Sexually Transmitted Infections Research Articles

What We (Don't) Know About the Infectious Disease Burden Among Youth Experiencing Homelessness in the United States and Canada.

Youth experiencing homelessness (YEH) and sexual and gender minority (SGM) YEH may be at increased risk for infectious diseases due to living arrangements, risk behaviors, and barriers to health care access that are dissimilar to those of housed youth and older adults experiencing homelessness. Here, we synthesize findings from 12 peer-reviewed articles published between 2012 and 2020 that enumerate YEH or SGM YEH infectious disease burden in locations across the United States or Canada. Pathogens presented in the reviewed studies were limited to sexually transmitted infections (STIs) and bloodborne infections (BBI). Only 3 studies enumerated infectious diseases among SGM YEH. There was a dearth of comparison data by housing status or SGM identity. We also introduce 3 publicly available surveillance datasets from the United States or Canada that quantify certain STIs, BBIs, and tuberculosis among YEH to support future analyses. Our review calls for more comprehensive YEH-centered research and surveillence to improve estimates of infectious diseases among this vulnerable population.

Molecular Detection of Human Papillomavirus (HPV) and Other Sexually Transmitted Pathogens in Cervical and Self-Collected Specimens

This study investigated the detection of high-risk Human Papillomavirus (hrHPV) and seven other pathogens associated with sexually transmitted infections (STIs) in matched clinician-collected cervical samples and self-taken vaginal and urine specimens collected from 342 asymptomatic women referred to colposcopy to evaluate (i) the concordance in the molecular detection of investigated pathogen in three different sample types; (ii) the analytical sensitivity and specificity of STIs detection on self-samples; and (iii) the distribution of STIs in hrHPV-positive and hrHPV-negative women. Pathogens detection was performed using Anyplex™II HR and Anyplex™II STI-7e, respectively. Good/substantial agreement was observed between cervical and self-taken samples in detecting hrHPV (κ = 0.870 and κ = 0.773 for vaginal and urine). The agreement between cervical and self-taken samples for detecting STIs was found to be significant (κ = 0.779 and κ = 0.738 for vaginal and urine), with almost perfect agreement between urine and vaginal specimens (κ = 0.899). The positivity rate for all investigated STIs was found to be higher in hrHPV-positive compared to hrHPV-negative women. In conclusion, self-sampling proved to be a valid alternative to cervical samples to detect hrHPV and STIs, but further studies are required to evaluate the role of STI coinfections in cervical lesions development and progression.

The effect of STI screening during pregnancy on vertical transmission of HIV and adverse pregnancy outcomes in South Africa: a modelling study.

Sexually transmitted infections (STIs) in pregnancy are associated with an increased risk of vertical HIV transmission and adverse pregnancy and birth outcomes. In South Africa, syndromic management is the standard of care for STI management. We assessed the potential impact of point-of-care (POC) screening for curable STIs (Chlamydia trachomatis [CT], Trichomonas vaginalis [TV] and Neisseria gonorrhoeae [NG]) during pregnancy on vertical HIV transmission and adverse pregnancy and birth outcomes. We developed a static mathematical model to estimate the impact of syndromic management compared to POC screening of STIs in pregnant women attending antenatal clinics in South Africa over one calendar year (2022). Our model assumptions regarding the effect of CT, NG and TV on adverse pregnancy/birth outcomes and vertical HIV transmission were informed by two separate meta-analyses that we conducted. Local studies informed estimates of STI prevalence, POC screening uptake and treatment, and sensitivity of syndromic management. In the absence of POC screening for curable STIs, 25.5% of pregnant women without HIV and 34.6% of pregnant women living with HIV were estimated to have undiagnosed and untreated STIs. In the POC scenario, 92% (95% CI: 85-100%) of STIs were diagnosed and treated during pregnancy, reducing antenatal maternal HIV incidence by 10.0% (95% CI: 1.0-20.1%). Overall, vertical HIV transmission was anticipated to reduce by 8.6% (5.2-13.8%), with reductions of 20.9% (15.2-27.0%) at birth and 2.5% (-0.9% to 9.0%) postnatally, in the POC screening scenario compared to current syndromic management. POC screening of curable STIs is further estimated to reduce the incidence of stillbirth by 10.1% (1.3-18.7%), preterm delivery by 6.3% (3.4-9.7%), infants born small for gestational age by 2.7% (0.7-4.9%) and low birth weight by 9.1% (0.9-18%). POC STI screening and treatment may modestly reduce maternal HIV incidence, vertical HIV transmission, and the risk of adverse pregnancy and birth outcomes, and would substantially reduce the burden of curable STIs in pregnancy. The study provides evidence to move beyond the syndromic management of STIs in South Africa, particularly in antenatal care.

