Prior Sexually Transmitted Infection Research Articles

Genetic Network Analysis to Assess the Risk of Human Immunodeficiency Virus Transmission Among Men Who Have Sex With Men Seeking Partners on the Internet.

Online partner seeking (OPS) among men who have sex with men (MSM) is associated with increased risk behavior including frequency of unprotected anal intercourse, number of partners, and incidence of sexually transmitted infections (STIs). However, the impact on transmission of human immunodeficiency virus (HIV) is uncertain. MSM diagnosed with acute and early HIV infection were recruited from the Primary Infection Resource Consortium. HIV transmission events in the year following infection were inferred using estimated date of infection combined with genetic network analysis with linked sequences defined as ≤0.015 sequences/site difference in the HIV type 1 (HIV-1) pol coding region. Participants completed a detailed baseline questionnaire including reported methods of meeting sexual partners, including OPS, in the prior 3 months, and regression was performed with inferred transmission as the outcome. From 147 MSM who completed the questionnaire, there were an associated 20 inferred HIV transmissions. No association with OPS was found (odds ratio, 0.64 [95% confidence interval, .24-1.69]; P = .37), though individuals who reported OPS were more likely to have reported a greater number of partners (P = .003) and prior STIs (P = .002). Geospatial analysis did not indicate that OPS was associated with increased geographical reach of the user (P = .68). Individuals reporting OPS did not have increased odds of inferred HIV-1 transmission in the year following infection using genetic linkage analysis despite apparently increased risk behavior. OPS also did not increase the geographic distance between genetically clustered HIV infections, suggesting that individuals mainly use the internet to meet partners in their local region.

2345. Knowledge, Practices, and Attitudes of Youth Providers About STI, HIV Testing, and PrEP

BackgroundIn 2015, over half of sexually transmitted infections (STI) and 22% of new HIV infections were among youth aged 15–24. Latest Utah data from 2014 showed this group accounted for 62% of chlamydia, 33% of gonorrhea, and 12% of new HIV infections. HIV testing in Utah is low with 24.2% of adults ever tested. There have been no studies published evaluating Utah HIV testing rates in youth.MethodsAn anonymous email-based survey was sent to 396 youth providers in Utah during an 8-week span in 2017. 102 (26%) responded and analysis was limited to 83 (21%) providers who reported caring for patients aged 15–24.ResultsThe median age of providers was 35.5; median years out of residency 8.5; most were female (54%); self-identified as Caucasian (86%); attending level physicians (70%) and many (61%) practiced in urban settings. Over half identified as moderately, very, or extremely comfortable screening for HIV. Approximately 75% were familiar with CDC HIV testing guidelines. However, only 16% report always or often testing youth for HIV. Providers were more likely to screen for HIV in older patients; 19% always or often screening patients age 17–24 and 10% of patients age 13–16. Factors that increased the likelihood of offering an HIV test included: patient request, men who report sex with men, prior STI or a history of injection drug use (Figure 1). Common reasons for rarely or never offering testing included: belief the patient panel is not sexually active, low prevalence of HIV and provider discomfort in discussing sexual behaviors (Figure 2). Less than one-third of providers reported familiarity with the CDC’s PrEP guidelines, but most (91%) expressed interest in more information. Provider discomfort in offering PrEP was highest in the younger patients (Figure 3). The same factors that increased the likelihood of testing for HIV held true for prescribing PrEP.ConclusionIn Utah, the majority of providers are familiar with CDC HIV testing guidelines; however, testing remains low. This may be due to misconceptions around HIV risk and provider comfort. This is a missed opportunity for early detection of HIV in a population with known high rates of other STIs. Youth providers are not familiar with PrEP but they would like further education. Disclosures All authors: No reported disclosures.

Predicting STI Diagnoses Amongst MSM and Young People Attending Sexual Health Clinics in England: Triage Algorithm Development and Validation Using Routine Clinical Data

