High Sexually Transmitted Disease Research Articles

Abstract B033: Increasing sexual transmitted diseases and promoting condom use among youth: Evaluation of year 2 data from the Proud Teens of Philly (PTOP) program

Abstract Background: Rates of sexually transmitted disease (STD) and teen pregnancy are much higher in Philadelphia than the national average. Proud Teens of Philly (PTOP) is a sexual health program aimed at reducing the high teen birth rate and STD cases in Philadelphia. The program provides sexual health education to high-risk youth ages 12-19 in the Greater Philadelphia area. The materials used to implement the PTOP program, “Making Proud Choices”, is an evidence-based curriculum that was reviewed and tailored for its cultural and age appropriateness, and medical accuracy. Methods: During the second year of the program, PTOP was implemented virtually and in-person to 411 youth in Philadelphia schools and community-based organizations. Community-based participatory research (CBPR) strategies and systems thinking approach were used in site and participant recruitment, program implementation, and evaluation. The educational content consisted of 8 modules of the “Making Proud Choices” curriculum. Pre and post surveys were administered to participants at the first and last implementation sessions, respectively. During Year 2, 391 pre-surveys and 208 post-surveys were collected. Results: There were significant increases in knowledge about fluids that transmit HIV (pre=23.47 post=25.07 t=4.65 p=<.0001), behaviors that transmit HIV (pre=10.86 post= 19.05 t=9.37 p=<.0001), condoms preventing pregnancy (pre=59.57 post=76.41 t=2.8 p=0.0057) and condoms preventing HIV (pre=46.29 post=68.92 t=2.98 p=0.0035). There was also significant increase in knowledge about affirmative consent before sexual behaviors (pre=20.05 post= 0.42 t=3.71 p=0.0003) and preparedness to use condoms (pre=39.34 post=59.19 t=2.43 p=0.0169) Conclusion: PTOP, a sexual health program was effective in increasing knowledge of STD and condom use among high-risk teens in Philadelphia. We will discuss the use of CBPR strategies and systems thinking in the design and implementation of this program. Citation Format: Jade A. Truehart, Ra'Ann Merceir, Aisha Bhimla, Yin Tan, Sabrina Liao, Min Qi Wang, Jane Sileo, Maya Allen, Grace X. Ma. Increasing sexual transmitted diseases and promoting condom use among youth: Evaluation of year 2 data from the Proud Teens of Philly (PTOP) program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B033.

Characterizing Financial Sustainability of Sexually Transmitted Disease Clinics Through Insurance Billing Practices.

Sexually transmitted infections (STIs) continue to increase in the United States. Publicly funded sexually transmitted disease (STD) clinics provide important safety net services for communities at greater risk for STIs. However, creating financially sustainable models of STI care remains a challenge. Characterization of clinic insurance billing practices and patient willingness to use insurance. Cross-sectional survey assessment of clinic administrators and patients. Twenty-six STD clinics and 4138 patients attending these clinics in high STD morbidity metropolitan statistical areas in the United States. Clinic administrators and patients of these clinics. Survey assessment. Insurance billing practices of STD clinics and patient insurance status and willingness to use their insurance. Fifteen percent of clinics (4/26) indicated that they billed only Medicaid, 58% (15/26) billed both Medicaid and private insurance, 27% (7/26) did not bill for any health insurance, and none (0%) billed only private health insurance companies. Of 4138 patients surveyed, just more than one-half of patients (52.6%) were covered by some form of health insurance. More than one-half (57.2%) of all patients covered by health insurance indicated that they would be willing to use their health insurance for that visit. After adjusting for patient demographics and clinic characteristics, the patients covered by government insurance were 3 times as likely (odds ratio: 3.16; 95% confidence interval, 2.44-4.10) than patients covered by private insurance to be willing to use their insurance for their visit. Opportunities exist for sustainable STI services through the enhancement of billing practices in STD clinics. The STD clinics provide care to large numbers of individuals who are both insured and who are willing to use their insurance for their care. As Medicaid expansion continues across the country, efforts focused on improving reimbursement rates for Medicaid may improve financial sustainability of STD clinics.