Comparing Men Who Have Sex With Men Only and Men Who Have Sex With Men and Women Visiting a Public Sexually Transmitted Infection Clinic.

Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STIs). Differences in clinical characteristics and STIs in men who have sex with men only (MSMO), with men and women (MSMW), and with women only (MSW) are not well described. First visits to 2 Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared with an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included chlamydia, gonorrhea, nongonococcal urethritis, and primary or secondary syphilis. χ2 Tests and logistic regression examined associations. Among N = 1226 MSMO, N = 491 MSMW, and N = 1717 MSW, most identified as Black/African American; mean age (29.8 years) was similar across groups. The percentages of MSMW, MSMO, and MSW who reported ≥2 partners in the last 6 months were 73.5%, 67.2%, and 60.3%, respectively. "Always" condom use was reported by 20.4%, 17.4%, and 14.1% of MSMW, MSMO, and MSW. Overall HIV prevalence was 13.8%. Among those tested, urogenital chlamydia prevalence rates were 21.7%, 8.3%, and 3.9% ( P ≤ 0.01) in MSW, MSMW, and MSMO. Urogenital gonorrhea prevalence was 11.6%, 7.7%, and 8.3% in MSMW, MSW, and MSMO, respectively. Extragenital STI (range, 2.7%-21.9%), nongonococcal urethritis (25.2%), and primary or secondary syphilis (5.3%-5.7%) positivity was similar in MSMW and MSMO. Older age was inversely associated with STI diagnosis in MSW and MSMO only; consistent condom use was protective against aSTI in MSW (adjusted odds ratio, 0.60; P < 0.01) and MSMW (adjusted odds ratio, 0.54; P = 0.03) only. Differences in behaviors and clinical characteristics associated with aSTI suggest that MSMO, MSMW, and MSW have diverse sexual health needs and may require tailored interventions to improve sexual health outcomes.

Acceptability of Doxycycline Prophylaxis, Prior Antibiotic Use, and Knowledge of Antimicrobial Resistance Among Australian Gay and Bisexual Men and Nonbinary People.

There is growing interest in novel sexually transmissible infection (STI) prevention strategies, including doxycycline postexposure prophylaxis (doxy-PEP). We assessed interest in doxy-PEP and other STI prevention strategies among gay and bisexual men and nonbinary people in Australia, as well as prior antibiotic use for STI prevention, and knowledge of antimicrobial resistance (AMR). We conducted a national, online survey in June to July 2023. Multivariable logistic regression was used to identify factors associated with the acceptability of doxy-PEP. Of 2046 participants, 26.9% had been diagnosed with an STI in the previous year. Condoms were rated as an acceptable STI prevention strategy by 45.1% of the sample, STI preexposure prophylaxis by 54.0%, and doxy-PEP by 75.8%. Previous antibiotic use for STI prevention was reported by 7.5% of the sample, and 2.6% were currently using antibiotics for STI prevention. Over half the sample (62.1%) had some knowledge of AMR. Of those who knew something about AMR, 76.2% were concerned about it. Interest in using doxy-PEP was independently associated with previous use of antibiotics for STI prevention (adjusted odds ratio, 3.09; 95% confidence interval, 1.78-5.35; P < 0.001), whereas those who were concerned about AMR were less interested in it (adjusted odds ratio, 0.51; 95% confidence interval, 0.36-0.72; P < 0.001). Doxycycline postexposure prophylaxis was highly acceptable to gay and bisexual men and nonbinary people in Australia, and few factors distinguished between interest in using it or not. We recommend community and professional discussion and education about the effective use of doxy-PEP, AMR, and who would most benefit from doxy-PEP.

Impact of doxycycline discharge kits on appropriate treatment of sexually transmitted infections among patients in the ED.

