Sexually Transmitted Diseases Diagnosis Research Articles

Level of knowledge about contraception and prevention of sexually transmitted diseases among students of the Medical School of the Universidad Abierta Interamericana - Sede Rosario (Argentina), year 2023

Introduction: Sexually transmitted diseases (STDs) constitute an important public health problem worldwide, being condoms the fundamental weapon for protection against STDs.Objective: To describe the level of knowledge about contraception and prevention of sexually transmitted diseases of students from 1st to 3rd year of medical school at the Universidad Abierta Interamericana - Rosario campus in the year 2023.Materials and methods: Quantitative, observational, descriptive, cross-sectional and retrospective study, carried out at the Universidad Abierta Interamericana (UAI), Rosario, Argentina, from December 2022 to May 2023. The population consisted of students studying from the first to the third year in the first four-month period of the Medical School. The data collection instrument consisted of a survey consisting of 21 questions on contraception and STDs. The variables were summarized through measures of central position (mean) and measures of dispersion (range and standard deviation) and expressed in absolute and relative frequency. Results: A total of 70 students were analyzed of which 77% (n=54) were female and 23% (n=16) were male. The mean age was 24.6 ± 5.02 years. Sixty-four percent (n=45) belonged to the third year of medicine, 29% (n=20) to the second year and 7% (n=5) to the first year. The mean score obtained was 16.75 ± 2.01 points. Seventy-six percent had a high level of knowledge and 24% medium. The population under 25 years of age had better knowledge than the population over 25 years of age. Similarly, women and third year students have better levels of knowledge. In relation to the function, choice, classification and form of use of contraceptive methods, the students had an average of 8 ± 0.98 correct answers, which represents a high level of knowledge about contraception. Regarding the concept, form of transmission, signs and symptoms, diagnosis, treatment, complications and preventive measures of STDs the students had on average 8.73 ± 1.49 correct answers, representing a medium level of knowledge about STDs.Conclusions: Of the 70 UAI medical students surveyed, there was a higher participation of women under 25 years of age. Of these students, 76% had a high level of knowledge about contraception and STDs

Sex and Sexual Identity Disparities in STDs and Their Mental Health or Substance Use Disorder Risk Factors Among Black/African American Adults

There is a lack of studies examining sexually transmitted disease (STD) diagnosis among subgroups of Black/African American population. We examined the association between STD diagnosis and sociodemographic, sexual identity, mental health, and substance use disorder factors based on sex among Black/African American adult population (N = 15,924). Secondary data analysis was computed using the 2017 to 2019 National Survey on Drug Use and Health, a cross-sectional survey. The prevalence of STDs was higher among Black/African American females (3.01%) than among males (2.61%). Compared to heterosexual females, bisexual females were more likely to have STDs. Males who identified as gay or bisexual were more likely than heterosexual individuals to have STDs. Males or females who experienced marijuana use disorder were more likely than their counterparts to be diagnosed with STDs. Major depressive episode (MDE), alcohol use disorder (AUD), opioid use disorder (OUD), marijuana use disorder, and illicit drugs other than marijuana moderated the association between STD diagnosis and sexual identity based on sex. This study revealed differences in STD diagnosis based on the intersection of sex and sexual identity, mental health, and substance use among Black/African American adults for tailored intervention development efforts.

Status and associated factors of pre-exposure prophylaxis use among men who have sex with men in 24 cities in China

