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Spurgeon ME, Townsend EC, Blaine-Sauer S, McGregor SM, Horswill M, den Boon JA, Ahlquist P, Kalan L, Lambert PF. Key aspects of papillomavirus infection influence the host cervicovaginal microbiome in a preclinical murine papillomavirus (MmuPV1) infection model. mBio 2024; 15:e0093324. [PMID: 38742830 DOI: 10.1128/mbio.00933-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Human papillomaviruses (HPVs) are the most common sexually transmitted infection in the United States and are a major etiological agent of cancers in the anogenital tract and oral cavity. Growing evidence suggests changes in the host microbiome are associated with the natural history and ultimate outcome of HPV infection. We sought to define changes in the host cervicovaginal microbiome during papillomavirus infection, persistence, and pathogenesis using the murine papillomavirus (MmuPV1) cervicovaginal infection model. Cervicovaginal lavages were performed over a time course of MmuPV1 infection in immunocompetent female FVB/N mice and extracted DNA was analyzed by qPCR to track MmuPV1 viral copy number. 16S ribosomal RNA (rRNA) gene sequencing was used to determine the composition and diversity of microbial communities throughout this time course. We also sought to determine whether specific microbial communities exist across the spectrum of MmuPV1-induced neoplastic disease. We, therefore, performed laser-capture microdissection to isolate regions of disease representing all stages of neoplastic disease progression (normal, low- and high-grade dysplasia, and cancer) from female reproductive tract tissue sections from MmuPV1-infected mice and performed 16S rRNA sequencing. Consistent with other studies, we found that the natural murine cervicovaginal microbiome is highly variable across different experiments. Despite these differences in initial microbiome composition between experiments, we observed that MmuPV1 persistence, viral load, and severity of disease influenced the composition of the cervicovaginal microbiome. These studies demonstrate that papillomavirus infection can alter the cervicovaginal microbiome.IMPORTANCEHuman papillomaviruses (HPVs) are the most common sexually transmitted infection in the United States. A subset of HPVs that infect the anogenital tract (cervix, vagina, anus) and oral cavity cause at least 5% of cancers worldwide. Recent evidence indicates that the community of microbial organisms present in the human cervix and vagina, known as the cervicovaginal microbiome, plays a role in HPV-induced cervical cancer. However, the mechanisms underlying this interplay are not well-defined. In this study, we infected the female reproductive tract of mice with a murine papillomavirus (MmuPV1) and found that key aspects of papillomavirus infection and disease influence the host cervicovaginal microbiome. This is the first study to define changes in the host microbiome associated with MmuPV1 infection in a preclinical animal model of HPV-induced cervical cancer. These results pave the way for using MmuPV1 infection models to further investigate the interactions between papillomaviruses and the host microbiome.
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Affiliation(s)
- Megan E Spurgeon
- McArdle Laboratory for Cancer Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Elizabeth C Townsend
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Simon Blaine-Sauer
- McArdle Laboratory for Cancer Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Stephanie M McGregor
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mark Horswill
- McArdle Laboratory for Cancer Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- John W. and Jeanne M. Rowe Center for Research in Virology, Morgridge Institute for Research, Madison, Wisconsin, USA
| | - Johan A den Boon
- McArdle Laboratory for Cancer Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- John W. and Jeanne M. Rowe Center for Research in Virology, Morgridge Institute for Research, Madison, Wisconsin, USA
| | - Paul Ahlquist
- McArdle Laboratory for Cancer Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- John W. and Jeanne M. Rowe Center for Research in Virology, Morgridge Institute for Research, Madison, Wisconsin, USA
| | - Lindsay Kalan
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Ontario, Canada
| | - Paul F Lambert
- McArdle Laboratory for Cancer Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Cervantes PW, Segelke BW, Lau EY, Robinson BV, Abisoye-Ogunniyan A, Pal S, de la Maza LM, Coleman MA, D’haeseleer P. Sequence, structure prediction, and epitope analysis of the polymorphic membrane protein family in Chlamydia trachomatis. PLoS One 2024; 19:e0304525. [PMID: 38861498 PMCID: PMC11166332 DOI: 10.1371/journal.pone.0304525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
The polymorphic membrane proteins (Pmps) are a family of autotransporters that play an important role in infection, adhesion and immunity in Chlamydia trachomatis. Here we show that the characteristic GGA(I,L,V) and FxxN tetrapeptide repeats fit into a larger repeat sequence, which correspond to the coils of a large beta-helical domain in high quality structure predictions. Analysis of the protein using structure prediction algorithms provided novel insight to the chlamydial Pmp family of proteins. While the tetrapeptide motifs themselves are predicted to play a structural role in folding and close stacking of the beta-helical backbone of the passenger domain, we found many of the interesting features of Pmps are localized to the side loops jutting out from the beta helix including protease cleavage, host cell adhesion, and B-cell epitopes; while T-cell epitopes are predominantly found in the beta-helix itself. This analysis more accurately defines the Pmp family of Chlamydia and may better inform rational vaccine design and functional studies.
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Affiliation(s)
- Patrick W. Cervantes
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Brent W. Segelke
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Edmond Y. Lau
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Beverly V. Robinson
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Abisola Abisoye-Ogunniyan
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Sukumar Pal
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, California, United States of America
| | - Luis M. de la Maza
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, California, United States of America
| | - Matthew A. Coleman
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Patrik D’haeseleer
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
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Akpan IN, Taskin T, Wheldon CW, Rossheim ME, Thompson EL. Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States. Prev Med 2024; 182:107951. [PMID: 38604575 DOI: 10.1016/j.ypmed.2024.107951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9-26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27-45 years. This study also assessed factors associated with HPV vaccine initiation after age 26. METHODS Data were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27-45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27-45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models. RESULTS Overall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males. CONCLUSIONS The ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.
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Affiliation(s)
- Idara N Akpan
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
| | - Tanjila Taskin
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122, USA.
| | - Matthew E Rossheim
- Department of Health Administration and Health Policy, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
| | - Erika L Thompson
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA; Department of Quantitative and Qualitative Health Sciences, Univeristy of Texas School of Public Health San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Solnick RE, López LH, Martinez PM, Zucker JE. Sexually Transmitted Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:335-368. [PMID: 38641394 DOI: 10.1016/j.emc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
As the United States faces a worsening epidemic of sexually transmitted infections (STIs), emergency departments (EDs) play a critical role in identifying and treating these infections. The growing health inequities in the distribution and disproportionate impact of STIs add to the urgency of providing high-quality sexual health care through the ED. Changes in population health are reflected in the new Centers for Disease Control recommendations on screening, diagnostic testing, and treatment of STIs. This review covers common, as well as and less common or emerging STIs, and discusses the state-of-the-art guidance on testing paradigms, extragenital sampling, and antimicrobial treatment and prevention of STIs.
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Affiliation(s)
- Rachel E Solnick
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA.
| | - Laura Hernando López
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Patricia Mae Martinez
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Jason E Zucker
- Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, Box 82, New York, NY 10032, USA
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Cohall A, Cohall R, Rais M, Zucker J, Sanchez D, Carnevale C, Gonzalez-Davila M. Implementing an STI screening initiative in New York City community colleges. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1034-1040. [PMID: 35622981 DOI: 10.1080/07448481.2022.2068018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/19/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Objectives: Nationally, community colleges provide academic instruction to 5.6 million students annually. However, sexual health services, are often lacking. This pilot study was developed to assess the feasibility of implementing screening for sexually transmitted infections in community college settings in New York City where approximately 86,075 students attend classes. Methods: We recruited and trained an interdisciplinary group of graduate students (public health, nursing, and post-baccalaureate/pre-med) to provide sexual health risk assessments, screening for sexually transmitted infections, and linkages to care at three community college campuses in New York City. Results: Over a three-year period (2017-2019), 545 students were screened for STIs and 7.2% were positive for Chlamydia. Conclusions: Community college students are at high risk for sexually transmitted infections yet have limited access to sexual health services. Coordinated partnerships between state and local departments of health, public health schools, and an academic medical center demonstrate an important model which can fill identified gaps for this vulnerable population.
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Affiliation(s)
- Alwyn Cohall
- Columbia University Mailman School of Public Health, New York City, New York, USA
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Renee Cohall
- Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Monica Rais
- Columbia University School of General Studies, New York City, New York, USA
| | - Jason Zucker
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Diana Sanchez
- Department of Health and Mental Hygiene, New York City, New York, USA
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Rodrigues DL, Carvalho AC, Prada M, Garrido MV, Balzarini RN, de Visser RO, Lopes D. Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain. JOURNAL OF SEX RESEARCH 2024; 61:709-726. [PMID: 36877803 DOI: 10.1080/00224499.2023.2181305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Marília Prada
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Richard O de Visser
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Diniz Lopes
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
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Andersson N, Waterboer T, Nylander E, Idahl A. Seroprevalence of sexually transmitted infections over 44 years - A cross-sectional study in Sweden. Int J STD AIDS 2024:9564624241248874. [PMID: 38659325 DOI: 10.1177/09564624241248874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) may cause substantial individual suffering and a large economic burden for society. This study examined the seroprevalence of Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus (HSV) types 1 and 2, and several human papillomaviruses (HPV) in the Swedish population over time. METHODS The study population consisted of 30-year-old women attending maternity care, and 50 year-old men and women attending health check-ups, from 1975 to 2018. Antibody status was determined by multiplex serology and quantified using median reporter fluorescence intensity (MFI). RESULTS A total of 891 samples were analysed (519 from 30-year-old women, 186 from 50 year-old women and 186 from 50 year-old men). Of these, 41.5% showed seropositivity for Chlamydia trachomatis, 16.7% for Mycoplasma genitalium, 70.5% for HSV-1, 14.9% for HSV-2, 13.2% for high-risk HPV, and 8.3% for low-risk HPV. Seropositivity for Mycoplasma genitalium, HSV-1 and especially Chlamydia trachomatis decreased over time. CONCLUSIONS There was a decrease over time in Chlamydia trachomatis seroprevalence, probably due to contact tracing, testing and early treatment; this might also have affected Mycoplasma genitalium seroprevalence. Despite the reduction, seroprevalences are still high, so continued and new efforts to reduce STI incidence are essential.
