Concurrent Sexually Transmitted Infections Research Articles

Sexually transmitted coinfections among at-risk HIV-positive MSM: implications for optimal preemptive treatment.

Concurrent sexually transmitted infections (STIs) are common in sexually active populations. We aimed to estimate the prevalence and coinfection rates of bacterial STIs among sexually active, HIV-positive men who have sex with men (MSM), and to assess the potential benefits of different combination treatment regimens in managing concurrent bacterial STIs. From September 2021 to September 2023, HIV-positive MSM underwent STI testing when they had symptoms suggestive of STIs or recently acquired hepatitis C virus (HCV) infection or early syphilis. The oral rinse, rectal swab, and urethral swab specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma spp., Ureaplasma spp., and Trichomonas vaginalis with the use of multiplex real-time polymerase-chain-reaction assays. The estimated coinfection rates were used to evaluate the benefits of different combination treatment regimens for managing coinfections. During the study period, 535 participants (median age, 37 years; and CD4 count, 615 cells/mm3) were enrolled. On their first visits, at least one bacterial pathogen was detected in 57.9% and concomitant bacterial infections were found in 32.9% of the participants. The most commonly identified pathogen was U. urealyticum (36.3%), followed by C. trachomatis (22.8%), and N. gonorrhoeae (19.8%). The factors associated with any bacterial STIs included older age (per 1-year increase, adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.95-1.00), early syphilis (AOR, 1.87; 95% CI, 1.22-2.84), and having more than 5 sex partners in the preceding 3 months (AOR, 2.08, 95% CI, 1.07-4.06). A combination therapy of benzathine penicillin G with a 7-day course of doxycycline could simultaneously treat 27.1% of C. trachomatis coinfections in participants with early syphilis, while a combination therapy of ceftriaxone with doxycycline could simultaneously treat 40.6% of chlamydial coinfections in participants with gonorrhea. Bacterial STIs were prevalent and concomitant infections were not uncommon among sexually active, HIV-positive MSM, supporting regular screening for bacterial STIs. The effectiveness of preemptive use of doxycycline as combination therapy for concurrent STIs warrants more investigations.

Вплив вживання психоактивних речовин та інфекцій, що передаються статевим шляхом, на цитологічний стан шийки матки

The introduction addresses the societal stigma surrounding psychoactive substance abuse and its implications for women’s health, particularly concerning cervical health. It sets the context for the study by highlighting the need to understand the impact of substance abuse and sexually transmitted infections (STIs) on cervical health. Purpose - to investigate the effects of psychoactive substance abuse and concurrent STIs on the health of the cervix in women. The study seeks to identify correlations between substance abuse, STIs, and cervical pathologies, providing valuable insights for healthcare strategies. Materials and methods. The study involved a sample of 160 women divided into groups based on their use of psychoactive substances and the presence of STIs. Cervical cytological smears were collected and analysed using Romanowsky-Giemsa and Papanicolaou staining methods. This approach aimed to detect and categorize any cellular abnormalities in the cervical epithelium. Results. The findings revealed a significant correlation between the abuse of psychoactive substances and the frequency of squamous cell abnormalities in the cervix, especially in those with concurrent STIs. Conditions like koilocytosis and low-grade squamous intraepithelial lesions (LSIL) were notably prevalent among substance abusers, indicating an increased risk for cervical dysplasia and potential progression to cervical cancer. Conclusions. The study concludes that psychoactive substance abuse, particularly in combination with STIs, significantly increases the risk of cervical pathologies in women. This underscores the necessity for enhanced cervical cancer screening and prevention strategies targeted at women who abuse psychoactive substances. The findings highlight the importance of addressing substance abuse and STIs in women’s health programs and public health initiatives, especially in high-risk groups. The study protocol was approved by the Local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in women. No conflict of interests was declared by the authors.