Chlamydia trachomatis is the most prevalent, reportable sexually transmitted infection (STI) in the United States. In 2021, the Centers for Disease Control and Prevention (CDC) updated treatment recommendations from a single azithromycin 1000mg dose to doxycycline 100mg twice daily for seven days for the treatment of chlamydia infections. In response to changes in treatment recommendations and addressing patient barriers to treatment, pharmacists at an urban, academic medical center collaborated with the state health department to create doxycycline kits dispensed upon emergency department (ED) discharge. To evaluate if ED doxycycline discharge kits improve appropriate and timely treatment of chlamydia. This was a single center, retrospective, chart review study of adult patients with a positive chlamydia test while seen in the ED between September 1, 2021 and September 30, 2023. Patients with a listed allergy to doxycycline and those who were incarcerated and/or pregnant were excluded. The primary outcome was appropriate, guideline recommended chlamydia treatment before and after doxycycline discharge kit implementation. Secondary outcomes included rate of ED return visits within 90days for STI-related complaints, time to treatment in those who received a prescription for doxycycline versus doxycycline kit, and rate of doxycycline initiation via emergency medicine (EM) pharmacist culture call-back list. A total of 170 patients were enrolled in the study, 72 patients in the pre-kit group and 98 patients in the post-kit group. Significantly more patients received appropriate treatment in the post kit group (pre-kit (45.8%) vs post-kit (69.1%); CI 95% 2.63 (1.4-5.0); p=0.002). Time to definitive treatment was significantly shorter in the post-kit group (22.7h pre-kit vs 1.3h post-kit; p<0.001). Doxycycline discharge kits significantly increased guideline-directed treatment and decreased time-to-treatment for chlamydia in the ED population at an urban academic medical center.

Factors affecting the efficacy of drug therapy in patients with plaque psoriasis

Relevance. The selection and modification of drug therapy for patients with plaque psoriasis does not have a specific solution for practicing specialists. Factors have been identified that can worsen the course of the disease when therapies with proven clinical efficacy are used and can even increase the severity and prevalence of the psoriatic process, leading to the development of erythroderma or resistance to the therapy. This article analyzed the actual clinical practice of plaque psoriasis therapy and the influence of concomitant diagnoses on the choice of therapy by physicians among patients who were treated in skin and venereal disease dispensaries in the Central Federal District from 2022 to 2023.Objective. To conduct a pharmacoepidemiological analysis of drug prescriptions and the volume of their consumption for plaque psoriasis using frequency analysis and analysis of average daily doses at the outpatient and inpatient stages of treatment, followed by a search for patterns.Materials and methods. An open, non-randomized, cross-sectional prospective study of outpatient records and hospital discharge summaries of 336 patients diagnosed with L40.0 plaque psoriasis was conducted over 2 years. Patients were surveyed by their physicians regarding their adherence to the physician recommendations using a questionnaire on adherence to therapy. The presence of complications of the primary diagnosis, concomitant diagnoses, and factors influencing the prescription of methotrexate and monoclonal antibodies were analyzed.Results. Patients prescribed methotrexate drugs had significantly more concomitant diseases (p &lt;0.05). In addition to the primary diagnosis, patients treated with methotrexate had significantly less of the following: psoriatic arthritis, polyarthritis, spondyloarthritis, dactylitis, enthesitis, and psoriatic onychodystrophy compared with the group of patients who were prescribed genetically engineered biological drugs (p &lt;0.05). The multivariate analysis revealed the influence of skin lesion severity and patient adherence on therapy choice.Conclusions. Among patients prescribed genetically engineered drugs, concomitant complications of an arthropathic nature were significantly more common — in 32.5 % of cases, versus 18.2 % in the group of patients on methotrexate (p &lt;0.05). Therefore, the choice in favor of monoclonal antibodies in most cases was due to the presence of arthropathic psoriatic complications, skin lesion severity, younger age, and high adherence to the innovative therapy prescribed by the doctor (p &lt;0.05).

Evidence of zero-risk transmission of HIV in the era of antiretroviral therapy: A systematic review and meta-analyses.

This systematic review aimed to assess the evidence on sexual transmission of HIV in high-income settings between serodiscordant couples where the index partner infected with HIV is on antiretroviral therapy. Systematic review and meta-analyses. We performed a systematic search in four databases: Embase, MEDLINE, The Cochrane Library, and Web of Science on September 24, 2022. We assessed the risk of bias with ROBINS-I and pooled estimates in meta-analyses using a Poisson regression model with a random effect of the study and population size. The study protocol was pre-registered at PROSPERO. The study involved high-income countries. The search identified 6886 studies, of which six were included for review. Altogether, studies reported zero linked transmissions among 2383 couples, more than 160,000 acts of intercourse, and 3578 couple years. The risk estimate from overall meta-analyses was 0.000 95%CI (0.000-0.103) per 100 couple-years. This systematic review and meta-analyses provide epidemiological evidence for a low risk of HIV transmission under antiretroviral therapy in high-income countries and thus cannot reject the theoretical "treatment as prevention" paradigm.