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Affiliation(s)
- Nirina Andersson
- Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, Germany
| | - Elisabet Nylander
- Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Tremblay F, Courtemanche Y, Bélanger RE, Turcotte-Tremblay AM. A systematic review of the association between history of sexually transmitted infections and subsequent condom use in adolescents. BMC Public Health 2024; 24:1000. [PMID: 38600483 PMCID: PMC11007949 DOI: 10.1186/s12889-024-18322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Sexually transmitted infections (STIs) are common among adolescents. According to the Health Belief Model, cues to action influence preventive behaviors. Cues to action can include health experiences such as being diagnosed with an STI. The impact of a history of STIs on subsequent condom use among adolescents remains largely unexamined, despite high rates of recurrence and their health impacts. This project aimed to systematically review the literature on the association between curable STIs and subsequent condom use among adolescents. The systematic review, reported following PRISMA guidelines, was conducted using the Joanna Briggs Institute method. Eligible studies, in the form of cohort studies, case-control studies, or cross-sectional studies, targeted adolescents aged 10 to 24, with or without a history of curable STIs; the outcome was subsequent condom use. MEDLINE (Ovid), Embase (Elsevier), and Web of Science were searched from January 2012 to December 2022 with the assistance of an information specialist. Two reviewers independently selected articles and extracted data. Risk of bias analysis was performed using ROBINS-E. The review explores results, with tables, based on population characteristics, exposure, and outcome, and addresses the influence of gender, ethnicity, and age. Of 3088 articles identified, seven studies were retained. Almost all the studies focused on African-American, Nigerian, or Rwandan adolescents, and several included only girls. Among girls, a history of STI increased subsequent condom use in combination with other contraceptive methods (n = 4). Among boys and older adolescents of both genders, a history of STI was associated with a decrease in condom use (n = 3). No study distinguished between different STIs. While all the studies (n = 7) presented a high risk of bias, six did not present a threat to conclusion validity. All the studies indicated that a history of STI could influence subsequent protective behaviors, possibly by acting as a cue to action, as posited by the Health Belief Model. This information enhances our understanding of factors leading to the adoption of preventive health measures among adolescents and could apply to other infectious experiences.Registration The protocol is registered in PROSPERO (CRD42023397443).
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Affiliation(s)
- Frédérique Tremblay
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada.
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada.
| | - Yohann Courtemanche
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada
| | - Richard E Bélanger
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada
- Department of Pediatrics, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada
| | - Anne-Marie Turcotte-Tremblay
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada
- Faculy of Nursing, Université Laval, 1050, avenue de la Médecine, Room 3645, Québec, (QC), G1V 0A6, Canada
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Mubasshera H. Pornography usage during adolescence: Does it lead to risky sexual behavior? HEALTH ECONOMICS 2024. [PMID: 38511292 DOI: 10.1002/hec.4825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
Are youths who consume pornography more likely to engage in risky sexual behaviors? Using longitudinal data from the National Study of Youth and Religion and an individual fixed effects strategy, this paper investigates the relationship between pornography use among 13- to 23-year-olds and a range of subsequent risky sexual behaviors. It also estimates a lagged dependent variable model where risky sexual behavior of the previous wave is included as a control. The findings suggest that moderate and frequent pornography use increases the likelihood of engaging in acts such as unprotected sex and having multiple sexual partners. Finally, a heterogeneity analysis by gender reveals that males and females behave differently in response to exposure to pornography, but that is true for only a few indicators of risky sex. The paper's findings provide critical information on determinants of risky sexual behavior and meaningful evidence for the policy debate on government censoring and monitoring online behavior.
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Affiliation(s)
- Hamida Mubasshera
- Department of Economics, Temple University, Philadelphia, Pennsylvania, USA
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Martin EG, Ansari B, Gift TL, Johnson BL, Collins D, Williams AM, Chesson HW. An Interactive Modeling Tool for Projecting the Health and Direct Medical Cost Impact of Changes in the Sexually Transmitted Diseases Prevention Program Budgets. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:221-230. [PMID: 38271104 DOI: 10.1097/phh.0000000000001868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CONTEXT Estimating the return on investment for public health services, tailored to the state level, is critical for demonstrating their value and making resource allocation decisions. However, many health departments have limited staff capacity and expertise to conduct economic analyses in-house. PROGRAM We developed a user-friendly, interactive Excel-based spreadsheet model that health departments can use to estimate the impact of increases or decreases in sexually transmitted infection (STI) prevention funding on the incidence and direct medical costs of chlamydia, gonorrhea, syphilis, and STI-attributable HIV infections. Users tailor results to their jurisdictions by entering the size of their population served; the number of annual STI diagnoses; their prior annual funding amount; and their anticipated new funding amount. The interface was developed using human-centered design principles, including focus groups with 15 model users to collect feedback on an earlier model version and a usability study on the prototype with 6 model users to finalize the interface. IMPLEMENTATION The STI Prevention Allocation Consequences Estimator ("SPACE Monkey 2.0") model will be publicly available as a free downloadable tool. EVALUATION In the usability testing of the prototype, participants provided overall positive feedback. They appreciated the clear interpretations, outcomes expressed as direct medical costs, functionalities to interact with the output and copy charts into external applications, visualization designs, and accessible information about the model's assumptions and limitations. Participants provided positive responses to a 10-item usability evaluation survey regarding their experiences with the prototype. DISCUSSION Modeling tools that synthesize literature-based estimates and are developed with human-centered design principles have the potential to make evidence-based estimates of budget changes widely accessible to health departments.
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Affiliation(s)
- Erika G Martin
- Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, Albany, New York (Dr Martin); Department of Organization, Work, and Leadership, Queen's Business School, Queen's University Belfast, Belfast, United Kingdom (Dr Ansari); Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (Drs Gift, Williams, and Chesson and Mr Collins), and Division of Workforce Development, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce (Ms Johnson), Centers for Disease Control and Prevention, Atlanta, Georgia
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Williams C, Skrip LA, Adams AS, Vermund SH. Examining County-Level Associations between Federally Qualified Health Centers and Sexually Transmitted Infections: A Political Ecology of Health Framework. Healthcare (Basel) 2024; 12:295. [PMID: 38338180 PMCID: PMC10855137 DOI: 10.3390/healthcare12030295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
Federally Qualified Health Centers (FQHCs) are the largest providers of healthcare for sexually transmitted infections (STIs) in medically underserved communities in the United States (US). Through the Affordable Care Act (ACA), FQHCs have grown in number, but the impact of this growth on STIs is poorly understood. This ecological study seeks to quantify the association between FQHCs and STI prevalence in all US counties. Variables were described utilizing medians and interquartile ranges, and distributions were compared using Kruskal-Wallis tests. Median rates of chlamydia in counties with high, low, and no FQHCs were 370.3, 422.6, and 242.1 cases per 100,000 population, respectively. Gonorrhea rates were 101.9, 119.7, and 49.9 cases per 100,000 population, respectively. Multivariable linear regression models, adjusted for structural and place-based characteristics (i.e., Medicaid expansion, social vulnerability, metropolitan status, and region), were used to examine county-level associations between FQHCs and STIs. Compared to counties with no FQHCs, counties with a high number of FQHCs had chlamydia rates that were an average of 68.6 per 100,000 population higher (β = 68.6, 95% CI: 45.0, 92.3) and gonorrhea rates that were an average of 25.2 per 100,000 population higher (β = 25.2, 95% CI: 13.2, 37.2). When controlled for salient factors associated with STI risks, greater FQHC availability was associated with greater diagnosis and treatment of STIs. These findings provide empirical support for the utility of a political ecology of health framework and the critical role of FQHCs in confronting the STI epidemic in the US.
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Affiliation(s)
- Christopher Williams
- School of Natural and Social Sciences, State University of New York at Purchase College, Purchase, NY 10577, USA
| | - Laura A. Skrip
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia 1000-10, Liberia;
- Quantitative-Data for Decision-Making Lab, Monrovia 1000-10, Liberia
| | | | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, CT 06510, USA;
- School of Medicine, Yale University, New Haven, CT 06510, USA
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12
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Ansari B, Martin EG. Integrating human-centered design in public health data dashboards: lessons from the development of a data dashboard of sexually transmitted infections in New York State. J Am Med Inform Assoc 2024; 31:298-305. [PMID: 37330670 PMCID: PMC10797265 DOI: 10.1093/jamia/ocad102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
OBJECTIVE The increased availability of public data and accessible visualization technologies enhanced the popularity of public health data dashboards and broadened their audience from professionals to the general public. However, many dashboards have not achieved their full potential due to design complexities that are not optimized to users' needs. MATERIAL AND METHODS We used a 4-step human-centered design approach to develop a data dashboard of sexually transmitted infections for the New York State Department of Health: (1) stakeholder requirements gathering, (2) an expert review of existing data dashboards, (3) a user evaluation of existing data dashboards, and (4) an usability evaluation of the prototype dashboard with an embedded experiment about visualizing missing race and ethnicity data. RESULTS Step 1 uncovered data limitations and software requirements that informed the platform choice and measures included. Step 2 yielded a checklist of general principles for dashboard design. Step 3 revealed user preferences that influenced the chart types and interactive features. Step 4 uncovered usability problems resulting in features such as prompts, data notes, and displaying imputed values for missing race and ethnicity data. DISCUSSION Our final design was accepted by program stakeholders. Our modifications to traditional human-centered design methodologies to minimize stakeholders' time burden and collect data virtually enabled project success despite barriers to meeting participants in-person and limited public health agency staff capacity during the COVID-19 pandemic. CONCLUSION Our human-centered design approach and the final data dashboard architecture could serve as a template for designing public health data dashboards elsewhere.
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Affiliation(s)
- Bahareh Ansari
- Organization, Work, and Leadership Department, Queen’s Management School, Queen’s University Belfast, Belfast, UK
| | - Erika G Martin
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, New York, USA
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13
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Prol B, Klein S, Rennie C, Andelija S. Respondent Demographics and Contraceptive Use Patterns in the United States: A National Survey of Family Growth Analysis. Cureus 2024; 16:e53121. [PMID: 38420091 PMCID: PMC10900169 DOI: 10.7759/cureus.53121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Contraception is an important tool for helping to prevent both unintended pregnancies and sexually transmitted infections (STIs). Medical costs related to STIs are high and impose a large burden on both patients and the healthcare system. In addition, unintended pregnancies account for a large portion of pregnancies in the United States (US) and are associated with adverse maternal and infant health outcomes. Both STIs and unintended pregnancies are continuous public health concerns, and this study aims to identify patterns in contraceptive method use in relation to specific social determinants of health. METHODS Utilizing the Centers for Disease Control and Prevention (CDC)'s 2017-2019 National Survey of Family Growth report on current contraceptive status, we isolated data from 3,572 respondents who reported using one of the following contraceptive methods: oral contraceptive pills (OCPs), male condoms, partner's vasectomy, female sterilization, withdrawal, medroxyprogesterone acetate injections (Depo-Provera), hormonal implant, or an intrauterine device (IUD). We analyzed these contraceptive methods among age, race, education, marital status, and insurance status. Data were analyzed in RStudio 2022.02.0 (RStudio Team, RStudio: Integrated Development for R. RStudio, PBC, Boston, MA) through a test of equal proportions for a significance of P < 0.05. A concurrent Yates' continuity correction was performed in order to limit erroneous significant findings based on small sample sizes where applicable. The study conception and data analysis were performed independently with oversight from our preceptor at HCA Florida Brandon Hospital, Brandon, Florida. RESULTS There were statistically significant differences for all our selected methods of contraception across different age groups. There were statistically significant differences for OCPs, male condoms, partner's vasectomy, female sterilization, Depo-Provera, hormonal implant, and IUD across different race groups and different insurance statuses. There were statistically significant differences for OCPs, male condoms, partner's vasectomy, female sterilization, withdrawal, hormonal implant, and IUD across different education levels and different marital statuses. CONCLUSION This analysis highlights gaps that are present in female reproductive autonomy through the statistical differences in contraceptive methods across various demographics and warrants continued focus on the role that social determinants of health play in the prevention of unintended pregnancies and STIs. In order to promote fairness and equality in healthcare, it is essential to increase education on these topics both within and beyond medical settings. This effort aims to provide patients with equitable access to healthcare and attempt to address health disparities that are prevalent in multiple different sectors.
