Current News about Sexually Transmitted Disease

Background Although numerous studies have demonstrated the effectiveness of interventions delivered by disease intervention specialists (DISs), relatively few studies have assessed their economic outcomes. We performed a systematic literature review of the cost, cost-effectiveness, and cost benefit of DIS-delivered interventions for sexually transmitted infections (STIs) in the United States. Methods Building on a recent systematic review of the effectiveness of DIS-delivered interventions, we reviewed economic outcomes associated with these interventions for STIs. We searched articles indexed in MEDLINE, Web of Science, CINAHL, and ProQuest from 2000 through December 2022, using these inclusion criteria: addressed an intervention of DIS-delivered interventions for STIs including partner services; United States setting; and included estimates for program cost, cost-effectiveness, or cost benefit. Findings were summarized through narrative synthesis. Results Seven studies met the inclusion criteria. Overall, DIS-delivered interventions including STI partner services can be a cost-effective use of public health resources. In some scenarios, the cost of these interventions can be completely offset by averted medical costs. Cost and cost-effectiveness estimates of DIS-delivered interventions can vary across geographic settings and under different epidemiologic conditions. Conclusions Although scarce, the available evidence suggests that DIS-delivered interventions including STI partner services are an efficient use of public health resources. Health economic modeling studies are needed to facilitate conversion of intermediate cost-effectiveness outcomes (eg, cost per syphilis case identified and treated) into standard cost-effectiveness outcomes (eg, cost per quality-adjusted life year gained). 03/14/2025 01:00 AM
 

Background Since 2013, national trends in behavioral factors that increase sexually transmitted infection risk among adolescent and young adult (A/YA) females have been mixed (e.g., fewer sex partners, lower condom use). We used data from a national sample of A/YA females to examine racial disparities in Chlamydia trachomatis (CT) prevalence considering these trends. Methods Using 2011–March 2020 National Health and Nutrition Examination Survey data, we estimated the prevalence, and unadjusted and adjusted prevalence ratios of a positive CT urine test result among sexually experienced non-Hispanic Black (Black), Hispanic, non-Hispanic Other race (NHO), and non-Hispanic White (White) A/YA females. Percentages were categorized by race/ethnicity, and each was compared with the average of the other race/ethnic groups (e.g., Black vs. Hispanic, NHO, and White). Covariates included age group, health insurance coverage, number of sex partners, and condom use (both past year). Results Overall, the prevalence of CT infection among A/YA females was 5.8% (95% confidence interval [CI], 4.5%–7.3%). The prevalence of CT was higher among Black females (vs. Hispanic, NHO, and White; 11.7%; 95% CI, 8.7%–15.2%) and lower among White females (vs. Black, Hispanic, and NHO; 3.2%; 95% CI, 1.7%–5.5%). Compared with the average CT prevalence for Hispanic, NHO, and White females, Black females had a higher adjusted CT prevalence (adjusted prevalence ratio, 2.48; 95% CI, 1.63–3.75). Conclusions Nationally, CT prevalence was 2.5 times as high among Black A/YA females than the average prevalence for Hispanic, NHO, and White females. Inclusion of behavioral sexually transmitted infection risk factors did not attenuate this association. Research incorporating sexual network–level factors associated with CT transmission may provide additional insights. 04/03/2025 01:00 AM
 

Background Chlamydia and gonorrhea are among the most commonly reported sexually transmitted infections in the United States. Testing for chlamydia and gonorrhea infection can be conducted by anatomic site (site-specific). Monitoring testing volume and positivity by anatomic site is important. Methods Using a large national laboratory dataset, we assessed chlamydia and gonorrhea test volume and positivity by anatomical site in patients aged 15 to 60 years. Results The data contained 45 million tests each for chlamydia and gonorrhea for 2019 to 2023. Of chlamydia tests, 71.6% were for women. Among women, 0.4%, 1.5%, and 98.1% were performed on rectal, pharyngeal, and urogenital specimens; chlamydia positivity rates were 7.3%, 2.0%, and 4.3%, respectively. Among men, 10.5%, 13.7%, and 75.8% were performed on rectal, pharyngeal, and urogenital specimens; chlamydia positivity rates were 8.0%, 1.4%, and 6.3%, respectively. Among people aged 15 to 24 years, chlamydia positivity was 12.8% for rectal, 3.4% for pharyngeal, and 8.7% for urogenital among women, and 11.6%, 2.4%, and 12.2% among men, respectively. Gonorrhea testing volume overall and by age and sex was similar to that of chlamydia. Gonorrhea rectal, pharyngeal, and urogenital positivity rates were 3.2%, 2.4%, and 1.0% among women; 6.8%, 5.2%, and 3.3% among men; and 4.3%, 3.0%, and 1.6% among women aged 15 to 24 years, and 10.5%, 7.2%, and 4.6% among men aged 15 to 24 years, respectively. Conclusions Although men accounted for <30% of overall chlamydia and gonorrhea testing, they accounted for a majority of extragenital testing. High rates of chlamydia and gonorrhea positivity by specimen type among many demographic groups, especially for extragenital specimens from men and young people, highlight the importance of sexually transmitted infection prevention in the United States. 04/03/2025 01:00 AM
 