2675. Concurrent HIV and Sexually Transmitted Infections in People with Mpox in Guatemala City

Abstract Background High rates of HIV and sexually transmitted infections (STIs) among people with mpox have been reported. Guatemala has the highest number of mpox cases reported in Central America. Data on this topic in the region is lacking. We report the prevalence of STIs and HIV in people evaluated for mpox at Hospital Roosevelt in Guatemala City. Methods We conducted a cross-sectional analysis of confirmed mpox cases with outpatient care at our institution between July 2022 and January 2023. Sociodemographic and clinical data was retrospectively collected. This analysis includes new diagnoses of HIV, syphilis, chlamydia, gonorrhea, mycoplasma genitalium infection and herpes virus simplex (HSV) infection. Diagnoses were confirmed by serology or nucleic acid amplification tests. Rates of HIV/STIs were assessed and association with sociodemographic, behavioral and clinical characteristics was analyzed through non-parametric statistical tests. Results Sixty participants with mpox were included. All cis-gender male, 34 (56.6%) younger than 30 years old, 52 (86.6%) were residents of Guatemala City, 57 (95%) men who have sex with men (MSM), 51 (85%) had above secondary education, 36 (60%) with known HIV-positive status. Recent participation in group sex was reported in 9 (15%) participants and inconsistent or no condom use in 49 (81.6%). Among participants with known HIV-positive status 34 (94.4%) had CD4 count > 200/µL and 32 (88.9%) had a HIV viral load < 200 copies/ml. Two previously undiagnosed HIV infections were detected. Overall, 27 new STIs were found in 20 (33.3%) participants (5 had more than one STI). Comparisons between participants with concurrent STIs and those without are shown in Table 1. Nine cases of syphilis were detected. Eighteen STIs involved mucous membranes (oropharyngeal, genital or anorectal). Rates by site are shown in Table 2. Conclusion At least one STI was detected in a third of the mpox cases with syphilis being the most frequent. Almost half of STIs cases involved the anorectal site. People with previously known HIV-positive status had a significantly higher rate of STIs. HIV/STI care is key to an appropriate mpox management. Disclosures All Authors: No reported disclosures

2666. Rates of STI Testing and Diagnoses among Patients with Mpox in New York City, 2022

Abstract Background The 2022 global mpox outbreak occurred in the context of rising rates of sexually transmitted infections (STIs). We hypothesize that concurrent STI rates were underestimated due to inadequate testing during virtual visits and non-sexual health clinical settings. Methods We included data from all patients with confirmed mpox (through non-variola orthopoxviral PCR testing) from June 25 to October 17, 2022 at an urban tertiary academic center in New York. Manual chart review supplemented data extracted from the electronic medical record. We calculated descriptive statistics for HIV, syphilis, genitourinary, rectal, and pharyngeal gonorrhea/chlamydia (GC/CT) screening and diagnosis rates. We evaluated relationships between site-specific symptoms and extragenital testing. Results Of 228 individuals in the database, 98% were male at birth, the median age was 34 years. 40% were Hispanic and 27% Black. 50% were living with HIV. Only 41% were tested for other STIs in the two weeks prior to their mpox diagnosis. At the time of their mpox visit, 62.7% of patients were tested for syphilis, with 45.5% showing evidence of active or previously treated syphilis. 67 persons without known HIV were tested for HIV, resulting in 3 new diagnoses within 2 weeks of mpox diagnosis. 57.5% of patients were screened with a genitourinary GC/CT nucleic acid amplification testing (NAAT), with 2.3% and 3.8% positive for gonorrhea and chlamydia, respectively. 46.5% were screened with a rectal GC/CT NAAT, with 16.0% and 6.6% positive for gonorrhea and chlamydia, respectively. 47.4% of individuals were screened with a pharyngeal GC/CT NAAT, with 7.4% and 0.9% positive for gonorrhea and chlamydia, respectively. Site specific GC/CT NAATs were obtained from 52.2%, 55%, and 54% of patients with urinary, rectal and pharyngeal signs or symptoms, respectively. Without extragenital testing, 10 of 28 total gonorrhea cases (35.7%) and 3 of 13 total chlamydia cases (23.1%) would have been missed. Conclusion STI testing was insufficient in people with confirmed mpox, likely leading to under diagnosis of STIs. HIV testing was inadequate in at-risk individuals, and patients presenting with site-specific symptoms were too frequently not offered targeted testing. Disclosures All Authors: No reported disclosures

Prior Sexually Transmitted Infections and HIV in Patients With Mpox, Chicago, Illinois (June 2022-March 2023).

HIV is associated with severe mpox. Sexually transmitted infections (STIs) could facilitate mpox transmission. We estimated HIV and STI frequency among patients with mpox and compared characteristics associated with mpox severity. Mpox cases during 1 June 2022 to 31 March 2023 were matched to Illinois HIV/AIDS surveillance data. Among 1124 patients with mpox, 489 (44%) had HIV and 786 (70%) had prior or concurrent STI; 307 (39%) had ≥3 STI episodes. More patients with mpox who were living with HIV were hospitalized than those without HIV (10.3% vs 4.1%, P < .001). STI screening visits are opportunities to vaccinate against mpox and provide HIV prophylaxis or treatment.