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Affiliation(s)
- Barbara Prol
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Sarah Klein
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Christopher Rennie
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Sanela Andelija
- Department of Obstetrics and Gynecology, HCA Florida Brandon Hospital, Brandon, USA
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14
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Debrine AM, Karplus PA, Rockey DD. A structural foundation for studying chlamydial polymorphic membrane proteins. Microbiol Spectr 2023; 11:e0324223. [PMID: 37882824 PMCID: PMC10715098 DOI: 10.1128/spectrum.03242-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023] Open
Abstract
IMPORTANCE Infections by bacteria in the genus Chlamydia cause a range of widespread and potentially debilitating conditions in humans and other animals. We analyzed predicted structures of a family of proteins that are potential vaccine targets found in all Chlamydia spp. Our findings deepen the understanding of protein structure, provide a descriptive framework for discussion of the protein structure, and outline regions of the proteins that may be key targets in host-microbe interactions and anti-chlamydial immunity.
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Affiliation(s)
- Abigail M. Debrine
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
- Department of Biochemistry and Biophysics, Oregon State University, Corvallis, Oregon, USA
| | - P. Andrew Karplus
- Department of Biochemistry and Biophysics, Oregon State University, Corvallis, Oregon, USA
| | - Daniel D. Rockey
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
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15
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Hamilton DT, Katz DA, Haderxhanaj LT, Copen CE, Spicknall IH, Hogben M. Modeling the impact of changing sexual behaviors with opposite-sex partners and STI testing among women and men ages 15-44 on STI diagnosis rates in the United States 2012-2019. Infect Dis Model 2023; 8:1169-1176. [PMID: 38074076 PMCID: PMC10709507 DOI: 10.1016/j.idm.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 01/18/2024] Open
Abstract
Objective To estimate the potential contributions of reported changes in frequency of penile-vaginal sex (PVS), condom use and STI screening to changes in gonorrhea and chlamydial diagnoses from 2012 to 2019. Methods An agent-based model of the heterosexual population in the U.S. simulated the STI epidemics. Baseline was calibrated to 2012 diagnosis rates, testing, condom use, and frequency of PVS. Counterfactuals used behaviors from the 2017-2019 NSFG, and we evaluated changes in diagnosis and incidence rates in 2019. Results Higher testing rates increased gonorrhea and chlamydia diagnosis by 14% and 13%, respectively, but did not reduce incidence. Declining frequency of PVS reduced the diagnosis rate for gonorrhea and chlamydia 6% and 3% respectively while reducing incidence by 10% and 9% respectively. Declining condom use had negligible impact on diagnosis and incidence. Conclusion Understanding how changing behavior drives STI incidence is essential to addressing the growing epidemics. Changes in testing and frequency of PVS likely contributed to some, but not all, of the changes in diagnoses. More research is needed to understand the context within which changing sexual behavior and testing are occurring.
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Affiliation(s)
- Deven T. Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Laura T. Haderxhanaj
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Casey E. Copen
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ian H. Spicknall
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Hogben
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Ren X, Su W, Li S, Zhao T, Huang Q, Wang Y, Wang X, Zhang X, Wei J. Immunogenicity and Therapeutic Efficacy of a Sendai-Virus-Vectored HSV-2 Vaccine in Mouse and Guinea Pig Models. Vaccines (Basel) 2023; 11:1752. [PMID: 38140157 PMCID: PMC10747028 DOI: 10.3390/vaccines11121752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To date, there is no licensed vaccine for preventing herpes simplex virus type 2 (HSV-2). The current treatment to address the infection and prevent its transmission is not always satisfactory. METHODS We constructed two recombinant vectors, one encoding HSV-2 glycoprotein D (gD, SeV-dF/HSV-2-gD) and one encoding HSV-2-infected cell protein 27 (ICP27, SeV-dF/HSV-2-ICP27), based on a replication-defective Sendai virus through reverse genetics, collectively comprising a combinatorial HSV-2 therapeutic vaccine candidate. The immunogenicity and proper immunization procedure for this vaccine were explored in a murine model. The therapeutic effect that helps prevent recurrent HSV-2 disease was evaluated in HSV-2-infected guinea pigs. RESULTS Both a robust humoral immune response and a cellular immune response, characterized by the neutralizing antibody titer and the IFN-γ level, respectively, were elicited in BALB/c mice. A further study of cellular immunogenicity in mice revealed that T lymphocytes were successfully enhanced with the desirable secretion of several cytokines. In HSV-2-seropositive guinea pigs, vaccination could reduce the severity of HSV-2 in terms of recurrent lesions, duration of recurrent outbreak, and frequency of recurrence by 58.66%, 45.34%, and 45.09%, respectively, while viral shedding was also significantly inhibited in the vaccine-treated group compared to the group treated with phosphate-buffered saline. CONCLUSIONS The replication-defective recombinant Sendai viruses conveying HSV-2-gD and ICP27 proteins showed great immunogenicity and potential for preventing recurrent HSV-2 disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiangbo Wei
- Weijiangbo Laboratory, National Vaccine and Serum Institute, Beijing 101111, China; (X.R.); (W.S.); (S.L.); (T.Z.); (Q.H.); (Y.W.); (X.W.); (X.Z.)
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17
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Karlow SL, Levano SR, von Esenwein SA, Ward MC, McCool-Myers M, Lawley ME. Chlamydia and Gonorrhea Testing Patterns Among Women with and Without Serious Mental Illness. Community Ment Health J 2023; 59:1490-1497. [PMID: 37382860 DOI: 10.1007/s10597-023-01134-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/28/2023] [Indexed: 06/30/2023]
Abstract
Rates of the sexually transmitted infections (STIs) Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have risen in women by 13% and 40%, respectively, since 2015. Women with Serious Mental Illness (SMI) are at disproportionate risk for STIs. A retrospective chart review was performed at a safety-net healthcare system in the Southeastern United States (US) from 2014 to 2017. CT/GC positivity rates did not differ between the general and SMI populations (6.6% vs. 6.5% for CT and 1.8% vs. 2.2% for GC, respectively). Emergency Medicine accounted for more positive STI test results in SMI patients than the general population (25.2% vs. 19.1% for CT, 47.8% vs. 35.5% for GC, respectively). SMI patients received large portions of STI care in emergency settings, where follow-up is poor. Point of Care (POC) testing could improve care in this setting, and mental healthcare providers must address sexual health with patients who otherwise may not receive this care.
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Affiliation(s)
- Samantha L Karlow
- Emory University School of Medicine, Atlanta, GA, USA.
- University of Missouri - Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA.
| | | | - Silke A von Esenwein
- Center for Public Partnerships and Research, University of Kansas, Lawrence, KS, USA
| | - Martha C Ward
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Megan McCool-Myers
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Megan E Lawley
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
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18
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Perez-Fernandez J, Arroyo-Velasco DO, Huaman MR, Chavez-Bustamante SG, Llamo-Vilcherrez AP, Delgado-Flores CJ, Toro-Huamanchumo CJ. Association between early sexual initiation and sexually transmitted infections among Peruvian reproductive-age women. Front Public Health 2023; 11:1191722. [PMID: 37790721 PMCID: PMC10544918 DOI: 10.3389/fpubh.2023.1191722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Background Sexually transmitted infections (STIs) are a serious public health problem worldwide, especially among reproductive-age women. The early sexual onset of sexual intercourse (EOSI) has been suggested as a risk factor, although there is no data at the national level. Objective To evaluate the association between EOSI and STIs in Peruvian women of childbearing age. Methods Analytical cross-sectional study with secondary data analyzes of the Peruvian Demographic and Family Health Survey 2018. The outcome was the presence of STIs in the last 12 months and the exposure variable was EOSI (age < 15 years at the time of their first sexual experience). To evaluate the association of interest, crude and adjusted prevalence ratios (aPRs) were calculated using generalized linear models with Poisson family and logarithmic link function. Results We analyzed data from 31,028 women of childbearing age. The 11.3% reported having STIs in the last 12 months and 20.2% of the participants had an EOSI. After adjusting for potential confounders, we found that EOSI was associated with STIs (aPR: 1.27; 95% CI: 1.08-1.50; p = 0.005). When conducting stratified analysis by area of residence and number of sexual partners, this association was maintained in women living in urban areas (aPR: 1.36; 95% CI: 1.11-1.66; p = 0.003) those who did not report having a history of multiple sexual partners (aPR: 1.27; 95% CI: 1.08-1.51; p = 0.005), and those in the middle (aPR: 1.42; 95% CI: 1.03-1.97; p = 0.034) and highest (aPR: 2.12; 95% CI: 1.33-3.39; p = 0.002) wealth quintiles. Conclusion Among reproductive-age women from Peru, EOSI was associated with STIs, especially in women living in urban areas, with no history of multiple sexual partners, and belonging to the middle to higher wealth index. The implementation of measures to prevent EOSI and fostering appropriate sexual health counseling for women with EOSI is advised.
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Affiliation(s)
| | | | - Mariella R. Huaman
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Anita P. Llamo-Vilcherrez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Carolina J. Delgado-Flores
- Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Centro de Obesidad y Salud Metabólica, Lima, Peru
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Sheele JM, Mi L, Monas J, Mohseni M. Patient and Provider Demographics and the Management of Genitourinary Tract Infections in the Emergency Department. Emerg Med Int 2023; 2023:1522347. [PMID: 37727654 PMCID: PMC10506883 DOI: 10.1155/2023/1522347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Urinary tract infections (UTIs) and sexually transmitted infections (STIs) can have overlapping signs, symptoms, and findings on urinalysis. Our objective was to determine if patient or provider demographics are associated with differences in the diagnosis and management of UTIs and STIs in the emergency department (ED). Methods We analyzed 38,062 ED patient encounters from a single healthcare system between April 18, 2014, and March 7, 2017. All encounters were women ≥18 years of age and not admitted to the hospital. We performed logistic regression using patient and provider demographics, laboratory testing results, ED triage data, and ED diagnoses. Results The patient's age, race, and marital status were not associated with having an ED UTI diagnosis with a urine culture ≥10,000 colony forming units (CFUs)/mL (vs. <10,000 CFUs/mL). Patient race and the sex of the ED provider were not associated with differences in empiric antibiotic treatment for gonorrhea and chlamydia during the ED encounter. Patient's race and the sex of the ED provider were also not associated with discordance between empiric antibiotic therapy given in the ED and the results of gonorrhea and chlamydia tests that resulted following the ED encounter. Conclusion In our multivariate analyses, we did not observe that the patient's race resulted in significant differences in the diagnosis of UTIs with bacteriuria ≥10,000 CFU/mL or differences in the empiric treatment of gonorrhea and chlamydia infections among those tested for the infection in the ED. The patient's age and marital status, but not the provider's sex, were significantly associated with differences in the management of gonorrhea and chlamydia.