Objective: To understand the cognition and medication use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China and its associated factors. Method: From August 25 to September 5, 2021, 2 447 MSM were recruited in 24 cities to complete the online questionnaire through a male social interaction platform, Blued 7.5 software. The survey contents included demographic information of the respondents, PrEP awareness and usage, and risk behaviors. Descriptive analysis and multi-level logistic regression were performed for data analysis. SPSS 24.0 and SAS 9.4 software were used for statistical analysis. Results: Among the 2 447 respondents of MSM, 1 712 (69.96%) had heard of PrEP, 437 (17.86%) ever used PrEP, 274 (11.20%) were on PrEP, and 163 (6.66%) had discontinued PrEP; among the 437 cases (whoever used PrEP), more than 61.88% (388/627) adopted emtricitabine/tenofovir disoproxil fumarate regimen, and most of them adopted on-demand regimen. The average PrEP dosage reported in the past year is 1.12 tabletsper person per week. PrEP purchase was primarily via an online channel, and the most concerned factor was the PrEP effectiveness on HIV prevention. The most common reasons for discontinuing PrEP, reported by 163 cases, were the lack of HIV risk perception, the use of a condom to prevent HIV, and the economic burden of PrEP use. The logistic regression analysis showed that PrEP use among MSM in 24 cities was statistically associated with age, monthly income, ever having unprotected anal sex in the past year, used sexual drugs and sexually transmitted disease (STD) diagnosis in the past year. Compared with MSM aged 18-24, the proportion of MSM was relatively lower among those aged 25-44, who discontinued the PrEP (aOR=0.54,95%CI:0.34-0.87) or never used PrEP (aOR=0.62,95%CI:0.44-0.87). The proportion of unprotected anal sex among MSM currently on PrEP use was higher than those who have stopped PrEP and never used PrEP (all P<0.05). Those MSM group, with monthly income higher than 5 000 Yuan, used sexual drugs and STD diagnosis in the past year were more likely to have a higher rate for PrEP usage (all P<0.05). Conclusions: Currently, pre-exposure prophylaxis in the MSM group is primarily obtained via the online channel and adopted in an on-demand mode. Although the PrEP users have reached a certain proportion, it is still necessary to strengthen health education on the PrEP effects and side effects of MSM and to improve the awareness and use rate, especially for young MSM group, which can be combined with the advantages of the internet targeting its needs and use barriers.

Misdiagnosis of Sexually Transmitted Diseases in Hong Kong Outpatient Private Healthcare

Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method; then the extracted DNA was tested using the DiagCor GenoFlowTM STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.

Relations Between Adolescent Sensation Seeking and Risky Sexual Behaviors Across Sex, Race, and Age: A Meta-Analysis.

Sensation seeking (SS)-the seeking of novel and intense sensations or experiences and the willingness to take risks for the sake of such experiences-has been shown to be related to various risky sexual behaviors (RSBs) in areas such as multiple sexual partners, condom use, and sexual initiation. The aims of the current meta-analysis were to examine (1) how SS relates to specific RSBs in adolescents and (2) how the overall relationship between SS and RSB differs across sex, race, and age. Overall, a total of 40 studies met the inclusion criteria for our meta-analysis examining the relationship between SS and RSB, contributing 102 effect sizes. RSB variables included unprotected sex; multiple sexual partners; hazardous sexual activity; sexual initiation; virginity status; and history of sexually transmitted disease (STD) diagnosis. Moderating effects of sex, race, and age were also examined. The overall mean effect size of the correlational relationship between adolescent SS and RSB was statistically significant, as were the mean effect sizes of the relationships between SS and RSB subgroups, except for history of STD diagnosis. Race and age did not significantly moderate the overall relationship between SS and RSB; however, results indicated that SS and RSB relations were stronger in females compared to males. Our findings suggest that adolescents with elevations in SS tendencies tend to engage in more RSBs compared to their peers with lower levels of SS, increasing their risk of unplanned pregnancy and STD acquisition.

Prevalence and Characterization of Undiagnosed Youths at Risk of Chlamydia trachomatis Infection: A Cross-sectional Study.

ObjectiveThe aim of this study was to determine the prevalence of Chlamydia trachomatis infection in undiagnosed young people aged between 15 and 24 years.Materials and MethodsA convenience sample of 623 youths, with a mean (SD) age of 20.1 (2.2) years, was recruited from key spaces in the North Metropolitan area of Barcelona in Catalonia, Spain. Participants completed a 21-item questionnaire and provided a urine sample or vaginal swab for testing.ResultsThe most common age at the first sexual intercourse was 16 years (24.6%), followed by 15 years (21.3%). Only 32.6% reported always use of condoms, 49.2% sometimes, and 15.6% never. A positive test for chlamydia was found in 34 participants (5.5%; 95% CI, 3.8–7.5), with no difference by sex. A positive test was significantly more common among the participants who were working, who had been diagnosed with a sexually transmitted disease (STD) at some point in their life, and who used web pages/apps to find new sexual partners more than once a month. In the multivariate analysis, working status was an independent factor associated with chlamydial infection (adjusted odds ratio[OR], 8.88; 95% CI, 1.71–46.17), whereas not having been previously diagnosed with an STD (OR, 0.34; 95% CI, 0.07–1.49) and never using the Internet to find sexual partners (OR, 0.16; 95% CI, 0.03–080) were protective factors against chlamydial infection.ConclusionsThe prevalence of C. trachomatis infection was 5.5%. Working status, a previous diagnosis of STD, and use of the Internet to find new sexual partners were associated with chlamydial test positivity.

