1
|
Zinsli K, Means AR, Barbee LA, Rodriguez EM, Kerani RP. A Participatory Approach to Identifying Gaps in and Recommendations for Sexually Transmitted Infection and Preexposure Prophylaxis Clinical Services in Pierce County, Washington. Sex Transm Dis 2024; 51:425-430. [PMID: 38403301 DOI: 10.1097/olq.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Pierce County, Washington, has a high burden of sexually transmitted infections (STIs) relative to Washington State and the United States. We used a participatory approach to identify gaps in STI and preexposure prophylaxis (PrEP) service provision in Pierce County and generate recommendations to address these gaps. METHODS In collaboration with the Tacoma-Pierce County Health Department (TPCHD), we conducted 14 key informant interviews with local STI/PrEP providers from varied clinical settings. Using rapid qualitative analysis, we identified key gaps and strengths in service provision. Local, state, and national HIV/STI subject matter experts (SMEs) prioritized the gaps and recommendations to address them via an online survey. RESULTS The primary 6 gaps ranked by SMEs (N = 32) in order of importance included the following: (1) inadequate availability of STI and PrEP services, (2) lack of awareness of STI and PrEP services, (3) need for free/low cost STI and PrEP care, (4) need for stronger relationships among providers and TPCHD, (5) reduced accessibility related to geographically distributed population and centralized services, and (6) frequent referrals pose a service barrier. Subject matter experts prioritized recommendations for each gap as follows: (1) create an STI specialty clinic, (2) implement an STI/PrEP service availability outreach campaign, (3) strengthen referral relationships between TPCHD and free/low-cost providers, (4) develop a provider support network, (5) create a mobile STI clinic, and (6) develop an STI specialty clinic. CONCLUSIONS Sexually transmitted infection specialty clinics were prioritized by SMEs to improve access to STI and PrEP care in Pierce County, and to serve as a resource for local providers.
Collapse
|
2
|
Lillis RA, Barbee LA, McNeil CJ, Newman L, Fortenberry JD, Alvarez-Arango S, Zenilman JM. Randomized Multicenter Trial for the Validation of an Easy-to-Administer Algorithm to Define Penicillin Allergy Status in Sexually Transmitted Infection Clinic Outpatients. Clin Infect Dis 2024; 78:1131-1139. [PMID: 38325290 DOI: 10.1093/cid/ciae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Approximately 15% of patients in sexually transmitted infection (STI) clinics report penicillin allergies, complicating treatment for syphilis and gonorrhea. Nonetheless, >90% do not have a penicillin allergy when evaluated. We developed and validated an algorithm to define which patients reporting penicillin allergy can be safely treated at STI clinics with these drugs. METHODS Randomized controlled trial to assess feasibility and safety of penicillin allergy evaluations in STI clinics. Participants with reported penicillin allergy answered an expert-developed questionnaire to stratify risk. Low-risk participants underwent penicillin skin testing (PST) followed by amoxicillin 250 mg challenge or a graded oral challenge (GOC)-amoxicillin 25 mg followed by 250 mg. Reactions were recorded, and participant/provider surveys were conducted. RESULTS Of 284 participants, 72 (25.3%) were deemed high risk and were excluded. Of 206 low-risk participants, 102 (49.5%) underwent PST without reactions and 3 (3%) had mild reactions during the oral challenge. Of 104 (50.5%) participants in the GOC, 95 (91.3%) completed challenges without reaction, 4 (4.2%) had mild symptoms after 25 mg, and 4 (4.2%) after 250-mg doses. Overall, 195 participants (94.7%) successfully completed the study and 11 (5.3%) experienced mild symptoms. Of 14 providers, 12 (85.7%) completed surveys and 11 (93%) agreed on the safety/effectiveness of penicillin allergy assessment in STI clinics. CONCLUSIONS An easy-to-administer risk-assessment questionnaire can safely identify patients for penicillin allergy evaluation in STI clinics by PST or GOC, with GOC showing operational feasibility. Using this approach, 67% of participants with reported penicillin allergy could safely receive first-line treatments for gonorrhea or syphilis. Clinical Trials Registration. Clinicaltrials.gov (NCT04620746).
Collapse
Affiliation(s)
- Rebecca A Lillis
- Section of Infectious Diseases, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Lindley A Barbee
- Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Candice J McNeil
- Section of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lori Newman
- National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Santiago Alvarez-Arango
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathan M Zenilman
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Quilter LAS, St Cyr SB, Barbee LA. The Management of Gonorrhea in the Era of Emerging Antimicrobial Resistance: What Primary Care Clinicians Should Know. Med Clin North Am 2024; 108:279-296. [PMID: 38331480 DOI: 10.1016/j.mcna.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Gonorrhea rates continue to rise in the United States and Neisseria gonorrhoeae's propensity to develop resistance to all therapies used for treatment has complicated the management of gonorrhea. Ceftriaxone is the only remaining highly effective recommended regimen for gonococcal treatment and few new anti-gonococcal antimicrobials are being developed. The 2021 CDC STI Treatment Guidelines increased the dose of ceftriaxone to 500 mg (1 g if ≥ 150 kg) for uncomplicated infections. It is recommended that all clinicians should be aware of antimicrobial resistant gonorrhea and be able to appropriately manage any suspected gonorrhea treatment failure case.
Collapse
Affiliation(s)
- Laura A S Quilter
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA.
| | - Sancta B St Cyr
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA
| | - Lindley A Barbee
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA
| |
Collapse
|
4
|
Reimche JL, Pham CD, Joseph SJ, Hutton S, Cartee JC, Ruan Y, Breaux M, Ivanof C, Joshi A, DeMartino M, Kirby JE, Barbee LA, Kersh EN, Roosevelt KA, Hsu KK. Novel strain of multidrug non-susceptible Neisseria gonorrhoeae in the USA. Lancet Infect Dis 2024; 24:e149-e151. [PMID: 38215769 DOI: 10.1016/s1473-3099(23)00785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Jennifer L Reimche
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Cau D Pham
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Sandeep J Joseph
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Shelby Hutton
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - John C Cartee
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Yuheng Ruan
- South Cove Community Health Center, Boston, MA, USA
| | - Mandy Breaux
- South Cove Community Health Center, Boston, MA, USA
| | - Caryn Ivanof
- Massachusetts Department of Public Health, Bureau of Infectious Diseases and Laboratory Sciences, Boston, MA, USA
| | - Akita Joshi
- Massachusetts Department of Public Health, Bureau of Infectious Diseases and Laboratory Sciences, Boston, MA, USA
| | - Mary DeMartino
- Massachusetts Department of Public Health, Bureau of Infectious Diseases and Laboratory Sciences, Boston, MA, USA
| | - James E Kirby
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lindley A Barbee
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ellen N Kersh
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kathleen A Roosevelt
- Massachusetts Department of Public Health, Bureau of Infectious Diseases and Laboratory Sciences, Boston, MA, USA
| | - Katherine K Hsu
- Massachusetts Department of Public Health, Bureau of Infectious Diseases and Laboratory Sciences, Boston, MA, USA
| |
Collapse
|
5
|
Sugarman J, Taylor HA, Bachmann LH, Barbee LA, Cahill S, Celum C, Luetkemeyer AF, Mayer KH, Mena L, Mermin J, Upshur R, Aral S. Ethical Considerations in Implementing Doxycycline Postexposure Prophylaxis for the Prevention of Bacterial Sexually Transmitted Infections. Sex Transm Dis 2024; 51:135-138. [PMID: 38079243 PMCID: PMC10922428 DOI: 10.1097/olq.0000000000001907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Jeremy Sugarman
- Johns Hopkins University, Berman Institute of Bioethics, Baltimore, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute and Harvard Medical School, Boston, USA
| | - Connie Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, USA
| | | | | | - Leandro Mena
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Sevgi Aral
- Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
6
|
Fenelon HT, Berzkalns A, Amiya RM, Barbee LA, Dombrowski JC, Golden MR, Kerani RP. STI partner services outcomes before and during the SARS-CoV-2 pandemic in King County, WA. Sex Transm Dis 2024:00007435-990000000-00331. [PMID: 38403296 DOI: 10.1097/olq.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND SARS-CoV-2 pandemic mitigation efforts resulted in reallocation of public health personnel, likely impacting provision of timely sexually transmitted infection (STI) partner services (PS). We describe PS outcomes before and during the pandemic in King County, WA. METHODS We examined PS outcomes for syphilis and gonorrhea cases diagnosed in 2019 and three periods in 2020 (pre-lockdown:1/1/2020-3/23/2020; lockdown: 3/24/2020-6/5/2020, post-lockdown: 6/6/2020-12/31/20). We described changes over time in three PS outcomes: cases initiated, interviewed, and with named sex partners. We calculated adjusted prevalence ratios (aPRs) with Poisson regression comparing these outcomes in the 2020 periods to 2019. RESULTS Reported gonorrhea (4,611 vs. 4,179) and syphilis (665 vs. 586) cases declined from 2019 to 2020. In 2019, 60.7% of cases were initiated, compared with 42.1% before lockdown (aPR:0.74, 95% CI:0.70-0.78%), 41.7% during lockdown (aPR:0.79; 95% CI:0.73-0.85), and 41.7% after lockdown (aPR:0.81, 95% CI:0.77-0.85). Among initiated cases, the proportion interviewed also appeared to drop in the three lockdown periods (52.4%, 41.0%, 44.1%) compared to 2019 (55.7%). However, in adjusted analyses, the prevalence of interview among case patients was only lower pre-lockdown (aPR:0.91; 95% CI:0.85-0.99), and higher during (aPR:1.10; 95% CI:1.01-1.20) and after (aPR:1.12; 95% CI:1.06-1.19). Interviewed patients named partners more often during (21.4%, aPR:1.35; 95% CI:1.05-1.74) and less often after lockdown (16.0%, aPR:0.63; 95% CI:0.51-0.79), compared to 2019 (26.6%). CONCLUSIONS These results underscore the need for a trained public health worker reserve, and plans for deployment of existing workers and prioritization of cases to continue essential STI public health activities during public health crises.