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Affiliation(s)
| | - Lanyu Mi
- Mayo Clinic, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Scottsdale, AZ, USA
| | - Jessica Monas
- Mayo Clinic, Department of Emergency Medicine, Phoenix, AZ, USA
| | - Michael Mohseni
- Mayo Clinic, Department of Emergency Medicine, Jacksonville, FL 32224, USA
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Pearson WS, Chan PA, Habel MA, Haderxhanaj LT, Hogben M, Aral SO. A Description of Telehealth Use Among Sexually Transmitted Infection Providers in the United States, 2021. Sex Transm Dis 2023; 50:518-522. [PMID: 37155609 PMCID: PMC10524588 DOI: 10.1097/olq.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Telehealth offers one approach to improving access to sexually transmitted infection (STI) prevention and care services. Therefore, we described recent telehealth use among those providing STI-related care and identified opportunities for improving STI service delivery. MATERIALS AND METHODS Using the DocStyles Web-based, panel survey conducted by Porter Novelli from September 14 to November 10, 2021, 1500 healthcare providers were asked about their current telehealth usage, demographics, and practice characteristics, and compared STI providers (≥10% of time spent on STI care and prevention) to non-STI providers. RESULTS Among those whose practice consisted of at least 10% STI visits (n = 597), 81.7% used telehealth compared with 75.7% for those whose practice consisted of less than 10% STI visits (n = 903). Among the providers with at least 10% STI visits in their practice, telehealth use was highest among obstetrics and gynecology specialists, those practicing in suburban areas, and those practicing in the South. Among providers whose practice consisted of at least 10% STI visits and who used telehealth (n = 488), the majority were female and obstetrics and gynecology specialists practicing in suburban areas of the South. After controlling for age, gender, provider specialty, and geographic location of their practice, providers whose practice consisted of at least 10% STI visits had increased odds (odds ratio, 1.51; 95% confidence interval, 1.16-1.97) of using telehealth compared with providers whose visits consisted of less than 10% STI visits. CONCLUSIONS Given the widespread use of telehealth, efforts to optimize delivery of STI care and prevention via telehealth are important to improve access to services and address STIs in the United States.
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Affiliation(s)
- William S. Pearson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Philip A. Chan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Department of Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Melissa A. Habel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laura T. Haderxhanaj
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sevgi O. Aral
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Rodrigues R, Vieira-Baptista P, Catalão C, Borrego MJ, Sousa C, Vale N. Chlamydial and Gonococcal Genital Infections: A Narrative Review. J Pers Med 2023; 13:1170. [PMID: 37511783 PMCID: PMC10381338 DOI: 10.3390/jpm13071170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Sexually transmitted infections (STIs) constitute one of the leading causes of disease burden worldwide, leading to considerable morbidity, mortality, health expenditures, and stigma. Of note are the most common bacterial STIs, chlamydial and gonococcal infections, whose etiological agents are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively. Despite being usually asymptomatic, in some cases these infections can be associated with long-term severe complications, such as pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of other STIs acquisition. As the symptoms, when present, are usually similar in both infections, and in most of the cases these infections co-occur, the dual-test strategy, searching for both pathogens, should be preferred. In line with this, herein we focus on the main aspects of CT and NG infections, the clinical symptoms as well as the appropriate state-of-the-art diagnostic tests and treatment. Cost-effective strategies for controlling CT and NG infections worldwide are addressed. The treatment for both infections is based on antibiotics. However, the continuing global rise in the incidence of these infections, concomitantly with the increased risk of antibiotics resistance, leads to difficulties in their control, particularly in the case of NG infections. We also discuss the potential mechanism of tumorigenesis related to CT infections. The molecular bases of CT and NG infections are addressed, as they should provide clues for control or eradication, through the development of new drugs and/or effective vaccines against these pathogens.
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Affiliation(s)
- Rafaela Rodrigues
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Pedro Vieira-Baptista
- Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Catalão
- Roche Sistemas de Diagnósticos, Estrada Nacional, 2720-413 Amadora, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal
| | - Carlos Sousa
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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Abrams R, Nordmyr J, Forsman AK. Promoting sexual health in schools: a systematic review of the European evidence. Front Public Health 2023; 11:1193422. [PMID: 37469692 PMCID: PMC10352496 DOI: 10.3389/fpubh.2023.1193422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Sexual ill-health is an urgent public health issue with subsequent social and economic costs. There is, therefore, a need for more effective sexual health promotion interventions in an early stage of life. Previous research has focused on preventive sexual health interventions applying a risk perspective, and the limited and scattered evidence concerning school-based sexual health promotion interventions employing a health-resource perspective has not been compiled and synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in schools in Europe. Method A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and included information on study characteristics, intervention content, methods, and outcomes relevant to the current review. A narrative synthesis of the included studies was performed, highlighting the collective results. Result Seventeen records were included in the review, reporting on 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All three studies with a qualitative research design described positive effects experienced by the participants. Six of thirteen quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. The outcomes of interest were grouped into five areas, and most studies focused on the area of attitudes toward sexual health. Conclusion The findings indicate promising evidence of effect for interventions with a health promotion approach, highlighting the importance of strengthening sexual health resources related to respect, communication skills, attitudes, and other positive psycho-social aspects of sexual health. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas a comprehensive focus on the multi-dimensional sexual health literacy concept is less common and can be recommended to be included in future intervention research.
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Paulich KN, Freis SM, Dokuru DR, Alexander JD, Vrieze SI, Corley RP, McGue M, Hewitt JK, Stallings MC. Exploring Relationships Between Internalizing Problems and Risky Sexual Behavior: A Twin Study. Behav Genet 2023; 53:331-347. [PMID: 37165251 PMCID: PMC11138211 DOI: 10.1007/s10519-023-10146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
Previous research links risky sexual behavior (RSB) to externalizing problems and to substance use, but little research has been conducted on relationships between internalizing problems (INT) and RSB. The current study addresses that literature gap, using both a twin sample from Colorado (N = 2567) and a second twin sample from Minnesota (N = 1131) in attempt to replicate initial results. We explored the hypothesis that the latent variable INT would be more strongly associated with the latent variable RSB for females than for males, examining relationships between INT and RSB via phenotypic confirmatory factor analysis and multivariate twin analyses. We found a small but significant phenotypic association between the latent variables. However, despite using two large twin samples, limited power restricted our ability to identify the genetic and environmental mechanisms underlying this association. Our sex differences hypothesis was not fully supported in either sample and requires further investigation. Our findings illustrate the complexity of the relationship between internalizing problems and risky sexual behavior.
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Affiliation(s)
- Katie N Paulich
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA.
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.
| | - Samantha M Freis
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Deepika R Dokuru
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | | | - Scott I Vrieze
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
| | - Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Michael C Stallings
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Van Wagoner N, Qushair F, Johnston C. Genital Herpes Infection: Progress and Problems. Infect Dis Clin North Am 2023; 37:351-367. [PMID: 37105647 DOI: 10.1016/j.idc.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Genital herpes (GH) is a sexually transmitted infection causing recurrent, self-limited genital, buttock, and thigh ulcerations. Symptoms range from unrecognized or mild to severe with frequent recurrences. Herpes simplex viruses (HSV) type-1 or type-2 cause GH. HSV establishes latency in sacral ganglia and causes lifelong infection. Viral reactivation leads to genital ulceration or asymptomatic shedding which may lead to transmission. HSV infection during pregnancy can cause fulminant hepatitis and neonatal transmission. Severe and atypical manifestations are seen in immunocompromised people. Guanosine analogs treat symptoms and prevent recurrences, shedding, and transmission. Novel preventive and therapeutic strategies are in development.
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Affiliation(s)
- Nicholas Van Wagoner
- Division of Infectious Diseases, Department of Medicine, University of Alabama Heersink School of Medicine, VH 102A, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
| | - Fuad Qushair
- University of Alabama Heersink School of Medicine, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Christine Johnston
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9th Avenue Box 359928, Seattle, WA 98104, USA
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25
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Manca E, Van der Pol B, Exten C, Pinto CN. A Review of the Scope of Direct-to-Consumer Sexually Transmitted Infection Testing Services Offered on the Internet. Sex Transm Dis 2023; 50:323-328. [PMID: 36807311 DOI: 10.1097/olq.0000000000001783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The prevalence of sexually transmitted infections (STIs) is at an all-time high. Direct-to-consumer STI testing services may help alleviate this undue health burden. These products are sold online and rarely require interaction with a health care professional (HCP). Vendors offer STI self-collection kits or prescriptions for HCP specimen collection. The objective was to understand the scope of direct-to-consumer STI testing services offered and provide recommendations for consumers and industry. METHODS Seven volunteers searched for "STD tests" on Google from February 1 through March 31, 2021 and shared their top 3 results. The study team extracted data from consumer-facing information on each website. Descriptive statistics and thematic qualitative analyses were performed. RESULTS Twenty vendors were identified. Most vendors (95%) used Clinical Laboratory Improvement Amendments (CLIA)-certified or College of American Pathologists (CAP) accredited laboratories. Analyses distinguished between STI self-collection kits (n = 9) using independent laboratories and HCP specimen collection (n = 10), which used commercial laboratories (n = 1 offered both). The STI self-collection kits were cheaper per test and bundle on average (eg, $79.00 vs. $106.50 for chlamydia/gonorrhea), and more closely aligned with clinical recommendations compared with the HCP specimen collection options. Websites often contained inaccurate or misleading information (n = 13), often promoting testing outside of the recommendations. CONCLUSIONS Direct-to-consumer STI testing services are part of an emerging market lacking regulation. Consumers should select vendors offering prescriptions for HCP specimen collection at CAP accredited and CLIA-certified laboratories. Vendors should provide a screening tool to assess individual patient risk prior to test purchase.
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Affiliation(s)
- Ellie Manca
- From the Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - Barbara Van der Pol
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Cara Exten
- Ross & Carol Nese College of Nursing, The Pennsylvania State University, Hershey, PA
| | - Casey N Pinto
- From the Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA
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26
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Guilamo-Ramos V, Benzekri A, Thimm-Kaiser M. Evaluating the efficacy of an online, family-based intervention to promote adolescent sexual health: a study protocol for a randomized controlled trial. Trials 2023; 24:181. [PMID: 36906589 PMCID: PMC10008101 DOI: 10.1186/s13063-023-07205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/28/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Adolescents in the U.S. experience significant negative sexual health outcomes, representing a public health priority in the U.S. Research shows that while parents play an influential role in shaping adolescent sexual behavior, surprisingly few programs engage parents in existing programming. Moreover, most efficacious parent-based programs focus on young adolescents, and few utilize delivery mechanisms that facilitate broad reach and scale-up. To address these gaps, we propose to test the efficacy of an online-delivered, parent-based intervention adapted to address both younger and older adolescent sexual risk behavior. METHODS In this parallel, two-arm, superiority randomized controlled trial (RCT), we propose to evaluate Families Talking Together Plus (FTT+), an adaptation of an existing and efficacious FTT parent-based intervention, in shaping sexual risk behavior among adolescents aged 12-17 and delivered via a teleconferencing application (e.g., Zoom). The study population will include n=750 parent-adolescent dyads recruited from public housing developments in the Bronx, New York. Adolescents will be eligible if they are between the ages of 12 and 17 years of age, self-report as Latino and/or Black, have a parent or primary caregiver, and are South Bronx residents. Parent-adolescent dyads will complete a baseline survey, after which they will be assigned to either the FTT+ intervention condition (n=375) or the passive control condition (n=375) in a 1:1 allocation ratio. Parents and adolescents in each condition will complete follow-up assessments 3 and 9 months post-baseline. The primary outcomes will include sexual debut and ever sex, and the secondary outcomes will include the frequency of sex acts, number of lifetime sexual partners, number of unprotected sex acts, and linkage to health and educational/vocational services in the community. We will utilize intent-to-treat analyses of 9-month outcomes and single degree of freedom contrasts comparing the intervention to the control group for primary and secondary outcomes. DISCUSSION The proposed evaluation and analysis of the FTT+ intervention will address gaps in the current cadre of parent-based programs. If efficacious, FTT+ would represent a model for scale-up and adoption of parent-based approaches designed to address adolescent sexual health in the U.S. TRIAL REGISTRATION ClinicalTrials.gov NCT04731649. Registered on February 1, 2021.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University School of Nursing, Durham, NC, USA. .,School of Nursing, Duke University, 307 Trent Dr, Durham, NC, 27710, USA. .,School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, 40 Duke Medicine Circle, Durham, NC, USA. .,Presidential Advisory Council on HIV AIDS, U.S. Department of Health and Human Services, Washington, D.C., USA.
