Sexually Transmitted Diseases Prevention Research Articles

Tell Me What You See: An Arts-Based Health Education Program for Youth

A cross-sector collaboration among a community-based organization, a prison arts program, and state departments of Public Health, Education, and Correction was established to address critical health education prevention efforts for at-risk high school-aged youth. The Tell Me What You See initiative utilizes artwork and poetry created by incarcerated youth to promote sexually transmitted disease (STD), HIV, and hepatitis prevention with students in public high schools and juvenile justice facilities. This innovative intervention integrates functional health knowledge and skills-based education through an art-based interdisciplinary approach reaching various populations of youth in multiple settings across a state. Evaluation results indicated that the materials effectively engage youth and open up a critical dialogue among peers and adults by addressing the role personal behavior can have in the prevention of STDs, hepatitis, and HIV. Lessons learned and recommendations are provided.

A Survey of Health Literacy in Sexually Transmitted Diseases of Vocational Schools in Health Region 7th, Thailand

Objective: To analyze the level of health literacy regarding prevention of sexually transmitted diseases (STDs) and studied the relationship between the health literacy and sexual experience of Vocational students in health region 7, Thailand. Materials and Methods: A cross-sectional survey was conducted using questionnaires. The questionnaires consisted of questions on health literacy and sexual experiences. Data were analyzed with descriptive statistics and inferential statistics, including chi-square tests to analyze the relationship between health literacy and sexual experiences. Results: The present study participants comprised of 364 vocational students, 220 (60.4%) male students, and 144 (39.6%) female students. Almost half of the male students (47.3%) had sexual relationship by the age of 15.8 years (SD 1.7), 98.1% of them had their first sexual relationship with their girlfriends, and 81.7% used condoms. Meanwhile, 31.3% of the female students had sexual relationship by the age of 15.7 years (SD 1.3), all of them had first sexual relationship with their boyfriends, and 88.9% used condoms. Most students had low health literacy level, which included 79.5% of the male students and 62.5% of female students. There was significant relationship between sexual experience and health literacy in STD prevention in both male and female students (p<0.05). Conclusion: The present study found that the health literacy in the prevention of STDs was low among the participants. Therefore, education and health care sector should be aware of the situation and jointly develop health education programs in the prevention of STDs for the vocational students and teenagers. Keywords: Sexually transmitted diseases, Health literacy, Social behavior, Vocational students

Systematic review on effectiveness of prevention programs for sexually transmitted diseases (STD)

Sexually transmitted diseases (STD) are one of the most common infections worldwide. The current study aimed to determine what the current STD prevention programs are and their effectiveness. A systematic review of the literature was done for a period of 10 years (2009–2019) in two databases (PubMed and Cochrane) based on PICO strategy. Inclusion criteria were articles published in the English language only, involving clinical trials with control groups. In order to determine the quality of studies, two reviewers reviewed all qualifying papers independently. Twelve studies met our inclusion criteria. Five of the studies were about tenofovir effectiveness, followed by three about community-based intervention, two regarding vaginal gel effectiveness and two about school-based intervention. The two studies on vaginal gel concluded no effectiveness. As a conclusion, community-based prevention programs targeting adolescent and tenofovir gel showed promising results but more studies and at different locations in the world are needed so that some recommendations can be made in the future.

The Estimated Impact of Implementing a Funding Allocation Formula on the Number of Gonorrhea Cases in the United States, 2014 to 2018.

The Centers for Disease Control and Prevention (CDC) allocates funds annually to state and local programs in the United States to monitor and prevent sexually transmitted diseases (STDs). In 2014, a funding formula was implemented to allocate prevention funds to jurisdictions according to their STD burden and population size. We estimated the effect of implementing the funding formula in terms of gonorrhea cases averted from 2014 to 2018, a period during which inflation-adjusted CDC STD prevention funding declined. Our model assumed that STD prevention funds have a measurable effect on subsequent reported gonorrhea case rates, and the magnitude of this effect was as estimated in an empirical analysis of decades of state-level gonorrhea rates. In applying this equation-based model, we assumed all factors affecting jurisdictions' gonorrhea rates were constant over time except for their STD prevention funding allocations. We used data on CDC STD prevention funding allocated to each jurisdiction over time. We estimated gonorrhea rates under the "funding formula" scenario compared with a hypothetical "status quo" funding scenario, which reflected traditional methods to allocate prevention funds. In the model, gonorrhea cases increased from 2014 to 2018 by approximately 6% because of a decline in prevention funding, regardless of how funds were allocated. However, the estimated increase in gonorrhea cases was 5222 (range, 1181-9195) cases less in the funding formula scenario than in the status quo scenario. By shifting resources toward jurisdictions with greater disease burden, the funding formula averted a substantial number of gonorrhea cases at no additional cost.

