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Fluoroquinolone Resistance in Neisseria gonorrhoeae After Cessation of Ciprofloxacin Usage in San Francisco: Using Molecular Typing to Investigate Strain Turnover

imageBackground: Ciprofloxacin resistance (CipR) among gonococcal strains in San Francisco (SF) increased between 2001 and 2006 and decreased between 2007 and 2009. Molecular typing of isolates obtained from 2005 to 2009 was performed to elucidate changes in CipR prevalence. Methods: A total of 2526 samples were collected at the SF City Clinic between 2001 and 2009. Minimum inhibitory concentrations to ciprofloxacin were obtained by agar dilution. Prevalences of CipR strains were determined, with corresponding confidence intervals (CIs). Between 2005 and 2009, 460 isolates were selected for molecular typing using Neisseria gonorrhoeae multiantigen sequence typing. Results: Between 2001 and 2006, the prevalence of CipR increased from 3.4% (95% CI, 1.3%–5.4%) to 44% (95% CI, 39%–50%). However, in 2007 prevalence began to decrease, reaching 9.6% (95% CI, 6.0%–13%) by 2009. Of the 203 strain types identified between 2005 and 2009, 126 genogroups of closely related strain types were formed (varying by ≤1% at both target loci). Levels of CipR within the data set correlate with the prevalence of 3 major genogroups (G): G437, G1407, and G3112. Conclusions: Molecular typing reveals that CipR within the tested population is maintained by strain turnover between resistant genogroups. Despite early recommendation in 2002 to stop ciprofloxacin use in California, CipR in SF increased through 2006. The subsequent decrease in CipR corresponds with the 2007 national recommendation to cease ciprofloxacin treatment of gonorrhea, which suggests that national recommendations are potentially more effective at reducing CipR than regional recommendations in areas with high strain turnover. 02/01/2015 01:00 AM
 

American Indians, Substance Use, and Sexual Behavior: Do Predictors of Sexually Transmitted Infections Explain the Race Gap Among Young Adults?

imageBackground: In this study, we examined whether substance use and risky sexual behaviors predicted sexually transmitted infections (STIs) among American Indian (AI) and white young adults. Furthermore, we explored whether these factors explained the race disparity in STIs. Methods: We conducted a cross-sectional analysis of wave 3 of the National Longitudinal Study of Adolescent Health collected in 2001 to 2002. Young adult participants (aged 18–26 years) provided urine specimens that were tested for chlamydia, gonorrhea, and trichomoniasis infection. Estimates of the association between AI with any STI were adjusted for sexual and other risk behavior correlates using multivariate regression techniques. Results: Nine percent of AIs (n = 367) and 3.6% of whites (n = 7813) tested positive for an STI. Race differences were found for substance use (injection drug use, 3.1% AI vs. 1.3% white; alcohol use frequency, 2.01% AI vs. 2.5% white; binge drinking frequency, 1.25% AI vs. 1.53% white). Among sexually active respondents, AIs were more likely to have paid for sex (9%) than whites (3%). After adjustment, early sexual initiation (adjusted odds ratio, 1.69; 95% confidence interval, 1.19–2.41), no condom use at last sex (adjusted odds ratio, 1.47; 95% confidence interval, 1.08–2.01), and AI race (adjusted odds ratio, 2.45; 95% confidence interval 1.46–4.11) were significantly associated with having an STI. Conclusions: Individual-level sexual and other risk behaviors do not fully explain disparities in STIs among AIs compared with white young adults. Further examination of network and community factors is needed to explain these disparities. 02/01/2015 01:00 AM
 

Generalized Lymphadenopathy and 18-Fluorine Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Targeting Diagnostic Intervention, Characterizing Disease Extent, and Assessing Treatment Efficacy in Syphilis

imageAbstract: 18-Fluorine fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has been shown to have use in the diagnosis of inflammatory and infectious diseases in addition to its primary use in cancer. We describe a case of early neurosyphilis that initially presented as symmetric, generalized lymphadenopathy on PET/CT. We conclude that PET/CT may play a role in evaluating targeted diagnostic interventions, disease extent, and treatment efficacy for disseminated syphilis. 02/01/2015 01:00 AM
 

