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Thomas L Gift - One of the best experts on this subject based on the ideXlab platform.
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availability of safety net Sexually Transmitted Disease clinical services in the u s 2018
American Journal of Preventive Medicine, 2020Co-Authors: Jami S Leichliter, Kari Odonnell, Kat Kelley, Kendra M Cuffe, Gretchen Weiss, Thomas L GiftAbstract:Introduction Safety-net Sexually Transmitted Disease services can prevent transmission of Sexually Transmitted Disease. This study assesses the availability of safety-net Sexually Transmitted Disease clinical services across the U.S. Methods A 2018 survey of U.S. local health departments examined the availability of safety-net providers and the availability of specific Sexually Transmitted Disease clinical services, including point-of-care testing and treatment. In 2019, Rao–Scott chi-square tests were used to compare service availability by clinic type (Sexually Transmitted Disease clinic versus other clinics). Results A total of 326 local health departments completed the survey (49% response rate). Of respondents, 64.4% reported that a clinic in their jurisdiction provided safety-net Sexually Transmitted Disease services. Having a safety-net clinic that provided Sexually Transmitted Disease services was more common in medium and large jurisdictions. Sexually Transmitted Disease clinics were the primary provider in 40.5% of jurisdictions. A wide range of specific Sexually Transmitted Disease services was offered at the primary safety-net clinic for Sexually Transmitted Diseases. Most clinics offered human papillomavirus vaccination and appropriate point-of-care treatment for gonorrhea and syphilis. Fewer than one-quarter of clinics offered point-of-care rapid plasma reagin or darkfield microscopy syphilis testing. Compared with other clinics, services more commonly offered at Sexually Transmitted Disease clinics included same-day services, hepatitis B vaccination, rapid plasma reagin testing (syphilis), any point-of-care testing for gonorrhea, point-of-care trichomonas testing, and extragenital chlamydia or gonorrhea testing. Conclusions One-third of local health departments reported no safety-net Sexually Transmitted Disease services or were not aware of the services, and availability of specific services varied. Without an expansion of resources, local health departments might explore collaborations with healthcare systems and innovations in testing to expand Sexually Transmitted Disease services.
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us public Sexually Transmitted Disease clinical services in an era of declining public health funding 2013 14
Sexually Transmitted Diseases, 2017Co-Authors: Jami S Leichliter, Thomas A. Peterman, Gretchen Weiss, Kate Heyer, Melissa A Habel, Kathryn A Brookmeyer, Stephanie Arnold S Pang, Mark R Stenger, Thomas L GiftAbstract:BackgroundWe examined the infrastructure for US public Sexually Transmitted Disease (STD) clinical services.MethodsIn 2013 to 2014, we surveyed 331 of 1225 local health departments (LHDs) who either reported providing STD testing/treatment in the 2010 National Profile of Local Health Departments sur
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willingness to use health insurance at a Sexually Transmitted Disease clinic a survey of patients at 21 us clinics
American Journal of Public Health, 2016Co-Authors: William S Pearson, Jami S Leichliter, Thomas L Gift, Guoyu Tao, Ryan Cramer, Karen W HooverAbstract:Objectives. To survey patients of publicly funded Sexually Transmitted Disease (STD) clinics across the United States about their willingness to use health insurance for their visit.Methods. In 2013, we identified STD clinics in 21 US metropolitan statistical areas with the highest rates of chlamydia, gonorrhea, and syphilis according to Centers for Disease Control and Prevention surveillance reports. Patients attending the identified STD clinics completed a total of 4364 surveys (response rate = 86.6%).Results. Nearly half of the insured patients were willing to use their health insurance. Patients covered by government insurance were more likely to be willing to use their health insurance compared with those covered by private insurance (odds ratio [OR] = 3.60; 95% confidence interval [CI] = 2.79, 4.65), and patients covered by their parents’ insurance were less likely to be willing to use their insurance compared with those covered by private insurance (OR = 0.72; 95% CI = 0.52, 1.00). Reasons for unw...
