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Kretz AM, Schumacher CM, Thornton N, Powell AM, Tilchin C, Muvva R, Jennings JM. Syphilis Diagnosis After a Chlamydia, Gonorrhea, or HIV Diagnosis Among Reproductive-Aged Women in Baltimore, MD. Sex Transm Dis 2024; 51:239-244. [PMID: 38301629 PMCID: PMC10978230 DOI: 10.1097/olq.0000000000001929] [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: 02/03/2024]
Abstract
BACKGROUND Syphilis incidence is increasing among reproductive-aged women, and previous sexually transmitted infections (STIs) are a risk factor for subsequent STIs. This study aimed to determine syphilis incidence after a chlamydia, gonorrhea, or HIV diagnosis, and identify characteristics associated with higher syphilis incidence rates among reproductive-aged women in 1 mid-Atlantic city. METHODS A retrospective cohort of 85,113 chlamydia, gonorrhea, and HIV diagnoses occurring between 2009 and 2021 and among women aged 13 to 50 years was constructed using public health surveillance data. Cumulative incidence curves were estimated to examine time to early syphilis (i.e., primary, secondary, or early latent) diagnosis, and multivariable analyses determined incidence rate ratios by age (<25 vs. ≥25 years) and number of prior STI diagnoses (0 vs. ≥1) during the study period, stratified by STI. RESULTS There were 85,113 reportable STI diagnoses and 646 syphilis diagnoses in the cohort. Approximately 1 of 150 chlamydia, 1 of 100 gonorrhea, and 1 of 50 HIV diagnoses were followed by a syphilis diagnosis within 5 years. Cumulative incidence of syphilis differed significantly by STI diagnosis ( P < 0.001). In multivariable analysis, syphilis incidence rates were higher among women diagnosed with ≥1 (vs. 0) prior STI regardless of STI type ( P < 0.05) and among women ≥25 (vs. <25) years old diagnosed with gonorrhea ( P < 0.05). CONCLUSIONS There were significant differences in syphilis incidence by prior STI type, number of STIs, and age. Our data support targeted screening for syphilis among women with a history of STIs, parwomen with ≥1 prior STI diagnosis, and older women diagnosed with gonorrhea.
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Affiliation(s)
- Alyssa M Kretz
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - Carla Tilchin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Jacky M Jennings
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Dionne-Odom J, Workowski K, Perlowski C, Taylor SN, Mayer KH, McNeil CJ, Hamill MM, Dombrowski JC, Batteiger TA, Sena AC, Wiesenfeld HC, Newman L, Hook EW. Coinfection With Chlamydial and Gonorrheal Infection Among US Adults With Early Syphilis. Sex Transm Dis 2022; 49:e87-e89. [PMID: 35067599 PMCID: PMC9283199 DOI: 10.1097/olq.0000000000001605] [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: 10/19/2022]
Abstract
ABSTRACT Among 865 adults with early syphilis considered for a multicenter treatment trial, 234 (27%) were excluded before enrollment because of bacterial sexually transmitted infection coinfection. Coinfection with Neisseria gonorrhoeae (29%), Chlamydia trachomatis (22%), or both (23%) was common. Study findings highlight the need for comprehensive bacterial sexually transmitted infection screening in patients with syphilis.
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Affiliation(s)
- Jodie Dionne-Odom
- From the Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Stephanie N Taylor
- Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, and Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Candice J McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Julia C Dombrowski
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Teresa A Batteiger
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Arlene C Sena
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Harold C Wiesenfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, and Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Lori Newman
- Enteric and Sexually Transmitted Infections Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Edward W Hook
- From the Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
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Byrne M, Akselrod H, Monroe AK, Horberg M, Lucar J, Castel AD, Denyer R, Doshi R, Secco A, Squires L, Schroeter S, Benator D. Identifying geographic areas of Washington DC with increased potential for sexual HIV transmission among People with HIV with STIs and concurrent elevated HIV RNA: Data from the DC Cohort. Open Forum Infect Dis 2022; 9:ofac139. [PMID: 35450084 PMCID: PMC9017371 DOI: 10.1093/ofid/ofac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/17/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The U=U (Undetectable=Untransmittable) campaign advances the goal of ending the HIV epidemic by promoting durable viral suppression and therefore reducing sexual transmission. We used geospatial analysis to assess the potential for sexual HIV transmission by ZIP code of residence in the District of Columbia (DC) using data from DC Cohort Longitudinal HIV Study (DC Cohort), a city-wide cohort of persons with HIV (PWH).
Methods
DC Cohort participants ages ≥13 were included in the study period between April 1, 2016 and March 31, 2018. Potential for sexual HIV transmission was defined as the proportion of participants with incident sexually transmitted infection (STI - gonorrhea, chlamydia, syphilis) and with HIV RNA ≥200 copies/mL from 9 months prior to 3 months after STI diagnosis. We performed geographic information system (GIS) analysis to determine the ZIP codes with the highest potential for sexual HIV transmission.
Results
Of 3,467 participants, 367 (10.6%) had at least one incident STI, with 89.4% residing in 11 of the 20 residential ZIP codes in DC. Of the 367 participants with an incident STI, at least one HIV RNA was available for 348 (94.8%). 97 (27.9%) of individuals with an incident STI had HIV RNA ≥200 copies/ml in the defined time window. Of these 97, 66 (68.0%) resided in 5 of the 20 DC ZIP codes.
Conclusions
In DC, 5 ZIP codes of residence accounted for the majority of the estimated potential for HIV transmission among participants in the DC Cohort. These results support focused neighborhood-level interventions to help end the HIV epidemic.
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Affiliation(s)
- Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Jose Lucar
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amanda D Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rachel Denyer
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Rupali Doshi
- DC Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC ,USA
| | | | - Leah Squires
- Department of Psychology, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Stefanie Schroeter
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Debra Benator
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
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