Background Congenital syphilis rates are rising in the United States and globally, necessitating standardized care for infants born to mothers with syphilis. The Centers for Disease Control recommends comprehensive evaluation, treatment, and follow-up for these infants to ensure optimal outcomes. Local Problem At Los Angeles General Medical Center, a retrospective review of 97 infants (2022–2023) revealed gaps in adherence to national guidelines, particularly in risk stratification, treatment decisions, and outpatient follow-up planning. Among 15 syphilis-exposed infants (2 unknown-risk, 4 high-risk, 9 low-risk), some received abbreviated or potentially inadequate treatment without a full evaluation, while others had treatment deferred without ensuring appropriate outpatient follow-up. These inconsistencies in postnatal management highlighted the need for a structured, multidisciplinary approach to improve adherence to best practices. Methods A quality improvement team developed the “Congenital Syphilis Pathway” to standardize care and improve adherence to the Centers for Disease Control guidelines. The intervention included recommended Pediatric Infectious Disease consultation to improve risk stratification and treatment decisions, targeted provider education to enhance guideline adherence, and systematic scheduling of outpatient follow-up to ensure appropriate postnatal monitoring. The pathway aimed to achieve 90% compliance with recommended evaluation, treatment, and follow-up practices between January and June 2024. Interventions The pathway recommended a Pediatric Infectious Disease consultation for all eligible infants during their hospital stay and included educational sessions on congenital syphilis management for key stakeholders at three points during implementation to reinforce protocol adherence. Results The population included all infants born to mothers with syphilis at Los Angeles General Medical Center. Following pathway implementation in January 2024, Pediatric Infectious Disease consultation rates reached 100% by June 2024. Appropriate management improved from 85% at baseline to 100% in Q2 2024, while follow-up scheduling increased from 54% at baseline to 91% in Q2 2024. Conclusion A structured care pathway integrating standardized consultations, provider education, and systematic follow-up planning significantly improved adherence to congenital syphilis management guidelines. While direct pediatric infectious disease consultation may not be feasible in all settings, the core elements of this intervention - standardized evaluation pathways, provider education, and public health collaboration - can be adapted to improve care in diverse health care environments. 05/19/2025 01:00 AM
 

Background This study aimed to estimate syphilis prevalence among people who were pregnant and delivered live births by race and ethnicity in 2016 to 2023. Methods We analyzed data on syphilis infection from US birth certificates using a Bayesian mathematical model, adjusting for test sensitivity, specificity, and screening coverage. We calibrated the model under 2 scenarios: (1) assuming screening coverage is as estimated in Medicaid claims data and (2) assuming higher screening coverage than observed in Medicaid claims data. We also compared the prevalence estimates to stillbirths attributable to syphilis reported through routine surveillance. We examined racial and ethnic disparities using the index of disparity. Results In scenario 1, syphilis prevalence among people who were pregnant and delivered live births increased from 101.1 (95% uncertainty interval [UI], 87.5–120.5) per 100,000 live births in 2016 to 533.4 (95% UI, 496.6–581.0) per 100,000 live births in 2023. In scenario 2, prevalence increased from 73.9 (95% UI, 51.2–130.0) per 100,000 live births to 378.1 (95% UI, 295.5–592.0) per 100,000 live births over the same period. With rising prevalence, relative racial and ethnic disparities narrowed over time. Prevalence was estimated to be higher among women with stillbirths compared with women with live births. Conclusions In the United States, syphilis prevalence among pregnant women has increased in all race and ethnicity groups. Improved estimates of screening coverage are needed to understand the gaps in congenital syphilis prevention and to inform estimates of syphilis prevalence among pregnant persons. 05/26/2025 01:00 AM
 