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continuing need for Sexually Transmitted Disease clinics after the affordable care act
American Journal of Public Health, 2015Co-Authors: Karen W Hoover, Jami S Leichliter, Melissa A Habel, Bradley W Parsell, Guoyu Tao, William S Pearson, Thomas L GiftAbstract:Objectives. We assessed the characteristics of Sexually Transmitted Disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues.Methods. In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity.Results. Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic.Conclusions. Despite access to other health care settings, patients chose STD clinics for sexu...
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are safety net Sexually Transmitted Disease clinical and preventive services still needed in a changing health care system
Sexually Transmitted Diseases, 2014Co-Authors: Ryan Cramer, Jami S Leichliter, Thomas L GiftAbstract:Aprimary goal of the Affordable Care Act (ACA) is to increase access to health care, particularly among the uninsured. Reforms under the ACA will therefore likely impact access to Sexually Transmitted Disease (STD) services, including services for the underinsured or uninsured (safety net services). We raise considerations related to the provision of safety net STD services that have resulted from the US Supreme Court’s 2012 decision that upheld much of the ACA while striking down portions of the law that resulted in states deciding whether to expand Medicaid. Furthermore, we highlight the complex and unique role that safety net providers have traditionally played in STD prevention.
Jami S Leichliter - One of the best experts on this subject based on the ideXlab platform.
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availability of safety net Sexually Transmitted Disease clinical services in the u s 2018
American Journal of Preventive Medicine, 2020Co-Authors: Jami S Leichliter, Kari Odonnell, Kat Kelley, Kendra M Cuffe, Gretchen Weiss, Thomas L GiftAbstract:Introduction Safety-net Sexually Transmitted Disease services can prevent transmission of Sexually Transmitted Disease. This study assesses the availability of safety-net Sexually Transmitted Disease clinical services across the U.S. Methods A 2018 survey of U.S. local health departments examined the availability of safety-net providers and the availability of specific Sexually Transmitted Disease clinical services, including point-of-care testing and treatment. In 2019, Rao–Scott chi-square tests were used to compare service availability by clinic type (Sexually Transmitted Disease clinic versus other clinics). Results A total of 326 local health departments completed the survey (49% response rate). Of respondents, 64.4% reported that a clinic in their jurisdiction provided safety-net Sexually Transmitted Disease services. Having a safety-net clinic that provided Sexually Transmitted Disease services was more common in medium and large jurisdictions. Sexually Transmitted Disease clinics were the primary provider in 40.5% of jurisdictions. A wide range of specific Sexually Transmitted Disease services was offered at the primary safety-net clinic for Sexually Transmitted Diseases. Most clinics offered human papillomavirus vaccination and appropriate point-of-care treatment for gonorrhea and syphilis. Fewer than one-quarter of clinics offered point-of-care rapid plasma reagin or darkfield microscopy syphilis testing. Compared with other clinics, services more commonly offered at Sexually Transmitted Disease clinics included same-day services, hepatitis B vaccination, rapid plasma reagin testing (syphilis), any point-of-care testing for gonorrhea, point-of-care trichomonas testing, and extragenital chlamydia or gonorrhea testing. Conclusions One-third of local health departments reported no safety-net Sexually Transmitted Disease services or were not aware of the services, and availability of specific services varied. Without an expansion of resources, local health departments might explore collaborations with healthcare systems and innovations in testing to expand Sexually Transmitted Disease services.
