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Neisseria gonorrhoeae and Chlamydia trachomatis Among Women Reporting Extragenital Exposures

imageBackground: The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women. Methods: All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections. Results: A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤18 years was the strongest predictor of extragenital infections in women. Conclusions: Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women. 05/01/2015 01:00 AM

Do Women Need Screening for Extragenital Gonococcal and Chlamydial Infections?

No abstract available 05/01/2015 01:00 AM

Evaluation of a New Website Design for Iwantthekit for Chlamydia, Gonorrhea, and Trichomonas Screening

imageAbstract: The provides Internet-based, at-home sexually transmitted infection screening. The Web site implemented an automated test result access system. To evaluate potential deleterious effects of the new system, we analyzed demographics, Web site usage, and treatment. The post–Web site design captured more participant information and no decrease in requests, kit return, or treatment adherence. 05/01/2015 01:00 AM

Behavioral, Immunologic, and Virologic Correlates of Oral Human Papillomavirus Infection in HIV-Infected Youth

imageBackground: Little is known about the epidemiology or risk factors for oral human papillomavirus (HPV) in HIV-infected youth. The objectives of this study were to determine the prevalence and correlates of oral HPV infection and to explore the association between HPV vaccination and oral infection in HIV-infected youth. Methods: Youth 12 to 24 years of age with behaviorally acquired HIV were recruited for this cross-sectional study. Procedures involved medical chart review, survey, and collection of an oral rinse sample. Univariable and multivariable logistic regression models were used to determine whether demographic, behavioral, immunologic, and virologic factors and history of vaccination were significantly associated with oral HPV infection. Results: Mean age of the 272 participants was 21.5 years; 64% were non-Hispanic black and 20.2% were Hispanic; and 10.8% of men compared with 20.3% of women were fully vaccinated. Human papillomavirus prevalence was 19.7% in men and 18.6% in women (P = 1.0). Only men were positive for vaccine-type HPV: 5.6% were positive for HPV-6, HPV-11, HPV-16, and/or HPV-18, and 4.2% were positive for HPV-16 and/or HPV-18. Among men who were fully vaccinated, none were positive for HPV-6, HPV-11, HPV-16, and/or HPV-18, compared with 12 (6.3%) of men who were not fully vaccinated (P = 0.37). Two variables were marginally associated with oral HPV (P < 0.10): marijuana use in the previous 3 months and lower CD4+ T-cell count. Conclusions: Prevalence rates of oral HPV were relatively high in this population of HIV-infected youth and were similar in male and female youth. No fully vaccinated men were infected with vaccine-type HPV. 05/01/2015 01:00 AM

Seroprevalence and Seroincidence of Herpes Simplex Virus (2006–2010), Syphilis (2006–2010), and Vaccine-Preventable Human Papillomavirus Subtypes (2000–2010) Among US Military Personnel

imageBackground: Sexually transmitted infections have historically been burdensome in military populations. We describe the seroprevalence and seroincidence of vaccine-preventable human papillomavirus (VP-HPV) subtypes in a sample of 200 servicemen, along with the seroprevalence and seroincidence of herpes simplex virus (HSV-1/2) and syphilis in a sample of 200 men and 200 women. Methods: Sera from 200 men, along with associated demographic data, were obtained and tested for HPV serotypes at service entry and 10 years later. Similarly, 200 active-duty men and 200 active-duty women were tested for HSV-1/2 at entry to service and 4 years later. Results: The baseline prevalence of VP-HPV subtypes was 14.5%, and cumulative seroincidence of new infection was 34% over a 10-year period (n = 68). Of these, 63% (n = 43) represented HPV-6, HPV-11, or both; 18% of new infections were either HPV-16 or HPV-18, and 19% (n = 13) were a mixture of all 4 strains. At entry to military service, 33.5% of men were seropositive for HSV-1 and 1.5% were positive for HSV-2; seroincidence was 3.4 and 1.1 per 100 person-years, respectively. Among women, 39% were seropositive for HSV-1 and 4.0% for HSV-2; seroincidence was 5.5 and 3.3 per 100 person-years, respectively. There were 2 prevalent and 3 incident cases of syphilis. Conclusions: Sexually transmitted infections in military populations are highly prevalent, incident, and epidemiologically distinct. Our data show the rates of HPV and HSV-1/2 acquisition that are higher than those seen in the general public, again highlighting the need for continued preventive efforts. Consideration of universal HPV vaccination among men is warranted. 05/01/2015 01:00 AM