Rapid Plasma Reagin Card Test: A Screening Method for Syphilis in Antenatal Patients of Bastar, Chhattisgarh, India

Introduction: Sexually Transmitted Disease (STD) like syphilis is one of the important factor leading to adverse pregnancy outcomes in antenatal mothers. The infant and neonatal mortality rate itself is higher in the tribal region of Chhattisgarh like Bastar due to poor educational status and limited availability of health infrastructures. To prevent the disease related adverse pregnancy outcomes, early diagnosis and treatment of STDs is important by rapid screening method like Rapid Plasma Reagin (RPR) card test, which is comparatively cost effective tool available at clinical settings. Aim: To detect the incidence of syphilis among antenatal mothers of Bastar, Chattisgarh, India by using RPR card test. Materials and Methods: The present cross-sectional study was conducted on 150 blood samples of patients attending Obstetrics and Gynaecology out-patient and in-patient Department (OPD and IPD) from August 2021 to October 2021. The samples referred to Microbiology laboratory of Late Baliram Kashyap Memorial Government Medical College Jagdalpur, Chhattisgarh, India, were tested by RPR card test taking all aseptic precautions. The data were collected in Microsoft Excel sheet and results were presented in counts and percentages using descriptive statistics. Results: Out of 150 samples, 11 (7.33%) were tested positive by RPR card test while rest 139 (92.67%) were found negative. Out of the 11 (7.33%) samples which tested positive, 3 (27.27%) were from Anti Retroviral Therapy (ART) centre (concurrent Human Immunodeficiency Virus (HIV) and syphilis positive), 7 (63.64%) were from Obstetrics and Gynaecology OPD and 1 (9.09%) sample was from labour ward. Age of the patients attending antenatal clinic ranged between 11-50 years with maximum patients 103 (68.67%) were in 21-30 years of age group. Conclusion: RPR card test is one of the important cost effective, rapid screening tools for STDs like syphilis, especially in the resource poor areas like tribal region of Bastar, Chattisgarh, India. Comparatively higher percentage of syphilitic infection reported in the study may contribute in improving health infrastructure policies in the affected regions of Bastar, Chattisgarh, India.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Inadequate Engagement in HIV Care Among People With HIV Newly Diagnosed With a Sexually Transmitted Disease: A Multijurisdictional Analysis.

A key challenge of HIV surveillance-based HIV care reengagement is locating people living with HIV (PLWH) who seem to be out of care to reengage them in care. Providing reengagement services to PLWH diagnosed with a sexually transmitted disease (STD)-individuals who are in jurisdiction and connected to the health care system-could be an efficient means of promoting HIV treatment and reducing HIV transmission. Early and late syphilis (ES/LS) and gonorrhea (GC) cases diagnosed in 2016 and 2017 in Louisiana, Michigan, Mississippi, Oregon, Rhode Island, and Texas were matched to each state's HIV surveillance data to determine the proportion of PLWH with these infections who (1) did not have evidence of a CD4 count or viral load in the prior ≥13 months (out of care) or (2) had a viral load ≥1500 copies/mL on their most recent HIV RNA test before STD diagnosis (viremic). Previously diagnosed HIV infection was common among persons diagnosed with ES (n = 6942; 39%), LS (n = 4329; 27%), and GC (n = 9509; 6%). Among these ES, LS, and GC cases, 26% (n = 1543), 33% (n = 1113), and 29% (n = 2391) were out of HIV medical care or viremic at the time of STD diagnosis. A large proportion of STD cases with prior HIV diagnosis are out of care or viremic. Integrating relinkage to care activities into STD partner services and/or the use of matching STD and HIV data systems to prioritize data to care activities could be an efficient means for relinking patients to care and promoting viral suppression.