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us public Sexually Transmitted Disease clinical services in an era of declining public health funding 2013 14
Sexually Transmitted Diseases, 2017Co-Authors: Jami S Leichliter, Thomas A. Peterman, Gretchen Weiss, Kate Heyer, Melissa A Habel, Kathryn A Brookmeyer, Stephanie Arnold S Pang, Mark R Stenger, Thomas L GiftAbstract:BackgroundWe examined the infrastructure for US public Sexually Transmitted Disease (STD) clinical services.MethodsIn 2013 to 2014, we surveyed 331 of 1225 local health departments (LHDs) who either reported providing STD testing/treatment in the 2010 National Profile of Local Health Departments sur
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willingness to use health insurance at a Sexually Transmitted Disease clinic a survey of patients at 21 us clinics
American Journal of Public Health, 2016Co-Authors: William S Pearson, Jami S Leichliter, Thomas L Gift, Guoyu Tao, Ryan Cramer, Karen W HooverAbstract:Objectives. To survey patients of publicly funded Sexually Transmitted Disease (STD) clinics across the United States about their willingness to use health insurance for their visit.Methods. In 2013, we identified STD clinics in 21 US metropolitan statistical areas with the highest rates of chlamydia, gonorrhea, and syphilis according to Centers for Disease Control and Prevention surveillance reports. Patients attending the identified STD clinics completed a total of 4364 surveys (response rate = 86.6%).Results. Nearly half of the insured patients were willing to use their health insurance. Patients covered by government insurance were more likely to be willing to use their health insurance compared with those covered by private insurance (odds ratio [OR] = 3.60; 95% confidence interval [CI] = 2.79, 4.65), and patients covered by their parents’ insurance were less likely to be willing to use their insurance compared with those covered by private insurance (OR = 0.72; 95% CI = 0.52, 1.00). Reasons for unw...
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continuing need for Sexually Transmitted Disease clinics after the affordable care act
American Journal of Public Health, 2015Co-Authors: Karen W Hoover, Jami S Leichliter, Melissa A Habel, Bradley W Parsell, Guoyu Tao, William S Pearson, Thomas L GiftAbstract:Objectives. We assessed the characteristics of Sexually Transmitted Disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues.Methods. In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity.Results. Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic.Conclusions. Despite access to other health care settings, patients chose STD clinics for sexu...
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are safety net Sexually Transmitted Disease clinical and preventive services still needed in a changing health care system
Sexually Transmitted Diseases, 2014Co-Authors: Ryan Cramer, Jami S Leichliter, Thomas L GiftAbstract:Aprimary goal of the Affordable Care Act (ACA) is to increase access to health care, particularly among the uninsured. Reforms under the ACA will therefore likely impact access to Sexually Transmitted Disease (STD) services, including services for the underinsured or uninsured (safety net services). We raise considerations related to the provision of safety net STD services that have resulted from the US Supreme Court’s 2012 decision that upheld much of the ACA while striking down portions of the law that resulted in states deciding whether to expand Medicaid. Furthermore, we highlight the complex and unique role that safety net providers have traditionally played in STD prevention.
Kyle T Bernstein - One of the best experts on this subject based on the ideXlab platform.
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insurance among patients seeking care at a municipal Sexually Transmitted Disease clinic implications for health care reform in the united states
Sexually Transmitted Diseases, 2014Co-Authors: Sally C Stephens, Stephanie E Cohen, Susan S Philip, Kyle T BernsteinAbstract:IntroductionLimited data exist on insured patients who receive care at publically funded Sexually Transmitted Disease (STD) clinics, despite having access to a primary care provider. In this analysis, we compare patients with and without health insurance who sought services at City Clinic, the San F
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trichomonas vaginalis in selected us Sexually Transmitted Disease clinics testing screening and prevalence