Medical Gender Affirmation and HIV and Sexually Transmitted Disease Prevention in Transgender Youth: Results from the Survey of Today's Adolescent Relationships and Transitions, 2018.

Purpose: We assessed the association of receipt of medical gender affirmation services (e.g., hormones, surgery) with HIV and other sexually transmitted disease (STD) prevention and knowledge indicators among transgender youth. Methods: A United States online sample of sexually experienced transgender youth ages 13-24 years (N = 1029) in 2018 completed a cross-sectional survey, including questions about sociodemographics, medical gender affirmation, and HIV and STD prevention outcomes (HIV testing, STD testing, pre-exposure prophylaxis [PrEP] awareness, and nonoccupational postexposure prophylaxis [nPEP] awareness). Logistic regression models were fit to assess the association of medical gender affirmation with HIV and STD prevention outcomes. Interaction terms and stratified models assessed differences in the association between medical gender affirmation and outcomes by gender identity. Results: Participants' mean age was 19.1 (standard deviation = 2.7), 45% were transgender female, 29% transgender male, 26% nonbinary, 53% were youth of color, and 19% accessed medical gender affirmation services. Medical gender affirmation was associated with increased odds of STD testing (adjusted odds ratio [aOR] = 1.90; 95% confidence interval [CI] = 1.33-2.73) with no significant interactions by gender identity. Associations between medical gender affirmation and awareness of PrEP and nPEP varied by gender identity. Among transgender male youth, medical gender affirmation was associated with awareness of PrEP (aOR = 2.65; 95% CI = 1.50-4.71) and nPEP (aOR = 2.03; 95% CI = 1.12-3.71). Among nonbinary youth, medical gender affirmation was associated with awareness of PrEP (aOR = 3.47; 95% CI = 1.26-11.27). Conclusion: Medical gender affirmation was associated with uptake and awareness of sexual health services. Bolstering medical gender affirmation for transgender youth may also bolster preventive health services broadly.

Trend Analysis of the Profiles of 12 Sexually Transmitted Disease Pathogens in the Republic of Korea in 2019.

Background: Sexually transmitted diseases (STDs) are common infectious diseases in humans transmitted through unprotected sexual activities. In South Korea, despite the high annual incidence of STDs, detailed examinations of pathogen-specific factors and causes for delays in diagnosis and treatment are still lacking. Furthermore, STD prevalence patterns and important pathogen-specific factors remain unclear. Herein, we retrospectively analyzed the epidemiology of STDs in South Korea in 2019 by analyzing the association of pathogen-specific infection patterns with factors such as sex, age, region, and month. Methods: We obtained the STD test results of 172,973 individuals from the Seoul Clinic Laboratory in 2019, most of whom had multiple infections; hence, 275,296 STD-positive cases were included in this analysis. Through deoxyribonucleic acid (DNA) amplification, they were categorized by pathogen type. Subsequently, they were further classified by month, region, and age while concurrently being stratified according to sex. Results: Among the 12 pathogens detected in this study, Gardnerella vaginalis had the highest prevalence, with 92,490 cases in both sex groups; moreover, many of them were concurrently infected by two or more pathogens. The prevalence of STDs did not differ according to month or region. Conversely, the pathogen-specific prevalence rates significantly differed according to age. Older adults had higher prevalence rates of Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, and herpes simplex virus type 1 infections than younger adults. Conclusion: These pathogen-specific prevalence patterns provide information that helps to understand population vulnerability according to region and age and helps develop STD prevention and treatment strategies in South Korea.