SERS-based sensor for the detection of sexually transmitted pathogens in the male swab specimens: A new approach for clinical diagnosis

The surface-enhanced Raman scattering (SERS) has been widely tested for its usefulness in microbiological studies, providing many information-rich spectra which are a kind of ‘whole-organism fingerprint’ and enabling identification of bacterial species. Here we show, previously not considered, the comprehensive SERS-chemometric analysis of five bacterial pathogens, namely Neisseria gonorrhoeae, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Haemophilus ducreyi, all being responsible for sexually transmitted diseases (STDs). In the designed biosensor, the direct, intrinsic format of the spectroscopic analysis was adopted for the SERS-based screening of gonorrhea and chlamydiosis due to vibrational analysis of men's urethra swabs. Our experiments demonstrated that the applied method enables identification the individual species of the Neisseria genus with high accuracy. In order to differentiate the sexually transmitted pathogens and to classify the clinical samples of male urethra swabs, three multivariate methods were used. In the external validation the created models correctly classified the men's urethra swabs with prediction accuracy reaching 89% for SIMCA and 100% for PLS-DA. As a result, the developed protocol enables: (i) simple and non-invasive analysis of clinical samples (the collection of urethra swabs specimens could be carried out at different points of care, such as doctor's office); (ii) fast analysis (<15 min); (iii) culture-free identification; (iv) sensitive and reliable SERS-based diagnosis of STD. The simplicity of the developed detection procedure, supported by high sensitivity, reproducibility, and specificity, open a new path in the improvement of the point-of-care applications.

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

Measuring the Impact of the COVID-19 Pandemic on Sexually Transmitted Diseases Public Health Surveillance and Program Operations in the State of California.

As public health personnel and resources are redirected to COVID-19, sexually transmitted diseases (STD) programs have been unable to sustain pre-COVID-19 activities. We used California (CA) surveillance data to describe trends in case reporting for gonorrhea, chlamydia, and syphilis of any stage in the pre- versus post-COVID-19 eras (January-June 2019 and January-June 2020). We also analyzed data from an electronic survey administered by the CA STD Control Branch to local health jurisdictions in April, June, and September of 2020, assessing the impact of COVID-19 on STD programs. There were sharp declines in cases of all reportable bacterial STDs occurring in conjunction with the March 19, 2020 CA stay-at-home order, most of which did not return to baseline by July. Comparing January-June 2020 to January-June of 2019, there were decreases in reported cases of chlamydia (31%), late syphilis (19%), primary/secondary syphilis (15%), early nonprimary nonsecondary syphilis (14%), and gonorrhea (13%). The largest percentage declines in STD case reporting were among Hispanic, Asian/Pacific Islander, and Black persons. Seventy-eight percent of local health jurisdiction respondents indicated that half or more of their workforce had been redeployed to COVID-19 by September 2020. During the COVID-19 era, STD case reporting and programmatic functions have diminished throughout CA. Because this may contribute to decreases or delays in STD diagnosis and treatment-with resultant increases in STD transmission-providers and public health officials should prepare for potential increases in STD-related morbidity in the months and years to come.

Bacterial sexually transmitted infection testing and diagnoses among men who have sex with men and report prescription opioid misuse––American Men's Internet Survey, 2017–2018