Sexually Transmitted Diseases, 2013Co-Authors: Elissa Meites, Preeti Pathela, Kyle T Bernstein, Eloisa Llata, Roxanne P Kerani, Jim Braxton, Jane R Schwebke, Lenore Asbel, Christie J Mettenbrink, Hillard WeinstockAbstract:Trichomonas vaginalis is the most prevalent curable Sexually Transmitted infection in the world.1 In the United States, according to the 2000 to 2004 National Health and Nutrition Examination Survey, an estimated 3.1% of women of reproductive age are infected with T. vaginalis, making this parasitic infection more prevalent than either chlamydia or gonorrhea.2,3 A disproportionately high burden of Disease has been observed among older women and non-Hispanic black women.2,4 Infection with T. vaginalis has been associated with serious adverse outcomes such as pelvic inflammatory Disease5,6 and 1.5 to 2.7 times greater risks of HIV acquisition and transmission.7–10 An estimated 70% to 85% of infected women are asymptomatic.2,11 Symptoms of trichomoniasis range from mild to severe inflammation and genital pruritis and may also include cervicovaginal and/or urethral discharge. A single oral dose of a nitroimidazole antimicrobial (ie, 2 g of metronidazole or tinidazole) is generally sufficient treatment to cure infection.12 Although in vitro antimicrobial resistance has been documented in 4% of vaginal culture specimens collected from Sexually Transmitted Disease (STD) clinics, in vivo antimicrobial resistance has remained infrequent to date.13,14 The Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines recommend that all women seeking care for symptoms of vaginal discharge should be tested for T. vaginalis infection.12 As for screening asymptomatic persons, however, these guidelines recommend routine annual screening only among HIV-infected women and currently do not include specific recommendations for T. vaginalis screening among the general population or among other high-risk groups.12 Although approximately 71% of male sexual partners of women with trichomoniasis are also infected with T. vaginalis, clinical testing for this parasite is not commonly conducted for male patients.15 Traditional diagnostic testing is by wet mount microscopy, in which a specimen of genital (eg, cervicovaginal) fluid is collected by a clinician during a pelvic examination and interpreted at the point of care; the test is inexpensive but operator dependent, and sensitivity is generally poor at 51% to 65%.16,17 Additional testing options include culture, which does not provide immediate results and is less commonly performed; recently developed rapid antigen tests, which may be performed at the point of care; and nucleic acid amplification tests (NAATs), the first of which was cleared for use in symptomatic or asymptomatic women by the US Food and Drug Administration in 2011, with high sensitivity (95%–100%) and specificity (95%–100%) for detecting T. vaginalis in urine specimens, endocervical swabs, or vaginal swabs.16,18,19 Little is known about current diagnostic testing and screening practices for this very common STD among persons presumably at high risk for infection, such as patients presenting at STD clinics.20 The objective of this analysis was to assess T. vaginalis prevalence among symptomatic and asymptomatic women tested or screened at a diverse group of STD clinics in the United States.
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Sexually Transmitted Disease core theory roles of person place and time
American Journal of Epidemiology, 2011Co-Authors: Dionne Gesink, Ashleigh B Sullivan, William C Miller, Kyle T BernsteinAbstract:The authors' purpose was to expand Sexually Transmitted Disease core theory by examining the roles of person, place, and time in differentiating geographic core areas from outbreak areas. The authors mapped yearly census-tract-level syphilis rates for San Francisco, California, based on new primary and secondary syphilis cases reported to the San Francisco City Sexually Transmitted Disease surveillance program between January 1, 1985, and December 31, 2007. SaTScan software (Information Management Services, Inc., Silver Spring, Maryland) was used to identify geographic clusters of significantly elevated syphilis rates over space and time. The authors graphed epidemic curves for 1) core areas, 2) outbreak areas, 3) neither core nor outbreak areas, and 4) noncore areas, where noncore areas included outbreaks, and stratified these curves according to demographic characteristics. Five clusters of significantly elevated primary and secondary syphilis rates were identified. A 5-year threshold was useful for differentiating core clusters from outbreak clusters. Epidemic curves for core areas, outbreak areas, neither core nor outbreak areas, and noncore areas were perfectly synchronized in phase trends and wavelength over time, even when broken down by demographic characteristics. Between epidemics, the occurrence of syphilis affected all demographic groups equally. During an epidemic, a temporary disparity in syphilis occurrence arose and a homogeneous core group of cases could be defined.