BackgroundSexual health (SH) services increasingly need to prioritise those at greatest risk of sexually transmitted infections (STIs). We used SH surveillance data to develop algorithms to triage individuals attending SH services within two high-risk populations: men who have sex with men (MSM) and young people (YP). MethodsSeparate multivariable logistic regression models for MSM and YP were developed using surveillance data on demographics, recent sexual history, prior STI diagnoses and drug/alcohol use from five clinics in 2015–2016 to identify factors associated with new STI diagnoses. The models were prospectively applied in one SH clinic in May 2017 as an external validation. Findings9530 YP and 1448 MSM SH episodes informed model development. For YP, factors associated with new STI diagnosis (overall prevalence: 10.6%) were being of black or mixed white/black ethnicity; history of chlamydia diagnosis (previous year); and multiple partners/new partner (previous 3-months). The YPs model had reasonable performance (c-statistic: 0.703), but poor discrimination when externally validated (c-statistic: 0.539). For MSM, being of South Asian ethnicity; being born in Europe (excluding the UK); and condomless anal sex or drug use (both in previous 3-months) were associated with STI diagnosis (overall prevalence: 22.0%). The MSM model had a c-statistic of 0.676, reducing to 0.579 on validation. InterpretationSH surveillance data, including limited behavioural data, enabled triage algorithms to be developed, but its implementation may be problematic due to poor external performance. This approach may be more suitable to self-triage, including online, ensuring patients are directed towards appropriate services. FundingNIHR HTA programme (12/191/05).

The role of sexual networks in studies of how BV and STIs increase the risk of subsequent reinfection.

Prior studies have demonstrated that both bacterial vaginosis (BV) and sexually transmitted infections (STIs) are strong independent risk factors for subsequent STI. In observational studies of this biological enhancement (BE) hypothesis, it is important to adjust for the risk of STI exposure so that the independent effect of BE can be assessed. We sought to model if two markers of local sexual network (partner concurrency and cumulative number of STIs) represented residual confounding in the models of risk for subsequent infection in a study that screened 3620 women for STIs every 3 months for a year. Mixed-effects logistic regression was used to calculate the odds ratios for an incident diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and BV following a diagnosis of any of these four at the prior visit, controlling for the cumulative number of STIs and partner concurrency variables. We found that partner concurrency and cumulative number of STIs were each associated with incident infection, and in general, controlling for these variables reduced the strength of the association between prior and incident infections. We conclude that the frequently found association between prior and incident STIs is associated with both BE and sexual network structure.

Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa: A cross sectional study.

We describe knowledge of human immunodeficiency virus (HIV) status, correct report of HIV status and antiretroviral therapy (ART) use among sexually transmitted infection (STI) service attendees in South Africa.An anonymous questionnaire was administered and serological HIV testing done. Proportions of attendees reporting knowledge of HIV status and HIV status consistent with laboratory results and ART use (among HIV positives) were determined as were factors associated with knowledge and inconsistent report of HIV status.Of 1054 attendees, 288 (27.3%) were HIV positive and 830 (78.8%) self-reported knowledge of HIV status. Not knowing one's HIV status was associated with male gender [adjusted Odds Ratio (aOR) 2.66 (95% confidence interval (CI) 1.70–4.18] medical circumcision [aOR 0.48 (95% CI 0.24–0.95)] and site [Gauteng Province (GP)-aOR 6.20 (95% CI 3.51–10.95), Eastern Cape (EC)-aOR 17.29 (95% CI 10.08– 29.66) versus Free State (FS)/Western Cape (WC) sites]. Of 219 HIV positive attendees with knowledge of HIV status, 136 (62.1%) self-reported being HIV positive, of whom 80 (58.8%) reported taking ARVs in the preceding 3 days. Inconsistent report of status was associated with males [aOR 2.26 (95%CI 1.05–4.87)], prior STI treatment [aOR 0.33 (95% CI 0.16–0.69)], recent HIV testing (6months) [aOR 3.20 (95% CI 1.62–6.36)] and site [GP-aOR 6.89 (95% 3.21–14.82), EC-aOR 5.08 (95% CI 2.15–11.64) versus FS/WC sites]. Knowledge of HIV status was lower than targeted. HIV testing and linkage to care services are essential in STI-related care and validation of self-reported indicators in this population maybe necessary.

Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.-Mexico Border.

U.S.-Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (< 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43-3.68), PR 1.88 (1.04-3.41), respectively] and sexual partners met online [PR 3.73 (1.00-14.06), PR 19.98 (5.70-70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60-3.87), AOR 1.52 (1.11-2.07), AOR 1.97 (1.20-3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities.

Perceived Risk of Intimate Partner Violence Among STI Clinic Patients: Implications for Partner Notification and Patient-Delivered Partner Therapy.

