disorders ◽

Veterans Health Administration ◽

Incidence Rates ◽

Veterans Health ◽

Health Administration ◽

Sexually Transmitted ◽

Stimulant Use ◽

Sti Testing

Abstract Background People with substance use disorders (SUDs) are at increased risk of acquiring sexually transmitted infections (STIs.) In response to the syndemic of STIs and SUDs, the Department of Health and Human Services’ 2020 STI National Strategic Plan called for increased STI testing among people with SUDs and integration of testing and treatment into non-traditional settings. Existing data describing STI testing and incidence rates among people with SUDs are limited to single or regional medical centers. National samples are needed to target interventions. We report on STI testing, test positivity, and incidence rates among people with SUDs who receive medical care in the Veterans Health Administration (VHA). Methods We performed a retrospective cohort study of individuals with SUDs who received VHA care in 2018 or 2019. Data were obtained from the Corporate Data Warehouse, a national database that includes data from VHA’s electronic medical record. For individuals with alcohol, opioid, cocaine, and/or other stimulant (e.g. methamphetamine) use disorders, we collected demographic data, testing and results for gonorrhea (GC), chlamydia (CT), syphilis, and HIV during 2019. We calculated rates of testing, test positivity, and incidence rates. Results Incidence of all four STIs was highest in the other stimulant use disorder group; incidence of syphilis was particularly elevated at 922.4 cases/100K. Veterans with multiple SUDs were three times more likely to be houseless in 2019 than those with a single SUD and had higher incidence of all STIs than those with single SUDs, except for people with other stimulant use disorders. People with alcohol use disorder (AUD) had a higher incidence of GC, CT, and syphilis than those with opioid use disorder despite similar testing rates. Percent positivity for HIV ranged from 0.27% for AUD to 2.0% for other stimulant use disorders. Conclusion High incidence of STIs among people with non-cocaine stimulant use disorder indicates a need for comprehensive testing. The data suggests that veterans with AUD would benefit from increased testing. Houselessness and mental health diagnoses were common, and comprehensive STI testing and treatment programs, including an assessment of HIV risk, should be integrated into programs addressing these comorbidities. Disclosures Holly Villamagna, MD, Nothing to disclose

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Opt-out Testing Pilot for Sexually Transmitted Infections Among Immigrant Detainees at 2 Immigration and Customs Enforcement Health Service Corps–Staffed Detention Facilities, 2018

Public Health Reports ◽

10.1177/0033354920928491 ◽

2020 ◽

Vol 135 (1_suppl) ◽

pp. 82S-89S

Author(s):

Edith Lederman ◽

Andria Blackwell ◽

Gina Tomkus ◽

Misty Rios ◽

Brent Stephen ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Staff Member ◽

Screening Program ◽

Sexually Transmitted ◽

Staff Members ◽

Sti Testing ◽

Opt Out ◽

Correctional Settings ◽

Immigration And Customs Enforcement ◽

Detention Facilities

Objectives Correctional settings (prisons, jails, detention facilities) provide a unique opportunity to screen for sexually transmitted infections (STIs) among correctional populations with a high prevalence of infection. Immigrant detainees are a distinct and poorly described correctional population. The main objective of this study was to determine the feasibility of a national STI screening program for immigrant detainees. Methods and Materials We developed an opt-out STI testing program that included electronic health record integration, patient education, and staff member training. We piloted this program from June 22 through August 19, 2018, at 2 detention facilities with different operational requirements and detainee demographic characteristics. We assessed STI test positivity rates, treatment outcomes, estimated cost to conduct testing and counseling, and staff member perceptions of program value and challenges to implementation. Results Of 1041 immigrant detainees approached for testing, 526 (50.5%) declined. Of 494 detainees who were tested, 42 (8.5%) tested positive for at least 1 STI; the percentage positivity rates were 6.7% (n = 33) for chlamydia, 0.8% (n = 4) for syphilis, 0.8% (n = 4) for gonorrhea, 0.6% (n = 3) for hepatitis B, and 0.2% (n = 1) for HIV. The estimated cost to detect any STI ranged from $500 to $961; the estimated cost to identify 1 person infected with HIV ranged from $22 497 to $43 244. Forty of 42 persons who tested positive began treatment before release from custody. Medical staff members had positive views of the program but had concerns about workload. Practice Implications STIs are prevalent among immigrant detainees. A routine screening program is feasible if operational aspects are carefully considered and would provide counseling, education, and treatment for this vulnerable population.