Concurrent Sexually Transmitted Infection Testing Among Patients Tested for Mpox at a Tertiary Healthcare System.

Coinfection with sexually transmitted infections (STIs) and mpox is common. We evaluated concurrent STI testing among Duke Health patients tested for mpox. We found that most patients tested for mpox were not comprehensively tested for STIs, despite concurrent STIs being diagnosed in 15% of patients when testing was performed.

Broadly neutralizing antibody-mediated protection against simian-HIV infection among macaques with vaginal sexually transmitted infections.

Sexually transmitted infections (STIs) increase mucosal HIV infection risk and have the potential to reduce preexposure prophylaxis efficacy. Clinical trials of a broadly neutralizing antibody (bNAb) provided proof-of-concept that passive immunization against HIV can be efficacious in people. We sought to evaluate preclinically the protective efficacy of passive bNAb immunization against simian-human immunodeficiency virus (SHIV) infection in the context of concurrent vaginal STIs. Using a macaque model of combined ulcerative and nonulcerative vaginal STIs caused by Treponema pallidum , Chlamydia trachomatis , and Trichomonas vaginalis , we determined the protection that passively administered bNAb 10-1074 conferred against repeated vaginal SHIV challenges and compared correlates of protection to contemporaneous and historical controls without STIs. Plasma viremia was monitored via RT-qPCR assay. Concentrations of 10-1074 were determined longitudinally in plasma samples via TZM-bl pseudovirus neutralization assay. Among macaques with vaginal STIs, a single subcutaneous injection of 10-1074 durably protected against vaginal SHIV acquisition, as compared with untreated controls. Interestingly, the median plasma concentration of 10-1074 at the time of SHIV breakthrough among macaques with STIs was significantly higher (10-fold) than that previously observed among 10-1074-treated macaques in the absence of STIs. Passive immunization with 10-1074 conferred significant protection against repeated vaginal SHIV challenges among macaques harboring vaginal STIs. However, our findings suggest that higher bNAb concentrations may be required for prophylaxis when STIs are present. Our findings potentially impact dose selection for the clinical development of bNAbs and highlight the importance of additional preclinical efficacy testing in STI models.

2022 Monkeypox outbreak: Why is it a public health emergency of international concern? What can we do to control it?

The World Health Organization (WHO) called the recent monkeypox (MPX) outbreak a Public Health Emergency of International Concern on July 23, 2022. The United States of America (US) alarmed the recent MPX outbreak as the US public health emergency on August 4, 2022. Since early May 2022, more than 35000 MPX cases and 12 deaths had been reported to WHO from 92 countries and territories by August 17, 2022, and MPX cases continue rising rapidly with improved surveillance, access to diagnosis, and continuous virus spreading globally. Approximately 99% MPX cases are men, of which 95% cases are men who have sex with man. No evidence of MPX being sexually transmitted infections (STIs) is found; however, a high percentage (25%) of concurrent STIs and frequent anogenital symptoms suggest transmission through local inoculation during close intimate contact or sexual activity. Many approaches including a comprehensive international vaccination strategy and adequate supplies are mandatory to prevent MPX pandemic. Education, vaccination, MPX scrutiny and careful monitoring, and crossborder collaborations with international sectors are practical strategy to contain MPX outbreaks. People are educated to reduce the risk of exposure and to reduce the number of sexual partners especially new ones, to avoid contacting travelers from epidemic regions or animals that may carry MPX virus, and avoid traveling to endemic areas.

Prevalence and risk factors for sexually transmitted infections among people living with HIV attending a sexually transmitted infection clinic in Trinidad

A cross-sectional study to determine the prevalence and risk factors for sexually transmitted infections (STIs) among people living with HIV (PLHIV) attending the STI clinic in Trinidad was conducted during the period April–September 2014. A questionnaire was administered to obtain socio-demographic data and risk factors for STIs and patients were screened for STIs. Two hundred and ten PLHIV (138 males [65.7%] and 72 females [34.3%]) were enrolled; age range 18–68 years, mean age 36.4 years. Seventy-eight (37.1%) of the 210 patients were diagnosed with a concurrent STI. Homosexual/bisexual study patients were more likely to be diagnosed with an STI (OR, 3.56; 95% CI, 1.94–6.51) and more likely to be diagnosed with syphilis (OR, 4.84; 95% CI, 2.40–9.77). Multivariate analysis using binary multiple regression showed that risk factors for STIs included male gender (OR, 2.46; 95% CI, 1.06–5.73), homosexual/bisexual sexual orientation (OR, 2.26; 95% CI, 1.06–4.80) and multiple sex partners within the past 12 months (OR, 1.99; 95% CI, 1.03–3.86). There is a high prevalence of STIs among homosexual/bisexual patients in this study in whom syphilis was the most commonly diagnosed STI. Hence more frequent STI screening and targeted HIV/STI prevention efforts to reduce high-risk behaviour are needed.