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with a bacterial sexually transmitted infection (STI) medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing and counseling. Despite a growing body of evidence in support of PDPT, literature is limited to date on the influence of perceived risk of intimate partner violence (IPV) on PDPT use. We analyzed mixed-method data from 196 quantitative surveys (61% male, M age=31.2, 92% Black or African-American) and 25 qualitative interviews to better understand the barriers and facilitators associated with PDPT delivery for patients attending a Midwestern, publicly funded STI clinic in the U.S. Nearly a third of surveyed patients (29; 34% of women, 26% of men) expressed worry about IPV when delivering PDPT. Patients had concerns about infidelity worry, embarrassment, and anxiety (referred to as IWEA hereafter) associated with partner notification and PDPT delivery. We found IWEA was highly correlated with IPV concerns in a fully adjusted logistic regression model. Women had 2.43 (95% CI=1.09-5.42) times greater odds of worrying about IPV than men; other significant factors associated with IPV worry included higher condom use, no prior STI diagnosis, and being uninsured (as compared to having Medicare/Medicaid insurance). Encouraging communication between healthcare providers and their patients about the potential for IPV could facilitate patient triaging that results in the consideration of alternative partner referral mechanisms for patients or partners at risk of harm and better outcomes for patients and their partners.

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.

The Prevalence of High-Risk HPV Types and Factors Determining Infection in Female Colombian Adolescents.

This study reports six HR-HPV types’ infection prevalence discriminated by species and multiple infection in unvaccinated Colombian female adolescents, as well as some factors modulating the risk of infection. HPV DNA for six high-risk viral types was identified in cervical samples taken from 2,134 12–19 year-old females using conventional generic and type-specific PCR. Binomial logistical regression analysis was used for modelling HR-HPV infection and multiple infection risk. The interaction between variables in a stepwise model was also included in such analysis. Viral DNA was detected in 48.97% of the females; 28.52% of them had multiple infections, HPV-16 being the most frequently occurring type (37.44%). Cytological abnormality prevalence was 15.61%. Being over 16 years-old (1.66: 1.01–2.71 95%CI), white ethnicity (4.40: 1.16–16.73 95%CI), having had 3 or more sexual partners (1.77: 1.11–2.81 95%CI) and prior sexually-transmitted infections (STI) (1.65: 1.17–2.32 95%CI) were associated with a greater risk of HPV infection. Having given birth was related to a higher risk of infection by A7 species and antecedent of abortion to less risk of coinfection. Where the females in this study came from also influenced the risk of infection by A7 species as female adolescents from the Andean region had a lower risk of infection (0.42: 0.18–0.99 95%CI). The presence of factors related to risky sexual behaviour in the study population indicated that public health services should pay special attention to female adolescents to modify the risk of infection by high-risk HPV types and decrease their impact on this age group.

Examining the Correlates of Sexually Transmitted Infection Testing Among Men Who Have Sex With Men in Ouagadougou and Bobo-Dioulasso, Burkina Faso.

Men who have sex with men (MSM) are a population at risk for HIV acquisition and transmission and other sexually transmitted infections (STIs). In Burkina Faso, the prevalence of HIV among MSM is higher than that of other reproductive-aged adults. Early and frequent STI testing and treatment can help prevent HIV acquisition and transmission and may improve linkage to care. A cross-sectional study used respondent-driven sampling of MSM in the urban centers of Ouagadougou and Bobo-Dioulasso, Burkina Faso, to complete a questionnaire and HIV and syphilis testing. The binary-dependent variable in these analyses was self-reported prior STI testing in the past 12 months. Independent variables included sociodemographic characteristics, sexual behaviors, and psychosocial factors, selected according to the modified social ecological model. Bivariate associations at the P<0.05 level were used to create a manual forward stepwise multivariable logistic regression. Seventy-six percent of participants (511/672) did not test for STIs in the last 12 months. Testing for STIs was associated with STI symptoms (odds ratio [OR], 2.56; 95% confidence interval [95% CI], 1.39-4.76) and independently associated with depressive symptoms (adjusted OR, 1.49; 95% CI, 1.01-2.20) and discussing HIV and STIs with main male partners (adjusted OR, 1.73; 95% CI, 1.23-1.76). These data suggest that periodic targeted STI screening for MSM in Burkina Faso may represent an important component of comprehensive HIV prevention programming. The relationship between depression and STI risks is well established, and these data further indicate that screening for depression may be warranted during these clinical encounters.

Risk factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study.

We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI). The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis. There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval (CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio (aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection (aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure (aHR 0.2; 95% CI 0.1-0.6; P < 0.001). In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.