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Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0011 ◽

2016 ◽

Vol 29 (6) ◽

Author(s):

Patrick T. Adegun ◽

Eyitope O. Amu

Keyword(s):

Health Care ◽

Sexually Transmitted Infections ◽

Health Care Seeking ◽

Care Seeking ◽

Self Medication ◽

Cross Sectional ◽

Sexually Transmitted ◽

Stomach Pain ◽

Health Care Seeking Behaviour ◽

Care Seeking Behaviour

Abstract Background: In Nigeria, adolescents are highly vulnerable to sexually transmitted infections (STIs) which have the potential of jeopardising their future reproductive lives if poorly treated. Objective: To determine the prevalence and health care seeking behaviour for STIs among secondary school adolescents in Ado, South-Western Nigeria. Subjects: Male and female adolescents aged 10–19 years. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 560 adolescents selected from public and private secondary schools in Ado Local Government Area (LGA) of Ekiti State, using a multistage sampling technique. The data were analyzed using descriptive and inferential statistics. Analyzed data were presented in the form of tables and charts. Results: Two hundred and fifty-one (47.1%) respondents had previous symptoms of STIs. The commonest symptoms among the males were penile discharge (30.5%), painful micturition (30.5%) and stomach pain with swollen testes (25.4%). The commonest symptoms among the females were genital itching (27.6%), genital sores (14.1%) and painful micturition (13.1%). Only 26.7% sought treatment from a health facility; 37.0% did nothing; 15.9% went to patent medicine stores, 10.0% used herbs; the rest did self-medication or prayed. Conclusion: The prevalence of STI symptoms among adolescents in Ado-Ekiti is high but their health care seeking behaviour is poor. Health education about the dangers of untreated STI and the importance of seeking treatment early, targeted at adolescents, should be intensified.

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Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

Infectious Diseases of Poverty ◽

10.1186/s40249-020-00792-2 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Karla Y. Ganley ◽

Marta Wilson-Barthes ◽

Andrew R. Zullo ◽

Sandra G. Sosa-Rubí ◽

Carlos J. Conde-Glez ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Mexico City ◽

Sex Workers ◽

Incidence Rates ◽

Consistent Condom ◽

Vaginal Intercourse ◽

Time Varying ◽

Male Sex Workers ◽

Sexually Transmitted ◽

Male Sex

Abstract Background Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City. Methods From January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results Among 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions Incidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections.

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Is it time to use nucleic acid amplification tests for identification of persons with sexually transmitted infections?

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.09.1168 ◽

2020 ◽

Vol 101 ◽

pp. 446

Author(s):

L. Tobin ◽

L. Guerra ◽

L. Ahouanvoeke ◽

J.A.G. Carpio ◽

D. Irambona ◽

...

Keyword(s):

Nucleic Acid ◽

Sexually Transmitted Infections ◽

Nucleic Acid Amplification ◽

Nucleic Acid Amplification Tests ◽

Sexually Transmitted ◽

Identification Of Persons

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Genital elephantiasis and sexually transmitted infections – revisited

International Journal of STD & AIDS ◽

10.1258/095646206775809150 ◽

2006 ◽

Vol 17 (3) ◽

pp. 157-166 ◽

Cited By ~ 24

Author(s):

Somesh Gupta ◽

C Ajith ◽

Amrinder J Kanwar ◽

Virendra N Sehgal ◽

Bhushan Kumar ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Causative Agent ◽

Significant Proportion ◽

Medical Problem ◽

Nucleic Acid Amplification ◽

Sexually Transmitted ◽

Laboratory Facilities ◽

Laboratory Investigations ◽

Polymerase Chain ◽

The Tropics

Genital elephantiasis is an important medical problem in the tropics. It usually affects young and productive age group, and is associated with physical disability and extreme mental anguish. The majority of cases are due to filariasis; however, a small but significant proportion of patients develop genital elephantiasis due to bacterial sexually transmitted infections (STIs), mainly lymphogranuloma venereum (LGV) and donovanosis. STI-related genital elephantiasis should be differentiated from elephantiasis due to other causes, including filariasis, tuberculosis, haematological malignancies, iatrogenic, or dermatological diseases. Laboratory investigations like microscopy of tissue smear and nucleic acid amplification test for donovanosis, and serology and polymerase chain reaction for LGV may help in the diagnosis, but in endemic areas, in the absence of laboratory facilities, diagnosis largely depends on clinical characteristics. The causative agent of LGV, Chlamydia trachomatis serovar L1–L3, is a lymphotropic organism which leads to the development of thrombolymphangitis and perilymphangitis, and lymphadenitis. Long-standing oedema, fibrosis and lymphogranulomatous infiltration result in the final picture of elephantiasis. Elephantiasis in donovanosis is mainly due to constriction of the lymphatics which are trapped in the chronic granulomatous inflammatory response generated by the causative agent, Calymmatobacterium (Klebsiella) granulomatis. The LGV-associated genital elephantiasis should be treated with a prolonged course of doxycycline given orally, while donovanosis should be treated with azithromycin or trimethoprim-sulphamethoxazole combination given for a minimum of three weeks. Genital elephantiasis is not completely reversible with medical therapy alone and often needs to be reduced surgically.

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