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hiv testing frequency among men who have sex with men attending Sexually Transmitted Disease clinics implications for hiv prevention and surveillance
Journal of Acquired Immune Deficiency Syndromes, 2009Co-Authors: Donna J Helms, Kyle T Bernstein, Charlotte K Kent, Hillard Weinstock, Kristen C Mahle, Bruce W Furness, Cornelis A Rietmeijer, Akbar Shahkolahi, James P Hughes, Matthew R GoldenAbstract:Objectives: To describe trends in the occurrence and frequency of HIV testing among men who have sex with men (MSM) receiving care in 4 US Sexually Transmitted Disease (STD) clinics and to define factors associated with HIV testing frequency and positivity. Study Design: Routine clinical encounters during 57,131 visits by MSM to STD clinics in 4 cities (Seattle-King County, San Francisco, Denver, and District of columbia), 2002-2006, were examined. Results: From 2002 to 2006, a city-specific median of 69.1% of presumptive HIV-uninfected MSM were tested for HIV, of which, a median of 86.7% had previously tested (4.5% unknown) and a median of 3.9% were newly diagnosed with HIV Between 2002 and 2006, the median percentage of tested MSM who reported no previous HIV testing decreased from 9.4% to 5.4% (P = 0.01) and the city-specific median intertest interval decreased from 302 to 243 days (P = 0.03). Among MSM with newly diagnosed HIV the median intertest interval decreased from 531 days in 2002 to 287 days in 2006 (P = 0.001). Predictors of newly diagnosed HIV infection included the following: younger age, longer intertest interval, black or Hispanic race/ethnicity, clinic in San Francisco, and concurrent diagnosis with a bacterial STD. Conclusions: In MSM seen at 4 STD clinics, the percentage of never previously HIV tested is decreasing and MSM are testing more frequently.
Julia C Dombrowski - One of the best experts on this subject based on the ideXlab platform.
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high prevalence of vaginal and rectal mycoplasma genitalium macrolide resistance among female Sexually Transmitted Disease clinic patients in seattle washington
Sexually Transmitted Diseases, 2020Co-Authors: Christine M Khosropour, Anna Unutzer, Julia C Dombrowski, Lindley A Barbee, Jorgen Skov Jensen, Olusegun O Soge, Gina Leipertz, Rushlenne PascualAbstract:Background: Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are increasingly recognized as common infections among women. Little is known about the prevalence of rectal Mycoplasma genitalium (MG), rectal MG/CT/GC coinfection, or MG antimicrobial resistance patterns among women. Methods: In 2017 to 2018, we recruited women at high risk for CT from Seattle's municipal Sexually Transmitted Disease clinic. Participants self-collected vaginal and rectal specimens for CT/GC nucleic acid amplification testing. We retrospectively tested samples for vaginal and rectal MG using nucleic acid amplification testing and tested MG-positive specimens for macrolide resistance-mediating mutations (MRM) and ParC quinolone resistance-associated mutations (QRAMs). Results: Of 50 enrolled women, 13 (26%) tested positive for MG, including 10 (20%) with vaginal MG and 11 (22%) with rectal MG; 8 (62%) had concurrent vaginal/rectal MG. Five (38%) were coinfected with CT, none with GC. Only 2 of 11 women with rectal MG reported anal sex in the prior year. Of MG-positive specimens, 100% of rectal and 89% of vaginal specimens had an MRM. There were no vaginal or rectal MG-positive specimens with ParC QRAMs previously associated with quinolone failure. Five MG-infected women received azithromycin for vaginal CT, 4 of whom had a MG MRM detected in their vaginal and/or rectal specimens. Conclusions: We observed a high prevalence of macrolide-resistant vaginal and rectal MG among a population of women at high risk for CT. This study highlights how the use of antimicrobials designed to treat an identified infection-in this case, CT-could influence treatment outcomes and antimicrobial susceptibility in other unidentified infections.