Correlates of African American female adolescent offenders 3, 4-Methylenedioxymethamphetamine (MDMA or “Ecstasy”) use and sexually transmitted infection morbidity

The current study was designed to determine the extent to which self-reported ecstasy use in a population of juvenile adolescent detainees in a southern state is associated with high-risk health behaviors pertaining to sexually transmitted infection (STI) symptomology and past history of STI occurrence. Participants were 764 African American females extracted from an overall sample of 2,260 juvenile offenders housed at selected Youth Development Campuses in the state of Georgia. Significance tests were conducted using univariate logistic regressions to examine the independent associations of participant’s self-reported ecstasy use and dichotomized HIV risk behavior correlates and history of having a prior STI before the most recent incarceration Participants who reported ecstasy use prior to incarceration were 1.7 (OR = 1.68, 95% CI = 0.78–3.64) and 1.8 times (OR = 1.87, 95% CI = 1.24–2.81) more likely respectively to indicate having had genital warts or chlamydia, and were more than 1.5 times (OR = 2.21, 95% CI = 0.83–5.44) and two times more likely to report having had gonorrhea or herpes, accordingly. Prevention programs for adolescent offender populations should develop interventions that target adolescents’ substance use behavior as a function of STI risk taking as well as being culturally competent to deal specifically with these problem behaviors.

O11.3 Trichomonas vaginalisrisk and cofactors among peripartum kenyan women: protective association with male partner circumcision

Introduction Trichomonas vaginalis (TV) is the most common non-viral sexually transmitted infection (STI) worldwide and has implications for reproductive health in young women. We measured risk and correlates of peripartum TV. Methods Kenyan women participating in a prospective study of peripartum HIV acquisition were enrolled during pregnancy and attended monthly follow-up visits until 9 months postpartum; HIV-seroconverters were excluded. TV was assessed every 1–3 months using wet mount microscopy and treated per Kenyan national guidelines. Recurrent TV was defined as TV detected ≥30 days after treatment or documented TV clearance. Male partner characteristics were reported by women. Andersen-Gill survival models were used to measure correlates of TV adjusting for age, socio-economic status, marital status, male partner circumcision status, and other STIs. Results 1271 women enrolled at a median of 22 weeks gestation (interquartile range [IQR] 18–26), representing 1223 person-years. Most women were married (78%), reported no prior STIs (94%) and had uncircumcised male partners (69%); median age was 22 years (IQR 19–27). Overall, 196 TV infections were detected (81 prevalent at baseline, 115 incident during follow-up) and 56 (28%) were recurrent; 25% of infections were symptomatic. TV incidence was 9.4 per 100 person-years. In multivariate analyses, women with circumcised male partners had a 36% lower risk of incident TV compared to women with uncircumcised partners (adjusted hazard ratio [aHR] 0.64, 95% CI 0.43–0.94, p = 0.023). Having lower education ( Chlamydia trachomatis infection (aHR 2.06, 95% CI 1.24–3.44, p = 0.006) were associated with TV. Compared to nonuse, postpartum injectable or oral hormonal contraception use was not associated with TV risk. Conclusion TV was relatively common in this peripartum cohort. Male circumcision promotion for HIV prevention may confer benefits in preventing TV among women in this setting. Disclosure of interest statement We have no conflicts of interest to disclose.

Factors related to vaccine uptake by young adult women in the catch-up phase of the National HPV Vaccination Program in Australia: Results from an observational study

BackgroundAustralia commenced a publically-funded, National Human Papillomavirus (HPV) Vaccination Program in 2007 with a two year catch-up phase for females aged 12–26 years. ObjectiveTo identify the factors associated with the uptake of the HPV vaccine (which has a recommended 3-dose schedule in Australia) by young adult women vaccinated by general practitioners and community-based programs within the catch-up phase. Methods1139 women who were eligible to receive the free HPV vaccine during the catch-up period were recruited in 2008–2009 (age 20–29 years at recruitment), in New South Wales, after having a normal (negative) cervical smear result recorded on the NSW Pap Test Register. Participants completed a self-administered questionnaire providing information on vaccination status, and sociodemographic and other factors. ResultsOverall, 880 (77%) women reported receiving ≥1 dose of the vaccine and 777 women (68%) reported receiving ≥2 doses. In multivariable analysis (adjusting for the period for which each woman was eligible for free HPV vaccination), uptake of ≥1 dose of the vaccine was significantly associated with being born in Australia (p<0.01), being single (p=0.02), being nulliparous (p<0.01), living in a higher socioeconomic status area (p-trend=0.03), living in more remote areas (p=0.03), drinking alcohol (p<0.01) and using hormonal contraceptives (p<0.01). Although vaccinated women were more likely to have fewer sexual partners than unvaccinated women (p-trend=0.02), they were also more likely to report a prior sexually transmitted infection (STI) (p=0.03). Similar factors were associated with receiving ≥2 doses. ConclusionsIn this group, women living in higher socioeconomic status areas were more likely to be vaccinated against HPV in the catch-up phase of the national program. Although vaccinated women tended to have fewer sexual partners, they also reported prior STIs, which may be a marker of increased risk of prior exposure to HPV. The findings of this study reinforce the continuing need to prioritise equitable delivery of vaccination to various population subgroups.

Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya

PurposeThe objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs),...

Powder and Crack Cocaine Use as a Determinant of Sexually Transmitted Infections (STIs) Occurrence among US Juvenile Offenders

The prevention of sexually transmitted infections (STIs) among adolescents is a major concern across the globe, in particular in the United States (U.S.), and A common indicator of risk in documented in the literature for STIs is substance use. Method: Participants were 2260 juvenile offenders in the state of Georgia. Significance tests were conducted using univariate logistic regressions to examine the independent associations of participant’s self-reported crack and powder cocaine use and dichotomized HIV risk behaviour correlates and history of having a prior STI before the most recent incarceration. Results: With respect to specific STI occurrence, participants who reported powder cocaine use were more likely to have reported having been told they had genital warts (OR=1.33, 95% CI=0.58-3.02), Chlamydia (OR=1.27, 95% CI=0.83-1.95), Syphilis (OR=1.33, 95% CI=0.58-3.02) and Trich (OR=1.39, 95% CI=0.82-2.38). Participants who reported past Crack use were three times more likely to having been told they had Syphilis prior (OR=3.39, 95% CI=0.49-23.41). Participants who reported using crack were three and two time to indicate that had been informed prior that they had Herpes (OR=3.04, 95% CI=0.44-2.1.16) and Trich (OR=2.32, 95% CI=0.73-7.41) accordingly. Conclusion: Even across racial/ethnic groups, gender, and geographic locations, several determinants of adolescents' sexual risk taking were identified. Of importance, is the need for STI risk reduction interventions to consider using more measures of overall reproductive health, especially for female juvenile offenders.

A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients.

The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

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...

P2.106 Utilization of Sexually Transmitted Infection Services by Male Partners of Antenatal Care Attendees in Jinja District-Uganda: A Case Control Study

<h3>Background</h3> Although men are key players in reproductive health services, their health seeking behaviours are poor. Sexually transmitted infections (STIs) are associated with increased spontaneous abortions, Human Immunodeficiency virus infection and infertility in pregnant women but men hardly utilise STI services when their partners seek antenatal care (ANC). In 2009/2010, men constituted 20% of patients who received treatment for STIs in Jinja district. Only 3.9% of ANC attendees in Jinja hospital went with their male partners and utilised STI services between February and August 2011. <h3>Objective</h3> To determine factors associated with utilisation of STI services by male partners of ANC attendees in Jinja district, Uganda. <h3>Methods</h3> A Case control study was conducted in 2012 on a consecutive sample of; 151 cases (Male partners of ANC attendees who utilised STI services at the health facility with their pregnant partners) and 151 controls (Male partners of ANC attendees who did not utilise STI services at the health facility with their pregnant partners) from 13 health facilities. Quantitative data was collected using semi-structured standardised questionnaires, entered in EPI INFO and analysed in stata/SE 10.0 using odds ratios from logistic regression models to assess associations. Qualitative data was collected by in-depth interviews and analysed using manifest content analysis. <h3>Results</h3> Cases had higher odds of; prior STI testing (AOR 4.03, CI 2.22, 7.32), receipt of STI information (AOR 4.94, CI 2.50, 9.75) and being satisfied with the level of confidentiality at the health facilities (AOR 4.51, CI 2.16, 9.42). Fear of STI tests, lack of trust for their female pregnant partners, inadequate staff and busy schedules bar men from utilising STI services. <h3>Conclusion</h3> Knowledge about STIs through prior STIs testing or Information Education and Communication materials as well as patients’ satisfaction with health providers’ handling of confidential information are important determinants of STI service utilisation.

Tubal risk markers for failure to place transcervical sterilization coils

BackgroundThere is a growing body of literature on placement rates of the Essure® procedure, yet prior studies have not attempted to identify tubal-associated risk factors for placement failures. The current study examines risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design. Study DesignWe used electronic medical record data to assess risk markers associated with the inability to place the Essure coils in the tubal lumen using the new ESS305 design. A total of 310 attempted procedures between June 14, 2007, and April 29, 2011, were analyzed. ResultsThere were 18 tubal failures (5.8%) out of the 310 attempted procedures. A history of a prior sexually transmitted infection (STI) was associated with tubal failure (odds ratio 2.64, 95% confidence interval 1.01–6.90, p=.048). ConclusionsWe speculate that the observed association between a prior STI and an inability to place the coil was due to a past history of pelvic inflammatory disease.