Treatment of chlamydia and gonorrhea infections during the COVID-19 pandemic using provisional Centers for Disease Control guidance.

The COVID-19 pandemic created new challenges in controlling the transmission of sexually transmitted diseases (STDs), forcing the Centers for Disease Control and Prevention (CDC) to temporarily modify recommendations. As rapid COVID-19 testing emerged, supplies for similar testing platforms, specifically Chlamydia trachomatis and Neisseria gonorrhoeae, became compromised. The local community was identified as having the highest rate of chlamydia infections in North Carolina. Concerns regarding disease transmission within the community were amplified as the project site began experiencing a critical shortage of chlamydia and gonorrhea testing kits. This quality improvement (QI) project, conducted in an emergency department, located in an underserved area with high STD infection rates, offered a prioritized approach to STD testing and treatment during a critical time with limited testing capabilities. Program analysis evaluated the management of 227 patients preintervention and 218 patients postintervention with confirmed or suspected infection, using a testing and treatment algorithm to identify and treat those most likely to be infected while preserving testing supplies for those at higher risk for complications from infections. Test utilization decreased by 25% (p-value = .003 via t-test), whereas a significant improvement in empiric treatment, increasing from 59% (133/227) to 73% (158/218), was also observed (p-value = .002 via chi-square analysis). Results suggest that a testing and treatment algorithm for providers can successfully guide testing and treatment decisions, reducing onward transmission and preserving supplies for those more likely to experience complications from chlamydia and gonorrhea infections.

Get In, Get Tested, Get Care: STD Services in Urban Urgent Care Centers.

Recent evidence indicates increased use of urgent care centers (UCCs) for sexually transmitted disease (STD) testing. We sought to learn more about STD services in UCCs in a large metropolitan area. Using a modified rapid gap assessment approach, we interviewed staff from 19 UCCs in metro Atlanta, GA. The UCCs were identified using two online search engines. We focused on a 50-mile radius around Atlanta. We then excluded duplicates and closed UCCs, and the ones outside Atlanta's five contiguous counties. Using a prioritization process, we visited UCCs in or adjacent to areas with mid to high local STD morbidity, or facilities from which STD cases were reported the year prior. We collected checklist-based data on STD testing, treatment, and preventive services, as well as supportive services (eg, substance use/mental health referrals). Checklist data, notes, and open-ended questions were summarized and analyzed descriptively. All UCCs (n = 19) reported offering basic to comprehensive STD testing. Although most could treat on-site for chlamydia and gonorrhea, most relied on referrals, or prescriptions and "return to facility" practices to treat syphilis. Sources for STD information/management included the health department/Centers for Disease Control and Prevention, online medical sites, and electronic medical record embedded information. Challenges UCCs acknowledged included staying up-to-date with treatment guidance and laboratory reporting requirements, inadequate time for sexual risk reduction counseling, and linking patients with extended care needs (eg, HIV+ case management, supportive services), or following up with patients. Urgent cares are STD testing resources. Service availability varies, but opportunities exist to enhance STD services in UCC settings and in communities.

Trichomonas vaginalis and Chlamydia trachomatis co-infections

Trichomonas vaginalis and Chlamydia trachomatis co-infections

Epidemiological, clinical, and immunological profile of cases at the time of HIV testing (a clinic-based observational cross-sectional study).

Introduction:With the availability of free antiretroviral therapy (ART), HIV/AIDS has become a chronic manageable disease, but its transmission still continues. Early testing, though desirable, is still a far-fetched goal.Materials and Methods:Forty-six newly detected HIV cases attending skin and sexually transmitted disease (STD) outpatient department (OPD) were studied. Careful inquiry was made to know the reason for HIV testing, marital status, concordance rate in married couples, and CD4 count at the time of presentation.Results:Of the 46 cases, 27 (59%) cases were in the age range of 20–40 years with 41% females and 59% males. Forty-one cases were married and cohabiting, out of which 19 were seroconcordant. Condom was used by 5/19 cases in seroconcordant group and 3/22 cases in serodiscordant group. Fourteen (30.4%) cases were tested for an epidemiologic reason (the most common being spouse positivity and antenatal care testing). Of the remaining 32 cases, the reason for testing was mucocutaneous manifestations in 16 cases, STD in 10 cases, and systemic illnesses (fever of unknown origin and weight loss) in 6 cases. Mean CD4 count was 336/cumm, with 17 cases having CD4 count <250/cumm.Conclusion:Except one, all cases were tested either because they were symptomatic or were referred by health-care provider for epidemiologic reasons. The presence of mucocutaneous manifestations including STD and systemic illnesses as the reason for testing as well as low CD4 count at the time of testing suggest less and late testing. Low condom use and high STD rate in married couple imply continued intramarital transmission. Although HIV seropositivity offers an entry point into continuum of comprehensive care package which includes free ART, it appears that HIV testing is still less and late.

