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State Variation in Enrollment Gap, Sexual Activity, and Chlamydia Testing Rate Among Young Medicaid Women

imageObjectives: To assess state variations in eligibility criteria based on enrollment length and sexual activity on chlamydia testing rates among Medicaid female enrollees aged 15 to 25 years and potential impact of the representatives of testing rates. Methods: We used 2010 Medicaid Analytic eXtract to estimate and compare the overall and state-level prevalence of gaps in coverage of ≥ 2 consecutive months, service utilization associated with sexuality, and chlamydia testing rates among Medicaid female enrollees aged 15 to 25 years who had ≥ 1 month of the full scope of Medicaid benefits and had ≥ 1 health service claim. The chlamydia testing rate was calculated as the proportion of sexually active Medicaid female enrollees who received a chlamydia test in 2010. Results: Of 5.7 million women aged 15 to 25 years enrolled in Medicaid in 2010, 42.3% had a 2-month gap of enrollment coverage in 2010. The proportion of women who had a 2-month gap varied from 26.1% to 73.2% across states. The proportion of women identified as sexually active was 59.8% among women who had a 2-month gap and 57.1% among women who had no 2-month gap. The chlamydia testing rate was 44.0% among sexually active women with a 2-month gap and 44.2% among sexually active women without a 2-month gap. Eleven states had ≥10% difference in sexual activity or chlamydia testing rates between women with a 2-month gap and women without a 2-month gap. Conclusions: States which exclude a substantial proportion of Medicaid enrollees from inclusion in the chlamydia testing denominator may have less representative testing estimates because those excluded tend to be women aged 19 to 25 years. 10/01/2016 01:00 AM

Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis

imageBackground: Three recent prospective studies have suggested that the 1-g dose of azithromycin for Chlamydia trachomatis (Ct) was less effective than expected, reporting a wide range of treatment failure rates (5.8%–22.6%). Reasons for the disparate results could be attributed to geographic or methodological differences. The purpose of this study was to reexamine the studies and attempt to harmonize methodologies to reduce misclassification as a result of false positives from early test-of-cure (TOC) or reinfection as a result of sexual exposure rather than treatment failure. Methods: Men who had sex with women, who received 1-g azithromycin under directly observed therapy for presumptive treatment of nongonococcal urethritis with confirmed Ct were included. Baseline screening was performed on urethral swabs or urine, and TOC screening was performed on urine using nucleic acid amplification tests. Posttreatment vaginal sexual exposure was elicited at TOC. Data from the 3 studies were obtained and reanalyzed. Rates of Ct retest positive were examined for all cases, and a sensitivity analysis was conducted to either reclassify potential false positives/reinfections as negative or remove them from the analysis. Results: The crude treatment failure rate was 12.8% (31/242). The rate when potential false positives/reinfections were reclassified as negative was 6.2% (15/242) or when these were excluded from analysis was 10.9% (15/138). Conclusions: In these samples of men who have sex with women with Ct-related nongonococcal urethritis, azithromycin treatment failure was between 6.2% and 12.8%. This range of failure is lower than previously published but higher than the desired World Health Organization's target chlamydia treatment failure rate of < 5%. 10/01/2016 01:00 AM

Reconsidering the Use of Azithromycin for Chlamydial Urethritis

No abstract available 10/01/2016 01:00 AM

Implementation of Oral and Rectal Gonococcal and Chlamydial Nucleic Acid Amplification-Based Testing as a Component of Local Health Department Activities

imageAbstract: From January 1, 2014, to May 31, 2015, 452 individuals received extragenital nucleic acid amplification-based Neisseria gonorrhoeae and Chlamydia trachomatis testing through public health venues. Seventy-four individuals (16%) tested positive for Neisseria gonorrhoeae and/or Chlamydia trachomatis at an extragenital site and 40 (54%) would not have been effectively diagnosed and treated in the absence of extragenital testing. 10/01/2016 01:00 AM

Gonorrhea in Indonesia: High Prevalence of Asymptomatic Urogenital Gonorrhea but No Circulating Extended Spectrum Cephalosporins-Resistant Neisseria gonorrhoeae Strains in Jakarta, Yogyakarta, and Denpasar, Indonesia