HIV-RNA decay in paired blood and semen samples of subjects receiving their first dolutegravir-based ART regimen

Background and objectivesWe aimed to investigate to what extent a first-line DTG-based ART regimen reduces HIV-RNA in semen compared to plasma. Study designIn this prospective, observational study, ART-naïve, HIV-infected males starting their first ART regimen with DTG plus TDF/FTC or ABC/3TC were enrolled. Paired blood (BP) and seminal plasma (SP) samples were collected at baseline (T0) and at week-2/4/12/24 after ART initiation. Sexually transmitted infections (STI) were ruled out before enrolment. ResultsMedian baseline HIV-RNA levels were lower in SP compared to BP (657 versus 38.200 copies/ml, p < 0.001), three subjects had undetectable semen HIV-RNA. After 12 weeks of treatment, HIV-RNA was below the quantification limit in both BP and SP of 11 pts (61.1%). Discordant results were obtained in 6 subjects (33.3%), showing quantifiable HIV-RNA in blood only (2 cases) and in semen only (4 cases). Finally, one subject had a positive HIV-RNA in SP/BP. At W24, only in 2/16 subjects (12.5%) HIV-RNA was detectable in semen, while in the others it was negative on SP/BP. No concurrent STI was found in subjects with detectable VL in semen. ConclusionsDTG demonstrated effectiveness in reducing VL with different kinetics in blood and semen, despite seminal viral suppression after 6 months of ART was not obtained in the totality of subjects.

New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men.

Rectal sexually transmitted infections (STI) have been associated with human immunodeficiency virus (HIV) diagnosis, but inferring a causal association requires disentangling them from receptive anal intercourse (RAI). We conducted a stratified case-control study by frequency matching 4 controls to each case within year using clinical data from men who have sex with men (MSM) attending the Seattle STD Clinic 2001 to 2014. Cases were MSM with a new HIV diagnosis and negative HIV test at 12 months or less. Controls were HIV-negative MSM. All included men had rectal STI testing, tested negative for syphilis, and had complete sexual behavior data. We categorized men by RAI: (1) none; (2) condoms for all RAI; (3) condomless RAI only with HIV-negative partners; and (4) condomless RAI with HIV-positive or unknown-status partners. We created 3 logistic regression models: (1) 3 univariate models of concurrent rectal gonorrhea, rectal chlamydia, and rectal STI in 12 months or less with new HIV diagnosis; (2) those 3 infections, plus age, race, year, number of sexual partners in 2 months or less, and methamphetamine use; and (3) model 2 with RAI categories. We calculated the population attributable risk of rectal STI on HIV diagnoses. Among 176 cases and 704 controls, rectal gonorrhea, chlamydia and rectal STI in 12 months or less were associated with HIV diagnosis. The magnitude of these associations attenuated in the second model, but persisted in model 3 (gonorrhea: adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.3-3.8; chlamydia: aOR, 2.5; 95% CI, 1.5-4.3; prior STI: aOR, 3.0; 95% CI, 1.5-6.2). One in 7 HIV diagnoses can be attributed to rectal STI. Rectal STI are independently associated with HIV acquisition. These findings support the hypothesis that rectal STI play a biologically mediated causal role in HIV acquisition and support screening/treatment of STI for HIV prevention.

Clinical and epidemiological characteristics of patients with early syphilis from three academic centres in Poland, Germany and Ireland: initial findings from the POETS study

ObjectivesSyphilis recognition in HIV-positive patients has important implications. Initial data from this study, established in June 2012 to better understand the natural history of syphilis and treatment response, examine the...

Second European Multi-Disciplinary Conference of National Strategies for Chlamydia Trachomatis and Human Papillomavirus (NSCP Conference) in Berlin, 2013 — Enhanced Detection, Management and Surveillance of Sexually Transmitted Infections in Europe are Essential!