A Survey of 25 North Carolina Health Departments/Districts on Knowledge, Attitudes, and Current Practices to Seeking Reimbursement From Third-Party Payers for Sexually Transmitted Disease Services.

North Carolina Administrative Code 10A Chapter 41A.0204 (a) states "local health departments shall provide diagnosis, testing, treatment, follow-up, and preventive services for syphilis, gonorrhea, chlamydia, … These services shall be provided upon request and at no charge to the patient." Although health departments/districts may bill governmental or nongovernmental insurance providers for sexually transmitted disease (STD) services, current billing practices are unknown. Because of its high STD morbidity, the eastern region of North Carolina was targeted. Using a Qualtrics Survey developed to measure attitudes as well as knowledge and reimbursement practices, this descriptive study was performed with staff from 25 eastern North Carolina health departments/districts. Snowball sampling was used to allow for greater inclusion. Analysis of data was performed at the individual and agency level based on types of questions in the survey. For knowledge, 87% of the respondents reported being aware of the possibility of reimbursement from third-party payers/commercial insurance carriers for STD services. In regard to current billing of these services, 20 health departments/districts (80%) reported they were billing these payers. When asked about their attitude of seeking reimbursement from commercial insurance, 92% reported it was acceptable or very acceptable. But when asked if STD services should remain a free service at the health department, 55% supported and 45% did not. These data provide a knowledge base for assisting health departments/districts to move forward in improving STD services as well as maximizing reimbursement from third-party payers/commercial insurance carriers when possible.

P2.191 DC-SIGN,DC-SIGNR and SDF-1 Polymorphism in High Risk Seronegative Sexually Transmitted Disease Patients from North Indian

BackgroundDendritic cells are the first to encounter HIV-1 at mucosal sites and virus binding occurs via receptors known as DC-SIGN/R. Variations in the number of repeats in the neck region...

Knowledge, beliefs and behaviours related to STD risk, prevention, and screening among a sample of African American men and women

Objective: Current data on sexually transmitted disease (STD) among African Americans show significant racial/ethnic disparities. The purpose of this study was to explore knowledge, attitudes, beliefs, and behaviours related to STD risk, prevention, and testing among African American adults to help inform the development of a health communication intervention to address the high rates of STDs in this community. Design: Cross-sectional survey. Setting: Four United States (US) communities with high cumulative incidence of STDs. Method: We administered a 44-item structured survey. Results: Participants were 185 sexually active heterosexual African Americans aged 18 to 45. Most participants (84.2%) had been tested for an STD at least once. Most participants (75.8%) perceived STDs to be a problem in their community, and almost all (91.2%) felt that people needed education to learn how to avoid STDs. Nonetheless, only half of participants (49.5%) agreed that they should get tested for STDs because they may be at risk. Misconceptions related to STD prevention and testing were identified. Results suggest that STDs remain highly stigmatized with concerns related to social and interpersonal consequences. Participants’ perceived personal risk was low, despite acknowledging high STD rates in their communities. Conclusion: Findings suggest that health communication may play an important role in addressing STD disparities by increasing perceptions of personal risk, minimizing STD-associated stigma, and marketing STD prevention and testing behaviours.