Home-Based Testing for Sexually Transmitted Infections: Leveraging Online Resources During the COVID-19 Pandemic.

Home-Based Testing for Sexually Transmitted Infections: Leveraging Online Resources During the COVID-19 Pandemic.

Response to Dr Robert E. Fullilove's Editorial Letter: "Race and Sexually Transmitted Diseases…Again?"

To the Editor: We appreciate Dr Fullilove continuing the work that his father started in the 1940s to bring attention to the limitations of using reported race and Hispanic ethnicity to identify the risk for sexually transmitted diseases (STDs).1 We agree that race and Hispanic ethnicity are social attributes of groups of people, not biological attributes of individuals in those social groups; therefore, the observed disparities in gonorrhea case rates by race and Hispanic ethnicity are unlikely to be caused by biological differences linked to race or Hispanic ethnicity. Those disparities are associated with a range of other social factors, including differential access to quality sexual health care and prevalence of disease in sexual networks. Measuring disparities in STDs can help direct limited prevention resources toward populations at greatest need. However, when reporting disparities in STDs, it is important to ensure that the underlying drivers of observed disparities are identified to avoid stigmatizing the affected groups and to inform the design and implementation of effective interventions to reduce or eliminate disparities. We also agree with Dr Fullilove that our investigation of race and Hispanic ethnicity classification strategies will not, in and of itself, reduce disparities; however, our work draws attention to some of the challenges in monitoring trends in observed disparities in rates of reported gonorrhea.2 Because Hispanics may be of any race, our goal was to determine whether important disparities in the rates of reported gonorrhea were being masked when using the current classification of all Hispanics into a single Hispanic ethnicity category. We found that the categorization strategy had a minimal impact on trends in disparities over time; however, the magnitude of the disparity each year was affected by the classification approach. In addition, we found that race and Hispanic ethnicity were missing for approximately 1 in 5 gonorrhea cases. If these data are not missing at random, estimates of disparities will be biased. Metrics used to evaluate interventions to reduce STDs in populations most affected will need to consider these limitations. Finally, we agree and support Dr Fullilove’s call for additional research to understand how to address the underlying drivers for proxy factors, such as race or Hispanic ethnicity, when implementing programs, policies, and interventions to minimize the impact of STDs. We would add a call to strengthen surveillance efforts to ensure systems are in place to adequately capture important contextual factors. Sentinel surveillance systems, such as the STD Surveillance Network,3 which conducts enhanced patient and provider investigations on a representative sample of gonorrhea cases, could be further leveraged to monitor trends in the underlying factors that may increase the risk for STDs. Viani Picchetti, MPH Northrop Grumman Contractor Atlanta, GA Division of STD Prevention Centers for Disease Control and Prevention Atlanta, GAHarrell Chesson, PhDElizabeth Torrone, PhDJo Valentine, MSW Division of STD Prevention Centers for Disease Control and Prevention Atlanta, GA [email protected]

Monogamy as Public Policy for STD Prevention: In Theory and in Practice

Monogamy is current public policy for preventing sexually transmitted diseases (STDs). To evaluate whether monogamy is serving its intended purposes, the Centers for Disease Control’s (CDC’s) definition of monogamy is considered. This definition does not convey to the public the fact that monogamy must be practiced very strictly to be effective and implies that serial monogamy is a safe practice. Benefits and drawbacks of employing (different versions of) monogamy to reduce STD transmission are considered. Although certain forms of monogamy are efficacious in reducing STDs, these versions of monogamy have not been adopted by the public and widely practiced forms of monogamy are not effective in practice. Finally, this review considers whether the public policy of monogamy helps society achieve its sexual health goals, explicating strengths and weaknesses of monogamy advice versus other tactics that might be utilized to curb STDs.

Critical Elements of Community Engagement to Address Disparities and Related Social Determinants of Health: The Centers of Disease Control and Prevention Community Approaches to Reducing Sexually Transmitted Disease Initiative.

