Sexually Transmitted Diseases Screening Research Articles

A randomized trial of home versus clinic-based sexually transmitted disease screening among men.

Preventing sexually transmitted diseases (STD) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) remains a public health challenge. The U.S. Preventive Services Task Force suggests STD screening among men will likely lead to a decrease in infection rates of women. However, innovative approaches are necessary to increase the traditionally low rates of male screening. The purpose of this study is to compare the acceptability and effectiveness of home-based versus clinic-based urine screening for CT and GC in men. We conducted a randomized clinical trial of 200 men aged 18 to 45 years who reside in St. Louis, MO. Men were enrolled via telephone and randomly assigned to receive a free urine CT/GC screening kit either in-person at the research clinic or to have it mailed to the participant's preferred address. Participants completed questionnaires at baseline and 10 to 12 weeks postenrollment. The primary outcome was whether STD screening was completed. Sixty percent (120/200) completed STD screening. Men assigned to home-based screening were 60% more likely to complete screening compared with clinic-based screening (72% vs. 48%, RRadj = 1.6, 95% CI = 1.3, 2.00). We identified 4 cases of CT or GC in the home-based group compared with 3 cases of CT in the clinic group. Men who completed screening were significantly more likely to be white, younger, and college educated. Home-based screening for CT and GC among men is more acceptable than clinic-based screening and resulted in higher rates of screening completion. Incorporating home-based methods as adjuncts to traditional STD screening options shows promise in improving STD screening rates in men.

The Unmet Medical Needs of Correctional Populations in the United States

The goal of this study was to document the health needs of members in the criminal justice system and the capacity of the system to meet those needs. Using data from the National Criminal Justice Treatment Practices survey, we estimated the number of adults under correctional control who need medical care and the capacity of the correctional system to provide needed care. A mailed survey of 431 adult correctional agencies and administrators was used to define the capacity and techniques of the correctional system to meet the medical needs of the offender population. Most offenders in jail and prison received tuberculosis screening, physical health services, and mental health screening and treatment. Screening for sexually transmitted diseases (STDs) and provision of detoxification or methadone maintenance were universally absent, regardless of criminal justice setting. Community corrections settings were lacking in most health care areas. Prisons and jails are constitutionally mandated to provide health care; however, community corrections agencies are not federally required to provide health services. While community correction settings have the lowest provision of health care services, prisons and jails also demonstrate a deficiency in most services, but particularly for STD screening, substance abuse detoxification, and opioid maintenance therapies.

Receipt of Preventive Health Services in Young Adults

To examine self-reported rates and disparities in delivery of preventive services to young adults. A population-based cross-sectional analysis, of 3,670 and 3,621 young adults aged 18-26 years who responded to California Health Interview Survey (CHIS) in 2005 and CHIS 2007, respectively. The main outcome measures were self-reported receipt of flu vaccination, sexually transmitted disease (STD) screening, cholesterol screening, diet counseling, exercise counseling, and emotional health screening. Multivariate logistic regression was used to examine how age, gender, race/ethnicity, income, insurance, and usual source of care influence the receipt of preventive services. Delivery rates ranged from 16.7% (flu vaccine) to 50.6% (cholesterol screening). Being female and having a usual source of care significantly increased receipt of services, with female participants more likely to receive STD screening (p < .001), cholesterol screening (p < .01), emotional health screening (p < .001), diet counseling (p < .01), and exercise counseling (p < .05) than male participants after controlling for age, race/ethnicity, income, insurance, and usual source of care. Young adults with a usual source of care were more likely to receive a flu vaccine (p < .05), STD screening (p < .01), cholesterol screening (p < .001), diet counseling (p < .05), and exercise counseling (p < .05) than those without a usual source of care after adjusting for age, race/ethnicity, income, and insurance. Rates of preventive services delivery are generally low. Greater efforts are needed to develop guidelines for young adults to increase the delivery of preventive care to this age-group, and to address the gender and ethnic/racial disparities in preventive services delivery.

Postpartum sexually transmitted disease: refining our understanding of the population at risk.