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evaluation of text message reminders to encourage retesting for chlamydia and gonorrhea among female patients at the municipal Sexually Transmitted Disease clinic in seattle washington
Sexually Transmitted Diseases, 2020Co-Authors: Anna Unutzer, David A Katz, Julia C Dombrowski, Lindley A Barbee, Matthew R Golden, Christine M KhosropourAbstract:BACKGROUND United States guidelines recommend retesting for chlamydia (CT) and gonorrhea (GC) approximately 3 months after treatment, but adherence to these guidelines is poor. METHODS In May 2016, the municipal Sexually Transmitted Disease (STD) Clinic in Seattle, WA, integrated opt-in short message system (SMS) (text message) retesting reminders for female patients into our clinic's routine electronic intake. Women were asked if they wanted to receive an SMS reminder for retesting for GC/CT in 3 months. We used Fisher exact tests to compare the proportion who returned to the clinic for retesting and the proportion who retested GC/CT positive 3 to 6 months after their initial diagnosis. We used Sexually Transmitted Disease surveillance data to ascertain repeat GC/CT diagnoses. RESULTS From May 2016 to December 2017, 743 (36%) of 2067 women opted to receive an SMS reminder. Overall, 95 of these women tested positive for GC or CT and provided a valid phone number; 31 (33%) had opted into SMS reminders. The percentage of women who returned to the clinic 3 to 6 months after their initial GC/CT diagnosis did not significantly differ for women who did and did not opt in to receive SMS reminders (23% vs 9%; P = 0.11). Repeat GC/CT diagnosis 3 to 6 months after the initial GC/CT diagnosis was not significantly different between women who did and did not opt in (7% vs 3%; P = 0.58). CONCLUSIONS Uptake of automated SMS reminders among women was low, and most women who received reminders did not return for retesting. Despite this, SMS reminders integrated into an existing clinic infrastructure may somewhat increase retesting among women with GC/CT.
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time trends in first episode genital herpes simplex virus infections in an urban Sexually Transmitted Disease clinic
Sexually Transmitted Diseases, 2019Co-Authors: Nazila M Dabestani, David A Katz, Julia C Dombrowski, Amalia Magaret, Anna Wald, Christine JohnstonAbstract:BACKGROUND Genital herpes simplex virus type 1 (HSV-1) has emerged as the leading cause of first-episode genital herpes among specific populations in the United States, such as adolescents, young adult women, and men who have sex with men (MSM). We examined trends in the etiology of first-episode genital herpes diagnoses over time in a Sexually Transmitted Disease (STD) clinic population. METHODS Using an electronic database, we identified persons diagnosed as having first-episode genital herpes at Public Health - Seattle & King County STD Clinic from 1993 to 2014 and compared risk factors for genital HSV-1 versus herpes simplex virus type 2 (HSV-2) infection. RESULTS Of 52,030 patients with genital ulcers, 3065 (6.15%) had first-episode genital herpes infection: 1022 (33.3%) with HSV-1 and 2043 (67.7%) with HSV-2. Overall, 1154 (37.7%) were women, the median age was 28 years (interquartile range, 24-36 years), 1875 (61.2%) patients were white, and 353 (11.5%) were MSM. The number of patients diagnosed as having first-episode genital HSV-2 declined on average by 5.5 persons per year, from 208 in 1993 to 35 in 2014 (change of -5.6 per year; 95% confidence interval [CI], -6.9 to -4.1), whereas HSV-1 diagnoses remained stable at approximately 50 per year (change of 0.2; 95% CI, -0.4 to 0.9). In a multivariate model, persons diagnosed as having first-episode genital HSV-1 rather than genital HSV-2 infection were more likely to be younger (age <30 years [relative risk {RR}, 1.38; 95% CI, 1.22-1.55]), white (RR, 3.16; 95% CI, 2.57-3.88), and MSM (RR, 1.50; 95% CI, 1.31-1.71). CONCLUSIONS We observed a significant decrease in the frequency of first-episode genital HSV-2 and a stable number of first-episode genital HSV-1 infections in a STD clinic over the last 2 decades.