Collapse
|
7
|
Tordoff DM, Fernandez A, Perry NL, Heberling WB, Minalga B, Khosropour CM, Glick SN, Barbee LA, Duerr A. A Quantitative Intersectionality Analysis of HIV/STI Prevention and Healthcare Access Among Transgender and Nonbinary People. Epidemiology 2023; 34:827-837. [PMID: 37756272 PMCID: PMC10539029 DOI: 10.1097/ede.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Transgender and nonbinary people experience substantial barriers to accessing healthcare, including prevention of HIV and other sexually transmitted infections (HIV/STI), due to structural inequities. We examined differences in insurance, HIV/STI prevalence, testing, and preexposure prophylaxis use among transgender and nonbinary people living in Washington State by race and ethnicity and gender. METHODS We pooled data from five 2019-2021 Washington State HIV/STI surveillance data sources to obtain a large and diverse sample of 1648 transgender and nonbinary participants. We calculated the risk difference (RD) for each outcome and used Poisson regression to estimate a surrogate measure of additive interaction-attributable proportion (AP)-that measures the proportion of the excess prevalence of the outcome observed at the intersection of gendered and racialized experience, beyond that expected from gender or race and ethnicity alone. RESULTS Participants reported overall high levels of poverty (29% incomes <$15,000 and 7% unstable housing). Certain groups, especially racial/ethnic minority transgender women, were disproportionately impacted by HIV/STIs (RDs from 20% to 43% and APs from 50% to 85%) and less likely to currently have insurance (RDs from 25% to 39% and APs from 74% to 93%) than that expected based on gendered or racialized experience alone. CONCLUSIONS Our findings highlight the heterogeneity in insurance access, HIV/STI positivity, and prevention utilization within transgender communities. We observed that a large proportion of increased HIV/STI prevalence among racial/ethnic minority transgender women was attributable to the intersection of gender and race and ethnicity. Our findings highlight the importance of trans-inclusive models of HIV/STI prevention that address multilevel barriers rooted in cissexism and structural racism.
Collapse
Affiliation(s)
- Diana M. Tordoff
- University of Washington, Department of Epidemiology, Seattle, WA
| | | | - Nicole Lynn Perry
- Lavender Rights Project, Washington Black Trans Task Force, Seattle, WA
| | | | | | | | - Sara N. Glick
- University of Washington, School of Medicine, Seattle, WA
- Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| | - Lindley A. Barbee
- University of Washington, School of Medicine, Seattle, WA
- Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| | - Ann Duerr
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | | |
Collapse
|
8
|
Chan PA, Le Brazidec DL, Becasen JS, Martin H, Kapadia J, Reno H, Bachmann L, Barbee LA. Safety of Longer-Term Doxycycline Use: A Systematic Review and Meta-Analysis With Implications for Bacterial Sexually Transmitted Infection Chemoprophylaxis. Sex Transm Dis 2023; 50:701-712. [PMID: 37732844 PMCID: PMC10592014 DOI: 10.1097/olq.0000000000001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have significantly increased over the past decade in the United States. Doxycycline as chemoprophylaxis (i.e., postexposure prophylaxis) offers promise for addressing bacterial STIs. The goal of the current study was to evaluate the safety of longer-term doxycycline use (defined as 8 or more weeks) in the context of potential use as STI chemoprophylaxis through a systematic literature review and meta-analysis. METHODS This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to search MEDLINE/PubMed for clinical studies published from August 2003 to January 2023 that reported on adverse events with doxycycline use with a focus on side effects and metabolic effects of long-term use. RESULTS A total of 67 studies were included in the systematic review. Overall, studies on longer-term doxycycline use reported 0% to greater than 50% adverse events ranging from mild to severe. Most common adverse events included gastrointestinal symptoms (i.e., nausea, vomiting, and abdominal pain), dermatologic (i.e., rash), and neurological (i.e., headache and dizziness) symptoms. Discontinuation of doxycycline due to adverse events was relatively uncommon in most studies. A meta-analysis of placebo controlled clinical trials (N = 18) revealed that gastrointestinal and dermatological adverse events were more likely to occur in the doxycycline group. CONCLUSIONS Longer-term (8+ weeks) doxycycline use is generally safe and may be associated with minor side effects. Further research is needed on the potential metabolic impact of longer-term doxycycline use.
Collapse
Affiliation(s)
- Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jeffrey S. Becasen
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Harrison Martin
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jhanavi Kapadia
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Hilary Reno
- 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, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura Bachmann
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lindley A. Barbee
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
9
|
Rowlinson E, Hughes JP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Inadequate performance of a risk score to predict asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infection among cisgender men who have sex with men. Sex Transm Infect 2023; 99:380-385. [PMID: 36609346 PMCID: PMC10323043 DOI: 10.1136/sextrans-2022-055608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Epidemiological treatment of persons who are sexual contacts to partners with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) often results in treatment of uninfected persons, which may increase the risk of antibiotic-resistant infections. We sought to identify the predictors of NG and/or CT infections to develop a risk score that could be used to limit epidemiological treatment to persons most likely to have these infections. METHODS We included visits to the Public Health - Seattle & King County Sexual Health Clinic by asymptomatic cisgender men who have sex with men (MSM) aged ≥18 who presented as a sexual contact to partner(s) with CT or NG infection between 2011 and 2019. We used logistic regression to estimate the odds of CT and/or NG infections associated with demographic and clinical predictors, selecting the final set of predictors using the Akaike information criteria and obtaining score weights from model coefficients. We used a cross-validation approach to obtain average model discrimination from each of 10 models, leaving out 10% of the data, and evaluated sensitivity and specificity at various score cut-offs. RESULTS The final model for predicting NG or CT infection included seven predictors (age <35 years, HIV status, receptive oral sex in the prior 2 months, CT diagnosis, condomless receptive anal intercourse, condomless insertive anal intercourse and methamphetamine use in the prior 12 months). Model discrimination, as measured by the receiver operating curve, was 0.60 (95% CI 0.54 to 0.66). Sensitivity for detection of infection was ≥90% for scores ≥3, ≥5 and ≥7; specificity for these cut-offs was <16%. At scores ≥9, ≥12 and ≥14, specificity increased but sensitivity decreased to ≤76%. CONCLUSIONS Our risk score did not sufficiently discriminate between asymptomatic MSM with and without NG/CT infection. Additional studies evaluating epidemiological treatment as a standard of care in diverse populations are needed to guide best practices in the management of contacts to NG/CT infection.
Collapse
Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Biostatistics, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Lindley A Barbee
- Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD, Public Health - Seattle & King County, Seattle, Washington, USA
| |
Collapse
|
10
|
Vojtech L, Paktinat S, Luu T, Teichmann S, Soge OO, Suchland R, Barbee LA, Khosropour CM. Use of viability PCR for detection of live Chlamydia trachomatis in clinical specimens. Front Reprod Health 2023; 5:1199740. [PMID: 37601895 PMCID: PMC10436598 DOI: 10.3389/frph.2023.1199740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background The current testing approach to diagnose Chlamydia trachomatis (CT) infection relies on nucleic acid amplification tests (NAATs). These tests are highly sensitive, but do not distinguish between active infection and residual bacterial nucleic acid which may remain after resolution of infection, or via cross-contamination. Better methods to assess the viability of CT detected in clinical samples would be useful in determining the relevance of CT detection in a variety of clinical settings. The goal of this study was to test viability PCR (vPCR) as a method to distinguish viable bacteria from non-viable CT. Methods The vPCR relies on a propidium monoazide dye (PMAxx), which intercalates into accessible DNA from dead organisms and prevents their detection in a PCR assay for the CT ompA gene. We used digital PCR to quantify absolute genome copy numbers from samples. We validated the vPCR approach using laboratory stocks of CT with known viability. Then, we tested total DNA, viable CT DNA, and culture results from 18 clinical vaginal specimens and 25 rectal clinical specimens, all of which had tested positive by NAAT. Results In laboratory stocks of CT, vPCR using defined ratios of heat-killed to live bacteria tracked closely with expected results. In vaginal clinical specimens, vPCR and total DNA results were correlated, though total DNA genomes outnumbered viable genomes by 2.2-52.6-fold more copies. As expected, vPCR detected more total genomes than culture results. Both vPCR and total DNA correlated with culture results (Spearman correlation R = 0.8425 for total DNA and 0.8056 for vPCR). Ten rectal NAAT positive specimens were negative by total DNA PCR, vPCR, and were negative or inconclusive by culture. Of the 6 rectal specimens that were culture positive, all were total DNA and vPCR positive. vPCR additionally detected viable bacterial DNA in 8 specimens which were NAAT + and culture negative, though levels were very low (mean 1,357 copies/ml). Conclusions vPCR is a fast and easy method to assess viability in clinical specimens and is more correlated with culture results than total DNA PCR. Inconsistent ratios between total DNA and vPCR results suggest that the amount of dead bacteria varies considerably in clinical specimens. Results from rectal specimens suggest that many NAAT positive specimens do not in fact represent live replicating bacteria, and likely result in significant overuse of unnecessary antibiotics.
Collapse
Affiliation(s)
- Lucia Vojtech
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Shahrokh Paktinat
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Tiffany Luu
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Stella Teichmann
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Olusegun O. Soge
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Robert Suchland
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, United States
- Public Health – Seattle and King County, HIV/STD Program, Seattle, WA, United States
| | | |
Collapse
|
11
|
Barry MP, Thibault CS, Berzkalns A, Spellman DR, Rowlinson E, Barbee LA, Golden MR, Kerani RP. Previous Sexually Transmitted Infections and Partner Services Interviews as Predictors of Subsequent Interview Completion Among Cisgender MSM: Partner Services Fatigue? Sex Transm Dis 2023; 50:506-511. [PMID: 37213183 PMCID: PMC10523844 DOI: 10.1097/olq.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Anecdotal reports suggest that partner services (PS) are less successful among people with repeat sexually transmitted infection (STI) diagnoses and/or previous PS interactions. We examine whether having repeated STI diagnoses and/or PS interactions is associated with PS outcomes among men who have sex with men (MSM). METHODS With STI surveillance and PS data for MSM diagnosed with gonorrhea, chlamydia, and/or syphilis from 2007 to 2018, in King County, WA, we used Poisson regression models to examine the relationships between PS outcomes (e.g., completing a PS interview and providing identifying information for a contact) with (1) number of previous STI case episodes and (2) number of previous PS interviews completed. RESULTS Of the 18,501 MSM STI case patients initiated for interview in the analytic period (2011-2018), 13,232 (72%) completed a PS interview, and 8,030 (43%) had at least 1 prior PS interview. The proportion of initiated cases successfully interviewed declined from 71% among those with no previous PS interview to 66% among those with ≥3 prior interviews. Similarly, the proportion of interviews with ≥1 partner identified declined with greater numbers of previous PS interviews (from 46% [0 interviews] to 35% [≥3 interviews]). In multivariate models, having ≥1 prior PS interview was negatively associated with completing a subsequent interview and providing partner locating information. CONCLUSIONS Having a history of STI PS interviews is associated with less PS engagement among MSM. New approaches to PS should be explored to address the growing epidemic of STIs among MSM.