Community Approaches to Reducing Sexually Transmitted Disease (CARS), a unique initiative of the US Centers for Disease Control and Prevention, promotes the use of community engagement to increase sexually transmitted disease (STD) prevention, screening, and treatment and to address locally prioritized STD-related social determinants of health within communities experiencing STD disparities, including youth, persons of color, and sexual and gender minorities. We sought to identify elements of community engagement as applied within CARS. Between 2011 and 2018, we collected and analyzed archival and in-depth interview data to identify and explore community engagement across 8 CARS sites. Five to 13 interview participants (mean, 7) at each site were interviewed annually. Participants included project staff and leadership, community members, and representatives from local community organizations (e.g., health departments; lesbian, gay, bisexual, transgender, and queer-serving organizations; faith organizations; businesses; and HIV-service organizations) and universities. Data were analyzed using constant comparison, an approach to grounded theory development. Twelve critical elements of community engagement emerged, including commitment to engagement, partner flexibility, talented and trusted leadership, participation of diverse sectors, establishment of vision and mission, open communication, reducing power differentials, working through conflict, identifying and leveraging resources, and building a shared history. This study expands the community engagement literature within STD prevention, screening, and treatment by elucidating some of the critical elements of the approach and provides guidance for practitioners, researchers, and their partners as they develop, implement, and evaluate strategies to reduce STD disparities.

Protect MSM from HIV and other sexually transmitted diseases by providing mobile health services of partner notification: protocol for a pragmatic stepped wedge cluster randomized controlled trial

BackgroundRecently, more and more men who have sex with men (MSM) look for casual partners through online dating platforms in China. However, most are unable to know their partners’ HIV and other sexually transmitted diseases (STD) statuses, leading to the rapid increase in HIV infection among Chinese MSM. Effective partner notification is urgently needed to increase the risk awareness of MSM and prevent HIV and other STDs transmission. However, the traditional intervention mainly targets to the HIV-positive MSM and the effect is not promising. Our study aims to provide Internet-based partner notification, along with a series of health services for HIV-negative MSM to protect them from HIV and other STDs.MethodsA pragmatic stepped wedge cluster randomized controlled trial design is used to evaluate the effectiveness of a new intervention paradigm, which aims to reduce HIV and other STDs incidences among MSM in China. Through integrating a mobile health (mHealth) service application (app) to the current HIV and other STDs prevention and control methods, the new paradigm provides partner notification of HIV, syphilis, hepatitis B, and hepatitis C statuses. A total of 6172 MSM in 16 districts of Beijing, China will be recruited and randomized to sequentially receive partner notification intervention through the app at 6-month intervals. The primary outcomes are HIV incidence and the additional cost of the intervention. The secondary outcomes include incidences of syphilis, hepatitis B, and hepatitis C, disease transmission social networks, testing adherence, knowledge of HIV and STDs control, health self-responsibility awareness, changes of high risk behaviors and other related outcomes. The generalized linear mixed models (GLMM) will be used to analyze the differences of outcomes in the control period and in the intervention period.DiscussionWe expect that the HIV incidence will be significantly lower and the secondary outcomes will also be improved with providing health service of partner notification through mhealth intervention. The feasible and affordable public health intervention paradigm will have implications for HIV and STDs prevention and control among MSM and other key populations.Trial registrationClinicalTrials.gov, NCT04349748. Registered on 16 April 2020.

Knowledge of Adolescent Girls regarding Sexually Transmitted Diseases: A Study in a Rural Area from North-Eastern Romania

This study aimed at assessing knowledge on sexually transmitted diseases (STDs) in rural 14 to 18-year-old adolescent girls. We administered a questionnaire about STDs to 534 girls and, then, organized a health education programme that included didactic lectures. The major sources of information about STDs were: family – 45.50%, professors – 21.70%, and the family doctor – 11.80%. Girls prefer to discuss sexuality with their mothers rather than with their fathers (23.03% vs. 2.62%). 16.60% knew about at least two STDs, while 8.10% had no knowledge about STDs. 95.30% of girls questioned had heard about HIV/AIDS, while 23.20% were aware that hepatitis B can be sexually transmitted, and 33.60% had heard about vaccination. Other STDs known by the adolescents were: syphilis (55.80%), candidiasis (12.90%), and trichomoniasis (6.60%). 33.10% of adolescents did not know of any methods of preventing STDs. Condoms were reported to be the first method of protection against pregnancy, not against STDs. If they had an STD, most adolescents (58.61%) would prefer to get their treatment from the pharmacy without first consulting a doctor. 74.50% of adolescents consider it useful to receive sexual education lectures in school, whereas 41.19% would like to receive information about STDs through brochures and 85.58% would rather find information on a website. STDs in teenage girls represent a special issue both for their families and society as a whole. The health education program contributed to raising awareness about STDs prevention and transmission in adolescents from rural area

The Potential Impact and Availability of Sexual Health Services During the COVID-19 Pandemic.