Comparison of Sexual Risky Factors of Men Who Have Sex With Men and Sex-buying Men as Groups Vulnerable to Sexually Transmitted Diseases

ObjectivesIt is necessary to examine groups carrying out sexually risky behavior because the prevalence of sexually transmitted diseases (STDs) is high among them. In this study, the prevalence of STDs among homosexuals and sex-buying men in South Korea was investigated, along with their sexual risk factors.MethodsMen who have sex with men (MSMs, n=108) were recruited in Seoul and Busan by applying the time location sampling method, while sex-buying men (n=118) were recruited from a john school in Gyeonggi province, the suburbs of Seoul. Dependent variables included past or present infection with syphilis, Chlamydia, gonorrhea, and human immunodeficiency virus. Independent variables included health behavior, social support, sexual behavior, and safe sex.ResultsIt was found that when the MSMs were non-drunk while having sexual intercourse (odds ratio [OR], 0.132), they showed a higher STD infection rate when they had a higher number of anal sex partners (OR, 5.872), rarely used condoms (OR, 1.980), had lower self-efficacy (OR, 0.229), and were more anxious about becoming infected with an STD (OR, 3.723). However, the men who paid for sex showed high STD infections when they had more sex partners (OR, 2.286) and lower education levels (OR, 3.028).ConclusionsSTD infections among the two groups were high when they were engaged with many sex partners and not having protected sex. In other words, there was a gap in risky sex behavior within such groups, which was significantly related to the possibility of developing an STD. Therefore, the preventive intervention against STDs for these groups needs to be expanded to include management of sex behaviors.

O3-S4.05 Treatment of students infected with chlamydia and gonorrhoea in a school-wide screening program

BackgroundProviding treatment to individuals screened for a health condition is a key component of any health screening program. School-based screenings for sexually transmitted diseases (STD) offer the possibility of efficiently and promptly treating participants because students can be easily located after they have been tested. We describe treatment rates and time to treatment for students with Chlamydia trachomatis (CT) orNeisseria gonorrhoeae(NG) infection in a school-wide screening program.MethodsBetween 1995 and 2005, 20 224 high school students were tested for CT and NG during annual screenings using urine specimens and commercial nucleic acid amplification tests. Test results were available approximately five working days after specimen collection. Students who tested positive were located at school during regular class hours for counselling and treatment by a school nurse, a clinic nurse, a public health nurse, or a physician. Treatment was with a single 1 gram oral dose of azithromycin for CT and 500 mg oral ciprofloxacin for NG, administered under direct observation. Before its removal from the market, cefixime 400 mg in single oral dose was used to treat NG. The names of infected students who could not be located in school were forwarded to a public health Disease Intervention Specialist (DIS) for follow-up. The DIS provided the program with an update on the follow-up status of each name referred.ResultsDuring the 10-year period, 3422 infections (CT: 2746; NG: 304; CT and NG: 372) were identified. Treatment was documented for 2844 infections (83.1%). There were no significant differences in rates of treatment (p&gt;0.37) by gender or by infection. The rates of treatment varied by school year from a low of 64.8% in 1996–1997 to a high of 94.9% in 1997–1998 (p&lt;0.0001). For 2692 infections with documented dates of treatment, the median time from specimen collection to treatment was 21 days (75th percentile: 33 days).ConclusionsThis high school STD screening and treatment program achieved high treatment rates for both CT and NG, although the treatment effort required strong commitments of various individuals from the screening program, the administrations in participating schools, and the local health services. Differences in treatment rates per school year reflected the dynamic interplay of these various individuals and organisations as well as the commonly high absentee, truancy, and dropout rates among students in the school district.

School-Based Health Center Access, Reproductive Health Care, and Contraceptive Use Among Sexually Experienced High School Students

The current analyses compared receipt of reproductive health care, contraceptive use, and screening for sexually transmitted diseases (STD) among adolescents who are sexually experienced, with or without access to a school clinic. A total of 12 urban California high schools, selected from areas with high teen pregnancy and STD rates, half with school-based health centers (SBHCs), participated in an intervention study designed to improve sexual health among adolescents. Of the participating students, 44% indicated that they had ever had intercourse and were included in these analyses. Access to an SBHC did not influence receipt of reproductive health care for either males or females and did not influence contraceptive use, either hormonal or condoms, for males. For females, however, those with access to an SBHC had increased odds of having received pregnancy or disease prevention care (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = 1.16-1.80), having used hormonal contraceptives at last sex (AOR = 1.68, 95% CI = 1.24-2.28), and were more likely to have ever been screened for an STD (AOR = 1.85, 95% CI = 1.43-2.40). Also among female students, those with access to an SBHC were more likely to have used emergency contraception at last sex (AOR = 2.1, 95% CI = 1.08-4.22). Although access to an on-site clinic does not seem to lead to increases in all types of reproductive care in the population as a whole, sexually active females are more likely to have received more specific care and to have used hormonal contraceptives if their school has an SBHC.