Scant literature exists on sexually transmitted disease (STD) risk specific to pregnancy and postpartum. The objective of this prospective study is to examine risk factors for incident postpartum STDs among young mothers (ages, 14-25). Pregnant women were enrolled at <24 weeks gestation (N = 848). Data were collected via in-depth interviews and STD testing conducted in the second and third trimesters and at 6 and 12 months postpartum. Prevalence and incidence of STD diagnosis in pregnancy and postpartum is described. Logistic and linear regression are used to identify risk factors for postpartum infection. Forty-four percent of enrolled women never had an STD, 29% had a history of an STD before pregnancy, 28% got an STD during pregnancy, and 27% were diagnosed with an STD postpartum. Incidence of postpartum infection was higher for women who contracted an STD in pregnancy (43%) compared with those with a prior STD (24%) or no STD (19%). In multivariate analysis, STD in pregnancy, having less than high school education, having a new sexual partner, and black race were risk factors for incident postpartum STD. Prenatal providers should be aware of the significant risk of incident infection among women diagnosed with STDs in pregnancy. Elevated postpartum incidence among those with an STD in pregnancy supports a shift toward more frequent and targeted postpartum STD screening, with implications for clinical care, future research, and interventions.

Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care.

We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors. The SUN study is a prospective observational HIV cohort study conducted in 4 US cities. At enrollment and every 6 months thereafter, participants completed a behavioral survey and were screened for STDs, and if diagnosed, were treated. Medical providers conducted brief risk-reduction counseling with all patients. Among men who have sex with men (MSM), we examined trends in STD incidence and rates of self-reported risk behaviors before and after exposure to the risk-reduction intervention. The "preintervention" visit was the study visit that was at least 6 months after enrollment STD screening and treatment and at which the participant was first exposed to the intervention. The "postintervention" visit was 12 months later. Among 216 MSM with complete STD and behavioral data, median age was 44.5 years; 77% were non-Hispanic white; 83% were on highly active antiretroviral treatment; 84% had an HIV RNA level <400 copies/mL and the median CD4 (cluster of differentiation 4) count was 511 cells/mm. Twelve months after first exposure to the risk-reduction intervention, STD incidence declined from 8.8% to 4.2% (P = 0.041). Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners increased (19% to 25%, P = 0.024), but did not change with HIV-negative partners or partners of unknown HIV status (24% to 22%, P = 0.590). STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling. These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM.

20. Access To Sexual Health Education and Care for Adolescents: Using Technology

Sexual Health Education is variable within the United States; hence adolescent knowledge of sexually transmitted diseases (STDs), and screening for STDs is suboptimal. Cell phone ownership and access to the Internet is high within this population; therefore, it seems logical to educate and communicate with teens via technology. In an inner city adolescent health center, we explored how youth access the Internet for sexual health education and their thoughts about using technology to connect with their health home.

Ongoing Sexually Transmitted Disease Acquisition and Risk-Taking Behavior Among US HIV-Infected Patients in Primary Care: Implications for Prevention Interventions

To better understand the factors associated with HIV- and sexually transmitted disease (STD)-transmitting behavior among HIV-infected persons, we estimated STD prevalence and incidence and associated risk factors among a diverse sample of HIV-infected patients in primary care. We analyzed data from 557 participants in the SUN Study, a prospective observational cohort of HIV-infected adults in primary care in 4 US cities. At enrollment and 6 months thereafter, participants completed an audio computer-assisted self-interview about their sexual behavior, and were screened for genitourinary, rectal, and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by nucleic acid amplification testing, and for serologic evidence of syphilis. Women provided cervicovaginal samples and men provided urine to screen for Trichomonas vaginalis by polymerase chain reaction. Thirteen percent of participants had a prevalent STD at enrollment and 7% an incident STD 6 months later. The most commonly diagnosed infections were rectal chlamydia, oropharyngeal gonorrhea, and chlamydial urethritis among the men and trichomoniasis among the women. Other than trichomoniasis, 94% of incident STDs were identified in men who have sex with men. Polysubstance abuse other than marijuana, and having ≥4 sex partners in the 6 months before testing were associated with diagnosis of an incident STD. STDs were commonly diagnosed among contemporary HIV-infected patients receiving routine outpatient care, particularly among sexually active men who have sex with men who used recreational drugs. These findings underscore the need for frequent STD screening, prevention counseling, and substance abuse treatment for HIV-infected persons in care.