Seroprevalence of Chlamydia trachomatis infection using an ELISA test sensitized with a recombinant protein

Chlamydia trachomatis causes one of the most frequent sexually transmitted infections (STIs), affecting mainly women and compromising their reproductive health. Therefore, its diagnosis is imminent. The seroprevalence of C. trachomatis was evaluated using an ELISA test and a recombinant major outer membrane protein (MOMPr) as an antigen. The sera were obtained from pregnant and infertile women attending the National Institute of Perinatology of Mexico City. As a result, the MOMPr was purified, and the ELISA test was standardized. Antigen concentration was 20 pg/well, and sera dilution was 1:256. The seroprevalence was 22.5% and 4.6% for infertile and pregnant women, respectively. In conclusion, the recombinant ELISA test identified an active and a past Chlamydia trachomatis infection using cut-off values of 0.4 and 0.2, respectively

A pilot, randomized controlled trial of Dual Daily HIV and sexually transmitted infection pre-exposure prophylaxis using tenofovir disoproxil fumarate/emtricitabine and doxycycline in gay, bisexual and other men who have sex with men and transgender women: The DuDHS Study.

Men who have sex with men (MSM) and transgender women experience high sexually transmitted infection (STI) rates. This study evaluated the feasibility of doxycycline pre-exposure prophylaxis (doxyPrEP) for STI prevention in these key populations. Sexually-active MSM and transgender women without HIV with prior syphilis were recruited. Participants initiated HIV PrEP with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) daily for 48 weeks, and were randomized 1:1 to daily doxyPrEP for 48 weeks (immediate arm), or doxyPrEP initiated at 24 weeks (deferred arm). Primary outcomes included adherence, measured using questionnaires, along with tolerability; STI incidence (chlamydia, gonorrhea, syphilis) was a secondary outcome. Nasal carriage of S. aureus was assessed serially for doxycycline resistance. Fifty-two participants were enrolled into the immediate (n=26) and deferred (n=26) arms. At 48 weeks, self-reported adherence (≥95%) was 75.0% vs. 66.7% (p=0.538) for TDF/FTC, and 70.8% vs. 61.9% (p=0.526) for doxycycline in the immediate vs. deferred arms, respectively. No doxyPrEP-related serious adverse events occurred. Incidence of any STI at 24 weeks was reduced in the immediate vs. deferred arms, and over 48 weeks, being on doxycycline (vs. being off; i.e. first 24 weeks of deferred arm) was associated with STI reduction (adjusted odds ratio [aOR] 0.36; 95 % confidence interval [CI] 0.15-0.89). Emergent doxycycline-resistant S. aureus was identified in six individuals, with five in the immediate arm (p=0.077). Dual HIV/doxyPrEP is feasible and associated with a significant reduction in incident STI. Further evaluation of dosing strategies, efficacy and impact on antimicrobial resistance is warranted.

High Incidence and Duration of Antibiotic Use Among a Cohort of Men Who Have Sex with Men in Seattle, WA

Abstract Background Doxycycline post-exposure prophylaxis (doxy-PEP) effectively prevents bacterial sexually transmitted infections (STIs) but may increase antibiotic pressure. Little is known about longitudinal antibiotic use among men who have sex with men (MSM), a key population for doxy-PEP. Methods We analyzed data from a prospective cohort of MSM in Seattle, WA, from 2016-2018, prior to the introduction of doxy-PEP. Antibiotic use and reason for prescription were self-reported in weekly surveys and extracted from medical records. We characterized antibiotic use across 49 weeks of follow-up, stratified by specific antibiotics of interest and reasons for prescription. Incidence rates (IR) were calculated for the number of incident events of antibiotic initiation per 100 person-years (PY) at risk. We assessed factors associated with antibiotic initiation using negative binomial regression to estimate adjusted incidence rate ratios (IRRs). Results Among 140 participants, 68.6% (n=96) received at least one antibiotic during follow-up, resulting in an overall IR=264.5 events of antibiotic initiation per 100 PY and 1,696 total days of antibiotic use. STI treatment was the most common reason for antibiotic initiation (IR=153.5 events per 100 PY; 462 days); however, treatment for other conditions contributed most to overall days of antibiotic use (IR=42.6 events per 100 PY; 947 days). An age of 25-39 years (IRR=1.54; 95%CI: 1.02,2.32) and a history of bacterial STIs &amp;lt;12 months prior to enrollment (IRR=1.81; 95%CI: 1.12,2.93) were significantly associated with higher incidence of antibiotic initiation. Conclusions Antibiotic consumption among this population was very high. Our analysis provides a necessary foundation for assessing the potential impacts of doxy-PEP.