Sexually Transmitted Diseases and Risk Behaviors Among Market Vendors in China

The rate of sexually transmitted diseases (STDs) in China has soared over the past 20 years. There is a need to study STD prevalence in the general population of the country. To report the prevalence and patterns of STDs and the relationships between STD status and demographic and behavioral factors. A total of 4,510 market vendors in a city in eastern China were interviewed and tested for STDs. The prevalence of any STD among participants was 16.55% (women, 21.04%; men, 11.54%). Among those who tested positive for an STD, chlamydia was most common (8.89%), followed by herpes (6.50%). Participants who had no schooling and participants who had college or higher level of schooling had a similarly high STD prevalence (26.19% vs. 24.00%, respectively). Prevalence of all STDs was significantly higher among women, those with more discretionary income, and those with multiple partners. Special considerations are needed for low versus high education groups as well as men versus women to maximize the effects of STD prevention programs and messages in China.

The Epidemiology of HIV/AIDS in Women in the Southern United States

We reviewed data from multiple sources to examine distinguishing features of the HIV epidemic among women in the South. The goal of this study was to identify HIV and sexually transmitted disease (STD) prevention research priorities in the South. Cases of HIV/AIDS and STDs were analyzed to compare rates by region and rates in urban versus rural areas. Data from interviews of persons reported with HIV/AIDS from rural areas in 4 southern states compared social and behavioral characteristics of men versus women. The South is characterized by high AIDS and STD rates. The epidemic among southern women is distinguished by the predominance of heterosexually acquired infection, the disproportionate impact on blacks, the high proportion residing in rural areas, and multiple high-risk behaviors. Research to identify determinants of high-risk sex and drug-using behaviors among poor, minority men and women in less urban and rural southern regions is needed.

High HIV Sexual Risk Behaviors and Sexually Transmitted Disease Prevalence Among Injection Drug Users in Northern Vietnam

HIV prevalence in Vietnam is currently concentrated among injection drug users (IDUs). The extent to which this core risk group represents a potential for broader HIV transmission to the general population is currently unknown. A community-based cross-sectional study among IDUs in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. Qualitative interview data enhanced quantitative findings. The prevalence of any STDs among 272 IDUs was 30% (chlamydia, 9%; herpes simplex virus type 2 [HSV-2], 22%; gonorrhea, 0%; and syphilis, 1%). Part-time work or unemployment (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.1 to 6.9), sex with > or =2 sex workers in the past year (OR = 4.9, 95% CI: 1.91 to 12.6), having ever smoked heroin (OR = 4.5, 95% CI: 1.1 to 18.3), and injecting less frequently than daily (OR = 3.9, 95% CI: 1.43 to 10.6) were independently associated with chlamydial infection. Urban residency (OR = 4.0, 95% CI: 1.4 to 11.0) and daily injecting (OR = 2.2, 95% CI: 1.1 to 4.4) were independently associated with HSV-2. Odds of HSV-2 among older (> or =28 years of age) IDUs who had sex with <2 sex workers in the past year was higher than among younger IDUs who had sex with more sex workers (OR = 6.4, 95% CI: 2.1 to 18.4). High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.