As the COVID-19 pandemic causes upheaval in New York City (NYC), 1 consequence is the accessibility of sexual health services. The NYC STD Prevention Training Center at Columbia University administered an online provider survey to understand how the COVID-19 pandemic is affecting the availability of sexual health care services regionally.

Increasing Chlamydia and Gonorrhea Infections among Female Juveniles: The Need for Collaboration to Improve Treatment.

Background: Youth in juvenile detention centers are at a high risk for sexually transmitted disease (STD). The current study assesses the trends of chlamydia and gonorrhea (GC) infections and treatment among females within a single county’s juvenile correctional facilities.Methods: This is a retrospective review of aggregate data of female adolescents between 12 and 18 years old who underwent STD screening from 2009 to 2016 in San Bernardino County.Results: Chlamydia infections among adolescent females increased from 11.8% in 2009 to 17.0% in 2016 (p = 0.0002), and GC infections increased from 1.3% in 2009 to 6.0% in 2016 (p < 0.0001). Treatment rates of chlamydia were stable, ranging from 66.7% to 70.8% of positive female adolescents were treated between 2009 and 2016 (p=0.1752). The treatment rate for GC increased from 33% in 2009 to 78.3% in 2016, but annual trends were not statistically significant (p=0.8419).Conclusions: Chlamydia and GC infections among female adolescents discovered during routine screening upon booking into a county juvenile detention system increased over the study time period. Effective collaboration between public health and various community organizations is needed to improve awareness and prevention of STDs amongst at-risk adolescents.

The concept of virginity from the perspective of Iranian adolescents: a qualitative study

BackgroundPremarital sex can increase the risk of sexually transmitted diseases (STDs) in adolescents, and lack of premarital sex can be considered as a reliable policy for STD prevention, which is used by some countries such as Iran. Since the success of this policy is related to the concept of virginity, the present study was conducted to determine the concept of virginity from the perspective of Iranian adolescents.MethodsIn this qualitative study with phenomenological approach, the research team visited public places, including parks and coffee shops, and interviewed a number of 15–19-year-old adolescents. The data were collected using in-depth interviews with semi-structured questions and analysed using thematic analysis method.ResultsSeveral themes, including virginity as the lack of emotional relationship with the opposite sex, lack of physical contact, nonpenetrative relationship, virginity as a myth, virginity as a commitment, having an intact hymen, and not knowing the meaning of virginity, were extracted from the data.ConclusionThe most reliable policy on STD prevention is the lack of premarital sex. The success of this policy is related to the concept of virginity. The findings of this study showed that the participants did not consider physical contact as the breach of virginity. This may indicate that the policy of not having sex before marriage or lack of premarital sex is not enough and Iranian adolescents are at risk of STDs. Therefore, policymakers must take steps towards modifying the concept of virginity in the adolescents’ value system and provide and implement educational programs on sexual health for adolescents.

Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020.