PurposePrescription opioid misuse is associated with behaviors which increase bacterial sexually transmitted diseases (STD) risk among men who have sex with men (MSM). Annual syphilis, gonorrhea, and chlamydia screening is recommended for sexually active MSM at anatomical sites of contact, regardless of condom use. We describe the prevalence of self-reported bacterial STD testing and diagnoses in the past 12 months among sexually active MSM who report prescription opioid misuse. MethodsWe used data from the 2017 and 2018 American Men's Internet Survey to examine the prevalence of self-reported bacterial STD testing and diagnoses in the past 12 months. We calculated unadjusted prevalence ratios, adjusted prevalence ratios (APR), and 95% confidence intervals (CI) to compare bacterial STD testing prevalence across demographic, clinical, and behavioral factors. ResultsOf 932 sexually active MSM who reported prescription opioid misuse, 433 (46.5%) self-reported bacterial STD testing in the past 12 months. Of those who reported being tested, 131 (30.2%) self-reported ≥ 1 bacterial STD. Approximately 50% of respondents who reported condomless anal sex (CAS), casual sex, or exchange sex reported bacterial STD testing in past 12 months. Factors associated with bacterial STD testing among MSM who misused prescription opioids included visiting a healthcare provider in the past 12 months (APR = 1.70, 95% CI = 1.09–2.67), ever disclosing same-sex behavior to a healthcare provider (APR = 1.78, 95% CI = 1.27–2.50), and CAS in the past 12 months (APR = 1.51, 95% CI = 1.10–2.04). ConclusionsPrevalence of self-reported bacterial STD testing in this sample was low and one-third of tested MSM reported ≥ 1 bacterial STD in the past 12 months. Innovative approaches to identify MSM who misuse prescription opioids and expand bacterial STD testing in this population are needed.

Impact of COVID-19 Lockdowns on Sexual Health Care Utilization and STD Reporting, Maricopa County.

The Maricopa County Department of Public Health (MCDPH) Sexually Transmitted Disease (STD) Clinic remained operational during a 6-week statewide Coronavirus Disease 2019 (COVID-19) Stay-at-Home Order. The present study sought to evaluate the effect of the Stay-at-Home Order on countywide STD reporting and uptake of sexual health services. We compared countywide daily median STD reporting and MCDPH STD clinic attendance across 3 timeframes; (1) Pre-Lockdown (01/01/2020–03/30/2020); (2) Lockdown (03/31/2020–05/15/2020); and (3) Post-Lockdown (05/16/2020–12/31/2020). STD reporting was characterized as incident chlamydia, gonorrhea, and primary and secondary syphilis. Clinic attendance was characterized as clients visiting through express testing or provider visits. Differences in STD reporting and clinic attendance were evaluated using non-parametric testing. Comparing Pre-Lockdown to Lockdown, we observed significant declines in the daily median chlamydia case reporting (−22%) and clinic express testing attendance (−29%). Comparing Lockdown to Post-Lockdown, we observed significant increases in daily median chlamydia and gonorrhea case reporting (+20%, +15%; respectively) and clinic express testing and provider visits (+42%, +20%; respectively). No significant difference was observed in countywide syphilis reporting across the 3 timeframes. Declines in STD reporting were observed countywide during the lockdown and were concurrent with declines in attendance observed at the MCDPH STD Clinic. Maintenance of clinic operations during the lockdown allowed for continued uptake of STD testing, diagnosis, treatment, and partner services. This study of sexual health care utilization at the public STD clinic in Maricopa County, Arizona, found reduced testing and provider visits contributed to lower countywide STD reporting during the Arizona COVID-19 Stay-at-Home Order.

Prevalence of sexually transmitted diseases in an urban slum area

Background: The early diagnosis and treatment of sexually transmitted diseases (STDs) helps in reducing the incidence of human immunodeficiency virus. High prevalence of STDs and sexually transmitted infections has been reported from various parts of India. Methods: A community-based cross-sectional study was carried out in an urban slum area in 140 females age 16 years and above to study the prevalence of STDs. For the diagnosis of STDs, the syndromic approach was used. Results: Majority of them (34.2%) were in the age group of 21–29 years. Among presenting complaints, low backache was the most common (48.5%) followed by dysmenorrhea (28.5%) of women. Lower abdominal pain was evident in 16.5%; it was highest in the age group of 21–29 years (20.8%). Vaginal discharge was present in 22.8%, it was highest in the age group of 21–29 years (46.9%). Genital ulcer was seen in 4 (2.9%) cases. Association between STDs and marital status, education, occupation was not found to be statistically significant. Conclusions: Our observations suggest that symptoms of STDs were high in the population, studied. However, no association could be established between presence of STDs and socio-demographic variables.