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effect of nucleic acid amplification testing on detection of extragenital gonorrhea and chlamydial infections in men who have sex with men Sexually Transmitted Disease clinic patients
Sexually Transmitted Diseases, 2014Co-Authors: Lindley A Barbee, Roxanne P Kerani, Julia C Dombrowski, Matthew R GoldenAbstract:BACKGROUND In 2010, the Centers for Disease and Control and Prevention recommended using nucleic acid amplification tests (NAATs) for extragenital gonorrhea (GC) and chlamydia (CT) testing because of NAATs' improved sensitivity compared with culture. METHODS In 2011, the Public Health-Seattle & King County Sexually Transmitted Disease Clinic introduced NAAT-based testing for extragenital GC and CT infection in men who have sex with men (MSM) using AptimaCombo2. We compared extragenital GC and CT test positivity and infection detection yields in the last year of culture-based testing (2010) to the first year of NAAT testing (2011). RESULTS Test positivity of GC increased by 8% for rectal infections (9.0%-9.7%) and 12% for pharyngeal infections (5.8%-6.5%) from 2010 to 2011; CT test positivity increased 61% for rectal infections (7.4%-11.9%). Pharyngeal CT was identified in 2.3% of tested persons in 2011 (not tested in 2010). We calculated the ratio of extragenital cases per 100 urethral infections to adjust for a possible decline in GC/CT incidence in 2011; the GC rectal and pharyngeal ratios increased 77% and 66%, respectively, and the CT rectal ratio increased 127%. The proportion of infected persons with isolated extragenital infections (i.e., extragenital infections without urethral infection) increased from 43% in 2010 to 57% in 2011. CONCLUSIONS Extragenital testing with NAAT substantially increases the number of infected MSM identified with GC or CT infection and should continue to be promoted.
John M Douglas - One of the best experts on this subject based on the ideXlab platform.
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problems with condom use among patients attending Sexually Transmitted Disease clinics prevalence predictors and relation to incident gonorrhea and chlamydia
American Journal of Epidemiology, 2007Co-Authors: Lee Warner, Laura Hoyt Danna, Martin Fishbein, John M Douglas, Jonathan Mark Zenilman, Gail Bolan, Judy Rogers, Daniel R. Newman, Mary L. Kamb, Thomas A. PetermanAbstract:Condom use remains important for Sexually Transmitted Disease (STD) prevention. This analysis examined the prevalence of problems with condoms among 1,152 participants who completed a supplemental questionnaire as part of Project RESPECT, a counseling intervention trial conducted at five publicly funded STD clinics between 1993 and 1997. Altogether, 336 participants (41%, 95% confidence interval: 38, 45) reporting condom use indicated that condoms broke, slipped off, leaked, or were not used throughout intercourse in the previous 3 months. Correspondingly, 8.9% (95% confidence interval: 7.0, 9.5) of uses resulted in STD exposure if partners were infected because of delayed application of condoms (4.3% of uses), breakage (2.0%), early removal (1.4%), slippage (1.3%), or leakage (0.4%). Use problems were significantly associated with reporting inconsistent condom use, multiple partners, and other condom problems. One-hundred thirty participants completing the questionnaire were tested for gonorrhea and chlamydia at this time and also 3 months earlier. Twenty-one (16.2%) were infected with incident gonorrhea and chlamydia, with no infections among consistent users reporting no use problems. Exact logistic regression revealed a significant dose-response relation between increased protection from condom use and reduced gonorrhea and chlamydia risk (p trend = 0.032). Both consistency of use and use problems must be considered in studies of highly infectious STD to avoid underestimating condom effectiveness.
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seroepidemiology of infection with human papillomavirus 16 in men and women attending Sexually Transmitted Disease clinics in the united states
The Journal of Infectious Diseases, 2004Co-Authors: Deborah L Thompson, John M Douglas, Anna E Baron, Mark Foster, Michael E Hagensee, Carolyn Diguiseppi, Jennifer E Cameron, Timothy C Spencer, Jonathan M ZenilmanAbstract:Background. The study sought to characterize the seroprevalence, seropersistence, and seroincidence of human papillomavirus (HPV)-16 antibody, as well as the behavioral risk factors for HPV-16 seropositivity. Methods. Serologic data at baseline and at 6- and 12-month follow-up visits were used to examine the seroprevalence, seropersistence, and seroincidence of HPV-16 antibody in 1595 patients attending United States clinics treating Sexually Transmitted Disease. Testing for antibody to HPV-16 was performed by capture enzyme-linked immunosorbent assay (ELISA) using viruslike particles. Results. The seroprevalence of HPV-16 antibody was 24.5% overall and was higher in women than in men (30.2% vs. 18.7%, respectively). In those who were HPV-16 seropositive at baseline, antibody response persisted to 12 months in 72.5% of women and in 45.6% of men. The seroincidence of HPV-16 antibody was 20.2/100 person-years (py) overall, 25.4/100 py in women, and 15.7/100 py in men. In multivariate analysis, the seroprevalence of HPV-16 antibody was significantly associated with female sex, age >20 years, and the number of episodes of sex with occasional partners during the preceding 3 months, whereas the seroincidence of HPV-16 antibody was significantly associated with female sex, age >20 years, baseline negative ELISA result greater than the median value, and the number of episodes of unprotected sex with occasional partners during the preceding 3 months. Conclusion. Sex- and age-related differences in both the seropositivity and seroincidence of HPV-16 antibody persisted after adjustment for behavioral and sociodemographic risk factors, and behavioral risk factors during the preceding 3 months were stronger predictors of the seroprevalence and seroincidence of HPV-16 antibody than was lifetime sexual behavior.