SummaryThis report (hereafter referred to as STD QCS) provides CDC recommendations to U.S. health care providers regarding quality clinical services for sexually transmitted diseases (STDs) for primary care and STD specialty care settings. These recommendations complement CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2015 (hereafter referred to as the STD Guidelines), a comprehensive, evidence-based reference for prevention, diagnosis, and treatment of STDs. STD QCS differs from the STD Guidelines by specifying operational determinants of quality services in different types of clinical settings, describing on-site treatment and partner services, and indicating when STD-related conditions should be managed through consultation with or referral to a specialist. These recommendations might also help in the development of clinic-level policies (e.g., standing orders, express visits, specimen panels, and reflex testing) that can facilitate implementation of the STD Guidelines. CDC organized the recommendations for STD QCS into eight sections: 1) sexual history and physical examination, 2) prevention, 3) screening, 4) partner services, 5) evaluation of STD-related conditions, 6) laboratory, 7) treatment, and 8) referral to a specialist for complex STD or STD-related conditions.CDC developed the recommendations by synthesizing relevant, evidence-based guidelines and recommendations issued by other experts; reviewing current practice in the United States; soliciting Delphi ratings by subject matter experts on STD care in primary care and STD specialty care settings; discussing the scientific evidence supporting the proposed recommendations at a consultation meeting of experts and institutional stakeholders held November 20, 2015, in Atlanta, Georgia; conducting peer reviews of draft recommendations and supporting evidence; and discussing draft recommendations and supporting evidence during meetings of the CDC/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment STD Work Group. These recommendations are intended to help health care providers in primary care or STD specialty care settings offer STD services at their clinical settings and to help the persons seeking care live safer, healthier lives by preventing and treating STDs and related complications.

Correlates of Socio-Demographic Variables and Attitude to Condom Use in HIV/AIDS Prevention among Students in Some Selected Nigerian Universities.

Background:Unprotected heterosexual sexual act has been correlated with unwanted pregnancy and sexually transmitted diseases (STDs) especially HIV/AIDS, which still has a high endemicity in Africa. This study aimed to determine the association between socio-demographic variables (SDVs), sexual experience, and the use of condom.Setting and Design:This was a cross-sectional study comprising 542 undergraduate students, randomly selected from three Nigerian universities.Methodology:Well-structured open-ended questionnaires were administered to respondents. Bivariate analysis was used to determine the association between SDVs and attitude to condom use and between the SDVs, sexual experience and the use of condom. Data were analyzed using Epi6 6.04 and SPSS 10.0 software packages. Pearson's Chi-square (χ2) and Fisher's exact tests were used as applicable. The level of significance was set at P < 0.05.Results:Approximately 46% of the respondents were sexually active (consisting of about 71% of those 25–29 years old and 58% of the males [P < 0.001]). About 50.4% had a single sexual partner and 86.7% had “ever used” condom. The most common reasons given for use of condom were prevention of pregnancy (91.7%) and STDs (89.1%). All the SDV except religion significantly (P < 0.05) accounted for the disparity in sexual attitudes of the students. Those aged 25 years and above, males and Tiv tribe were more likely to indulge in sexual activities (P < 0.001). More females (98%) compared to males (83%) had ever used condom in their sexual experience (P = 0.010), while there was no significant association between any of the SDVs and use of condom in the last sexual exposure (P > 0.05).Conclusion:SDVs play a role in determining the attitude of students towards condom use and sexual experiences. Programs regarding sexual and reproductive health including safe sex education especially among young Nigerian students should be developed or strengthened.

Testing for Sexually Transmitted Diseases in US Public Health Laboratories, 2016.

Background:Laboratory testing practices are an important part of sexually transmitted disease (STD) diagnosis and control. The goal of this article is to describe the volume and types of STD tests performed in public health laboratories (PHLs) in the United States in 2016.Methods:A total of 105 state and local PHLs who were members of the Association of Public Health Laboratories were invited to participate in a survey between May and August 2017. This web-based survey included questions on types of tests offered for different types of STDs, the number of tests offered in 2016, and number of samples that tested positive for each STD.Results:Eighty-one (77.1%) of 105 member PHLs responded. Overall in 2016, 2,242,728 Chlamydia trachomatis tests, 2,298,596 Neisseria gonorrhoeae (GC) tests, 1,235,037 Treponema pallidum (syphilis) tests, 177,571 Trichomonas vaginalis tests, 37,101 herpes simplex virus tests, and 8707 human papillomavirus tests were performed in 2016 in surveyed laboratories. Sixty-seven (82.7%) of PHLs offered C. trachomatis and GC nucleic acid amplification testing. Ninety percent of laboratories performed syphilis testing, 42% performed T. vaginalis testing, and 28.4% performed herpes simplex virus type–specific nucleic acid amplification testing. Few laboratories tested for human papillomavirus.Conclusions:This survey collected important information on PHL STD laboratory testing practices. Capacity for important reference laboratory testing, such as GC culture and antimicrobial susceptibility, are needed to support STD programs. Public health laboratories play a key role in STD screening, surveillance, and prevention by offering test methods that are not available at commercial laboratories. Funding constraints affect the resources available for STD screening and surveillance, and thus, it is important to continue to monitor testing practices and the capacity of PHLs to test for STDs.