Human Immunodeficiency Virus (HIV) and Treponema pallidum (Syphilis) Co-infection in Uyo, Nigeria

Aim: HIV/AIDS remains a leading cause of death and disability in Sub Saharan Africa and this accounts for almost half of the world’s HIV related deaths. On the other hand, bacterial sexually transmitted diseases (STDs) such as syphilis contributes to the morbidity and mortality obtained in developing countries. Co-infection of syphilis and HIV may increase the risk of HIV transmission and adversely affect reproductive health. Prompt diagnosis and treatment of STDs in HIV positive individuals can help prevent spread to their partners. There is also very little information about incidence and prevalence of HIV/Syphilis co-infection and their determinants. The aim of this study is to evaluate the HIV/Syphilis co-infection among HIV-infected individuals in Uyo, Nigeria.&#x0D; Methods: A total of 176 individuals living with HIV participated in this study. The average age of the study participants was 39.1 years from a range of 6-67 years. Plasma samples obtained from the human subjects were analysed for presence of HIV and Syphilis antibodies using enzyme-Linked immunosorbent Assay.&#x0D; Results: Our findings showed that the overall prevalence of HIV/Syphilis co-infection in Uyo was 1.7%. Analysis of the results revealed that the variables—sex and educational background—significantly influenced the rate of syphilis sero-positivity among the population under study. While variables- age, marital status and occupational skills non-significantly influenced the rate of syphilis sero-positivity among the population under study.&#x0D; Conclusion: This study confirmed the co-infection of HIV and Syphilis in Uyo, Nigeria. Early screening of Syphilis and other STDs contributes to the control of infection and reduces the spread of HIV to partners. A number of primary preventive interventions for HIV and syphilis need to be adopted including use of condoms and medical male circumcision in order to improve sexual and reproductive health amongst individuals.

Association between head and neck cancer and sexually transmitted diseases: a Danish nationwide, case-control study

Background: An association between sexually transmitted diseases (STDs) and occurrence of head and neck cancer (HNC) is proposed.Aims/objectives: We aimed to determine the association between selected STDs (syphilis, gonorrhoea, HIV) and HNC.Materials and methods: Patients diagnosed with HNC in Denmark between 1978 and 2014 identified through the Danish Cancer Registry were included. Patients were age- and sex-matched in a 1:10 ratio with general population controls. Uni- and multivariate analyses were performed using the Cox regression model to assess the correlation between STD and HNC.Results: A total of 39,405 HNC patients (63% men; 63.0 years at HNC diagnosis) and 393,238 controls were included. STD in HNC patients was 0.27%, vs. 0.11% in controls. Patients with cancer of the upper airways had a significantly higher prevalence of an STD prior to the HNC compared to controls. Most HNC patients with a prior STD (64.1%) developed the HNC within five years after the STD diagnosis.Conclusions: Although the studied STDs are rare, patients with cancer of the upper aerodigestive tract more commonly had a previous diagnosis of STD compared to controls. The study promotes the hypothesis that a causal link exists between STD and HNC.

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.

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 …

Presenting to the Emergency Department Versus Clinic-Based Sexually Transmitted Disease Care Locations for Testing for Chlamydia and Gonorrhea: A Spatial Exploration.

Rates of sexually transmitted diseases (STDs) including chlamydia and gonorrhea are increasing in the United States while public health funding for STD services is decreasing. Individuals seek care in various locations including the emergency department (ED). The objective of this study is to investigate whether there are more physically proximal clinic-based STD care locations available to individuals who present to the ED in a major metropolitan area. Addresses of EDs, clinics, and patients 13 years or older in St. Louis City or County given a nucleic acid amplification test and assigned an STD diagnosis (n = 6100) were geocoded. R was used to analyze clinics within 5 radii from the patients' home address and assess missed clinic opportunities (open, no charge, with walk-in availability) for those living in an urban versus suburban area. In urban areas, 99.1% of individuals lived closer to a clinic than the ED where they sought STD services; in suburban areas, 82.2% lived closer to a clinic than the ED where they presented. In the region, 50.6% lived closer to the health department-based STD care location than the hospital where they presented. Up to a third of ED patient visits for STD care could have occurred at a clinic that was closer to the patient's home address, open, no charge, and available for walk-in appointments. Clinic availability is present for most of the individuals in our study. Clinics providing STD services can increase advertising efforts to increase public awareness of the services which they provide.