Screening of Oropharynx and Anorectum Increases Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Female STD Clinic Visitors

The relevance of screening of oropharynx and anorectum in addition to endocervical tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae infection is unclear in women, while there is a documented benefit of this approach in men who have sex with men. Female visitors to the sexually transmitted disease (STD) clinic were asked about their sexual practice as a part of the routine electronic patient file. In addition to tests for endocervical infection, swabs were taken from the oropharynx and anorectum to test for C. trachomatis and N. gonorrhoeae based on the history of sexual contact. Routinely, all electronic patient files are anonymously included in a database for surveillance purposes. In this observational study, we analyzed all consultations in the database over an 18 months period. A total of 4299 consultations were registered; 10% of women had endocervical chlamydia and 1.1% had gonorrhea. The detection rates for C. trachomatis and N. gonorrhoeae from oropharyngeal samples were 1.9% and 0.8%, and from anorectal samples 8.7% and 1.7%, respectively. Except for 2 cases of pharyngeal gonorrhea, all oropharyngeal and anorectal infections were asymptomatic. Inclusion of oropharyngeal and anorectal tests in the screening protocol was associated with a percentage increase in prevalence of chlamydia by 9.5% and gonorrhea by 31%, relative to tests for endocervical tests alone. The percentage increase in prevalence was higher than that for the symptom-based approach (3.7% and 10.4%, respectively). Inclusion of oropharyngeal and anorectal tests in the STD screening protocol increases the prevalence of chlamydia and gonorrhea in women. Screening of anatomical sites based on sexual history is preferred over a symptom-based protocol.

P5-S6.06 Utilisation and cost of diagnostic methods for STD screening among insured American Youth, 2008

BackgroundInformation on the private sector utilisation and cost of sexually transmitted disease (STD) screening and diagnostic testing in the USA is limited. We present STD diagnostic method-specific utilisation and cost...

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.

Infecciones vaginales y lesiones celulares cervicales (IV). Cuestionario de conocimiento de ETS. Estudio multivariante

ObjectiveJaworski and Carey's 2007 sexually-transmitted disease (STD)-knowledge questionnaire was administered to patients with infections and lesions (disease group) and to a control group over a 1-year period. Material and methodsThe disease group consisted of 256 patients with infections and lesions identified by screening for other STDs. The control group was composed of 513 patients without infections or lesions. The questionnaire was administered at the end of consultations. In the first analysis, responses were coded as correct, incorrect or don’t know. In the multivariate analysis, using the formula C-I (correct minus incorrect responses), the code, N, was established. ResultsThe disease group was older than the control group, with a mean age of 36.42 years. Significant differences were found in age, labor and abortions in this group. Significant differences were found in favor of the control group, which showed a greater number of correct responses and fewer incorrect and don’t know responses. The disease group showed a greater lack of knowledge. There were significantly more patients in the disease group who responded «don’t know» to all 27 questions (p<0.05) or who provided incorrect responses to all questions (p<0.01). In the multivariate analysis, the mean score was significantly better (p<0.001) in the control group (5.55 versus 3.51). In all comparisons, the mean scores by age groups were significantly better (p<0.001) in the control group, as were the mean scores by educational level (p<0.001). Scores were not correlated with age but were strongly correlated with educational level: the higher the level of education, the higher the scores, which were highest among patients with a university education. ConclusionsKnowledge of STD is correlated with educational level and is best among persons with university education. Women should receive health education on contraception, STD prevention, female psychophysiology, and human relationships, as an important and necessary part of their studies, whatever they may be.

Association Between Sexually Transmitted Diseases and Young Adults' Self-reported Abstinence

Self-reported behavior has been the cornerstone of sexual health research and clinical practice, yet advances in sexually transmitted disease (STD) screening provide researchers with the opportunity to objectively quantify sexual risk behaviors. However, the extent to which young adults' laboratory-confirmed STD results and self-reported sexual behaviors are consistent has not been assessed in a nationally representative sample. Data are derived from participants who completed wave 3 in the National Longitudinal Study of Adolescent Health. Young adults (N = 14 012) completed an audio computer-assisted self-interviewing survey and provided a urine specimen to detect the presence of Chlamydia trachomatis and Neisseria gonorrhoeae, and a polymerase chain reaction assay to detect Trichomonas vaginalis. More than 10% of young adults with a laboratory-confirmed positive STD result reported abstaining from sexual intercourse in the 12 months before assessment and STD testing. After controlling for several sociodemographic factors, self-reported sex (versus those who reported abstinence) in the previous 12 months was significantly associated with testing positive, but the odds of testing positive were only slightly more than twofold (adjusted odds ratio: 2.11 [95% confidence interval: 2.097-2.122]). Findings indicate discrepancy between young adults' positive STD status and self-reported sexual behavior. No significant correlates of discrepant reporting were identified. From a clinical standpoint, the discrepancies between STD positivity and self-reported sexual behavior observed in this nationally representative sample suggest that routine STD screening may be beneficial and necessary to reduce STD morbidity among young adults.