HIV and hospitals between knowledge and stigma

ABSTRACT The advent of effective antiretroviral treatments has led to the reclassification of HIV as a chronic disease for those on an effective treatment plan. However, the well-being of individuals with HIV is adversely affected by a number of factors, including stigma and discrimination, which hinder access to healthcare. To address this issue, it is first necessary to understand the current levels of knowledge and stigma surrounding HIV, and consequently, HIV Outcomes Italy has created a survey with the aim of assessing these levels. A total of 914 healthcare professionals, comprising clinicians, obstetricians, nurses and LPNs (licensed practical nurses) participated in an anonymous online survey with questions pertaining to knowledge on HIV, stigma, and training on STIs (sexually transmitted infections). The survey was conducted in Italy between August 2022 and February 2023. The results show a reasonable level of knowledge regarding HIV-related topics among healthcare workers. However, a notable minority exhibited deficiencies. The findings indicate the presence of stigma, both in the form of observed discriminatory practices and in the form of personal enactment of discriminatory behaviour. The results of the survey indicate an inverse relationship between knowledge and stigma, emphasising the need for ongoing and specific education on HIV.

P-1389. Portrayal of Sexually Transmitted Infections in Popular Films

Abstract Background Stigmatization of sexually transmitted infections (STIs) threatens provider-patient relationships and leads to the underutilization of STI services. Media can shape public attitudes toward healthcare topics by perpetuating or reducing stigma. Considering the prevalence of STIs and the widespread consumption of media, healthcare providers must be cognizant of factors influencing societal perceptions of STIs. This study aims to analyze the representation and accuracy of STIs in popular narrative films. Characteristics of Films and Characters Portraying Sexually Transmitted Infections. a Other STIs featured in films include HSV (n=11), gonorrhea (n=6), syphilis (n=8), pubic lice (n=4), unspecified STI (n=3), chlamydia (n=2), HPV (n=1), trichomoniasis (n=0). b Other STIs featured in characters include HSV (n=13), gonorrhea (n=8), syphilis (n=8), pubic lice (n=5), unspecified STI (n=4), chlamydia (n=3), HPV (n=1), trichomoniasis (n=0). Methods This study is a descriptive analysis of popular films depicting STIs. Full-length, English-language, narrative films featuring characters with confirmed or suspected STIs were gathered through a keyword search from the Internet Movie Database. Descriptive statistics were used to determine the proportion of characters with accurately portrayed STI clinical variables of symptoms, transmission, diagnosis, and treatment. Stacked bar graph displaying proportion of accurate (blue) and inaccurate (orange) STIs in individual characters by clinical variable (symptoms, transmission, diagnosis, and treatment). Character counts are presented as data labels within their respective colors. Results This study examined 128 characters from 77 films. Human immunodeficiency virus (HIV) was the most commonly portrayed STI in 42 films (55%). HIV was most commonly featured in dramas (62%). Herpes simplex virus, gonorrhea, syphilis, pubic lice, chlamydia, and human papillomavirus were most frequently portrayed in comedies (40%). Other characteristics are displayed in Table 1. Characters with STIs were primarily adult (93%), non-Hispanic White (78%), and male (75%). Figure 1 shows the rates of clinical variable depiction and accuracy by character. Accuracy of each clinical variable was 92% for symptoms, 89% for transmission, 84% for diagnosis, and 85% for treatment. Four (3%) characters represented all clinical variables, 2 (50%) of which were accurately portrayed. Death occurred in 39 characters (30%), with HIV contributing to the majority of deaths (82%). Conclusion Films commonly represent accurate symptoms, transmission, diagnosis, and treatment of STIs. However, the frequency of death secondary to STIs is exaggerated and may contribute to STI stigmatization. Understanding the portrayal of STIs in popular films can provide valuable insights for clinicians, enabling them to address patient misconceptions and knowledge gaps. Disclosures All Authors: No reported disclosures

P-1382. Utilization of Doxycycline Post-Exposure Prophylaxis at a Midwestern United States HIV/PrEP Clinic