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University School of Nursing, Durham, NC, USA.,School of Nursing, Duke University, 307 Trent Dr, Durham, NC, 27710, USA
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University School of Nursing, Durham, NC, USA.,School of Nursing, Duke University, 307 Trent Dr, Durham, NC, 27710, USA
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Katz DA, Copen CE, Haderxhanaj LT, Hogben M, Goodreau SM, Spicknall IH, Hamilton DT. Changes in Sexual Behaviors with Opposite-Sex Partners and Sexually Transmitted Infection Outcomes Among Females and Males Ages 15-44 Years in the USA: National Survey of Family Growth, 2008-2019. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:809-821. [PMID: 36472765 PMCID: PMC9735137 DOI: 10.1007/s10508-022-02485-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/11/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Rates of reported gonorrhea and chlamydial infections have increased substantially over the past decade in the USA and disparities persist across age and race/ethnicity. We aimed to understand potential changes in sexual behaviors, sexual network attributes, and sexually transmitted infection (STI) screening that may be contributing to these trends. We analyzed data from 29,423 female and 24,605 male respondents ages 15-44 years from the National Survey of Family Growth, 2008-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in sexual behaviors with opposite-sex partners, network attributes, and STI testing, treatment, and diagnosis. Significant declines were observed in condom use at last vaginal sex, mean number of vaginal sex acts, proportion of condom-protected sex acts in the past 4 weeks, and racial/ethnic homophily with current partners among males and females from 2008-2010 through 2017-2019. Among males, mean number of female partners in the past 12 months and concurrency also declined, while the percent reporting ever having sex with another male increased. Past-year testing for chlamydia and any STI increased among females. Research is needed to understand how these changes interact and potentially contribute to increasing reported gonorrhea and chlamydia diagnoses and identify avenues for future intervention.
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Affiliation(s)
- David A Katz
- Department of Global Health, University of Washington, Box 351620, Seattle, WA, 98195, USA.
| | - Casey E Copen
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Hogben
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Ian H Spicknall
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
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Gopalappa C, Balasubramanian H, Haas PJ. A new mixed agent-based network and compartmental simulation framework for joint modeling of related infectious diseases- application to sexually transmitted infections. Infect Dis Model 2022; 8:84-100. [PMID: 36632177 PMCID: PMC9827035 DOI: 10.1016/j.idm.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
Background A model that jointly simulates infectious diseases with common modes of transmission can serve as a decision-analytic tool to identify optimal intervention combinations for overall disease prevention. In the United States, sexually transmitted infections (STIs) are a huge economic burden, with a large fraction of the burden attributed to HIV. Data also show interactions between HIV and other sexually transmitted infections (STIs), such as higher risk of acquisition and progression of co-infections among persons with HIV compared to persons without. However, given the wide range in prevalence and incidence burdens of STIs, current compartmental or agent-based network simulation methods alone are insufficient or computationally burdensome for joint disease modeling. Further, causal factors for higher risk of coinfection could be both behavioral (i.e., compounding effects of individual behaviors, network structures, and care behaviors) and biological (i.e., presence of one disease can biologically increase the risk of another). However, the data on the fraction attributed to each are limited. Methods We present a new mixed agent-based compartmental (MAC) framework for jointly modeling STIs. It uses a combination of a new agent-based evolving network modeling (ABENM) technique for lower-prevalence diseases and compartmental modeling for higher-prevalence diseases. As a demonstration, we applied MAC to simulate lower-prevalence HIV in the United States and a higher-prevalence hypothetical Disease 2, using a range of transmission and progression rates to generate burdens replicative of the wide range of STIs. We simulated sexual transmissions among heterosexual males, heterosexual females, and men who have sex with men (men only and men and women). Setting the biological risk of co-infection to zero, we conducted numerical analyses to evaluate the influence of behavioral factors alone on disease dynamics. Results The contribution of behavioral factors to risk of coinfection was sensitive to disease burden, care access, and population heterogeneity and mixing. The contribution of behavioral factors was generally lower than observed risk of coinfections for the range of hypothetical prevalence studied here, suggesting potential role of biological factors, that should be investigated further specific to an STI. Conclusions The purpose of this study is to present a new simulation technique for jointly modeling infectious diseases that have common modes of transmission but varying epidemiological features. The numerical analysis serves as proof-of-concept for the application to STIs. Interactions between diseases are influenced by behavioral factors, are sensitive to care access and population features, and are likely exacerbated by biological factors. Social and economic conditions are among key drivers of behaviors that increase STI transmission, and thus, structural interventions are a key part of behavioral interventions. Joint modeling of diseases helps comprehensively simulate behavioral and biological factors of disease interactions to evaluate the true impact of common structural interventions on overall disease prevention. The new simulation framework is especially suited to simulate behavior as a function of social determinants, and further, to identify optimal combinations of common structural and disease-specific interventions.
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29
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Ailincai D, Bercea M, Mititelu Tartau L, Marin L. Biocompatible drug delivery systems able to co-deliver antifungal and antiviral agents. Carbohydr Polym 2022; 298:120071. [DOI: 10.1016/j.carbpol.2022.120071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/19/2022] [Accepted: 09/01/2022] [Indexed: 11/02/2022]
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Beste LA, Keddem S, Borgerding J, Lowy E, Gardella C, McFarland L, Comstock E, Fonseca GA, Van Epps P, Ohl M, Hauser RG, Ross D, Maier MM. Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2022; 9:ofac433. [PMID: 36514443 PMCID: PMC9452156 DOI: 10.1093/ofid/ofac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background We performed a retrospective study of chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) testing in the Veterans Health Administration (VHA) during 2019-2021. Methods We determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019 through 2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of preexposure prophylaxis. Results The VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV. Declines and subsequent improvements in sexually transmitted infection (STI) testing occurred unequally across age, sex, race, and geographic groups. Testing for all 4 STIs in 2021 remained below baseline in rural Veterans. Excluding those aged <25 years, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021. Conclusions After dramatic reductions from 2019 to 2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, female, Asian American, Hawaiian/Pacific Islander, and Black Veterans.
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Affiliation(s)
- Lauren A Beste
- Correspondence: Lauren A. Beste, MD, MSc, VA Puget Sound Health Care System,1660 S Columbian Way, Seattle, WA 98108 ()
| | - Shimrit Keddem
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joleen Borgerding
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Elliott Lowy
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Carolyn Gardella
- Gynecology Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lorenzo McFarland
- Office of Specialty Care Services, Veterans Health Administration, Washington, District of Columbia, USA
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Giuseppe Allan Fonseca
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Puja Van Epps
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Veterans Affairs Northeast Ohio Healthcare System,Cleveland, Ohio, USA
| | - Michael Ohl
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs, Iowa City, Iowa, USA
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ronald G Hauser
- Pathology and Laboratory Medicine Department, Veterans Affairs Connecticut Healthcare, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Ross
- Office of Specialty Care Services, Veterans Health Administration, Washington, District of Columbia, USA
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Bonett S, Teixeira da Silva D, Lazar N, Makeneni S, Wood S. Trends in sexually transmitted infection screening during COVID-19 and missed cases among adolescents. Public Health 2022; 213:171-176. [PMID: 36423495 PMCID: PMC9576220 DOI: 10.1016/j.puhe.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic disrupted sexual health services for young people, with potential consequences of decreasing preventive screening and increasing undiagnosed sexually transmitted infections (STIs). This study aimed to assess trends in asymptomatic screening among patients receiving STI testing and to estimate the number of STI cases that were missed during the early months of the pandemic. STUDY DESIGN A cross-sectional study of electronic health records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014 to November 2020. METHODS A total of 35,548 testing encounters were analyzed, including 2958 during the pandemic. We assessed whether testing at each encounter was performed as asymptomatic screening, risk-based testing, or symptomatic testing. We evaluated screening trends over time and estimated the number of missed STI cases during the pandemic. RESULTS The mean monthly testing encounters decreased from 479 per month prepandemic to 329 per month during the pandemic. The percent of tests performed as asymptomatic screening dropped from 72.5% prepandemic to a nadir of 54.5% in April 2020. We estimate that this decrease in asymptomatic screening would represent 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. CONCLUSIONS During the pandemic, the total volume of STI testing encounters and the proportion of tests performed as asymptomatic screening decreased, potentially resulting in missed diagnoses. Undiagnosed STIs can result in severe sequelae and contribute to community transmission of STIs. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.
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Affiliation(s)
- S. Bonett
- School of Nursing, University of Pennsylvania, USA,Corresponding author. School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA. Tel.: +215-573-4299
| | | | - N. Lazar
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
| | - S. Makeneni
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - S.M. Wood
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA,PolicyLab, Children's Hospital of Philadelphia, USA
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Kridin K, Ingram B, Becker D, Shiloah N, Azrad M, Habib S, Peretz A. Sexually Transmitted Diseases in Northern Israel: Insights From a Large Referral Laboratory. J Low Genit Tract Dis 2022; 27:51-55. [DOI: 10.1097/lgt.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Ansari B, Hart-Malloy R, Rosenberg ES, Trigg M, Martin EG. Modeling the Potential Impact of Missing Race and Ethnicity Data in Infectious Disease Surveillance Systems on Disparity Measures: Scenario Analysis of Different Imputation Strategies. JMIR Public Health Surveill 2022; 8:e38037. [PMID: 36350701 PMCID: PMC9685511 DOI: 10.2196/38037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/03/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Monitoring progress toward population health equity goals requires developing robust disparity indicators. However, surveillance data gaps that result in undercounting racial and ethnic minority groups might influence the observed disparity measures. OBJECTIVE This study aimed to assess the impact of missing race and ethnicity data in surveillance systems on disparity measures. METHODS We explored variations in missing race and ethnicity information in reported annual chlamydia and gonorrhea diagnoses in the United States from 2007 to 2018 by state, year, reported sex, and infection. For diagnoses with incomplete demographic information in 2018, we estimated disparity measures (relative rate ratio and rate difference) with 5 imputation scenarios compared with the base case (no adjustments). The 5 scenarios used the racial and ethnic distribution of chlamydia or gonorrhea diagnoses in the same state, chlamydia or gonorrhea diagnoses in neighboring states, chlamydia or gonorrhea diagnoses within the geographic region, HIV diagnoses, and syphilis diagnoses. RESULTS In 2018, a total of 31.93% (560,551/1,755,510) of chlamydia and 22.11% (128,790/582,475) of gonorrhea diagnoses had missing race and ethnicity information. Missingness differed by infection type but not by reported sex. Missing race and ethnicity information varied widely across states and times (range across state-years: from 0.0% to 96.2%). The rate ratio remained similar in the imputation scenarios, although the rate difference differed nationally and in some states. CONCLUSIONS We found that missing race and ethnicity information affects measured disparities, which is important to consider when interpreting disparity metrics. Addressing missing information in surveillance systems requires system-level solutions, such as collecting more complete laboratory data, improving the linkage of data systems, and designing more efficient data collection procedures. As a short-term solution, local public health agencies can adapt these imputation scenarios to their aggregate data to adjust surveillance data for use in population indicators of health equity.