Correlates of Human Papillomavirus Vaccine Coverage: A State-Level Analysis

imageBackground: We tested the hypothesis that states with higher rates of cancers associated with human papillomavirus (HPV) would have lower HPV vaccine coverage. Methods: We gathered state-level data on HPV-related cancer rates and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered state-level data on demographic composition and contact with the health care system. We calculated Pearson correlations for these ecological relationships. Results: Human papillomavirus vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r = −0.29 and −0.46, respectively). In addition, vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r = −0.30). Other cancer rates were associated with HPV vaccine initiation and follow-through among girls, but not among boys. Human papillomavirus vaccine initiation among girls was lower in states with higher proportions of non-Hispanic black residents and lower proportions of higher-income residents. Human papillomavirus vaccine follow-through was higher in states with greater levels of adolescents’ contact with the health care system. Conclusions: Human papillomavirus vaccine coverage for girls was lower in states with higher HPV-related cancer rates. Public health efforts should concentrate on geographic areas with higher cancer rates. Strengthening adolescent preventive health care use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage. 02/01/2015 01:00 AM
 

Male Human Papillomavirus Vaccine Acceptance Is Enhanced by a Brief Intervention that Emphasizes Both Male-Specific Vaccine Benefits and Altruistic Motives

imageBackground: Although female human papillomavirus (HPV) vaccine acceptance has been widely studied, research on vaccine uptake among boys and men is needed. Male HPV vaccination can provide both individual and community-level benefit by offering recipients personal health protection while concurrently minimizing HPV transmission and ultimately providing female health protection. As such, male vaccine acceptance may be enhanced by emphasizing both altruistic motives (female health protection) and personal health benefits. Methods: A university-based sample of young men completed computer-administered surveys and viewed informational interventions that varied in the inclusion or exclusion of altruistic motives and in the level of emphasis on male-specific HPV-related illnesses and vaccine benefits. Human papillomavirus vaccine acceptance was assessed immediately after intervention. Results: Participants who received the intervention emphasizing both altruistic motives and male-specific information endorsed the greatest vaccine acceptance (mean [SD], 3.6 [1.0]). Conclusion: Provider and community-level interventions highlighting both altruistic motives and personal health vaccine benefits may enhance HPV vaccine uptake among young men. 02/01/2015 01:00 AM
 

Substantial Increases in Chlamydia and Gonorrhea Positivity Unexplained by Changes in Individual-Level Sexual Behaviors Among Men Who Have Sex With Men in an Australian Sexual Health Service From 2007 to 2013

imageBackground: To determine the risk-adjusted temporal trend of gonorrhea and chlamydia positivity and associated risk behaviors among men who have sex with men (MSM) attending a sexual health clinic in Melbourne in Australia. Methods: Gonorrhea and chlamydia positivity by anatomical site adjusted for year of test, age, number of sexual partners, and condom use among MSM attending Melbourne Sexual Health Centre from 2007 to 2013 were calculated using generalized estimating equation regression models. Results: A total of 12,873 MSM were included with a median age of 30.0 years. The proportion with pharyngeal, urethral, and anal gonorrhea was 1.7%, 2.3%, and 2.9%, respectively. The adjusted odds of gonorrhea positivity increased by 9% (95% confidence interval [CI], 3%–15%), 11% (95% CI, 6%–17%), and 12% (95% CI, 7%–17%) per year, respectively. The proportion of MSM who were infected with anal chlamydia was 5.6%, with an average increase of 6% (95% CI, 3%–10%) per year; however, no significant change was observed in urethral chlamydia positivity (adjusted odds ratio, 1.02; 95% CI, 0.98–1.06). Increases in gonorrhea and chlamydia positivity were primarily restricted to MSM who reported more than 10 partners in 12 months. The number of partners in the last 12 months fell from 16.6 to 10.5, whereas consistent condom use with casual partners decreased from 64.6% to 58.9% over the study period. Conclusions: Gonorrhea and chlamydia have increased among MSM despite the decrease in the number of sexual partners and are occurring primarily in MSM with high numbers of partners and persist after adjusting for known risk factors, suggesting that unmeasured factors (e.g., more assortative mixing patterns) may explain the observed changes. 02/01/2015 01:00 AM
 