Abstract Background Limited real-world data exist regarding usage of doxycline post-exposure prophylaxis (doxyPEP). We evaluated appropriate doxyPEP prescribing and monitoring following implementation of a doxyPEP protocol at the University of Nebraska Medical Center (UNMC) Specialty Care Clinic. Methods We retrospectively evaluated patients receiving doxyPEP between 3/1/2023-2/29/2024. Patients receiving doxycycline for other indications were excluded. The primary outcome was adherence to the UNMC doxyPEP protocol. Secondary outcomes included total doxyPEP doses prescribed, sexually transmitted infection (STI) incidence in the doxyPEP cohort compared to 2023 UNMC STI incidence, and factors associated with protocol adherence or STIs while prescribed doxyPEP. We performed descriptive statistics for cohort characteristics and outcomes. Fisher’s exact test or student t-test was used to assess associations of patient characteristics with protocol adherence or STIs while on doxyPEP. Results Characteristics of the cohort and prescriptions are listed in Table 1. Primary and secondary outcomes are reported in Tables 2 and 3. Of 90 patients receiving doxyPEP prescriptions, 30% were not prescribed in concordance with UNMC protocol; the most common reason was missed STI screenings (89%). There were 145 chlamydia/gonorrhea (CT/GC) and 163 syphilis screenings obtained from 90 patients; 13% of the patients on doxyPEP were diagnosed with an STI. Between patients prescribed doxyPEP and 2023 UNMC STI incidence, there was no difference in incidence of GC/CT (p &amp;gt; 0.05); however, syphilis incidence was lower (p=0.01) in patients on doxyPEP. There were no characteristics associated with doxyPEP protocol adherence. Age, reason for care, and number of STIs within 12 months of first doxyPEP prescription were significantly associated with an STI diagnosis while on doxyPEP. Conclusion Appropriate doxyPEP prescribing patterns occurred for 70% of prescriptions; missed STI screenings was the most common reason for protocol non-adherence. Patients with HIV and with &amp;gt; 1 STI in the past 12 months were more likely to be diagnosed with an STI while on doxyPEP. As utilization expands, it is necessary to ensure appropriate follow-up and monitoring. Disclosures Josh Havens, PharmD, Gilead Sciences: Grant/Research Support|Medscape: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Sara H. Bares, MD, Gilead Sciences: Expert Testimony|Janssen: Grant/Research Support|ViiV Healthcare: Grant/Research Support Kimberly Scarsi, PharmD, Organon, Inc.: Grant/Research Support|Viiv Healthcare: Grant/Research Support

P-1376. Impact of COVID-19 and Mpox on Inpatient Screening of STIs

Abstract Background Sexually transmitted infections (STIs) continue to pose a considerable public health challenge, with a notable uptick in STI rates over the last few years. Access to care, both inpatient and outpatient, was disrupted during COVID-19 with a subsequent increase in STIs reported in many areas, followed by additional strain on services with the emergence of Mpox in Oregon. Abbreviations: sexually transmitted infection (STI) STIs include chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV), and hepatitis C Methods We conducted a retrospective cohort of hospitalized patients at the Oregon Health &amp; Science University (OHSU) Internal Medicine and Family Medicine services to evaluate STI screening and diagnoses (including chlamydia, gonorrhea, HIV, HCV and syphilis) across distinct periods: pre-COVID-19 pandemic (1/1/2018-2/29/2020), during the COVID-19 pandemic (3/1/2020-7/31/2022), and amidst the Mpox surge (8/1/2022-3/1/2023). We calculated the proportion screened, percent positivity by time and compared proportions between our pre-designated periods using the two-sample test of equal proportions. Results During the study period, 5802 patients were admitted to OHSU. Most were White (4705, 81.1%), non-Hispanic (5308, 91.5%) and Female sex (3600, 62.1%). In total, 2151 (37%) were screened for one or more STIs. HIV and syphilis were the most frequently screened STIs at 15.0% and 33.1%. The highest proportion of STI screenings were among those 25-44 years at 40.9% with the highest percent positivity in those 55-64 years at 34.0%. There was a statistically significant increase in proportion screened for all STIs (see Table 2), along with percent positivity for syphilis (P&amp;lt;0.01) between pre-COVID-19 and COVID-19 period, however this trend did not consistently continue after emergence of Mpox. Conclusion The proportion of inpatient STI screening is low for patients admitted to internal medicine and family medicine services with percent positivity by age ranging from 5.9-34.0%. We observed an overall increase in proportion screened during the COVID-19 period. Disclosures All Authors: No reported disclosures

P-1392. Sexual History Documentation Among Veterans with a Sexually Transmitted Infection (STI)