Collapse
Affiliation(s)
- Michael P. Barry
- Department of Epidemiology, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
| | | | - Anna Berzkalns
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
| | - Dawn R. Spellman
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
| | - Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Lindley A. Barbee
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| |
Collapse
|
12
|
Khosropour CM, Coomes DM, LeClair A, Saechao F, Vorn S, Soge OO, Barbee LA. High Prevalence of Rectal Chlamydia and Gonorrhea Among Men Who Have Sex With Men Who Do Not Engage in Receptive Anal Sex. Sex Transm Dis 2023; 50:404-409. [PMID: 36943790 PMCID: PMC10272102 DOI: 10.1097/olq.0000000000001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND In the United States, annual screening for rectal gonorrhea and chlamydia is only recommended for men who report receptive anal sex (RAS), but other behaviors (e.g., rimming) may lead to rectal Chlamydia trachomatis and Neisseria gonorrhoeae acquisition. METHODS We enrolled individuals assigned male sex at birth who reported sex with men and denied RAS in the past 2 years or reported RAS 1 to 2 years ago but were tested and treated since last RAS. Participants enrolled in-person at the Sexual Health Clinic in Seattle, Washington (December 2019-July 2022), or online (July 2021-March 2022). Participants completed a survey that asked about 13 non-RAS behaviors and self-collected a rectal swab for gonorrhea/chlamydia nucleic acid amplification testing. We used log binomial regression to estimate the prevalence of rectal gonorrhea/chlamydia (adjusted prevalence ratio [aPR]) by behavior, adjusting for all other behaviors. RESULTS We enrolled 292 participants (247 in-person and 45 online); 277 (95%) had nucleic acid amplification testing results. Rectal gonorrhea/chlamydia test positivity was 14.1% overall: 10.5% for rectal chlamydia and 4.3% for rectal gonorrhea. Most participants (70%) reported ≥1 behavior that involved direct contact with their anus. We observed a higher risk of rectal chlamydia for those who did versus did not report perianal play at 12 months (aPR, 2.39; 95% confidence interval, 1.10-5.22) and 2 months (aPR, 2.21; 95% confidence interval, 1.02-4.79). This was the only behavior significantly associated with testing positive. CONCLUSIONS Rectal C. trachomatis and N. gonorrhoeae prevalence was high among men who deny RAS, suggesting other possible routes of acquisition. Rectal screening for those who deny RAS should be made with careful consideration of individual- and population-level effects.
Collapse
Affiliation(s)
| | - David M. Coomes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Angela LeClair
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Farchung Saechao
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Seila Vorn
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Olusegun O. Soge
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| |
Collapse
|
13
|
Chesson HW, Bernstein KT, Barbee LA. Kiss Around and Find Out: Kissing as a Risk Factor for Pharyngeal Gonorrhea. Sex Transm Dis 2023; 50:402-403. [PMID: 37074310 DOI: 10.1097/olq.0000000000001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Harrell W Chesson
- From the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
| | - Kyle T Bernstein
- Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lindley A Barbee
- From the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
| |
Collapse
|
14
|
Tordoff DM, Minalga B, Perry NL, Gross B, Khosropour CM, Glick SN, Barbee LA, Duerr A. Heterogeneity in HIV/Sexually Transmitted Infection Prevalence and Prevention Among the Partners of Transgender and Nonbinary People. Sex Transm Dis 2023; 50:280-287. [PMID: 36881439 DOI: 10.1097/olq.0000000000001796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Transgender and nonbinary (TNB) people are diverse in their sexual orientation and partnerships. We describe the epidemiology of HIV/sexually transmitted infection (STI) prevalence and prevention utilization among the partners of TNB people in Washington State. METHODS We pooled data from five 2017 to 2021 cross-sectional HIV surveillance data sources to generate a large sample of TNB people and cisgender people who had a TNB partner in the past year. We described characteristics of recent partners of trans women, trans men, and nonbinary people and used Poisson regression to assess if having a TNB partner was associated with self-reported HIV/STIs prevalence, testing, and preexposure prophylaxis (PrEP) use. RESULTS Our analysis included 360 trans women, 316 trans men, 963 nonbinary people, 2896 cis women, and 7540 cis men. Overall, 9% of sexual minority cis men, 13% of sexual minority cis women, and 36% of TNB participants reported having any TNB partners. There was significant heterogeneity in HIV/STI prevalence, testing, and PrEP use among the partners of TNB people by study participant gender and the gender of their sex partners. In regression models, having a TNB partner was associated with a higher likelihood of HIV/STI testing and PrEP use but was not associated with higher HIV prevalence. CONCLUSIONS We observed significant heterogeneity in HIV/STI prevalence and preventative behaviors among the partners of TNB people. Given that TNB people are diverse in their sexual partnerships, there is a need to better understand individual-, dyad-, and structural-level factors that facilitate HIV/STI prevention across these diverse partnerships.
Collapse
Affiliation(s)
- Diana M Tordoff
- From the Department of Epidemiology, University of Washington
| | | | | | | | | | | | | | | |
Collapse
|
15
|
McLaughlin SE, Golden MR, Soge OO, Berzkalns A, Thibault CS, Barbee LA. Pharyngeal Gonorrhea in Heterosexual Male and Female Sex Partners of Persons With Gonorrhea. Sex Transm Dis 2023; 50:203-208. [PMID: 36548117 PMCID: PMC10919293 DOI: 10.1097/olq.0000000000001760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current guidance from the US Centers for Disease Control and Prevention recommends empiric treatment for persons exposed to sexually transmitted infections, including Neisseria gonorrhoeae ( NG ). As an antimicrobial stewardship measure, some clinics now recommend a test and treat strategy, but reliance on urogenital testing only may miss cases. METHODS We conducted a descriptive analysis of pharyngeal NG infection in men who have sex with women (MSW) and women seeking care at a sexual health clinic in Seattle, WA, from February 2017 to July 2021 because of sexual contact to a partner diagnosed with gonorrhea. We also explored behavioral factors associated with pharyngeal NG positivity (by culture or nucleic acid amplification test by χ2 analysis. RESULTS Among 352 NG contacts tested for urogenital or pharyngeal infection, 34% were positive for NG at ≥1 anatomic site (27% for MSW and 40% for women). Among 161 NG contacts tested at the pharynx, 30% (n = 48) were positive: 20% of 54 MSW (n = 11) and 35% (n = 37) of 107 women. If only urogenital testing were performed, 36% of MSW NG infections (n = 5) and 19% of female NG infections (n = 9) would have remained unidentified. CONCLUSIONS Pharyngeal NG is relatively common among MSW and women who have been exposed to NG, and likely represents an underdiagnosed reservoir of NG infection. If empiric treatment is abandoned in favor of testing and treating, testing the throats of heterosexuals will be necessary.
Collapse
Affiliation(s)
| | - Matthew R. Golden
- Department of Medicine, University of Washington
- Public Health—Seattle & King County, HIV/STD Program
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Olusegun O. Soge
- Department of Medicine, University of Washington
- Department of Global Health, University of Washington, Seattle, WA
| | | | | | - Lindley A. Barbee
- Department of Medicine, University of Washington
- Public Health—Seattle & King County, HIV/STD Program
| |
Collapse
|
16
|
Rowlinson E, Soge OO, Hughes JP, Berzkalns A, Thibault C, Kerani RP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Prior Exposure to Azithromycin and Azithromycin Resistance Among Persons Diagnosed With Neisseria gonorrhoeae Infection at a Sexual Health Clinic: 2012-2019. Clin Infect Dis 2023; 76:e1270-e1276. [PMID: 36001447 PMCID: PMC10169409 DOI: 10.1093/cid/ciac682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is conflicting evidence on whether prior azithromycin (AZM) exposure is associated with reduced susceptibility to AZM (AZMRS) among persons infected with Neisseria gonorrhoeae (NG). METHODS The study population included Public Health-Seattle and King County Sexual Health Clinic (SHC) patients with culture-positive NG infection at ≥1 anatomic site whose isolates were tested for AZM susceptibility in 2012-2019. We used multivariate logistic regression to examine the association of time since last AZM prescription from the SHC in ≤12 months with subsequent diagnosis with AZMRS NG (minimum inhibitory concentration [MIC], ≥2.0 µg/mL) and used linear regression to assess the association between the number of AZM prescriptions in ≤12 months and AZM MIC level, controlling for demographic, behavioral, and clinical characteristics. RESULTS A total of 2155 unique patients had 2828 incident NG infections, 156 (6%) of which were caused by AZMRS NG. AZMRS NG was strongly associated with receipt of AZM from the SHC in the prior 29 days (adjusted odds ratio, 6.76; 95% confidence interval [CI], 1.76 to 25.90) but not with receipt of AZM in the prior 30-365 days. Log AZM MIC level was not associated with the number of AZM prescriptions within ≤12 months (adjusted correlation, 0.0004; 95% CI, -.04 to .037) but was associated with number of prescriptions within <30 days (adjusted coefficient, 0.56; 95% CI, .13 to .98). CONCLUSIONS Recent individual-level AZM treatment is associated with subsequent AZMRS gonococcal infections. The long half-life and persistence of subtherapeutic levels of AZM may result in selection of resistant NG strains in persons with recent AZM use.
Collapse
Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Olusegun O Soge
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Neisseria Reference Laboratory, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Anna Berzkalns
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Christina Thibault
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Roxanne P Kerani
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| |
Collapse
|
17
|
Tordoff DM, Dombrowski JC, Ramchandani MS, Barbee LA. Trans-inclusive Sexual Health Questionnaire to Improve Human Immunodeficiency Virus/Sexually Transmitted Infection (STI) Care for Transgender Patients: Anatomic Site-Specific STI Prevalence and Screening. Clin Infect Dis 2023; 76:e736-e743. [PMID: 35594554 PMCID: PMC10169399 DOI: 10.1093/cid/ciac370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2018, the municipal Sexual Health Clinic in Seattle, implemented trans-inclusive questions about sexual behavior, anatomy, gender-affirming surgeries, and sexually transmitted infection (STI) symptoms in the clinic's computer-assisted self-interview (CASI) to improve care for transgender and nonbinary (TNB) patients. METHODS We calculated test positivity, the proportion of TNB patient visits that received testing for human immunodeficiency virus (HIV); syphilis; pharyngeal, rectal, and urogenital gonorrhea (GC); and chlamydia (CT) before (5/2016-12/2018) and after (12/2018-2/2020) implementation of new CASI questions, and the proportion of asymptomatic patients who received anatomic site-specific screening based on reported exposures. RESULTS There were 434 TNB patients with 489 and 337 clinic visits during each period, respectively. Nonbinary patients assigned male at birth (AMAB) had the highest prevalence of GC (10% pharyngeal, 14% rectal, 12% urogenital). Transgender women, transgender men, and nonbinary people AMAB had a high prevalence of rectal CT (10%, 9%, and 13%, respectively) and syphilis (9%, 5%, and 8%). Asymptomatic transgender women, transgender men, and nonbinary patients AMAB were more likely to receive extragenital GC/CT screening compared with nonbinary patients assigned female at birth. After implementation of trans-inclusive questions, there was a 33% increase in the number of annual TNB patient visits but no statistically significant increase in HIV/STI testing among TNB patients. CONCLUSIONS TNB people had a high prevalence of extragenital STIs and syphilis. Implementation of trans-inclusive medical history questions at a clinic that serves cisgender and transgender patients was feasible and important for improving the quality of affirming and inclusive sexual healthcare.