Estimating HIV Protective Effects of Method Adherence With Combinations of Preexposure Prophylaxis and Condom Use Among African American Men Who Have Sex With Men

imageBackground: Prevention of sexually acquired HIV infection now includes both consistent condom use and daily use of oral antiretroviral preexposure prophylaxis (PrEP). Persons at substantial HIV risk can now use one or both prevention methods, but a combined HIV protective effect has not been assessed. Methods: We use deterministic models to examine the impact of method adherence and rates of PrEP and male condom use on number of anticipated HIV infections. Analyses were based on hypothetical cohorts of 10,000 African American men who have sex with men (AAMSM), a population with the highest HIV incidence in the United States. Parameters used in the model (condom effectiveness, PrEP effectiveness, HIV incidence) were based on published findings. Results: Among AAMSM who never use PrEP, an estimated 323 annual HIV infections would occur among those who always use condoms, 1007 among sometimes condom users, and 1094 among never condoms users. Among AAMSM who never (or inconsistently) use condoms, 295 (272) infections would occur among those who report at least 90% PrEP adherence and 744 (684) infection occur with less than 50% adherence. Among AAMSM who are consistently (or sometimes) taking PrEP, the highest protection is seen with consistent condom use, 87 (220) HIV infections and 92.0% (79.9%) prevention effectiveness. Discussion: Among AAMSM with inconsistent or never condom use, the addition of PrEP at either modest or high adherence can increase HIV protection. For consistent condom users, any PrEP use can increase HIV protection. These analyses provide an approach for rethinking HIV risk management by calculating combined HIV protective effects of using one or more effective prevention methods. 02/01/2015 01:00 AM
 

A Longitudinal Study of Human Papillomavirus 16 L1, E6, and E7 Seropositivity and Oral Human Papillomavirus 16 Infection

imageBackground: Individuals with human papillomavirus (HPV) infections can develop IgG antibodies to HPV proteins including the L1 capsid and E6 and E7 oncoproteins. Evidence on whether L1 antibodies reduce the risk of cervical HPV infection is mixed, but this has not been explored for oral HPV infections. Antibodies to HPV16’s E6 oncoprotein have been detected in some oropharyngeal cancer cases years before cancer diagnosis, but it is unknown if these antibodies are associated with oral HPV16 DNA. Methods: Enzyme-linked immunosorbent assays tested for serum antibodies to HPV16’s L1 capsid in 463 HIV-infected and 293 HIV-uninfected adults, and for antibodies to recombinantly expressed E6 and E7 oncoproteins to HPV16 in 195 HIV-infected and 69 HIV-uninfected cancer-free participants at baseline. Oral rinse samples were collected semiannually for up to 3 years and tested for HPV DNA using PGMY 09/11 primers. Adjusted Poisson, logistic, and Wei-Lin-Weissfeld regression models were used. Results: Human papillomavirus 16 L1 seroreactivity did not reduce the subsequent risk of incident oral HPV16 infection in unadjusted (hazard ratio, 1.4; 95% confidence interval, 0.59–3.3) or adjusted (adjusted hazard ratio = 1.1; 95% confidence interval, 0.41–3.0) analysis. Antibodies to HPV16 E6 and E7 oncoproteins were detected in 7.6% and 3.4% of participants, respectively, but they were not associated with baseline oral HPV16 DNA prevalence or oral HPV16 persistence (each P > 0.40). Conclusions: Naturally acquired HPV16 L1 antibodies did not reduce the risk of subsequent oral HPV16 infection. Human papillomavirus 16 E6 and E7 seropositivity was not a marker for oral HPV16 infection in this population without HPV-related cancer. 02/01/2015 01:00 AM