Relationship Between Community-Level Alcohol Outlet Accessibility and Individual-Level Herpes Simplex Virus Type 2 Infection Among Young Women in South Africa

imageBackground: Exposure to alcohol outlets may influence sexual health outcomes at the individual and community levels. Visiting alcohol outlets facilitates alcohol consumption and exposes patrons to a risky environment and network of potential partners, whereas the presence of alcohol outlets in the community may shift social acceptance of riskier behavior. We hypothesize that living in communities with more alcohol outlets is associated with increased sexual risk. Methods: We performed a cross-sectional analysis in a sample of 2174 South African schoolgirls (ages 13–21 years) living across 24 villages in the rural Agincourt subdistrict, underpinned by long-term health and sociodemographic surveillance. To examine the association between number of alcohol outlets in village of residence and individual-level prevalent herpes simplex virus type 2 (HSV-2) infection, we used generalized estimating equations with logit links, adjusting for individual- and village-level covariates. Results: The median number of alcohol outlets per village was 3 (range, 0–7). Herpes simplex virus type 2 prevalence increased from villages with no outlets (1.4% [95% confidence interval, 0.2–12.1]), to villages with 1 to 4 outlets (4.5% [3.7–5.5]), and to villages with more than 4 outlets (6.3% [5.6, 7.1]). An increase of 1 alcohol outlet per village was associated with an 11% increase in the odds of HSV-2 infection (adjusted odds ratio [95% confidence interval], 1.11 [0.98–1.25]). Conclusions: Living in villages with more alcohol outlets was associated with increased prevalence of HSV-2 infection in young women. Structural interventions and sexual health screenings targeting villages with extensive alcohol outlet environments could help prevent the spread of sexually transmitted infections. 05/01/2015 01:00 AM

It Is Complicated: Sexual Partner Characteristic Profiles and Sexually Transmitted Infection Rates Within a Predominantly African American Population in Mississippi

imageBackground: Mississippi has among the highest prevalence of sexually transmitted infections (STIs) in the United States. Understanding sexual networks can provide insight into risk factors for transmission and guide prevention interventions. Methods: Participants included 1437 primarily African American (95%) adults presenting for care at an STI clinic in Jackson, Mississippi. Latent class analysis identified underlying population subgroups with unique patterns of response on a comprehensive set of 14 sexual partner variables, such as living with or having a child with a partner, partner dependence and trust, 1-time sexual encounters, multiple main partners, substance use, sexual concurrency, and incarceration. Classes were compared on participant age, sex, sexual orientation, public assistance, lifetime partners, relationship status, and self-reported past-year STI. Results: Three classes emerged. Class 1 (n = 746) participants were less dependent on partners and less likely to live with or have a child with a partner. Class 2 participants (n = 427) endorsed multiple STI risk factors, including partner incarceration, 6 or more lifetime partners, sexual concurrency, 1-time sexual encounters, and substance use at last sex. Class 3 participants (n = 226) were more likely to be in dependent, committed relationships with children. Class 2 had a higher proportion of self-report past-year STIs (36.7%) compared with classes 1 (26.6%) and 3 (26.1%). Conclusions: Certain partner factors such as incarceration, substance use, and concurrency may contribute to increased STI risk. Partner factors may be useful proxies for STI risks and could be useful questions to include in screening questionnaires in clinical settings. 05/01/2015 01:00 AM

Incidence, Persistence, and Determinants of Human Papillomavirus Infection in a Population of Inuit Women in Northern Quebec

imageBackground: To study the incidence, persistence, and determinants of human papillomavirus (HPV) infection in a population of Inuit women from Nunavik, Quebec, by overall HPV infection, Alphapapillomavirus (α) species, and oncogenic risk grouping. Methods: We recruited a cohort of Inuit women living in communities in Nunavik when they presented for routine care. Baseline sociodemographic and lifestyle characteristics were collected and cervical specimens collected throughout the follow-up period were tested for HPV-DNA using the PGMY Line-blot assay. Results: A total of 416 women were eligible for this analysis. Almost 40% of women acquired a new any-type HPV infection, at a rate of 14.44 infections per 1000 women-months. High-risk HPV infections were acquired at a higher rate than low-risk infections and persisted for longer durations. Multivariate logistic regression found age and marital status to be the most important predictors of overall HPV infection acquisition. Over the study period, 36.1% of women cleared their incident infections. The cumulative incidence of any HPV type at 12 months was 10.3% (95% confidence interval, 7.9–13.1). No predictors of clearance were found. Conclusions: The high incidence and persistence of HPV infections found demonstrate that this population is at high risk for HPV infection. These data provide a deeper understanding of the HPV infection experience of Inuit women, but they may also help evaluate vaccination strategies currently used for this high-risk population. 05/01/2015 01:00 AM