Effective communication of risks to young adults: Using message framing and visual aids to increase condom use and STD screening.

Sexually Transmitted Diseases (STDs)-including HIV/AIDS-are among the most common infectious diseases in young adults. How can we effectively promote prevention and detection of STDs in this high risk population? In a two-phase longitudinal experiment we examined the effects of a brief risk awareness intervention (i.e., a sexual health information brochure) in a large sample of sexually active young adults (n = 744). We assessed the influence of gain- and loss-framed messages, and visual aids, on affective reactions, risk perceptions, attitudes, behavioral intentions, and reported behaviors relating to the prevention and detection of STDs. Results indicate that gain-framed messages induced greater adherence for prevention behaviors (e.g., condom use), whereas loss-framed messages were more effective in promoting illness-detecting behaviors (e.g., making an appointment with a doctor to discuss about STD screening). The influence of the framed messages on prevention and detection of STDs was mediated by changes in participants' attitudes toward the health behaviors along with changes in their behavioral intentions. Moreover, when visual aids were added to the health information, both the gain- and loss-framed messages became equally and highly effective in promoting health behaviors. These results converge with other data indicating that well-constructed visual aids are often among the most highly effective, transparent, fast, memorable, and ethically desirable means of risk communication. Theoretical, economic, and public policy implications of these results are discussed.

STD Screening of HIV-Infected MSM in HIV Clinics

National guidelines for the care of human immunodeficiency virus (HIV)-infected persons recommend asymptomatic routine screening for sexually transmitted diseases (STDs). Our objective was to determine whether providers who care for HIV-infected men who have sex with men (MSM) followed these guidelines. We abstracted medical records to evaluate STD screening at 8 large HIV clinics in 6 US cities. We estimated the number of men who had at least one test for syphilis, chlamydia (urethral and/or rectal), or gonorrhea (urethral, rectal, and/or pharyngeal) in 2004, 2005, and 2006. Urethral testing included nucleic acid amplification tests of both urethral swabs and urine. We also calculated the positivity of syphilis, chlamydia, and gonorrhea among screened men. Medical records were abstracted for 1334 HIV-infected MSM who made 14,659 visits from 2004-2006. The annual screening rate for syphilis ranged from 66.0% to 75.8% during 2004-2006. Rectal chlamydia and rectal and pharyngeal gonorrhea annual screening rates ranged from 2.3% to 8.5% despite moderate to high positivity among specimens from asymptomatic patients (3.0%-9.8%) during this period. Annual urethral chlamydia and gonorrhea screening rates were higher than rates for nonurethral sites, but were suboptimal, and ranged from 13.8% to 18.3%. Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines. The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening.

A Mixed Methods Study of the Sexual Health Needs of New England Transmen Who Have Sex with Nontransgender Men

The sexual health of transmen--individuals born or assigned female at birth and who identify as male--remains understudied. Given the increasing rates of HIV and sexually transmitted diseases (STDs) among gay and bisexual men in the United States, understanding the sexual practices of transmen who have sex with men (TMSM) may be particularly important to promote sexual health or develop focused HIV prevention interventions. Between May and September 2009, 16 transmen who reported sexual behavior with nontransgender men completed a qualitative interview and a brief interviewer-administered survey. Interviews were conducted until redundancy in responses was achieved. Participants (mean age, 32.5, standard deviation [SD] = 11.1; 87.5% white; 75.0% "queer") perceived themselves at moderately high risk for HIV and STDs, although 43.8% reported unprotected sex with an unknown HIV serostatus nontransgender male partner in the past 12 months. The majority (62.5%) had used the Internet to meet sexual partners and "hook-up" with an anonymous nontransgender male sex partner in the past year. A lifetime STD history was reported by 37.5%; 25.0% had not been tested for HIV in the prior 2 years; 31.1% had not received gynecological care (including STD screening) in the prior 12 months. Integrating sexual health information "by and for" transgender men into other healthcare services, involving peer support, addressing mood and psychological wellbeing such as depression and anxiety, Internet-delivered information for transmen and their sexual partners, and training for health care providers were seen as important aspects of HIV and STD prevention intervention design and delivery for this population. "Embodied scripting" is proposed as a theoretical framework to understand sexual health among transgender populations and examining transgender sexual health from a life course perspective is suggested.