Chlamydia and Gonorrhea Incidence and Testing Among Patients in the Human Immunodeficiency Virus Outpatient Study (HOPS), 2007-2017.

Although chlamydia (CT) and gonorrhea (GC) infections are increasing in the United States, there are limited data on their incidence, testing rates, and associated risk factors among persons living with HIV (PLWH), including by anatomic site among men who have sex with men (MSM). We analyzed 2007-2017 medical records data from Human Immunodeficiency Virus (HIV) Outpatient Study (HOPS) participants in care at 9 HIV clinics. We calculated CT (and GC) incidence and testing rates and assessed associations with sociodemographic and clinical factors using log-linear regression. Among 4727 PLWH, 397 had 881 CT infections and 331 had 861 GC infections, with an incidence of 2.95 and 2.88 per 100 person-years, respectively. From 2007 to 2017, incidence and testing rates increased by approximately 3.0- and 1.9-fold for CT and GC, respectively. Multivariable factors associated with incident CT (GC) included younger age, MSM, and prior diagnoses of sexually transmitted diseases (STDs). Among 1159 MSM, 583 (50.3%) had 844 CT and 843 GC tests during 2016-2017, and 26.6% of tests were 3-site (urethra, rectum, and pharynx), yielding the highest rates of CT (GC) detection. Multivariable factors associated with CT (GC) testing included younger age, non-Hispanic/Latino black race, and having prior STDs. Recent CT and GC incidence and testing increased among PLWH; however, only half of MSM were tested for CT or GC during 2016-2017 and less than a third of tests were 3-site. To promote sexual health and STD prevention among PLWH who are MSM, research regarding the added value of CT and GC testing across 3 anatomic sites is needed.

Confidentiality and Consent in the Care of the Adolescent Patient.

1. Sofya Maslyanskaya, MD* 2. Elizabeth M. Alderman, MD* 1. *Division of Adolescent Medicine, Children's Hospital at Montefiore, and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY * Abbreviations: CDC: : Centers for Disease Control and Prevention EHR: : electronic health record EOB: : explanation of benefits HIPAA: : Health Insurance Portability and Privacy Act HIV: : human immunodeficiency virus SAHM: : Society for Adolescent Health and Medicine STD: : sexually transmitted disease Confidentiality protections are critical in the provision of comprehensive primary care of adolescent patients. The protections differ based on state laws and are limited by electronic health record documentation and billing operations of individual physician practices. Physicians need to strive to increase their knowledge regarding confidentiality protections for their adolescent patients. Moreover, physicians should understand their role in preventing possible confidentiality breaches. After completing this article, readers should be able to: 1. Define confidentiality, its limitations, and reasons for developmentally appropriate confidentiality protections for adolescents. 2. Recognize confidentiality protections for adolescents provided by state and federal laws, including the Health Insurance Portability and Privacy Act privacy rule. 3. Explain minor consent laws. 4. Describe the limitations and advantages of the electronic health record in providing confidentiality protections. 5. Identify concerns and solutions related to billing for confidential services. A 16-year-old girl who has been your patient since birth presents to an appointment alone and requests testing for sexually transmitted diseases (STDs). She also does not want her parents to find out about this visit. How would you proceed? ### Confidentiality and Autonomy The provision of confidentiality and the ability of adolescents to consent for certain health concerns are the cornerstone of optimal adolescent health-care. (1) According to this tenet, information about an adolescent’s health-care is not disclosed without his or her permission. Assurance of confidentiality is important to protect the adolescent’s health and to safeguard public health. The major causes of morbidity and mortality in adolescents are due to risky behaviors such as sexual activity and alcohol and substance use, as well as unmet mental health needs. During the past 3 decades, research has supported the importance of the …