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incidence of herpes simplex virus type 2 infection in 5 Sexually Transmitted Disease std clinics and the effect of hiv std risk reduction counseling
The Journal of Infectious Diseases, 2004Co-Authors: Sami L Gottlieb, John M Douglas, Gail Bolan, Daniel R. Newman, Scott D Schmid, Michael Iatesta, Kevin C Malotte, Mark P Foster, Anna E Baron, Jonathan Mark ZenilmanAbstract:The seroincidence of herpes simplex virus type 2 (HSV-2) infection was determined among 1766 patients attending Sexually Transmitted Disease (STD) clinics and enrolled in a randomized, controlled trial of human immunodeficiency virus (HIV)/STD risk-reduction counseling (RRC). Arm 1 received enhanced RRC (4 sessions); arm 2, brief RRC (2 sessions); and arm 3, the control arm, brief informational messages. The overall incidence rate was 11.7 cases/100 person-years (py). Independent predictors of incidence of HSV-2 infection included female sex; black race; residence in Newark, New Jersey; <50% condom use with an occasional partner; and, in females, incident trichomoniasis and bacterial vaginosis. Only 10.8% of new HSV-2 infections were diagnosed clinically. Incidence rates were 12.9 cases/100 py in the control arm, 11.8 cases/100 py in arm 2, and 10.3 cases/100 py in arm 1 (hazard ratio, 0.8 [95% confidence interval, 0.6-1.1], vs. controls). The possible benefit of RRC in preventing acquisition of HSV-2 infection offers encouragement that interventions more specifically tailored to genital herpes may be useful and should be an important focus of future studies.
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seroprevalence and correlates of herpes simplex virus type 2 infection in five Sexually Transmitted Disease clinics
The Journal of Infectious Diseases, 2002Co-Authors: Sami L Gottlieb, John M Douglas, Jonathan Mark Zenilman, Gail Bolan, Scott D Schmid, Michael Iatesta, Kevin C Malotte, Mark P Foster, Anna E Baron, John F SteinerAbstract:The seroprevalence of herpes simplex virus type 2 (HSV-2) infection was studied among 4128 patients from Sexually Transmitted Disease (STD) clinics who were enrolled in a randomized controlled trial of human immunodeficiency virus and STD counseling efficacy. HSV-2 seroprevalence was 40.8% and was higher in women than in men (52.0% vs. 32.4%; P<.0001) and higher in blacks than in nonblacks (48.1% vs. 29.6%; P<.0001). Among 14-19-year-old patients, 36.8% of black women and 25.8% of nonblack women were infected with HSV-2. Independent predictors of HSV-2 seropositivity included female sex, black race, older age, less education, more lifetime sex partners, prior diagnosis of syphilis or gonorrhea, and lack of HSV-1 antibody. The majority of HSV-2-seropositive persons (84.7%) had never received a diagnosis of genital herpes. HSV-2 infection is common in STD clinic attendees in the United States, even among young age groups, especially among women. Efforts to prevent genital herpes should begin at an early age. The high rate of undiagnosed HSV-2 infection likely contributes to ongoing transmission.