Collapse
Affiliation(s)
- Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Meena S Ramchandani
- Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lindley A Barbee
- Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
18
|
Khosropour CM, Coomes DM, Barbee LA. Frequency and Combination of Sequential Sexual Acts That May Lead to Sexually Transmitted Infections at Different Anatomic Sites Within the Same Person. Arch Sex Behav 2023; 52:823-831. [PMID: 36459349 PMCID: PMC9717570 DOI: 10.1007/s10508-022-02486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Modeling studies suggest that transmission of gonorrhea and chlamydia to multiple anatomic sites within the same person is necessary to reproduce observed high rates of extragenital gonorrhea/chlamydia. Limited empiric behavioral data support this idea. In this cross-sectional study, we enrolled individuals assigned male at birth who reported sex with men (MSM) and denied receptive anal sex (RAS) in the past 2 years. Participants enrolled in-person at the Sexual Health Clinic in Seattle, Washington (December 2019-September 2021) or online (July 2021-September 2021), and completed a sexual history questionnaire that asked about specific sexual acts and sequence of those acts during their last sexual encounter. We enrolled 210 MSM during the 16-month recruiting period. The median number of sex acts reported at last sexual encounter was 4 (interquartile range 3-5). The most commonly reported acts at last sex were: kissing (83%), receiving oral sex (82%), and insertive anal sex (65%). There was substantial variability in the sequence of acts reported; no unique sequence of sex acts was reported by more than 12% of the population. Ninety percent of participants reported sequences of behaviors that could lead to gonorrhea or chlamydia transmission within the same person (respondent or partner); the most common of these combinations was kissing followed by receiving oral sex (64% reporting). Engaging in multiple sex acts within a single sexual encounter is common and may lead to gonorrhea/chlamydia transmission within the same person. This complicates empiric measurements of transmission probabilities needed to estimate population-level transmission.
Collapse
Affiliation(s)
- Christine M Khosropour
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA.
| | - David M Coomes
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| |
Collapse
|
19
|
Kumbhakar R, Barbee LA, Berzkalns A, Herrmann S, Ramchandani MS, Golden MR, Dombrowski JC. Etiologies of Proctitis at a Sexual Health Clinic in Seattle, Washington From 2011 to 2021. Sex Transm Dis 2022; 49:860-862. [PMID: 35969837 PMCID: PMC10538061 DOI: 10.1097/olq.0000000000001696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We analyzed microbiologic etiologies of proctitis among patients seen in an urban sexual health clinic during 2011 to 2021. Among 759 cases, 179 (24%) tested positive for Neisseria gonorrhoeae , 171 (23%) for Chlamydia trachomatis , 21 (3%) for herpes simplex virus, 30 (4%) for syphilis, and 73 (10%) for multiple pathogens; no pathogen was identified in 425 (56%).
Collapse
Affiliation(s)
- Raaka Kumbhakar
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Lindley A. Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Anna Berzkalns
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Susannah Herrmann
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Meena S. Ramchandani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Matthew R. Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Julia C. Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| |
Collapse
|
20
|
Bole M, Khosropour CM, Glick SN, Barbee LA, Golden MR, Dhanireddy S, Dombrowski JC. Characterization of Patients Seeking Care at a Sexual Health Clinic Who Report Engaging in Exchange Sex. Sex Transm Dis 2022; 49:719-725. [PMID: 35797525 PMCID: PMC9481692 DOI: 10.1097/olq.0000000000001666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People who exchange sex (PWES) for money or drugs are at increased risk for poor health outcomes and may be reluctant to engage in health services. METHODS We conducted a cross-sectional analysis of patients seen for new problem visits at the Public Health-Seattle and King County Sexual Health Clinic between October 2010 and March 2020 who reported exchanging sex for drugs or money in a computer assisted self-interview. We analyzed demographics; sexually transmitted infections (STIs), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) history; and HIV preexposure prophylaxis (PrEP) use, stratified by gender. We compared characteristics of people who ever versus never exchanged sex using χ 2 tests and analyzed the visit reason and outcomes among PWES. RESULTS Among 30,327 patients, 1611 (5%) reported ever exchanging sex: 981 (61%) cisgender men, 545 (34%) cisgender women, and 85 (5%) transgender and gender diverse persons. Compared with people who never exchanged sex, PWES were more likely to report homelessness (29% vs 7%, P < 0.001), injection drug use (39% vs 4%, P < 0.001), prior STIs (36% vs 19%, P < 0.001), prior HIV diagnosis (13% vs 5%, P < 0.001), and prior HCV diagnosis (13% vs 2%, P < 0.001). People who exchange sex came to the clinic seeking STI tests (60%), HIV tests (45%), and care for STI symptoms (38%). Overall, 320 (20%) PWES were diagnosed with STIs, 15 (1%) were newly diagnosed with HIV, and 12 (1%) initiated PrEP at the visit. CONCLUSION People who exchange sex have complex barriers to care, and sexual health clinic visits present an opportunity to improve health services for this population.
Collapse
Affiliation(s)
| | | | - Sara N. Glick
- From the Departments of Medicine
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA
| | - Lindley A. Barbee
- From the Departments of Medicine
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA
| | - Matthew R. Golden
- From the Departments of Medicine
- Epidemiology, University of Washington
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA
| | | | - Julia C. Dombrowski
- From the Departments of Medicine
- Epidemiology, University of Washington
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA
| |
Collapse
|
21
|
Khosropour CM, Soge OO, Golden MR, Hughes JP, Barbee LA. Incidence and Duration of Pharyngeal Chlamydia Among a Cohort of Men Who Have Sex With Men. Clin Infect Dis 2022; 75:875-881. [PMID: 34893806 PMCID: PMC9477446 DOI: 10.1093/cid/ciab1022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prevalence of pharyngeal chlamydia is low, but its incidence and duration are unknown. A high incidence or duration may support the role of pharyngeal chlamydia in sustaining chlamydia transmission. METHODS From March 2016 to December 2018, we enrolled men who have sex with men (MSM) in a 48-week cohort study in Seattle, Washington. Participants self-collected pharyngeal specimens weekly. We tested specimens using nucleic acid amplification testing at the conclusion of the study. In primary analyses, we defined incident pharyngeal chlamydia as >2 consecutive weeks of a positive pharyngeal specimen. In sensitivity analyses, we defined incident chlamydia as >1 week of a positive specimen. We estimated duration of pharyngeal chlamydia, censoring at loss to follow-up, receipt of antibiotics, or end of study. RESULTS A total of 140 participants contributed 70.5 person-years (PY); 1.4% had pharyngeal chlamydia at enrollment. In primary analyses, there were 8 pharyngeal chlamydia cases among 6 MSM (incidence = 11.4 per 100 PY; 95% confidence interval [CI]: 6.0-21.9). In sensitivity analysis, there were 19 cases among 16 MSM (incidence = 27.1 per 100 PY; 95% CI: 18.5-39.8). The median duration was 6.0 weeks (95% CI: 2.0-undefined) in primary analysis and 2.0 weeks (95% CI: 1.1-6.0) in sensitivity analysis. Duration was shorter for those with a history of chlamydia compared with those without (3.6 vs 8.7 weeks; P = .02). CONCLUSIONS Pharyngeal chlamydia has a low incidence and duration relative to other extragenital sexually transmitted infections. Its contribution to population-level transmission remains unclear.
Collapse
Affiliation(s)
| | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health–Seattle & King County HIV/STD Program, Seattle, Washington, USAand
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health–Seattle & King County HIV/STD Program, Seattle, Washington, USAand
| |
Collapse
|
22
|
Ramchandani MS, Berzkalns A, Cannon CA, Dombrowski JC, Ocbamichael N, Khosropour CM, Barbee LA, Golden MR. A Demedicalized Model to Provide PrEP in a Sexual Health Clinic. J Acquir Immune Defic Syndr 2022; 90:530-537. [PMID: 35499503 PMCID: PMC9283215 DOI: 10.1097/qai.0000000000003005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexual health clinics (SHCs) serve large numbers of patients who might benefit from preexposure prophylaxis (PrEP). Integrating longitudinal PrEP care into SHCs can overburden clinics. We implemented an SHC PrEP program that task shifted most PrEP operations to nonmedical staff, disease intervention specialists (DIS). METHODS We conducted a retrospective cohort analysis of PrEP patients in an SHC in Seattle, WA, from 2014 to 2020 to assess the number of patients served and factors associated with PrEP discontinuation. Clinicians provide same-day PrEP prescriptions, whereas DIS coordinate the program, act as navigators, and provide most follow-up care. RESULTS Between 2014 and 2019, 1387 patients attended an initial PrEP visit, 93% of whom were men who have sex with men. The number of patients initiating PrEP per quarter year increased from 20 to 81. The number of PrEP starts doubled when the clinic shifted from PrEP initiation at scheduled visits to initiation integrated into routine walk-in visits. The percentage of visits performed by DIS increased from 3% in 2014 to 45% in 2019. Median duration on PrEP use was 11 months. PrEP discontinuation was associated with non-Hispanic black race/ethnicity [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.02 to 1.76], age <20 years (HR 2.17, 95% CI: 1.26 to 3.75), age between 20 and 29 years (HR 1.55, 95% CI: 1.06 to 2.28), and methamphetamine use (HR 1.98, 95% CI: 1.57 to 2.49). The clinic had 750 patients on PrEP in the final quarter of 2019. CONCLUSIONS A demedicalized SHC PrEP model that task shifts most operations to DIS can provide PrEP at scale to high priority populations.
Collapse
Affiliation(s)
- Meena S Ramchandani
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
| | - Anna Berzkalns
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
| | - Chase A Cannon
- Department of Medicine, University of Washington, Seattle, WA
| | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
- Department of Epidemiology, University of Washington, Seattle, WA
| |
Collapse
|
23
|
Ramchandani MS, Bourne C, Barbee LA, Hoornenborg E, Pathela P, Taylor SN, de Vries H. The need for sexual health clinics, their future role, and contribution to public health. Sex Health 2022; 19:346-356. [PMID: 35995430 DOI: 10.1071/sh22087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Specialised sexual health clinics (SHCs) play an important role in addressing the staggering rates of STIs seen in many high-income nations. Despite increasing healthcare coverage in the US and nationalised health care in some countries, there is a continued need for SHCs to meet the needs of patients and the community, especially for high-priority populations: those at high risk of STI acquisition and/or groups historically marginalised and underserved in the traditional healthcare system. We need to mobilise resources to support a stronger clinical infrastructure in specialised SHCs. This review describes the importance of SHCs, their future role, and some of the innovative programs housed within SHCs in the US, Australia, and the Netherlands to address both STI and HIV prevention for the populations they serve.