The influence of pregnancy, sexually transmitted diseases, and human immunodeficiency virus perceived susceptibility patterns on sexual risk reduction for adolescent females

AbstractRisky sexual behavior can lead to pregnancy, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV). Our study of 300 adolescent females takes an integrative approach by incorporating these multiple outcomes to assess the influence of risk perceptions on sexual behavior by (1) identifying subgroups of perceived susceptibility to pregnancy, STDs, and HIV using cluster analysis and (2) comparing subgroups on demographics, sexual history, sexual risk behavior over time, and subsequent STD acquisition. Results demonstrated five perceived susceptibility clusters (no susceptibility; high HIV; high pregnancy; high STD; and high multisusceptibility) that differed in three important ways: demographic and sexual history profiles, current sexual risk behavior, and subsequent STDs. Young women in the no susceptibility cluster had the lowest sexual risk and those in the high multisusceptibility cluster had the highest sexual risk and the highest number of subsequent STDs. There were no significant changes in sexual risk over time, regardless of cluster. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 313–331, 2005.

An evaluation of parental knowledge of sexually transmitted diseases (STDs)

Previous research at our institution on adolescent knowledge about STDs found that parents were a common source for their information about these infections. There is little documented, however, on the level of parental knowledge about STDs. Using the same STD knowledge assessment previously used in the adolescent study, we sought to evaluate knowledge about STDs, and examine the correlates of high STD knowledge in a convenience sample of parents.

Identification of women at high STD risk among STD clinic attendees: implications for STD programmes.

We showed an association between current infection with a recognized sexually transmitted infection (STI) pathogen and HIV infection in women but not in men with non-ulcerative genital disease. While the accuracy of recognition of male urethritis and genital ulcer syndromes is high, this is significantly less for non-ulcerative STIs in women. The symptoms associated with the latter have a broad differential diagnosis including conditions of a non-STI nature. Local sexually transmitted disease (STD) clinic attendees often comprise patients with and without STIs. We hypothesized that this may be responsible for the association of current STI pathogens and HIV in women. To identify a group of women that would be representative of a true STD clinic population we looked at those with a past history of treated genital ulcers. When we analysed in this subset the association of current STI pathogen and HIV infection, a pattern emerged that was comparable with that in men.

Community-based screening and treatment for STDs: results from a mobile clinic initiative.

The persistence of syphilis and other bacterial sexually transmitted diseases (STDs) in many areas of the United States suggests that innovative approaches to controlling these diseases are needed. To evaluate the feasibility, acceptability, and yield of mobile community-based STD screening and treatment services in high STD incidence areas. Free, voluntary, confidential screening and treatment for STDs were conducted in high STD incidence neighborhoods of Baton Rouge, Louisiana, using a 32-foot mobile van. Demographic and behavioral data were obtained from participants. Participants were screened for syphilis, chlamydia, and gonorrhea and were also offered HIV testing. Community attitudes toward the screening program were assessed with street-intercept surveys conducted two weeks after screening events. From March 1997 to August 2000, 256 community-based screening events were held. During this period, 3110 blood samples were collected for syphilis testing, of which 37 (1.2%) new cases of syphilis were identified. Of the 2807 blood samples collected for HIV testing, 70 (2.5%) were positive. Of 2229 urine samples, 185 (8.3%) tested positive for Chlamydia trachomatis and 108 (4.9%) positive for Neisseria gonorrhoeae. Of 389 street-intercept surveys, 97% of respondents thought that neighborhood STD testing was a "good" or "very good" idea. Mobile community-based STD screening and treatment are feasible, identify high positivity of STDs, and are accepted by the community as an innovative approach to STD control.

Screening Adolescents in a Juvenile Detention Center for Gonorrhea and Chlamydia: Prevalence and Reinfection Rates

Adolescents ( n = 5,558) processed through a juvenile temporary detention center were screened for gonorrhea and chlamydia. Overall, the prevalence was 5.1% for gonorrhea and 14.7% for chlamydia. Female adolescents were 3.5 and 3.3 times more likely to have gonorrhea and chlamydia, respectively, than were male adolescents. Reinfection rates for the 180 adolescents who had a sexually transmitted disease (STD) at first screening and were screened on another occasion were 10.0% for gonorrhea and 28.9% for chlamydia. Given the high STD prevalence and reinfection rates uncovered in this study, administrators at juvenile detention facilities could potentially decrease the long-term cost burden on their facilities through a screening program designed to detect STDs before the detainees experience the costly sequelae of STDs or are released into the community to further spread the STDs. Research is also needed to devise intervention strategies that are effective in reducing risky sexual behaviors and STD morbidity in this high-risk adolescent population.