Abstract Background Sexual health discussions in routine healthcare encounters can help identify sexually transmitted infection (STI) risk. We measured the prevalence of sexual history completion in Veterans with an STI and association between STI testing and offer of HIV pre-exposure prophylaxis (PrEP).Table 1.Summaries of levels of sexual history and STI tests ordered by sample sites (N=285)a Pearson Chi-Square Test of Independence Methods We conducted a retrospective review of a Veteran cohort with a STI documented on a clinical encounter between December 2020-December 2021 at five Veterans Affairs (VA) facilities in the southern United States. Primary care, emergency room, and specialty clinic visits were included, and infectious disease clinic visits excluded. STI was defined as a positive result for chlamydia, gonorrhea, and/or syphilis. The CDC’s definition of an appropriate sexual history utilizing the “5 Ps” (partners, practices, protection, pregnancy, and past STIs) was used as the reference standard. Level of sexual history taken was categorized as none (0 Ps), minimal (1-2 Ps), moderate (3 Ps), or full (4-5 Ps for a male, 5 Ps for female). Chi-square tests and logistic regression were used for analyses.Table 2.Associations of demographic characteristics with extent of sexual history taken during the encounter and HIV testing controlling for VA site. (N=285)a Multinomial logistic regression, log likelihood testb p-value of relative risk ratio (RRR), adjusted for study sitec Number of sites included = 283d Other included American-Indian/Alaska Native (1), Asian(1), Hispanic/Latino(6), Native Hawaiian/Pacific Islander(2), Multiple races(6) Results We included 285 records in the review. A sexual history was not conducted (0 Ps) in 43% (122/285) of encounters. There were statistically significant differences in obtaining sexual history and number of STI tests ordered across VA facilities (p&amp;lt; .001 and .006, respectively). No evidence of documentation occurred for sexual practices (93%), history of STIs (78%), and sexual partners (67%). Males were less likely to receive a full sexual health history (p=.01) and HIV testing (53 vs 72%, p=.007) compared to females. Only 4 (1%) Veterans were offered PrEP. After controlling for facility, a statistically significant association between the extent of documented sexual history and STI tests ordered (p=.019). No significant associations were observed between extent of history or HIV testing for Veterans’ age, race, or provider type.Table 3.Associations of extent of sexual health history taken and tests ordered after controlling for VA site. (N=285)a Multinomial logistic regression, log likelihood testb p-value of relative risk ratio (RRR), adjusted for study sitec Other included American-Indian /Alaska Native1), Asian (1), Hispanic/Latino (6), Native Hawaiian/Pacific Islander (2), Multiple races (6) Conclusion Incomplete assessment of sexual history was common in outpatient visits and varied by facility for Veterans with a STI. There was a relationship between increasing level of sexual history and number of STI tests ordered. Future work includes identifying systematic interventions to support standardization of sexual history taking. Disclosures All Authors: No reported disclosures

P-1377. Rates of Screening of Sexually Transmitted Infections in Male Military Trainees who Present with Dysuria

Abstract Background A high burden of sexually transmitted infections (STIs) exists among trainees entering United States Air Force Basic Military Training (BMT). While women entering training are universally screened for STIs, men, who account for the majority of trainees, are rarely tested. The rates of testing among symptomatic men who present with dysuria during BMT are unknown. Furthermore, rates of follow-up testing among male service members who present with dysuria during BMT are unknown. Demographics of 82 men diagnosed with dysuria or urinary tract infection during BMT, 2019-2023 Methods All male basic trainees who received a diagnostic code of dysuria or urinary tract infection between 2019-2023 were retrospectively analyzed to evaluate their diagnostic workup and follow-up over the three years after diagnosis. To assess the impact of presumptive STI therapy on subsequent follow-up, patients who received empiric treatment for STIs were compared to those who did not, with a focus on evaluating future STI testing rates and incidence. Nominal variables were compared using Fisher’s Exact Test while continuous variables were analyzed using the Mann-Whitney U test. Diagnostic Workup and follow-up for male basic trainees diagnosed with dysuria or urinary tract infection compared by receipt of empiric antibiotics for sexually transmitted infections Results Of the 102,382 men who entered BMT during the study period, 82 (0.08%) were diagnosed with dysuria or a urinary tract infection during training. Dysuria accounted for the majority of diagnoses (79%) (Table 1). 70% of symptomatic men were tested for gonorrhea and chlamydia (GC/CT). Among those tested, 23% had a positive GC/CT test. Only 25 (30%) received any additional follow-up STI testing in their next 3 years in the military, with a positivity rate of 12%. Those who were empirically treated for STIs were more likely to have a documented sexual history (80% vs. 45%, p=0.004), receive a GC/CT test (96% vs. 57%, p=0.002), and have additional STI testing in the 3 years after diagnosis (46% vs. 23%, p=0.04) (Table 2). Conclusion There is limited data on the diagnostic workup and follow-up of men presenting with symptoms of dysuria during BMT. This study found that despite a high positivity rate for STIs in symptomatic men, sexual history documentation and STI screening were inconsistent in this population. As males account for the vast majority of basic trainees, efforts to accurately capture the burden of STIs are imperative to limit the impact on military populations. Disclosures All Authors: No reported disclosures