Collapse
Affiliation(s)
- Meena S Ramchandani
- Department of Medicine, University of Washington, Seattle, WA, USA; and Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Christopher Bourne
- NSW STI Programs Unit, Centre for Population Health, New South Wales Health, NSW, Australia; and Sydney Sexual Health Centre, Sydney, NSW, Australia; and Kirby Institute, Sexual Health Program, Sydney, NSW, Australia
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA; and Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Elske Hoornenborg
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Preeti Pathela
- New York City Department of Health and Mental Hygiene Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA
| | - Stephanie N Taylor
- Section of Infectious Diseases at Louisiana State University Health Sciences Center, New Orleans, LA, USA; and LSU-CrescentCare Sexual Health Center, New Orleans, LA, USA; and Louisiana Office of Public Health STD/HIV Program, New Orleans, LA, USA
| | - Henry de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands; and Amsterdam Institute for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
24
|
Barbee LA, Khosropour CM, Soge OO, Hughes JP, Haglund M, Yeung W, Golden MR. The Natural History of Rectal Gonococcal and Chlamydial Infections: The ExGen Study. Clin Infect Dis 2022; 74:1549-1556. [PMID: 34355734 PMCID: PMC9070839 DOI: 10.1093/cid/ciab680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The duration of rectal gonococcal and chlamydial infection remains unknown. This basic epidemiologic parameter is needed to understand transmission dynamics. METHODS We conducted a prospective, longitudinal, observational cohort study of 140 men who have sex with men (MSM) at risk of gonorrhea and chlamydia acquisition. For 48 weeks, enrolled men collected rectal swabs (Aptima multi-test kit) at home and responded to an electronic survey about sexual behavior and health conditions weekly. Swabs remained untested until participants completed the study. We used Kaplan-Meier estimates to determine the median duration of infection, censoring infections for treatment, loss to follow-up, and end-of-study. We used log-rank test to compare duration of infection by human immunodeficiency virus (HIV) status, history of infection with gonorrhea or chlamydia, and coinfection with the other pathogen. RESULTS 140 enrolled MSM contributed 70.5 person-years of follow-up. Eighteen men had 20 incident rectal gonococcal infections, which persisted for 2-23 weeks; 30% were censored for treatment. The estimated median duration of rectal gonorrhea was 9 weeks (95% confidence interval [CI]: 3-12 weeks). Twenty-four men experienced 32 rectal chlamydial infections, persisting between 2 and 42 weeks; 60% were censored. The estimated duration of rectal chlamydia was 13 weeks (95% CI: 6 weeks-undefined). There were no differences in the duration of rectal gonorrhea or chlamydia by HIV status, history of chlamydia/gonorrhea, or coinfection. CONCLUSIONS On average, rectal gonorrhea and chlamydial infections last 2-3 months, although some infections persisted for 6-11 months. Further understanding into predictors of persistence is needed.
Collapse
Affiliation(s)
- Lindley A Barbee
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health—Seattle & King County, HIV/STD Program, Seattle, Washington, USA
| | | | - Olusegun O Soge
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Neisseria Reference Laboratory, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Micaela Haglund
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Winnie Yeung
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health—Seattle & King County, HIV/STD Program, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
25
|
Barbee LA, St Cyr SB. Management of Neisseria gonorrhoeae in the United States: Summary of Evidence From the Development of the 2020 Gonorrhea Treatment Recommendations and the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Treatment Guidelines. Clin Infect Dis 2022; 74:S95-S111. [PMID: 35416971 DOI: 10.1093/cid/ciac043] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern given limited antibiotic options currently and an even smaller antimicrobial development pipeline. Since the release of the Centers for Disease Control and Prevention (CDC) 2015 STD Treatment Guidelines, azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance. The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed weighing the priorities of treating the individual, protecting the population, and preventing antimicrobial resistance. METHODS Gonorrhea subject matter experts (SME) generated 8 key questions and conducted a literature review of updated data from 2013 to 2019 on gonorrhea antimicrobial resistance, treatment failures, clinical trials, and other key topics. More than 2200 abstracts were assessed, and 248 clinically relevant articles were thoroughly reviewed. SMEs also evaluated N gonorrhoeae antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP). EVIDENCE Although there have been reports of ceftriaxone treatment failures internationally, GISP data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL). However, GISP documented a rapid rise in the proportion of isolates with an elevated MIC (≥ 2.0 mcg/mL) to azithromycin-nearly 5% in 2018. At the same time, new pharmacokinetic/pharmacodynamic data are available, and there is greater recognition of the need for antimicrobial stewardship. SUMMARY The 2021 CDC STI Treatment Guidelines now recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites. If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added. Few alternative therapies exist for persons with cephalosporin allergies; there are no recommended alternative therapies for N gonorrhoeae infection of the throat.
Collapse
Affiliation(s)
- Lindley A Barbee
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,University of Washington, Seattle, Washington, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Sancta B St Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
26
|
Tordoff DM, Minalga B, Gross BB, Martin A, Caracciolo B, Barbee LA, Balkus JE, Khosropour CM. Erasure and Health Equity Implications of Using Binary Male/Female Categories in Sexual Health Research and Human Immunodeficiency Virus/Sexually Transmitted Infection Surveillance: Recommendations for Transgender-Inclusive Data Collection and Reporting. Sex Transm Dis 2022; 49:e45-e49. [PMID: 34407018 PMCID: PMC8755589 DOI: 10.1097/olq.0000000000001533] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Diana M. Tordoff
- University of Washington, Department of Epidemiology, Seattle, WA
| | - Brian Minalga
- Fred Hutch, Office of HIV/AIDS Network Coordination, Seattle, WA
| | | | - Aleks Martin
- Public Health – Seattle & King County, Seattle, WA
| | | | - Lindley A. Barbee
- University of Washington, Department of Medicine, Seattle, WA
- Public Health – Seattle & King County, Seattle, WA
| | | | | |
Collapse
|
27
|
Affiliation(s)
- Lindley A Barbee
- From the Division of Infectious Diseases, Department of Medicine, University of Washington; and Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| |
Collapse
|
28
|
Thibault CS, Golden MR, Barbee LA, Spellman D, Soge OO, Kerani RP. Partner Elicitation After Partner Services Interviews and Reinterviews Among Patients With Antimicrobial-Resistant Gonorrhea. Sex Transm Dis 2021; 48:S137-S143. [PMID: 34407015 DOI: 10.1097/olq.0000000000001531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Partner notification services (PS) are often used to control sexually transmitted infections, but their effectiveness is limited by patients' reluctance to name sex partners. We hypothesized that being notified of having antimicrobial-resistant Neisseria gonorrhoeae (ARGC) would make patients more likely to provide named partner information. METHODS We used King County, Washington STD surveillance and Strengthening the US Response to Resistant Gonorrhea data to identify gonorrhea cases. Using log-binomial regression, we computed unadjusted and adjusted prevalence ratios for factors associated with naming any partners during routine PS interview vs. interview after ARGC diagnosis. Among those who completed a standard PS interview and later a reinterview after ARGC diagnosis, we compared mean numbers of reported and contactable partners at initial interview and reinterview using the Wilcoxon rank sum test. RESULTS From July 2018 to October 2020, 1588 gonorrhea cases were interviewed; 103 (6%) had ARGC. After adjusting for sexual exposure, age, year, disease intervention specialist, reinterview, and diagnosing clinic, being interviewed after ARGC diagnosis remained predictive of naming ≥1 partner relative to routine PS (prevalence ratio, 2.2; 95% confidence interval, 1.6-2.9). Among 40 cases who completed a standard PS interview and later a reinterview after ARGC diagnosis, there was a modest increase in mean partners named at initial versus reinterview (1.4 vs. 1.9 per case, P = 0.09). CONCLUSIONS Cases interviewed after ARGC diagnosis named more contactable partners than did those undergoing routine PS. Reinterviewing patients after ARGC diagnosis provides only a modest increase in contactable partners but may be useful to limit transmission of this potentially challenging infection.
Collapse
Affiliation(s)
| | | | | | - Dawn Spellman
- From the HIV/STD Program, Public Health-Seattle & King County
| | | | | |
Collapse
|
29
|
Khosropour CM, Dombrowski JC, Vojtech L, Patton DL, Campbell LA, Barbee LA, Franzi MC, Hybiske K. Rectal Chlamydia trachomatis Infection: A Narrative Review of the State of the Science and Research Priorities. Sex Transm Dis 2021; 48:e223-e227. [PMID: 34475361 PMCID: PMC8595876 DOI: 10.1097/olq.0000000000001549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chlamydia trachomatis (CT) is the most commonly reported infection in the United States. Most chlamydial research to date has focused on urogenital infection, but a growing body of research has demonstrated that rectal chlamydia is a relatively common infection among clinic-attending men and women. We know that most rectal CT infections are asymptomatic, but the health implications of these infections, particularly for women, are unclear. In addition, there are key knowledge gaps related to the epidemiologic parameters of rectal chlamydia, the routes of acquisition, the duration of infection, and the clinical significance of a positive rectal CT test result. This lack of information has led to a blind spot in the potential role of rectal chlamydia in sustaining high levels of CT transmission in the United States. Furthermore, recent findings from animal models suggest that the immune response generated from gastrointestinal chlamydial infection can protect against urogenital infection; however, it remains to be determined whether rectal chlamydia similarly modulates anti-CT immunity in humans. This is a critical question in the context of ongoing efforts to develop a CT vaccine. In this narrative review, we summarize the state of the science for rectal chlamydia and discuss the key outstanding questions and research priorities in this neglected area of sexual health research.