Background Syphilis cases have increased by 80% in the United States in the past 5 years, demanding new approaches to screening and treatment, particularly among key populations. This study aimed to assess the impact of syphilis screening in a large urban county jail, determining rates of new syphilis infections, identifying demographic groups most affected by syphilis, and assessing treatment completion rates. Methods Electronic health records of individuals with positive rapid plasma reagin (RPR) results during incarceration in the Dallas County Jail between April 2023 and March 2024 were reviewed. New cases were defined by either a first positive RPR, a 4-fold titer increase, or a positive result after a previously negative RPR. Data on demographics, HIV coinfection, and recent chlamydia or gonorrhea infection were collected. Treatment medication and completion (no, partial, or full) were recorded. Comparisons of proportions were performed using χ2 analysis, and data analyses were conducted using SAS OnDemand for Academics (SAS 9.4 M8). Results Of 15,589 individuals tested for syphilis, 12,607 (80.9%) were male and 2982 (19.1%) were female. Among these, there were 1816 (11.6%) cases of positive test results; 815 individuals (5.2%) were newly diagnosed with syphilis: 568 males (4.5%) and 247 females (8.3%). Among those newly diagnosed, most (71.2%) were treated with doxycycline. Overall, 482 individuals (59.1%) completed treatment, 191 (23.4%) received partial treatment, and 142 (17.4%) were released before receiving any treatment. Conclusions Syphilis screening in a large urban jail identified high rates of new infections and provided an opportunity for counseling, testing for other STIs and treatment. Females and African Americans had disproportionately high infection rates. Treatment completion was similar between doxycycline and intramuscular penicillin. Future studies should focus on increasing syphilis screening, treatment, and prevention in jails and other high-incidence settings. 05/23/2025 01:00 AM
 

Background Depression involves intertwining socioeconomic, behavioral, and health factors, creating a complex landscape for providers to address during pregnancy. Its association with social determinants of health and immunologic inflammation complicates its relationship with sexually transmitted infections (STIs). This study aimed to assess the association between depression and STIs among underserved pregnant patients. Methods A cross-sectional study was conducted of pregnant patients from February 2019 to May 2023 within a public health system. Medical records for patients undergoing pregnancy screening were reviewed. Demographic data, depression data, STI data, and obstetric outcomes were recorded. Patients with depression were identified through self-reports to providers and Edinburgh Postnatal Depression Scale scores of 10 or higher. A multivariable logistic regression model with robust error variance was used for analysis. Results Among the 20,111 singleton pregnant patients studied, 1054 (5.24%) reported experiencing depression during pregnancy, and 3.2% were diagnosed with any STI. After multivariable adjustment, compared with patients without depression, those with depression had increased odds of having any STI (adjusted odds ratio, 1.54; 95% confidence interval, 1.20–1.99). Patients with depression had higher odds (adjusted odds ratio, 1.81, 95% confidence interval, 1.16–2.84) of having syphilis compared with those without. Conclusions Our findings exemplify an elevated association of STI, particularly syphilis, among underserved pregnant patients with depression. 05/26/2025 01:00 AM
 

Background This study investigated the associations between Chlamydia trachomatis and depression in subjects with and without urogenital symptoms, in males and females, and across different severities of depression. Methods We reviewed electronic medical records from the University of Louisville Campus Health Services. Data on mood, C. trachomatis and Neisseria gonorrhoeae infection statuses, symptoms, age, sex, and the use of alcohol, cigarettes, and illicit drugs were analyzed. Results Across the entire study cohort (n = 839), C. trachomatis infection was associated with an increased likelihood of reporting depression (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.19–2.69). The odds of reporting depression remained elevated when the analysis was restricted to infected patients without urogenital symptoms (aOR, 1.75; 95% CI, 1.07–2.80). In a sex-stratified analysis, C. trachomatis infection was associated with a statistically significant increased odds of reporting depression in females (aOR, 2.09; 95% CI, 1.25–3.45) but not in males. When subjects were categorized according to an ordered scale of depression, C. trachomatis infection was associated with increased odds of falling into a more severe category (OR, 1.83; 95% CI, 1.251–2.694). Finally, using a within-subject design, patients were more likely to report depression when infected at the time of the appointment compared with when the same patients were uninfected (OR, 3.17; 95% CI, 1.22–9.69). Conclusions Our results are consistent with C. trachomatis contributing to the spectrum of depression independent of urogenital symptoms. We propose that these depression findings may result from an immune system response that lowers serotonin availability. 05/26/2025 01:00 AM