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Affiliation(s)
- Bahareh Ansari
- Center for Policy Research, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, NY, United States
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, NY, United States
| | - Rachel Hart-Malloy
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, NY, United States
- New York State Department of Health, Albany, NY, United States
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, NY, United States
| | - Eli S Rosenberg
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, NY, United States
- New York State Department of Health, Albany, NY, United States
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, NY, United States
| | - Monica Trigg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Erika G Martin
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, NY, United States
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, NY, United States
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Habel MA, Sullivan P, Hall C, Aral S. Remote Health: Optimizing the Delivery of Sexual Health Care. Sex Transm Dis 2022; 49:S1-S6. [PMID: 35312660 PMCID: PMC10197151 DOI: 10.1097/olq.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa A Habel
- From the Centers for Disease Control and Prevention, Division of STD Prevention
| | | | | | - Sevgi Aral
- From the Centers for Disease Control and Prevention, Division of STD Prevention
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Johnston C, Magaret A, Son H, Stern M, Rathbun M, Renner D, Szpara M, Gunby S, Ott M, Jing L, Campbell VL, Huang ML, Selke S, Jerome KR, Koelle DM, Wald A. Viral Shedding 1 Year Following First-Episode Genital HSV-1 Infection. JAMA 2022; 328:1730-1739. [PMID: 36272098 PMCID: PMC9588168 DOI: 10.1001/jama.2022.19061] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Herpes simplex virus type 1 (HSV-1) is the leading cause of first-episode genital herpes in many countries. OBJECTIVE To inform counseling messages regarding genital HSV-1 transmission, oral and genital viral shedding patterns among persons with first-episode genital HSV-1 infection were assessed. The trajectory of the development of HSV-specific antibody and T-cell responses was also characterized. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort followed up for up to 2 years, with 82 participants followed up between 2013 and 2018. Participants were recruited from sexual health and primary care clinics in Seattle, Washington. Persons with laboratory-documented first-episode genital HSV-1 infection, without HIV infection or current pregnancy, were referred for enrollment. EXPOSURES First-episode genital HSV-1 infection. MAIN OUTCOMES AND MEASURES Genital and oral HSV-1 shedding and lesion rates at 2 months, 11 months, and up to 2 years after initial genital HSV-1 infection. Participants self-collected oral and genital swabs for HSV polymerase chain reaction testing for 30 days at 2 and 11 months and up to 2 years after diagnosis of genital HSV-1. Blood samples were collected at serial time points to assess immune responses to HSV-1. Primary HSV-1 infection was defined as absent HSV antibody at baseline or evolving antibody profile using the University of Washington HSV Western Blot. HSV-specific T-cell responses were detected using interferon γ enzyme-linked immunospot. RESULTS Among the 82 participants, the median (range) age was 26 (16-64) years, 54 (65.9%) were women, and 42 (51.2%) had primary HSV-1 infection. At 2 months, HSV-1 was detected from the genital tract in 53 participants (64.6%) and in the mouth in 24 participants (29.3%). Genital HSV-1 shedding was detected on 275 of 2264 days (12.1%) at 2 months and declined significantly to 122 of 1719 days (7.1%) at 11 months (model-predicted rate, 6.2% [95% CI, 4.3%-8.9%] at 2 months vs 3.2% [95% CI, 1.8%-5.7%] at 11 months; relative risk, 0.52 [95% CI, 0.29-0.93]). Genital lesions were rare, reported on 65 of 2497 days (2.6%) at 2 months and 72 of 1872 days (3.8%) at 11 months. Oral HSV-1 shedding was detected on 88 of 2247 days (3.9%) at 2 months. Persons with primary HSV-1 infection had a higher risk of genital shedding compared with those with nonprimary infection (model-predicted rate, 7.9% [95% CI, 5.4%-11.7%] vs 2.9% [95% CI, 1.7%-5.0%]; relative risk, 2.75 [95% CI, 1.40-5.44]). Polyfunctional HSV-specific CD4+ and CD8+ T-cell responses were maintained during the follow-up period. CONCLUSIONS AND RELEVANCE Genital HSV-1 shedding was frequent after first-episode genital HSV-1, particularly among those with primary infection, and declined rapidly during the first year after infection.
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Affiliation(s)
- Christine Johnston
- Department of Medicine, University of Washington, Seattle
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Amalia Magaret
- Department of Medicine, University of Washington, Seattle
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Hyunju Son
- Department of Medicine, University of Washington, Seattle
| | - Michael Stern
- Department of Medicine, University of Washington, Seattle
| | - Molly Rathbun
- Departments of Biology, Biochemistry and Molecular Biology, Center for Infectious Disease Dynamics, and the Huck Institutes of the Life Sciences, Pennsylvania State University, University Park
| | - Daniel Renner
- Departments of Biology, Biochemistry and Molecular Biology, Center for Infectious Disease Dynamics, and the Huck Institutes of the Life Sciences, Pennsylvania State University, University Park
| | - Moriah Szpara
- Departments of Biology, Biochemistry and Molecular Biology, Center for Infectious Disease Dynamics, and the Huck Institutes of the Life Sciences, Pennsylvania State University, University Park
| | - Sarah Gunby
- Department of Medicine, University of Washington, Seattle
| | - Mariliis Ott
- Department of Medicine, University of Washington, Seattle
| | - Lichen Jing
- Department of Medicine, University of Washington, Seattle
| | | | - Meei-li Huang
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Stacy Selke
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Keith R. Jerome
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - David M. Koelle
- Department of Medicine, University of Washington, Seattle
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Departments of Global Health, University of Washington, Seattle
- Benaroya Research Institute, Seattle, Washington
| | - Anna Wald
- Department of Medicine, University of Washington, Seattle
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Departments of Epidemiology, University of Washington, Seattle
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Ansari B, Martin EG. Development of a usability checklist for public health dashboards to identify violations of usability principles. J Am Med Inform Assoc 2022; 29:1847-1858. [PMID: 35976140 PMCID: PMC9552210 DOI: 10.1093/jamia/ocac140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/31/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To develop a usability checklist for public health dashboards. MATERIALS AND METHODS This study systematically evaluated all publicly available dashboards for sexually transmitted infections on state health department websites in the United States (N = 13). A set of 11 principles derived from the information visualization literature were used to identify usability problems that violate critical usability principles: spatial organization, information coding, consistency, removal of extraneous ink, recognition rather than recall, minimal action, dataset reduction, flexibility to user experience, understandability of contents, scientific integrity, and readability. Three user groups were considered for public health dashboards: public health practitioners, academic researchers, and the general public. Six reviewers with usability knowledge and diverse domain expertise examined the dashboards using a rubric based on the 11 principles. Data analysis included quantitative analysis of experts' usability scores and qualitative synthesis of their textual comments. RESULTS The dashboards had varying levels of complexity, and the usability scores were dependent on the dashboards' complexity. Overall, understandability of contents, flexibility, and scientific integrity were the areas with the most major usability problems. The usability problems informed a checklist to improve performance in the 11 areas. DISCUSSION The varying complexity of the dashboards suggests a diversity of target audiences. However, the identified usability problems suggest that dashboards' effectiveness for different groups of users was limited. CONCLUSIONS The usability of public health data dashboards can be improved to accommodate different user groups. This checklist can guide the development of future public health dashboards to engage diverse audiences.
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Affiliation(s)
- Bahareh Ansari
- Center for Policy Research, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, New York, USA
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, New York, USA
| | - Erika G Martin
- Center for Policy Research, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, New York, USA
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, New York, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, New York, USA
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Incident Chlamydia trachomatis Infection in a High School Population. BIOLOGY 2022; 11:biology11091363. [PMID: 36138842 PMCID: PMC9495774 DOI: 10.3390/biology11091363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 01/09/2023]
Abstract
Simple Summary After a pathogen that causes disease has been introduced in a human population, an understanding of that disease in the population depends on knowing how many people in the population have the disease (prevalence), how fast the disease spreads from one person to another within the population (incidence), and how long the disease remains in an individual once acquired (duration). Infections caused by Chlamydia trachomatis are the most common sexually transmitted bacterial infections in the world. Individuals younger than 25 are the most affected due to the patterns of their sexual activity. In most individuals, these infections do not produce symptoms. Thus, affected individuals usually are not prompted to seek care, and most cases can only be detected through screening. Screenings for chlamydia in United States schools have given an indication of how many adolescents in the population might have chlamydia. In this study, we assessed how quickly chlamydia is acquired within the adolescent population. We determined that 14–19-year-old adolescents are acquiring chlamydia at a pace of 6.6 cases per 100 person-years for boys and 11.9 cases per 100 person-years for girls. Male and female students are acquiring chlamydia within 10 and within 7 months, respectively. Abstract Prospective cohort studies of sexually transmitted infections (STIs) are logistically impractical owing to time and expenses. In schools, students are readily available for school-related follow-ups and monitoring. Capitalizing on the logistics that society already commits to ensure regular attendance of adolescents in school, a school-based STI screening in New Orleans made it possible to naturally observe the occurrence of chlamydia and to determine its incidence among 14–19-year-old adolescents. Among participants screened repeatedly, we calculated incidence rates, cumulative incidence, and incidence times. Male (n = 3820) and female (n = 3501) students were observed for 6251 and 5143 person-years, respectively, during which 415 boys and 610 girls acquired chlamydia. Incidence rates per 100 person-years were 6.6 cases for boys and 11.9 cases for girls. In multivariable analysis, the adjusted hazard ratio was 5.34 for boys and 3.68 for girls if the student tested positive for gonorrhea during follow-up, and 2.76 for boys and 1.59 for girls if at first participation the student tested positive for chlamydia, and it increased with age among boys but not among girls. In joinpoint trend analysis, the annual percentage change in the incidence rate was 6.6% for boys (95% CI: −1.2%, 15.1%) and 0.1% for girls (95% CI: −5.3%, 5.7%). Annual cumulative incidence was 5.5% among boys and 8.6% among girls. Median incidence time was 9.7 months for boys and 6.9 months for girls. Our findings can be used to refine assumptions in mathematical modeling and in cost analysis studies of C. trachomatis infection, and provide strong evidence in support of annual chlamydia screening for adolescent boys.