Collapse
Affiliation(s)
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Lucia Vojtech
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Dorothy L. Patton
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Lee Ann Campbell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | | | - Kevin Hybiske
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Microbiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
30
|
Gieseker KE, Learner ER, Mauk K, Barbee LA, McNeil CJ, Hasty GL, Black JM, Johnson K, Nguyen TQ, Shrestha D, Pham CD, St Cyr S, Schlanger K, Kirkcaldy RD. Demographic and Epidemiological Characteristics Associated With Reduced Antimicrobial Susceptibility to Neisseria gonorrhoeae in the United States, Strengthening the US Response to Resistant Gonorrhea, 2018 to 2019. Sex Transm Dis 2021; 48:S118-S123. [PMID: 34433798 PMCID: PMC8711092 DOI: 10.1097/olq.0000000000001541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Jurisdictions participating in Strengthening the US Response to Resistant Gonorrhea (SURRG) implemented specimen collection for culture and antimicrobial susceptibility testing from a sample of persons of all genders (at multiple anatomic sites) attending sexually transmitted disease clinics and community clinics. We describe the percentage and characteristics of patients whose isolates demonstrated reduced susceptibility (RS) to azithromycin, ceftriaxone, or cefixime. METHODS We included patients from clinics that participated in SURRG whose isolates underwent antimicrobial susceptibility testing by Etest. We defined RS as azithromycin minimum inhibitory concentrations (MICs) ≥2 μg/mL (AZM-RS), ceftriaxone MICs ≥0.125 μg/mL (CRO-RS), or cefixime MICs ≥0.25 μg/mL (CFX-RS). Patients with repeated infections appeared >1 time in the data. We calculated the frequency and percentage of patients with an isolate demonstrating RS by epidemiological characteristics. RESULTS During the period 2018-2019, 10,013 patients from 8 jurisdictions provided 10,735 isolates. Among 10,013 patients, 11.0% (n = 1099) had ≥1 isolate with AZM-RS (range by jurisdiction, 2.5%-18.0%). Approximately 11.3% of 8771 of patients visiting sexually transmitted disease clinics and approximately 8.8% of 1242 patients visiting community clinics had an AZM-RS isolate. Nearly 6% of 1013 females had an AZM-RS isolate; among males, the percents of patients with an AZM-RS isolate were 17.7% among 4177 men who have sex only with men and 6.1% among 3581 men who have sex only with women. Few (0.4%) patients had isolates with CFX-RS (n = 40) or CRO-RS (n = 43). CONCLUSIONS Although infections with reduced cephalosporin susceptibility were rare, AZM-RS infections were prevalent in this sample of patients in multiple jurisdictions and across gender and gender of sex partner categories.
Collapse
Affiliation(s)
- Karen E Gieseker
- From the Colorado Department of Public Health and Environment, Denver, CO
| | | | - Kerry Mauk
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Lindley A Barbee
- Department of Medicine, Infectious Diseases, University of Washington, Seattle, WA
| | - Candice J McNeil
- Wake Forest University School of Medicine/Guilford County Department of Health, Winston-Salem, NC
| | | | | | - Kimberly Johnson
- New York City Department of Health and Mental Hygiene, New York, NY
| | | | | | - Cau D Pham
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Sancta St Cyr
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | |
Collapse
|
31
|
Cannon CA, Piraino AK, Golden MR, Barbee LA. Sexually Transmitted Infection Testing Using Online Companies: Benefits, Drawbacks, and Call for Official Guidance. Sex Transm Dis 2021; 48:e168-e170. [PMID: 33633071 DOI: 10.1097/olq.0000000000001401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this brief case series, we outline issues with some online sexually transmitted infection services and delayed reporting of results. Commercial entities providing sexually transmitted infection testing should ensure that all results are reported to local public health jurisdictions and that procedures exist to link persons to appropriate treatment and follow-up.
Collapse
Affiliation(s)
- Chase A Cannon
- From the Department of Medicine, University of Washington, Seattle
| | - Alyssa K Piraino
- Public Health-Seattle & King County, HIV/STD Program, King County, WA
| | | | | |
Collapse
|
32
|
Khosropour CM, Dombrowski JC, Barbee LA, Kerani RP, Berzkalns A, Golden MR. Changing Patterns of Sexual Behavior and HIV/STI Among Men Who Have Sex With Men in Seattle, 2002 to 2018. J Acquir Immune Defic Syndr 2021; 87:1032-1039. [PMID: 33770066 PMCID: PMC8458506 DOI: 10.1097/qai.0000000000002686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The extent to which uptake of biomedical HIV prevention strategies have affected population-level sexual behavior and sexually transmitted infections (STIs) among men who have sex with men (MSM) is not well understood. METHODS We collected data as part of routine care from MSM attending the municipal STI clinic in Seattle, Washington, 2002-2018. MSM were asked about condom use in the previous 12 months. We classified behaviors into 4 mutually exclusive categories: no anal sex; consistent condom use for anal sex; serosorting [condomless anal sex (CAS) only with HIV-concordant partners]; and CAS with serodiscordant/unknown-status partners. STI/HIV testing was performed per routine clinic protocol. RESULTS There were 45,656 and 6987 visits by MSM without HIV and MSM with HIV, respectively. The use of antiretroviral therapy and preexposure prophylaxis increased substantially during the study period to 94% and 50%, respectively, by 2018. CAS with serodiscordant/unknown-status partners decreased through 2013 but increased thereafter (to 40% among MSM without HIV; 68% among MSM with HIV). Serosorting increased among MSM without HIV but declined after 2013 among MSM with HIV. Consistent condom use declined for all MSM (from 35% to 11% among MSM without HIV; from 20% to 5% among MSM with HIV). HIV test positivity declined substantially (3.5%-0.5%), whereas STI test positivity increased over time. CONCLUSIONS Since 2013, CAS with HIV-discordant/unknown-status partners increased substantially concurrent with declining HIV test positivity and increasing STI test positivity. This highlights the success of biomedical HIV prevention strategies to reduce HIV incidence while affirming the need for new approaches to STI prevention.
Collapse
Affiliation(s)
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Anna Berzkalns
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| |
Collapse
|
33
|
Berzkalns A, Thibault CS, Barbee LA, Golden MR, Khosropour C, Kerani RP. Decreases in Reported Sexually Transmitted Infections During the Time of COVID-19 in King County, WA: Decreased Transmission or Screening? Sex Transm Dis 2021; 48:S44-S49. [PMID: 33967230 PMCID: PMC8284355 DOI: 10.1097/olq.0000000000001463] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/28/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, Washington State's Stay Home, Stay Healthy (SHSH) order was implemented on March 24, 2020. We hypothesized that pandemic mitigation measures might reduce sexually transmitted infection (STI) screening and/or transmission. METHODS We used King County, WA STI surveillance and sexual health clinic (SHC) data from January 1, 2019, to July 31, 2020. We calculated mean weekly case counts for gonorrhea, primary and secondary (P&S) syphilis, male urethral gonorrhea, and early latent (EL) syphilis for 3 periods in 2020: pre-SHSH (January 1-March 23), SHSH (March 24-June 5), and reopening (June 6-July 31). Primary and secondary syphilis and male urethral gonorrhea were used as proxies for sexual behavior, and EL syphilis was used as a proxy for STI screening. We compared SHC visits (2019 vs. 2020) and SHC gonorrhea treatment practices (across 2020 periods). RESULTS Compared with January to July 2019, from January to July 2020, reported cases of gonorrhea, male urethral gonorrhea, P&S syphilis, and EL syphilis decreased by 9%, 5%, 16%, and 22%, respectively. Mean weekly case counts of gonorrhea, male urethral gonorrhea, and EL syphilis decreased pre-SHSH to SHSH, but all returned to pre-SHSH levels during reopening. Sexual health clinic visits during SHSH were 55% lower in 2020 than in 2019. In the SHC during SHSH, ceftriaxone treatment of gonorrhea decreased, whereas cefixime/cefpodoxime treatment and gonorrhea treatment with no testing increased. CONCLUSIONS Decreases in reported STIs concurrent with COVID-19 SHSH may reflect a true decline in STI transmission. However, the larger decreases in asymptomatic infections indicate that much of the observed decrease was likely due to decreased screening.
Collapse
Affiliation(s)
| | | | | | - Matthew R. Golden
- From the Public Health—Seattle & King County
- Departments of Medicine
- Epidemiology, University of Washington, Seattle, WA
| | | | - Roxanne P. Kerani
- From the Public Health—Seattle & King County
- Epidemiology, University of Washington, Seattle, WA
| |
Collapse
|
34
|
Barbee LA, Golden MR. Aztreonam for Neisseria gonorrhoeae: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 75:1685-1688. [PMID: 32259846 DOI: 10.1093/jac/dkaa108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ceftriaxone is the only consistently active antimicrobial agent recommended for the treatment of Neisseria gonorrhoeae. Although some new antimicrobials are in development, the necessity to expand treatment options in the near term may require using older drugs that have not been widely used to treat gonorrhoea. METHODS We conducted a literature review of clinical trials and case series, published from 1983 to 2017, reporting treatment efficacy results following administration of 1 g aztreonam intramuscularly or IV for uncomplicated gonococcal infections. We summed trial data, stratified by anatomical site of infection, and calculated summary efficacy estimates and 95% CI for each site of infection. RESULTS The 10 identified clinical trials enrolled 678, 38 and 16 individuals with urogenital, rectal and pharyngeal gonorrhoea, respectively. Aztreonam had an efficacy of 98.6% (95% CI: 97.5%-99.4%) for urogenital, 94.7% (95% CI: 82.3%-99.4%) for rectal and 81.3% (95% CI: 54.4%-96.0%) for pharyngeal gonococcal infections. CONCLUSIONS Although most clinical trials included in this meta-analysis were conducted >30 years ago, aztreonam appears to have excellent efficacy for urogenital gonorrhoea; its efficacy at extragenital sites remains uncertain.
Collapse
Affiliation(s)
- Lindley A Barbee
- Division of Infectious Diseases, Department of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA 98104, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, 325 9th Ave, Box 359777, Seattle, WA 98104, USA
| | - Matthew R Golden
- Division of Infectious Diseases, Department of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA 98104, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, 325 9th Ave, Box 359777, Seattle, WA 98104, USA.,Department of Epidemiology, University of Washington, Seattle, WA, 325 9th Ave, Box 359777, Seattle, WA 98104, USA
| |
Collapse
|
35
|
Barbee LA, Soge OO, Morgan J, Leclair A, Bass T, Werth BJ, Hughes JP, Golden MR. Gentamicin Alone Is Inadequate to Eradicate Neisseria Gonorrhoeae From the Pharynx. Clin Infect Dis 2021; 71:1877-1882. [PMID: 31712813 DOI: 10.1093/cid/ciz1109] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/08/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Centers for Disease Control and Prevention (CDC) guidelines recommend 240 mg gentamicin plus 2 g azithromycin for the treatment of gonorrhea in cephalosporin-allergic patients. The efficacy of gentamicin alone in the treatment of pharyngeal gonorrhea is uncertain. METHODS Between September 2018 and March 2019, we enrolled men who have sex with men with nucleic acid amplification test-diagnosed pharyngeal gonorrhea in a single-arm, unblinded clinical trial. Men received a single 360-mg intramuscular dose of gentamicin and underwent test of cure by culture 4-7 days later. The study measured creatinine at enrollment and test of cure, serum gentamicin concentration postdose to establish peak concentration (Cmax), and standard antimicrobial minimum inhibitory concentrations (MICs) by agar dilution. The trial was designed to establish a point estimate for gentamicin's efficacy for pharyngeal gonorrhea. We planned to enroll 50 evaluable participants; assuming gentamicin was 80% efficacious, the trial would establish a 95% confidence interval (CI) of 66%-90%. We planned interim analyses at n = 10 and n = 25. RESULTS The study was stopped early due to poor efficacy. Of 13 enrolled men, 10 were evaluable, and only 2 (20% [95% CI, 2.5%-55.6%]) were cured. Efficacy was not associated with gentamicin Cmax or MIC. No participants experienced renal insufficiency. The mean creatinine percentage change was +5.2% (range, -6.7% to 21.3%). Six (46%) participants experienced headache, all deemed unrelated to treatment. CONCLUSIONS Gentamicin alone failed to eradicate Neisseria gonorrhoeae from the pharynx. Clinicians should use caution when treating gonorrhea with the CDC's current alternative regimen (gentamicin 240 mg plus azithromycin 2 g) given increases in azithromycin resistance and gentamicin's poor efficacy at the pharynx. CLINICAL TRIALS REGISTRATION NCT03632109.