There is a need for updated guidance on detection, management and surveillance of sexually transmitted infections (STIs). Chlamydia, gonorrhoea and syphilisreporting needs to be mandatory in more European countries to aid collection of data. More widespread Chlamydia screening is needed in many countries as this is the only way to reduce complications. The role of Human Papillomavirus (HPV) screening in a situation where the prevalence of HPV infection has dropped significantly was also discussed in the context of the high cost of screening, the need for a relatively complex infrastructure, particularly in developing countries, and falling vaccination costs. An integrated HPV vaccination and screening policy could be the most appropriate with vaccination at 9-13 years as recommended by WHO and a single HPV screen at 35-39 years, possibly repeated thereafter every 10 years. Female and male HPV vaccination programmes could lead to near elimination of genital warts in both females and males. Surveillance of STIsshould be intensified where needed; additional or better quality data should be collected including reasons for testing, denominator data to estimate positivity rates, diagnostic methods, concurrent STIs, sexual orientation and country of acquisition; more analytical rather than descriptive epidemiology is needed.

P3.127 High Prevalence of Asymptomatic Sexually Transmitted Infections (STIs) in HIV-Infected Men Who Have Sex with Men (MSM) in Ireland: Strategies to Improve Screening

Background In Ireland the prevalence of STI’s is steadily increasing while the number of new HIV-diagnoses in MSM has more than doubled in the past decade. International guidelines recommend annual STI screening for MSMs regardless of reported history, with more frequent screening recommended for at-risk individuals. This study investigates prevalence of STIs in asymptomatic HIV-infected MSM in the largest HIV-centre in Dublin. Methods A retrospective analysis was performed via electronic patient record review. Pharyngeal, urethral and rectal testing for Gonorrhoea (Gc) and Chlamydia (CT) was performed using validated nucleic acid amplification techniques. Results Fifty HIV-infected MSM were included in the study (mean age [SD] 38 years [9], 66% Irish). Mean [SD] number of sexual partners in the preceding 12 months was 8 [13]. By subject report 10% were abstinent, 40% always used condoms, 42% used codoms inconsistently while 4% reported never using condoms. Thirty-nine (78%) were on HAART and 38 (97%) were virally suppressed. Eight (16%) tested positive for an STI. Two (25%) were documented as having two concurrent STIs and two (25%) were not on HAART. Gc was detected in all 8 positive screens (4 cases of rectal and 4 cases of pharyngeal Gc). There were 2 cases of rectal CT which occurred with a concurrent positive rectal Gc. Younger age [29 vs. 40 years, p Conclusion Sixteen percent of HIV-infected MSMs screened were diagnosed with an STI. 46% of HIV-infected MSM reported unprotected sexual activity. Recognising a need to optimise provision and delivery of STI screening, a pilot self-screening programme has been successfully introduced to our HIV-clinic. Our study highlights the importance of screening for asymptomatic STI’s and the need for increased educational interventions targeting unsafe sexual-behaviour as a means of disease prevention.

P3.209 Low Rates of STI Co Infection Observed in HIV Positive Women Participating in an HPV Vaccine Study In Canada

BackgroundHIV positive women with sexually transmitted infections (STIs) face increased reproductive health risks and negative health outcomes. This sub-analysis was performed to determine the co-factors associated with a history of...

Pubic lice and scabies: an opportunity for STI screening

Health Protection Agency data in 2011 have revealed another increase in diagnoses of sexually transmitted infections (STIs) of 2% in the UK, with nearly 247 000 new cases, which reverses a small decline in the previous year. Increased rates are partly due to increased rates of STI testing and better tests. Gonorrhoea, genital warts, herpes, chlamydia, and syphilis all rose in incidence, especially among young heterosexual adults aged 15–24 years and men who have sex with men, who continue to have the highest risk. The data also include the incidence of infestation with the ectoparasites pubic lice and scabies mites, which present in genitourinary medicine clinics; however, these conditions may also present in primary care and other settings where healthcare providers may also have an opportunity to screen for concurrent STIs. In this article, factors associated with infestation and STIs are discussed.

P1-S5.32 The differential associations of HPV prevalence with other sexually transmitted infections in hormonal and non-hormonal contraceptive users

Background This study evaluated the associations of recent sexually transmitted infections (STIs) with cervical HPV prevalence among hormonal and non-hormonal contraceptive users. Methods Data came from a prospective study conducted...