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Kattari SK, Gross EB, Harner V, Andrus E, Stroumsa D, Moravek MB, Brouwer A. "Doing it on my own terms": Transgender and nonbinary adults' experiences with HPV self-swabbing home testing kits. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2022; 10:496-512. [PMID: 38105788 PMCID: PMC10720596 DOI: 10.1080/23293691.2022.2094737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/19/2022] [Indexed: 12/19/2023]
Abstract
The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23-59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: 1) Multilevel barriers; 2) "Get it done, so I know that I am safe"; 3) Contrasting preferences for care; and 4) Community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.
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Affiliation(s)
- Shanna K. Kattari
- School of Social Work & Department of Women’s
and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Emma B. Gross
- School of Social Work, Department of Psychology,
University of Michigan, Ann Arbor, MI, USA
| | - Vern Harner
- School of Social Work, University of Washington, Seattle,
WA, USA
| | - Emily Andrus
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
| | - Daphna Stroumsa
- Medical School, Department of Obstetrics and Gynecology
& Institute for Healthcare Policy and Innovation, University of Michigan, Ann
Arbor, MI, USA
| | - Molly B. Moravek
- Medical School, Department of Obstetrics and Gynecology,
University of Michigan, Ann Arbor, MI, USA
| | - Andrew Brouwer
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
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Pearson WS, Chan PA, Cramer R, Gift TL. Characterizing Financial Sustainability of Sexually Transmitted Disease Clinics Through Insurance Billing Practices. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:358-365. [PMID: 34939604 PMCID: PMC9982656 DOI: 10.1097/phh.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Sexually transmitted infections (STIs) continue to increase in the United States. Publicly funded sexually transmitted disease (STD) clinics provide important safety net services for communities at greater risk for STIs. However, creating financially sustainable models of STI care remains a challenge. OBJECTIVE Characterization of clinic insurance billing practices and patient willingness to use insurance. DESIGN Cross-sectional survey assessment of clinic administrators and patients. SETTING Twenty-six STD clinics and 4138 patients attending these clinics in high STD morbidity metropolitan statistical areas in the United States. PARTICIPANTS Clinic administrators and patients of these clinics. INTERVENTION Survey assessment. MAIN OUTCOME MEASURE Insurance billing practices of STD clinics and patient insurance status and willingness to use their insurance. RESULTS Fifteen percent of clinics (4/26) indicated that they billed only Medicaid, 58% (15/26) billed both Medicaid and private insurance, 27% (7/26) did not bill for any health insurance, and none (0%) billed only private health insurance companies. Of 4138 patients surveyed, just more than one-half of patients (52.6%) were covered by some form of health insurance. More than one-half (57.2%) of all patients covered by health insurance indicated that they would be willing to use their health insurance for that visit. After adjusting for patient demographics and clinic characteristics, the patients covered by government insurance were 3 times as likely (odds ratio: 3.16; 95% confidence interval, 2.44-4.10) than patients covered by private insurance to be willing to use their insurance for their visit. CONCLUSION Opportunities exist for sustainable STI services through the enhancement of billing practices in STD clinics. The STD clinics provide care to large numbers of individuals who are both insured and who are willing to use their insurance for their care. As Medicaid expansion continues across the country, efforts focused on improving reimbursement rates for Medicaid may improve financial sustainability of STD clinics.
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Affiliation(s)
- William S Pearson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Pearson, and Gift and Mr Cramer); and Department of Medicine, Brown University, Providence, Rhode Island (Dr Chan)
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40
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Lim S, Pintye J, Seong H, Bekemeier B. Estimating the Association Between Public Health Spending and Sexually Transmitted Disease Rates in the United States: A Systematic Review. Sex Transm Dis 2022; 49:462-468. [PMID: 35312659 DOI: 10.1097/olq.0000000000001627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Public health spending is important for managing increases in sexually transmitted diseases (STDs) in the United States. Although previous studies suggest that a beneficial link exists between public health spending and changes in STD rates, there have been no systematic reviews synthesizing existing evidence regarding the association for STDs at the population level. The objective of this study was to synthesize evidence from studies that assessed the associations between general and STD-specific public health spending and STD rates. We conducted a systematic review using Ovid-Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and EconLit for relevant studies that examined the association between public health spending and gonorrhea, syphilis, chlamydia, and chancroid rates following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 5 articles (2 regarding general public health spending and 3 regarding STD-specific public health spending) met our inclusion criteria. There was a significant decrease in gonorrhea, syphilis, chlamydia, and chancroid rates associated with increased public health spending. We also found that STD-specific public health spending has a greater effect on STD rates compared with general public health spending. Our review provides evidence that increases in general and STD-specific public health spending are associated with a reduction of STD rates. Such research regarding estimates of the impact of STD prevention spending can help policy makers identify priority funding areas and inform health resource allocation decisions.
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Affiliation(s)
- Sungwon Lim
- From the Departments of Child, Family, and Population Health
| | - Jillian Pintye
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA
| | - Hohyun Seong
- School of Nursing, University of Maryland, Baltimore, MD
| | - Betty Bekemeier
- From the Departments of Child, Family, and Population Health
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Rusley JC, Tao J, Koinis-Mitchell D, Rosenthal AE, Montgomery MC, Nunez H, Chan PA. Trends in risk behaviors and sexually transmitted infections among youth presenting to a sexually transmitted infection clinic in the United States, 2013-2017. Int J STD AIDS 2022; 33:634-640. [PMID: 35387518 DOI: 10.1177/09564624221077785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sexually transmitted infections (STIs) are increasing among adolescents and young adults (AYA) across the United States. However, data are scarce on trends in condom use, number of partners, and other STI risk factors among AYA. The present study evaluated associations between sexual behaviors and STI diagnoses over time among AYA. Methods: We evaluated linked encounters of AYA aged 13-26 attending an urban Northeast public STI clinic from 2013-2017. Demographics, risk behaviors, self-reported past year and lifetime STI, and STI diagnosis during clinic encounter (positive test for urine, oral, or anal chlamydia; urine, oral, or anal gonorrhea; urine trichomonas; HIV; and syphilis) were extracted from electronic health records. We estimated prevalence and performed trend analyses of the repeated cross-sectional data. Cochran-Armitage and Kruskal-Wallis trend test were conducted for categorical and continuous variables, respectively. Results: Among 3822 encounters, clinical STIs demonstrated statistically significant increases including chlamydia (+9%, p = 0.001), gonorrhea (+5%, p = 0.008), and syphilis (+3%, p = 0.006) all of which significantly increased over time, as did any STI (+10%, p < 0.001). HIV and trichomonas rates remained low and unchanged. Self-reported STI increased as well, both past year (+9%) and lifetime (+14%). Greater proportions of AYA reported multiple partners (+9%, p < 0.001), and condomless oral (+12%, p = 0.001) and vaginal/anal (+7%, p = 0.001) sex. Conclusion: Among AYA presenting to a STI clinic, the proportion who engaged in condomless sex and had multiple partners increased over a 5 year period, which corresponded to increased STI prevalence during this period. Preventions efforts for AYA should continue to emphasize the importance of condoms and partner selection.
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Affiliation(s)
- Jack C Rusley
- Department of Pediatrics, Division of Adolescent Medicine, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA.,Department of Health Services, Policy, and Practice, RinggoldID:12321Brown University School of Public Health, Providence RI
| | - Jun Tao
- Department of Pediatrics, Division of Adolescent Medicine, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Department of Psychiatry and Human Behavior, 174610Alpert Medical School of Brown University, Providence, RI, USA
| | - Alex E Rosenthal
- Department of Pediatrics, Division of Adolescent Medicine, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Madeline C Montgomery
- Department of Medicine, Division of Infectious Diseases, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, 12321Brown University School of Public Health, Providence RI
| | - Hector Nunez
- Department of Medicine, Division of Infectious Diseases, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Division of Infectious Diseases, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
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Williams AM, Eppink ST, Guy JN, Seña AC, Berruti AA. Costs Associated With Incorporation of Network Approaches Into Sexually Transmitted Disease Program Activities. Sex Transm Dis 2022; 49:325-329. [PMID: 35001018 PMCID: PMC9018482 DOI: 10.1097/olq.0000000000001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Network approaches can be used to study sociosexual partnerships and identify individuals at high risk of infection. Little is known about the cost structure of these services and their association with STD diagnoses. METHOD We collected costs associated with using a peer network strategy to recruit men who have sex with men and transwomen of color in 4 counties in North Carolina: Guilford, Forsyth, Durham, and Wake from February through October 2019. We used a comprehensive costing approach to gather detailed retrospective information on the intervention cost, broken down by category and programmatic activity. RESULTS The sociosexual networks collected consisted of 31 initial seeds (index cases) and 49 peers of those seeds. In peers, 5 cases of human immunodeficiency virus (HIV) and 10 cases of syphilis were identified. The cost per case (HIV or syphilis) identified was $7325. Personnel costs accounted for 80% of total expenditures, followed by laboratory expenses (12%). Personnel cost was distributed between disease intervention specialist patient navigators (51%), nonclinical (37%), and management (12%) staff. General administration was the costliest programmatic activity (37%), followed by case management and field services (37%), and study activities (11%). The estimated average cost per patient tested was $2242. CONCLUSIONS Finding positive peer cases in nonclinical settings is costly but may be crucial for limiting the spread of sexually transmitted diseases. The cost of staff was the major driver. This study demonstrates that using a network strategy can be a cost-effective way to identify, test, and refer patients at high risk of syphilis and HIV infections to care.
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Affiliation(s)
- Austin M. Williams
- Division of Sexually Transmitted Disease Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Samuel T. Eppink
- Division of Sexually Transmitted Disease Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jalila N. Guy
- Institute for Global Health and Infectious Diseases, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Arlene C. Seña
- Institute for Global Health and Infectious Diseases, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Andrés A. Berruti
- Division of Sexually Transmitted Disease Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Workowski KA, Bachmann LH. Centers for Disease Control and Prevention's Sexually Transmitted Diseases Infection Guidelines. Clin Infect Dis 2022; 74:S89-S94. [PMID: 35416966 DOI: 10.1093/cid/ciab1055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kimberly A Workowski
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Laura H Bachmann
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lujan AL, Croci DO, Rabinovich GA, Damiani MT. Galectins as potential therapeutic targets in STIs in the female genital tract. Nat Rev Urol 2022; 19:240-252. [PMID: 35105978 DOI: 10.1038/s41585-021-00562-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 12/12/2022]
Abstract
Every day, more than one million people worldwide acquire a sexually transmitted infection (STI). This public health problem has a direct effect on women's reproductive and sexual health as STIs can cause irreversible damage to fertility and can have negative consequences associated with discrimination and social exclusion. Infection with one sexually transmitted pathogen predisposes to co-infection with others, suggesting the existence of shared pathways that serve as molecular links between these diseases. Galectins, a family of β-galactoside-binding proteins, have emerged as endogenous mediators that facilitate cell-surface binding, internalization and cell invasion of many sexually transmitted pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans, HIV and herpes simplex virus. The ability of certain galectins to dimerize or form multimeric complexes confers the capacity to interact simultaneously with glycosylated ligands on both the pathogen and the cervico-vaginal tissue on these proteins. Galectins can act as a bridge by engaging glycans from the pathogen surface and glycosylated receptors from host cells, which is a mechanism that has been shown to be shared by several sexually transmitted pathogens. In the case of viruses and obligate intracellular bacteria, binding to the cell surface promotes pathogen internalization and cell invasion. Inflammatory responses that occur in cervico-vaginal tissue might trigger secretion of galectins, which in turn control the establishment, evolution and severity of STIs. Thus, galectin-targeted therapies could potentially prevent or decrease STIs caused by a diverse array of pathogenic microorganisms; furthermore, anti-galectin agents might reduce treatment costs of STIs and reach the most vulnerable populations.