Collapse
Affiliation(s)
- Lindley A Barbee
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.,Human Immunodeficiency Virus/Sexually Transmitted Disease Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jennifer Morgan
- Human Immunodeficiency Virus/Sexually Transmitted Disease Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Angela Leclair
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Tamara Bass
- Human Immunodeficiency Virus/Sexually Transmitted Disease Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Brian J Werth
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.,Human Immunodeficiency Virus/Sexually Transmitted Disease Program, Public Health-Seattle & King County, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
36
|
Tordoff DM, Barbee LA, Khosropour CM, Hughes JP, Golden MR. Derivation and Validation of an HIV Risk Prediction Score Among Gay, Bisexual, and Other Men Who Have Sex With Men to Inform PrEP Initiation in an STD Clinic Setting. J Acquir Immune Defic Syndr 2021; 85:263-271. [PMID: 32658131 DOI: 10.1097/qai.0000000000002438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinicians and health departments would ideally undertake targeted efforts to promote HIV pre-exposure prophylaxis (PrEP) and frequent HIV testing using data-based criteria to identify populations at elevated risk for HIV. We developed an HIV risk prediction score for men who have sex with men (MSM) to identify individuals at substantial risk for HIV acquisition. METHODS We created a retrospective cohort of MSM who tested HIV-negative at the sexually transmitted disease clinic in Seattle, WA, from 2001 to 2015, and identified seroconversions using HIV surveillance data. We split the cohort randomly 2:1 into derivation and validation data sets, and used Cox proportional hazards to estimate the hazard of acquiring HIV associated with behavioral and clinical predictors, and the Akaike information criterion to determine which variables to retain in our model. RESULTS Among 16,448 MSM, 640 seroconverted over a 14.3-year follow-up period. The best prediction model included 13 variables and had an area under the receiver operating characteristic curve of 0.73 (95% confidence interval: 0.71 to 0.76), 76% sensitivity, and 63% specificity at a score cutoff ≥11. A simplified model restricted to 2011-2015 included 4 predictors [methamphetamine use, condomless receptive anal intercourse (CRAI), ≥10 partners, and current diagnosis or self-reported gonorrhea/syphilis in the past year]. This model, the Seattle PrEP Score, had an area under the receiver operating characteristic curve of 0.69 (95% confidence interval: 0.64 to 0.73), 62% sensitivity, and 70% specificity. One-year incidence was 0.5% for a score of 0, 0.7% for a score of 1, and 2.1% for scores ≥2. CONCLUSIONS The Seattle PrEP Score was predictive of HIV acquisition and could help clinicians and public health agencies identify MSM who could benefit from PrEP and frequent HIV testing.
Collapse
Affiliation(s)
| | - Lindley A Barbee
- Medicine, University of Washington, Seattle, WA.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| | - Christine M Khosropour
- Departments of Epidemiology.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Matthew R Golden
- Departments of Epidemiology.,Medicine, University of Washington, Seattle, WA.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| |
Collapse
|
37
|
Barbee LA, Soge OO, Khosropour CM, Haglund M, Yeung W, Hughes J, Golden MR. The Duration of Pharyngeal Gonorrhea: A Natural History Study. Clin Infect Dis 2021; 73:575-582. [PMID: 33513222 DOI: 10.1093/cid/ciab071] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pharyngeal gonorrhea is relatively common. However, the duration of untreated pharyngeal gonorrhea is unknown. METHODS From March 2016 to December 2018, we enrolled 140 MSM in a 48-week cohort study. Participants self-collected pharyngeal specimens and completed a survey weekly. Specimens were tested using a nucleic acid amplification test at the conclusion of the study. We estimated the incidence and duration of infection. We defined incident infections as two consecutive positive tests, and clearance as two consecutive negative tests; and, after visual inspection of the data, we reclassified up to two weeks of missing or negative tests as positive if they occurred between 2 episodes of infections. We used Kaplan Meier estimates to define duration of infection. Lastly, we report on the frequency of single positive tests and the time between last negative test and the positive test. RESULTS Nineteen (13.6%) of 140 participants experienced 21 pharyngeal infections (incidence 31.7 per 100 person years (py); 95% CI 20.7 - 48.6 per 100 py). The estimated median duration of pharyngeal gonorrhea was 16.3 weeks (95%CI 5.1-19.7). Twenty-two men had 25 single positive specimens, a median of 7 days (IQR 7-10) following their last negative test. CONCLUSIONS The median duration of untreated pharyngeal gonorrhea is 16 weeks, more than double previous estimates. This long duration of infection likely contributes to high levels of gonorrhea transmission.
Collapse
Affiliation(s)
- Lindley A Barbee
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Olusegun O Soge
- Neisseria Reference Laboratory, Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Micaela Haglund
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Winnie Yeung
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - James Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
38
|
Rowlinson E, Golden MR, Berzkalns A, Thibault C, Barbee LA. Epidemiologic Treatment for Contacts to Neisseria gonorrhoeae and Chlamydia trachomatis Infection in Sexually Transmitted Disease Clinic Patients in Seattle, WA; 1994 to 2018. Sex Transm Dis 2020; 47:665-671. [PMID: 32649579 PMCID: PMC8549494 DOI: 10.1097/olq.0000000000001234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Current Centers for Disease Control and Prevention guidelines recommend that clinicians empirically treat the sex partners of persons with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) infection before confirming that they are infected. It is possible that this practice, known as epidemiologic treatment, results in overtreatment for uninfected persons and may contribute to development of antimicrobial resistance. We sought to quantify the number of patients who received epidemiologic treatment and the proportion of those who were overtreated. METHODS We reviewed records from a municipal sexually transmitted disease clinic in Seattle, WA, from 1994 to 2018 to identify visits by asymptomatic patients seeking care because of sexual contact to a partner with GC and/or CT. We defined overtreatment as receipt of antibiotic(s) in the absence of a positive GC/CT test result and calculated the proportions of contacts epidemiologically treated and tested positive for GC/CT and overtreated in five 5-year periods stratified by sex and gender of sex partner. We used the Cochran-Armitage test to assess for temporal trends. RESULTS The number of asymptomatic contacts epidemiologically treated for GC/CT increased from 949 to 3159 between the 1994-1998 and 2014-2018 periods. In 2014-2018, 55% of persons were overtreated, most (82.1%) of these were men who have sex with men (MSM). The proportion of MSM overtreated decreased from 74% to 65% (P < 0.01), but the total number of overtreated MSM increased from 172 to 1428. DISCUSSION A high proportion of persons receiving epidemiologic treatment of GC/CT are uninfected. The current practice of routinely treating all sex partners of persons with GC/CT merits reconsideration in light of growing antimicrobial resistance.
Collapse
Affiliation(s)
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | - Anna Berzkalns
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | | | - Lindley A. Barbee
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| |
Collapse
|
39
|
Barbee LA, Golden MR, Thibault CS, McNeil CJ, Soge OO. Performance of Patient-collected Specimens for Neisseria gonorrhoeae Culture. Clin Infect Dis 2020; 73:e3196-e3200. [PMID: 32766821 DOI: 10.1093/cid/ciaa1089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neisseria gonorrhoeae culture is necessary to determine antimicrobial resistance, but typically requires specimen collection by clinicians. We sought to determine the sensitivity of patient-collected specimens for N. gonorrhoeae culture. METHODS We performed N. gonorrhoeae cultures on paired, clinician- and patient-collected specimens from the pharynx (n=93), rectum (n=88), endocervix/vagina (n=89), and urethra/urine (46). We calculated the percent concordance and the kappa statistic for paired-specimen results, and determined the test sensitivity for each specimen type using positivity of either specimen in a pair as a gold standard defining the presence of true infection. RESULTS At least one specimen was positive in 26%, 31%, 61% and 3% in the pharynx, rectum, urethra/urine, and endocervix/vagina paired specimens, respectively. Patient- and clinician-collected results were highly concordant at the pharynx (95%, kappa 0.85), rectum (99%, kappa 0.97), urethra/urine (83%, kappa=0.87) and endocervix/vagina (100%, kappa 1.0) (p<0.005 for all comparisons). Patient-collected pharyngeal and rectal swabs and urine were 92%, 96%, 96% sensitive, while clinician-collected specimens at these anatomic sites were 87.5%, 100%, 94% sensitive (p>0.05 for all comparisons). Among 24 urine specimens held for 4 - 22 hours post collection, 100% yielded concordant N. gonorrhoeae culture results compared to immediate processing. CONCLUSIONS Patient- and clinician-collected specimens are comparably sensitive for N. gonorrhoeae culture. These findings suggest that patient-collected specimens could be used to expand the availability of gonococcal antimicrobial resistance testing for both clinical and surveillance purposes.
Collapse
Affiliation(s)
- Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA.,Public Health - Seattle & King County, Seattle, WA, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, USA.,Public Health - Seattle & King County, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Candice J McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, NC, USA
| | - Olusegun O Soge
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
40
|
Khosropour CM, Soge OO, Suchland R, Leipertz G, Unutzer A, Pascual R, Hybiske K, Barbee LA, Manhart LE, Dombrowski JC, Golden MR. Recurrent/Intermittent Vaginal and Rectal Chlamydial Infection Following Treatment: A Prospective Cohort Study Among Female Sexually Transmitted Disease Clinic Patients. J Infect Dis 2020; 220:476-483. [PMID: 30873541 DOI: 10.1093/infdis/jiz113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rectal Chlamydia trachomatis (CT) is common among clinic-attending women, but little is known about clearance and health implications of rectal CT. METHODS At the municipal sexually transmitted disease clinic in Seattle, Washington, in 2017-2018, we enrolled women at high risk for urogenital CT into an 8-week prospective study. Women received standard CT treatment at enrollment. Women self-collected daily rectal and vaginal specimens for nucleic acid amplification tests (NAATs) and completed weekly sexual exposure diaries. We performed CT culture on the enrollment rectal specimen. RESULTS We enrolled 50 women; 13 (26%) tested positive for vaginal (n = 11) and/or rectal (n = 11) CT. Sixty percent of women with rectal CT per NAAT were also culture positive. Median time to CT clearance after azithromycin treatment was 8.0 days for vaginal CT and 7.0 days for rectal CT. Eight women with rectal CT at enrollment had at least 1 rectal CT-positive NAAT after clearance of the initial infection; none reported anal sex. CONCLUSIONS Most NAAT-positive rectal infections were culture positive, suggesting active infection. Time to NAAT clearance of rectal and genital tract CT was similar, and intermittent rectal CT positivity was common in the absence of anal sexual exposure. The cause of recurrent/intermittent rectal CT and the clinical implications of these infections require further study.