New Syphilis Cases and Concurrent STI Screening in a Southeastern U.S. HIV Clinic: A Call to Action

Syphilis outbreaks in the United States have been reported since 2000 with highest rates in the South and many cases among HIV-infected individuals. We evaluated incident syphilis cases and concurrent gonorrhea and chlamydia screening at a southern HIV clinic. A retrospective cohort study included HIV-infected patients with at least one reactive plasma reagin (test for serum reagin antibodies to cardiolipin-cholesterol-lecithin antigen) and primary care visit from July 2004 to June 2007. Primary, secondary, and early latent syphilis cases were identified as incident syphilis and evaluation for gonorrhea and chlamydia within 1 month were described. Logistic regression was performed to determine factors associated with incident syphilis. Among 1544 patients, 40 incident syphilis cases were identified (5 primary, 29 secondary, and 6 early latent). The majority of patients were not virologically suppressed and only 25% had gonorrhea and chlamydia testing. In adjusted analyses, younger age (0.57 per 10 years, 95% confidence interval [CI] 0.41-0.80) and minority race (2.26, 95% CI 1.12-4.59) were associated with incident syphilis. Among 40 incident syphilis cases, only 1 in 4 were further tested for gonorrhea and chlamydia. These low rates are concerning as concurrent sexually transmitted infections (STIs) increase risk for HIV transmission. HIV care provider education with emphasis on STI testing in the setting of incident syphilis is key in prevention.

Trichomoniasis and Other Sexually Transmitted Infections: Results From the 2001–2004 National Health and Nutrition Examination Surveys

To estimate the association between Trichomonas vaginalis infection (TV) and 6 sexually transmitted infections: chlamydia, gonorrhea, herpes simplex virus (Types 1 and 2), syphilis, and human immunodeficiency virus (HIV) in a nationally representative sample. We used data from the National Health and Nutrition Examination Survey combining the 2001-2002 and 2003-2004 waves to estimate the association between TV and sexually transmitted infections (STIs) among women in the civilian, noninstitutionalized US population. The final sample included data from 3648 women, which when weighted, represents the experience of 65,563,298 US women between the ages of 14 and 49. Crude and adjusted relative risks were estimated using logistic regression for rare STIs (<10%; chlamydia, syphilis, and HIV) and Poisson regression for common STIs (herpes simplex virus [HSV] Types 1 and 2). Statistical analyses were conducted using Stata (version 9.2). The prevalence of trichomoniasis was 3.2% with over 80% of cases asymptomatic in the past month. All STIs examined (chlamydia, gonorrhea, HSV-1, HSV-2, syphilis, and HIV) were more common among women with a positive test for trichomoniasis. HSV-1 (RR = 1.20, 95% CI: 1.09, 1.34) and HSV-2 (RR = 1.51, 95% CI: 2.32, 3.23) were significantly associated with trichomoniasis after adjusting for race/ethnicity, age, and recent sexual partners. In crude analyses, a positive treponemal test was 6 times (95% CI: 2.07, 18.8) more common and HIV was 13 times (95% CI: 2.88, 59.1) more common among women with trichomoniasis, but these estimates were greatly attenuated after adjustment for potential confounders. Trichomoniasis is significantly associated with concurrent STI.

Phthirus pubis as a predictor for chlamydia infections in adolescents.

Providers not skilled in the evaluation of sexually transmitted infections (STIs) may treat pubic lice infestation without considering other organisms. This study compared the rate of chlamydia and gonorrhea infections in adolescents with and without pubic lice. The goals of the study were to compare the rate of chlamydia and gonorrhea infections between adolescents infested or not infested with pubic lice and to evaluate lice infestation as a predictor for concurrent chlamydia or gonorrhea infection. A retrospective chart review of sexually active adolescents at a juvenile detention center in the Midwest between July 1998 and June 2000 was conducted. The index group was 62 adolescents with pubic lice screened for concurrent STIs. The control group included 201 randomly selected adolescents without pubic lice who underwent STI screening. In the entire study population (263 subjects), there were 60 cases of chlamydia (23% of all subjects) and 29 cases of gonorrhea (11%). Neisseria gonorrhoeae infection was present in 18% of index subjects and 9% of controls. Chlamydia trachomatis infection was noted in 39% of index subjects and 18% of controls. Pubic lice infestation predicted C trachomatis infection (odds ratio = 3.31). Pubic lice infestation is predictive of a concurrent C trachomatis infection in this population. Adolescents infested with pubic lice should be screened for other STIs, including chlamydia and gonorrhea.