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Affiliation(s)
- Agustin L Lujan
- Laboratorio de Bioquímica e Inmunidad, Instituto de Bioquímica y Biotecnología, Facultad de Ciencias Médicas, Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Universidad Nacional de Cuyo (UNCUYO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina.,Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Diego O Croci
- Laboratorio de Inmunopatología, Facultad de Ciencias Exactas y Naturales, Instituto de Histología y Embriología de Mendoza (IHEM), Universidad Nacional de Cuyo (UNCUYO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina
| | - Gabriel A Rabinovich
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina. .,Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires (UBA), C1428AGE, Buenos Aires, Argentina.
| | - Maria T Damiani
- Laboratorio de Bioquímica e Inmunidad, Instituto de Bioquímica y Biotecnología, Facultad de Ciencias Médicas, Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Universidad Nacional de Cuyo (UNCUYO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina.
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Abstract
IMPORTANCE Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. OBSERVATIONS From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception. CONCLUSIONS AND RELEVANCE Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew M Hamill
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wood S, Min J, Tam V, Pickel J, Petsis D, Campbell K. Inequities in Chlamydia trachomatis Screening Between Black and White Adolescents in a Large Pediatric Primary Care Network, 2015-2019. Am J Public Health 2022; 112:135-143. [PMID: 34936422 PMCID: PMC8713640 DOI: 10.2105/ajph.2021.306498] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician's implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician's practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135-143. https://doi.org/10.2105/AJPH.2021.306498).
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Affiliation(s)
- Sarah Wood
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Jungwon Min
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Vicky Tam
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Julia Pickel
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Danielle Petsis
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Kenisha Campbell
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
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47
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Nsuami MJ. Chlamydia and Gonorrhea Control Programs in the United States: Time to Use the Knowledge Accumulated to Advance Practice. Sex Transm Dis 2022; 49:90-91. [PMID: 34407016 DOI: 10.1097/olq.0000000000001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Jacques Nsuami
- From the School of Medicine, Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA
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Karlow SL, McCool-Myers M, Henn MC, Sheth AN, Owens S, Kottke MJ. Trends in Chlamydia and Gonorrhea Testing and Positivity Rates in a Safety Net Hospital in Georgia: 2014 to 2017. Sex Transm Dis 2022; 49:29-37. [PMID: 34310527 DOI: 10.1097/olq.0000000000001522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) in the United States continue to increase at an alarming rate. Since 2015, reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), the 2 most prevalent reportable STIs, have increased by 19% and 56%, respectively. Characterizing testing patterns could elucidate how CT/GC care and positivity have evolved over time in a high-risk urban setting and illustrate how patients use the health care system for their STI needs. METHODS Using electronic medical record data from a large safety net hospital in Georgia, patient demographics and clinical characteristics were extracted for all nucleic acid amplification tests ordered from 2014 to 2017 (n = 124,793). Descriptive statistics were performed to understand testing patterns and assess positivity rates. RESULTS Annual nucleic acid amplification test volume grew by 12.0% from 2014 to 2017. Obstetrics/gynecology consistently accounted for half of all tests ordered; volume in emergency medicine grew by 45.2% (n = 4108 in 2014 to n = 5963 in 2017), whereas primary care volume fell by -4.3% (n = 4186 in 2014 to n = 4005 in 2017). The largest number of positive results was detected among 15- to 24-year-olds. The positivity of CT was higher among females, and GC among males. The percent positivity of CT remained stable (range, 6.4%-7.0%). The percent positivity of GC increased from 2.7% to 4.3% over time. CONCLUSIONS Testing volume in emergency medicine has increased at a faster rate than other specialties; point-of-care testing could ensure more accurate treatment and improve antibiotic stewardship. The rates of CT/GC were high among adolescents and young adults. Tailored approaches are needed to lower barriers to care for this vulnerable population.
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Affiliation(s)
| | | | | | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
| | - Sallie Owens
- Emory University Office of Information Technology, Atlanta, GA
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49
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Schlanger K, Kirkcaldy RD. Rising to Meet the Programmatic Public Health Challenges of Emerging Neisseria gonorrhoeae Antimicrobial Resistance: Strengthening the United States Response to Resistant Gonorrhea. Sex Transm Dis 2021; 48:S91-S92. [PMID: 34310529 PMCID: PMC10258813 DOI: 10.1097/olq.0000000000001521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Karen Schlanger
- From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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50
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Llata E, Cuffe KM, Picchetti V, Braxton JR, Torrone EA. Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2021; 70:1-20. [PMID: 34735419 PMCID: PMC8575410 DOI: 10.15585/mmwr.ss7007a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM Sexually transmitted diseases (STDs) are a major cause of morbidity in the United States, with an estimated $15.9 billion in lifetime direct medical costs. Although the majority of STDs are diagnosed in the private sector, publicly funded STD clinics have an important role in providing comprehensive sexual health care services, including STD and HIV screening, for a broad range of patients. In certain cases, STD clinics often are the only source of sexual health care for patients, particularly among gay, bisexual, and other men who have sex with men (MSM). PERIOD COVERED 2010-2018. DESCRIPTION OF THE SYSTEM The STD Surveillance Network (SSuN) is an ongoing sentinel surveillance system for monitoring clinical information among patients attending STD clinics. SSuN is a collaboration of competitively selected state and city health departments that conduct facility-based sentinel surveillance in STD clinics. Information routinely collected through the course of patient encounters is obtained for all patients seeking care in the participating STD clinics. This information includes demographic, behavioral, and clinical characteristics (e.g., STD and HIV tests performed and STD and HIV diagnoses). This report presents 2010-2018 SSuN data from 14 STD clinics in five cities (Baltimore, Maryland; New York City, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) to describe the patient populations seeking care in these STD clinics. Estimated numbers and percentages of patients receiving selected STD-related health services were calculated for each year by using an inverse variance weighted random-effects model, adjusting for heterogeneity among SSuN jurisdictions. Trends in receipt of selected STD-related health services were examined and included HIV screening after an acute STD diagnosis among persons not previously known to have HIV infection, annual chlamydia screening among adolescent and young females, and extragenital chlamydia and gonorrhea screening among MSM. RESULTS During 2010-2018, the total number of annual visits made in the 14 participating STD clinics decreased 29.8% (from 145,728 to 102,275 visits), and the total number of unique patients examined in the clinics decreased 35.1% (from 94,281 to 61,172 patients). Decreases in the number of unique patients occurred both among men who have sex with women only (42.4%; from 37,842 in 2010 to 21,781 in 2018) and among females (51.4%; from 36,485 in 2010 to 17,721 in 2018). The decreases in the number of female patients were observed across all age groups, although they were more pronounced among females aged ≤24 years (66.4%; from 17,721 in 2010 to 5,962 in 2018). In contrast, the number of patients identified as MSM increased 44.0% (from 12,859 in 2010 to 18,512 in 2018), with the greatest increase among MSM aged ≥25 years (58.6%; from 9,918 in 2010 to 15,733 in 2018). Among visits during which an acute STD (defined as chlamydia, gonorrhea, or primary or secondary syphilis) was diagnosed, the percentage of visits during which an HIV test was performed within approximately 14 days of the STD diagnosis increased from 58.2% in 2010 to 70.2% in 2018. Among those patients tested, 1,672 HIV infections were identified, of which 84.0% were among MSM. Among females aged 15-24 years, the percentage screened for chlamydia in any calendar year increased from 88.6% in 2010 to 90.6% in 2018. However, because fewer females aged 15-24 years attended these clinics during the study period, the crude number of adolescent and young females tested for chlamydia decreased from 14,249 in 2010 to 4,507 in 2018. During 2010-2018, the percentage of females retested after their first positive chlamydia diagnosis during the same year ranged from 11.4% to 13.3%. During 2010-2018, the percentage of MSM tested for rectal chlamydia and rectal gonorrhea increased (from 54.7% to 57.8% and from 55.0% to 58.4%, respectively). During the same period, increases were noted in the percentage of MSM with diagnosed rectal chlamydia (from 15.5% in 2010 to 17.7% in 2018) and rectal gonorrhea (from 13.3% in 2010 to 17.1% in 2018). In contrast with pharyngeal chlamydia, pharyngeal gonorrhea screening was more common (from 69.5% in 2010 to 74.6% in 2018), and the percentage positive doubled during the study period (from 7.3% in 2010 to 14.8% in 2018). Pharyngeal chlamydia testing also increased (from 50.3% in 2010 to 72.9% in 2018), with concurrent decreases in positivity (from 4.2% in 2010 to 2.6% in 2018). INTERPRETATION During 2010-2018, changes occurred in the demographic composition of patients attending STD clinics participating in SSuN. Understanding trends in the demographic profile of STD patients and services provided can help identify addressable gaps in STD control efforts and direct public health action. Overall, fewer females, especially those aged 15-24 years, accessed care in these STD clinics during the study period. Untreated STDs among adolescent and young females can have serious consequences, including pelvic inflammatory disease and infertility. Additional efforts to monitor where adolescent and young females seek care and to ensure they are receiving quality STD-related health services are needed, especially considering increases in reported cases of STDs among females. Increases in the number of MSM attending STD clinics present a unique opportunity to reach this population with STD and HIV prevention services. Although a large percentage of STD cases are diagnosed outside of STD clinics, publicly funded STD clinics are an important safety-net provider of STD-related health services and provide vital STD-related health services for patient populations at risk for the consequences of STDs and HIV infection. PUBLIC HEALTH ACTIONS STD-related health services represent effective strategies for preventing STD and HIV transmission and acquisition or STD-related sequelae. Ensuring that all persons receive quality HIV and STD prevention and treatment services is vital for an effective public health approach to reducing STDs. STD clinics provide crucial safety-net services for preventing STD-related morbidity, including timely identification and treatment of curable STDs such as chlamydia, gonorrhea, and syphilis. Increases in the numbers of MSM attending STD clinics participating in SSuN provide additional opportunities for linking patients to high-impact HIV preventive services (e.g., pre-exposure prophylaxis), and the clinics are positioned to facilitate initiation or resumption of treatment among persons living with HIV.
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Affiliation(s)
- Eloisa Llata
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Kendra M Cuffe
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Viani Picchetti
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Jimmy R Braxton
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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