Sexually Transmitted Diseases Among Users of Erectile Dysfunction Drugs: Analysis of Claims Data

Pharmacologic treatments for erectile dysfunction (ED) have gained popularity among middle-aged and older men. Increased sexual activity among those who use these drugs raises concerns about sexually transmitted diseases (STDs). To examine the rates of STDs in men who use and do not use ED drugs. Retrospective cohort study. Database of claims from 1997 to 2006 for 1,410,806 men older than age 40 years with private, employer-based insurance from 44 large companies. 33,968 men with at least 1 filled prescription for an ED drug and 1,376,838 patients with no prescription. STD prevalence among users and nonusers of ED drugs. Users of ED drugs had higher rates of STDs than nonusers the year before initiating ED drug therapy (214 vs. 106 annually per 100,000 persons; P = 0.003) and the year after (105 vs. 65; P = 0.004). After adjustment for age and other comorbid conditions, users of ED drugs had an odds ratio (OR) for an STD of 2.80 (95% CI, 2.10 to 3.75) in the year before initiating drug therapy; the OR was 2.65 (CI, 1.84 to 3.81) in the year after. These differences were largely due to infections with HIV. The OR for HIV infection was 3.32 (CI, 2.38 to 4.36) in the year before and 3.19 (CI, 2.11 to 4.83) in the year after an ED drug prescription was filled. Significant changes in STD rates from the year before to the year after the first ED drug prescription was filled were not documented (adjusted OR for STD for users before vs. after the first ED drug prescription was filled, 0.96 [CI, 0.87 to 1.06]). Selection bias precludes conclusions about whether use of ED treatments directly leads to increases in STDs. Men who use ED drugs have higher rates of STDs, particularly HIV infection, both in the year before and after use of these drugs. The observed association between ED drug use and STDs may have more to do with the types of patients using ED drugs rather than a direct effect of ED drug availability on STD rates. Counseling about safe sexual practices and screening for STDs should accompany the prescription of ED drugs. RAND Roybal Center, National Institutes of Health, and Agency for Healthcare Research and Quality.

Prevalence Of Sexually Transmitted Diseases In Pregnant And Non-Pregnant Women In Calabar, Cross River State, Nigeria.

The prevalence of sexually transmitted diseases (STDs) in pregnant and non-pregnant women in Calabar was studied. Blood, high vaginal swabs (HVS) and Endocervical swab (ECS) samples were aseptically collected from five hundred and sixty two (562) antenatal pregnant women attending two tertiary hospitals in Calabar (the General Hospital and the University of Calabar Teaching Hospital ) and randomly from one hundred and eight (108) non-pregnant women in Calabar, and investigated for various etiologic agents of STDs including Neisseria gonorrhoeae, Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis (Bacterial vaginosis), Treponema pallidum (Syphilis), Hepatitis B surface Antigen (HBsAg), Human immunodeficiency virus and Chlamydiae species, using standard microbiological methods. The HVS and the ECS swabs were analyzed using direct wet smear, Gram-stained smear and culture techniques while blood samples were examined serologically using standard proprietory reagents. Out of the 562 pregnant and 108 non-pregnant women examined, 250(44.5%) and 51(47.2%) were infected with various aetiologic agents respectively. In pregnant women, Candida albicans had the highest percentage of infections 121(21.5%) followed by HIV 38(6.8%) and Chlamydiae species 35(6.2%). Others were Hepatitis B surface antigen (HBsAg) 8(1.4%); Trichomonas vaginalis, 29(5.2%); Gardnerella vaginalis (Bacterial vaginosis), 12(2.1%) and Treponema pallidum (Syphilis) 7(1.2%). Neisseria gonorrhoeae was not isolated among the pregnant women. In non-pregnant women, Candida albicans also had the highest percentage of infections 23(21.3%) followed by Chlamydia species 11(10.2%) and HIV 9(8.3%). Others were Trichomonas vaginalis 4(3.7%); Hepatitis B surface antigen (HBsAg) 3(2.8) and Gardnerella vaginalis, 1(0.9). Neisseria gonorrhoeae and Treponema pallidum were not isolated. The prevalent rates of infections were inversely associated with increase in age and educational status. Increased pre/post conception screening for STDs is essential in preventing disease transmission and adverse pregnancy outcomes among these groups.