imageBackground: Little is known about the epidemiology of asymptomatic urogenital gonorrhea and antimicrobial susceptibility of Neisseria gonorrhoeae (NG) strains circulating in Indonesia. We studied these issues in 3 large Indonesian cities. Methods: In 2014, participants were recruited from sexually transmitted infection clinics and through outreach in Jakarta, Yogyakarta, and Denpasar. Neisseria gonorrhoeae detection in genital specimens was performed with NG-qPCR at the Public Health Service in Amsterdam. Antimicrobial susceptibility was investigated using the Etest. Results: Among 992 participants, 781 were asymptomatic and included in the risk factors analysis: 439 (56.2%) men, 258 (33.0%) women, and 84 (10.8%) transwomen. They differed significantly in age and were mostly men who have sex with men (35.2%) and female sex workers (29.3%). Overall, 175 (22.4%) asymptomatic participants had a positive NG-qPCR result. Factors positively associated with asymptomatic urogenital gonorrhea were being recruited through outreach (vs clinic-based), inconsistent condom use, and being divorced/widowed (vs single). Among 79 urogenital cultured isolates derived from 27 symptomatic and 52 asymptomatic participants, all isolates were susceptible to ceftriaxone and cefixime, and 98.7% of isolates were susceptible to azithromycin. In contrast, resistance to doxycycline (98.7%) and ciprofloxacin (97.4%) was common. Conclusions: Prevalence of asymptomatic urogenital gonorrhea among Indonesian key populations is very high. Little to no resistance against extended spectrum cephalosporins and azithromycin was observed. However, almost all isolates were resistant to doxycycline and ciprofloxacin. Strengthening outreach sexually transmitted infections services, composing guidelines to screen asymptomatic individuals, and implementing periodical antimicrobial resistance surveillance are recommended. 10/01/2016 01:00 AM

Trichomonas vaginalis and Human Immunodeficiency Virus Coinfection Among Women Under Community Supervision: A Call for Expanded T. vaginalis Screening

imageBackground: The United States has a large community supervision population, a growing number of whom are women. Trichomonas vaginalis infection is strongly associated with an increased risk of human immunodeficiency virus (HIV) acquisition and transmission, particularly among women, but there is a paucity of research on HIV and T. vaginalis co-infection among women under community supervision. Methods: This article examines the prevalence of T. vaginalis infection and T. vaginalis and HIV coinfection at baseline among women under community supervision in New York City. It also examines the 12-month outcomes of women treated for T. vaginalis. Women received biological tests for HIV and T. vaginalis at baseline and 12 months follow-up. Results: Of the 333 women tested for sexually transmitted infections, 77 women (23.1%) tested positive for T. vaginalis at baseline and 44 (13.3%) were HIV positive. Human immunodeficiency virus–positive women had significantly higher rates of T. vaginalis infection than HIV-negative women (36.4% vs 21.3%, P ≤ 0.05). Sixteen women (4.8%) were coinfected with T. vaginalis and HIV. Of the 77 women who were positive for T. vaginalis infection at baseline, 58 (75.3%) received treatment by a health care provider. Of those who received treatment, 17 (29.3%) tested positive for T. vaginalis at the 12-month follow-up. Conclusions: Given the high prevalence of T. vaginalis among this sample of women, particularly among HIV-positive women, and high levels of reinfection or persistent infection, screening for T. vaginalis among women under community supervision may have a substantial impact on reducing HIV acquisition and transmission among this high-risk population. 10/01/2016 01:00 AM

Clinical Evaluation of 2 Point-of-Care Lateral Flow Tests for the Diagnosis of Syphilis

imageAbstract: A diagnostic performance study comparing the only Food and Drug Administration–approved, point-of-care (POC) treponemal test (Syphilis Health Check) and the World Health Organization pre-qualified SD Bioline POC treponemal test against a treponemal hemagglutination test (TPHA) and a sequential algorithm of nontreponemal rapid plasma reagin and TPHA found both POC tests had >85% sensitivity compared with the TPHA and >85% sensitivity and >95% specificity compared with the rapid plasma reagin and TPHA standards. 10/01/2016 01:00 AM

Development and Validation of the Human Papillomavirus Attitudes and Beliefs Scale in a National Canadian Sample

imageBackground: Parents' human papillomavirus (HPV) vaccination decision-making is strongly influenced by their attitudes and beliefs toward vaccination. To date, psychometrically evaluated HPV vaccination attitudes scales have been narrow in their range of measured beliefs and often limited to attitudes surrounding female HPV vaccination. The study aimed to develop a comprehensive, validated and reliable HPV vaccination attitudes and beliefs scale among parents of boys. Methods: Data were collected from Canadian parents of 9- to 16-year-old boys using an online questionnaire completed in 2 waves with a 7-month interval. Based on existing vaccination attitudes scales, a set of 61 attitude and belief items were developed. Exploratory and confirmatory factor analyses were conducted. Internal consistency was evaluated with Cronbach's α and stability over time with intraclass correlations. Results: The HPV Attitudes and Beliefs Scale (HABS) was informed by 3117 responses at time 1 and 1427 at time 2. The HABS contains 46 items organized in 9 factors: Benefits (10 items), Threat (3 items), Influence (8 items), Harms (6 items), Risk (3 items), Affordability (3 items), Communication (5 items), Accessibility (4 items), and General Vaccination Attitudes (4 items). Model fit at time 2 were: χ2/df = 3.13, standardized root mean square residual = 0.056, root mean square error approximation (confidence interval) = 0.039 (0.037–0.04), comparative fit index = 0.962 and Tucker-Lewis index = 0.957. Cronbach’s αs were greater than 0.8 and intraclass correlations of factors were greater than 0.6. Conclusions: The HABS is the first psychometrically-tested scale of HPV attitude and beliefs among parents of boys available for use in English and French. Further testing among parents of girls and young adults and assessing predictive validity are warranted. 10/01/2016 01:00 AM