Collapse
Affiliation(s)
| | - Olusegun O Soge
- Department of Medicine, University of Washington, Washington.,Department of Global Health, University of Washington, Washington
| | - Robert Suchland
- Department of Medicine, University of Washington, Washington
| | - Gina Leipertz
- Department of Epidemiology, University of Washington, Washington
| | - Anna Unutzer
- Department of Epidemiology, University of Washington, Washington
| | | | - Kevin Hybiske
- Department of Medicine, University of Washington, Washington
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Washington.,HIV/STD Program, Public Health-Seattle & King County, Washington
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Washington.,Department of Global Health, University of Washington, Washington
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Washington.,Department of Medicine, University of Washington, Washington.,HIV/STD Program, Public Health-Seattle & King County, Washington
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Washington.,Department of Medicine, University of Washington, Washington.,HIV/STD Program, Public Health-Seattle & King County, Washington
| |
Collapse
|
41
|
Montaño MA, Dombrowski JC, Dasgupta S, Golden MR, Duerr A, Manhart LE, Barbee LA, Khosropour CM. Changes in Sexual Behavior and STI Diagnoses Among MSM Initiating PrEP in a Clinic Setting. AIDS Behav 2019; 23:548-555. [PMID: 30117076 DOI: 10.1007/s10461-018-2252-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined changes in sexual behavior and sexually transmitted infection (STI) prevalence among 183 men who have sex with men (MSM) initiating pre-exposure prophylaxis (PrEP) at an STD Clinic in Seattle, WA. We used generalized estimating equations to measure changes in sexual behavior during PrEP use, and linked PrEP patient data with STI surveillance data to compare the prevalence of chlamydia, gonorrhea, and early syphilis in the periods prior to and during PrEP use. Reporting never using condoms in the prior 30 days increased (adjusted relative risk = 1.46; 95% confidence interval 1.13, 1.88) at 12 months after PrEP initiation compared to the initial PrEP visit. Reporting unknown status partners in the prior 30 days decreased at 12 months compared to the initial PrEP visit, but there was no change in number of sexual partners or reporting HIV-positive or HIV-negative partners. The percentage of patients diagnosed with any STI while using PrEP (49.2%) was higher than the percentage diagnosed in the 12 months prior to PrEP use (35.0%), likely driven in part by increased STI screening during PrEP use. Among MSM on PrEP, we observed decreases in condom use, and a higher prevalence of STIs during PrEP use compared to prior to PrEP initiation.
Collapse
|
42
|
Kerani RP, Herbeck JT, Buskin SE, Dombrowksi JC, Bennett A, Barash E, Barbee LA, Golden MR. Evidence of Local HIV Transmission in the African Community of King County, Washington. J Immigr Minor Health 2018; 19:891-896. [PMID: 27395379 DOI: 10.1007/s10903-016-0458-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the frequency of ongoing HIV transmission within U.S. African immigrant communities. We used HIV surveillance and partner services data to describe African-born persons newly reported with HIV infection in King County (KC), WA from 1/1/2010 to 12/31/2013. We performed phylogenetic clustering analysis of HIV-1 pol to identify putative transmission events within this population. From 2010 to 2013, 1148 KC adults were reported with HIV, including 102 (9 %) born in Africa. Forty-one African-born cases were interviewed and reported diagnosis after arrival in the U.S. Fourteen (34 %) reported ≥1 negative test prior to diagnosis, and 9 (26 %) reported ≥1 negative test after U.S. arrival. Pol genotypes were available for seven of these nine. For two of these seven, a KC case was the nearest phylogenetic neighbor; two others were infected with subtype B virus. We found substantial evidence of ongoing HIV transmission in the African community of KC.
Collapse
Affiliation(s)
- Roxanne P Kerani
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan E Buskin
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julia C Dombrowksi
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Amy Bennett
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Elizabeth Barash
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Lindley A Barbee
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
43
|
Barbee LA, Soge OO, Katz DA, Dombrowski JC, Holmes KK, Golden MR. Increases in Neisseria gonorrhoeae With Reduced Susceptibility to Azithromycin Among Men Who Have Sex With Men in Seattle, King County, Washington, 2012-2016. Clin Infect Dis 2018; 66:712-718. [PMID: 29045604 PMCID: PMC5848236 DOI: 10.1093/cid/cix898] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022] Open
Abstract
Background Antimicrobial-resistant Neisseria gonorrhoeae is a major public health threat. The Centers for Disease Control and Prevention (CDC) recommends ceftriaxone 250 mg plus azithromycin (AZM) 1 g for gonorrhea treatment. Resistance to AZM could affect gonorrhea control efforts. Methods Using gonococcal isolates collected at the Public Health-Seattle & King County (PHSKC) Sexually Transmitted Disease (STD) Clinic from 2012 to 2016, focusing on 2014-2016, we compared cases with the CDC AZM alert value minimum inhibitory concentration (MIC) (≥2 µg/mL) to those with AZM MIC ≤1 µg/mL, antimicrobial susceptibility profiles and clinical outcomes. Results In 2012 and 2013, none of the 263 patients from whom we isolated N. gonorrhoeae from the urethra were infected with organisms with an AZM MIC ≥2 µg/mL. Between 2014 and 2016, 4.4% of 926 gonorrhea cases demonstrated reduced susceptibility to AZM; 93% of these cases occurred among men who have sex with men (MSM). Among MSM, 5.0% of 2014-2016 cases demonstrated reduced susceptibility to AZM. No AZM alert value isolates had concomitant cephalosporin resistance. There were 2 potential treatment failures: 1 pharyngeal infection treated with AZM 2 g alone, and 1 pharyngeal infection that persisted after study drug. Conclusions Among MSM with gonorrhea in Seattle, 5% have gonorrhea with reduced susceptibility to AZM. The World Health Organization recommends changing treatment guidelines when >5% of isolates are resistant to a recommended drug. The emergence of resistant AZM gonorrhea should prompt reconsideration of current treatment recommendations, and highlights the need for new therapies for gonorrhea.
Collapse
Affiliation(s)
- Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington
- HIV/STD Program, Public Health–Seattle & King County
| | - Olusegun O Soge
- Department of Global Health
- Neisseria Reference Laboratory and Chlamydia Laboratory
| | - David A Katz
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington
- HIV/STD Program, Public Health–Seattle & King County
| | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington
- HIV/STD Program, Public Health–Seattle & King County
- Department of Epidemiology, University of Washington, Seattle
| | - King K Holmes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington
- HIV/STD Program, Public Health–Seattle & King County
- Department of Global Health
- Department of Epidemiology, University of Washington, Seattle
| | - Matthew R Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington
- HIV/STD Program, Public Health–Seattle & King County
- Department of Epidemiology, University of Washington, Seattle
| |
Collapse
|
44
|
Barbee LA, Golden MR. Editorial Commentary: When to Perform a Test of Cure for Gonorrhea: Controversies and Evolving Data: Table 1. Clin Infect Dis 2016; 62:1356-9. [DOI: 10.1093/cid/ciw142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
|
45
|
Barbee LA, Soge OO, Dombrowski JC, Katz DA, Holmes KK, Golden MR. 001.2 Azithromycin-resistantneisseria gonorrhoeaein men who have sex with men (msm) in seattle, washington: 2014–2015. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
46
|
Barbee LA, Khosropour CM, Dombrowski JC, Golden MR. 007.4 Incident hiv associated with rectal gonorrhoea (gc) and chlamydia (ct) independent of sexual behaviour in men who have sex with men (msm). Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
47
|
Khosropour CM, Barbee LA, Dombrowski JC, Kerani RP, Katz DA, Swanson F, Golden MR. P11.05 Proportion of hiv and sexually transmitted infection (sti) cases among men who have sex with men (msm) attributable to serosorting. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect 2015; 92:155-60. [PMID: 26297719 DOI: 10.1136/sextrans-2015-052214] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/04/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. METHODS We conducted a case-control study of MSM attending Public Health-Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel-Haenszel OR estimates. RESULTS Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal urethritis, 31.4% of chlamydial urethritis and 35.9% non-gonococcal, non-chlamydial urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal urethritis, chlamydial urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. CONCLUSIONS The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
Collapse
Affiliation(s)
- Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program
| | | | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program Department of Epidemiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
49
|
|
50
|
Barbee LA, Soge OO, Holmes KK, Golden MR. In vitro synergy testing of novel antimicrobial combination therapies against Neisseria gonorrhoeae. J Antimicrob Chemother 2014; 69:1572-8. [PMID: 24468865 PMCID: PMC4019328 DOI: 10.1093/jac/dkt540] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/18/2013] [Accepted: 12/22/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antimicrobial-resistant Neisseria gonorrhoeae is a major public health threat. Current CDC treatment guidelines for uncomplicated gonorrhoea recommend only ceftriaxone plus either azithromycin or doxycycline. Additional treatment options are needed. METHODS We used antibiotic gradient synergy testing (the Etest) to evaluate antimicrobial combinations that included a third-generation cephalosporin (cefixime or ceftriaxone) plus azithromycin, doxycycline, gentamicin, rifampicin or fosfomycin. We tested each combination against 28 clinical N. gonorrhoeae isolates and four control strains of varying susceptibility profiles, and compared the results with those obtained using combination antimicrobial testing using agar dilution. We calculated the fractional inhibitory concentration index (FICI) for each combination to determine synergy, the results being interpreted as follows: FICI ≤ 0.5 = synergy; FICI > 4.0 = antagonism; and FICI > 0.5-4 = indifference. RESULTS The combinations of a third-generation cephalosporin plus azithromycin, doxycycline, rifampicin, gentamicin or fosfomycin produced FICIs of indifference. The Etest and agar dilution methods produced comparable results. CONCLUSIONS Combinations of ceftriaxone plus rifampicin, gentamicin or fosfomycin may warrant further clinical investigation as treatments for gonorrhoea. Using the Etest for synergy testing is a viable method that has practical advantages over agar dilution.
Collapse
Affiliation(s)
- Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Olusegun O Soge
- Neisseria Reference Laboratory, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Center for AIDS and STD, University of Washington, Seattle, WA, USA
| | - King K Holmes
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA Neisseria Reference Laboratory, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Center for AIDS and STD, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA Center for AIDS and STD, University of Washington, Seattle, WA, USA
| |
Collapse
|