Brief and intensive behavioral interventions to promote sexual risk reduction among STD clinic patients: results from a randomized controlled trial.

The purpose of this study was to evaluate the separate and combined effectiveness of brief and intensive interventions for sexual risk reduction among patients at a sexually transmitted disease (STD) clinic. Patients (N =1483; 54% men; 64% African-American; M = 29.2 years old) were recruited from a publicly funded, walk-in STD clinic. Patients completed a baseline assessment, and then were randomized to one of six intervention arms; each arm combined a brief intervention with an intensive intervention. The interventions provided different levels of information, motivational counseling, and behavioral skills training, guided by theory, formative research, and empiric precedent. Follow-up assessments, including STD screening, occurred at 3, 6, and 12 months post-intervention. The results showed that infection rates declined from 18.1% at baseline to 4.5% at 12 months. At a 3-month follow-up, patients reported fewer sexual partners, fewer episodes of unprotected sex, and a lower percentage of unprotected sexual events; they strengthened sexual health knowledge, safer sex attitudes and intentions, and self-efficacy beliefs. No consistent pattern of differential risk reduction was observed among the six intervention conditions, nor was any evidence of decay from 3 to 12-month follow-ups obtained. We conclude that implementing behavioral interventions in a STD clinic was associated with significant reduction of sexual risk behavior and risk antecedents.

Sexually transmitted diseases and incarceration

To summarize recent literature on the prevalence and burden of sexually transmitted diseases (STDs) - focusing on syphilis, chlamydia, and gonorrhea - among adult correctional inmates and detained juveniles. The review is largely limited to US settings. The prevalence is higher and the consequences of STDs are generally more severe for incarcerated women than men. Chlamydia and gonorrhea may be more prevalent among confined juveniles than among incarcerated adults, whereas syphilis is probably more prevalent among adults. The opportunity exists to provide effective STD prevention, screening, and treatment to seriously affected and underserved correctional populations, thus benefiting patients and their partners as well as the larger public health. Substantial research shows how screening might be targeted to be most cost-effective. Few correctional systems, however, have implemented the STD screening and treatment programs needed to take full advantage of this public health opportunity. Moreover, few systems have adopted condom provision for inmates, in the face of clear evidence that high-risk sexual activity occurs in correctional settings. The clinical tools are available to improve STD prevention, screening, and treatment in correctional facilities. However, more research and advocacy is needed to convince decision makers of the importance of committing the necessary resources and adopting the policies needed to close the gap between opportunity and reality in correctional STD programs.

HIV and syphilis infections among men who have sex with men in Chongqing municipality, China

To examine the prevalence and predictors of HIV and syphilis infections among men who have sex with men (MSM) in Chongqing municipality, China. Cross-sectional studies were conducted in three districts of Chongqing municipality from July to September, 2006 and 2007, respectively. Questionnaire-based interviews were conducted to provide information on demographic characteristics, behaviors on sex and drug use, and HIV and sexually transmitted diseases (STD) related health services. Blood samples were tested for HIV and syphilis infections. Of 1773 participants, 10.6% were HIV-positive and 8.4% were sero-positive for syphilis infection. Factors independently associated with HIV infection included older age (26-35 year: AOR = 1.7, 95% CI: 1.1-2.6; >35 years of age: AOR = 2.3, 95% CI: 1.4-3.8), low level of education (AOR = 2.3, 95% CI: 1.5-3.5), having had multiple male sex partners (AOR = 1.8, 95% CI: 1.2-2.8), venues of recruitment from bathhouses/sauna (AOR = 2.3, 95% CI: 1.1-4.7), with self-reported STD symptoms in the past 12 months (AOR = 1.8, 95% CI: 1.2-2.7) and syphilis infection (AOR = 1.7, 95% CI: 1.1-2.9). The prevalence rates on both HIV and syphilis infections were considered to be high among MSM in Chongqing city. Unprotected anal sex and multiple sex partners were common in this group. Education, condom promotion, combination of HIV and STD screening, and treatment to the diseases are essential to this population in Chongqing. However, MSM had not hitherto been perceived to be in the epidemic mainstream in this area.