P-504. Disparities in PrEP Coverage by Sex Among Individuals Diagnosed with Bacterial STIs in a Large Municipal Healthcare System

Abstract Background Nationally almost 20% of new HIV diagnosis are in females. Females carry 53% of sexually transmitted infection (STI) disease burden in the US, yet nationally represent only 10% of individuals on Pre-Exposure Prophylaxis (PrEP). The US Preventive Services Task Force and CDC include females diagnosed with bacterial STIs as one of the populations to be considered for PrEP. However, females are often not the focus of HIV PrEP campaigns, resulting in knowledge gaps, bias and stigma that further challenge PrEP access for women. As part of efforts to improve sexual health services and access within NYC's municipal healthcare system, we designed a sexual health dashboard (SHD) that included a “PrEP Eligible” metric focused on federal PrEP guidelines related to bacterial STIs. Methods All alive patients aged 13-75 years old with a primary care or women’s health clinic visit within a NYC Health and Hospitals facility during April 2023-March 2024 were included in the SHD. The SHD displays testing and positivity rates for Chlamydia, Gonorrhea, and Syphilis, in addition to PrEP eligibility and PrEP active status. PrEP eligibility is based on high frequency of HIV or STI tests (3+ in 1 year), an abnormal STI lab or STI diagnosis and ‘PrEP Active’ is defined as an active prescription for PrEP within the preceding 6-months. Results Females represented 82% of PrEP eligible patients but only 13.2% (162) of PrEP Active patients (1,223). Among all people with Chlamydia, 0.2% of females were PrEP Active compared to 16% of males. For Gonorrhea, 2.6% of females were PrEP Active compared to 44.3% of males. For Syphilis, 1.9% of females were PrEP Active compared to 18.6% of males (Figure 1). Conclusion According to the CDC, 6% of sexually acquired HIV can be attributed to bacterial STIs, however PrEP usage remains low among eligible females within a municipal healthcare system in NYC. Dedicated efforts are being made within NYC Health and Hospitals to expand PrEP to primary care and women’s health, with the hopes that diversifying care settings for PrEP will reach populations not currently accessing PrEP services. Lack of recognition of the connection between HIV risk and STIs may disproportionately impact females and contribute to underutilization of PrEP. Disclosures Emma Kaplan-Lewis, MD, Gilead Pharmaceuticals: Grant/Research Support

P-1396. Compliance Rates to Updated CDC Guidelines and an Automatic Communication Intervention Following Positive Sexually Transmitted Infection Results in the Emergency Department

Abstract Background The emergency department (ED) remains at the forefront of the growing sexually transmitted infection (STI) epidemic. Despite being a critical leverage point for STI management, current practices can be incongruent with recent 2021 CDC STI Guidelines. The transitory role of the ED poses challenges to establishing follow-up. We sought to assess the degree of deviation from CDC STI guidelines in the Hartford Hospital ED and optimize management by having positive STI tests automatically routed to the outpatient infectious disease (ID) clinic for follow-up. Methods This was a retrospective, observational study of 342 patients from October 31st, 2021 to August 18th, 2023. Pre-intervention, ED providers were solely responsible for reviewing results and contacting patients to return for treatment. An intervention was initiated on October 31st, 2022, whereby positive STI test results from the ED were automatically rerouted to the ID clinic EPIC inbox, eliminating the modulatory role of ED providers. Manual chart review was conducted to evaluate compliance to CDC guidelines and parameters before and after the intervention, including the rate of referral to and follow-up with ID. Results Significant deviations from CDC guidelines were observed: 78.8% of practitioners took inadequate sexual history, 95.0% did not order comprehensive STI screening (gonorrhea, chlamydia, HIV, and syphilis), and only 60.8% initiated empiric antibiotic therapy. Of those, only 71.6% were guideline-based therapies. This intervention was successful in decreasing the proportion of patients lost to follow-up; Prior to intervention, 3.9% of patients were seen in the ID clinic for follow-up which increased to 15.3% after intervention (p &amp;lt; 0.001). Conclusion Although guidelines were updated almost 3 years ago, current practices remain incongruent with recommendations. Automatically rerouting positive STI results resulted in a higher rate of follow-up. We propose other hospital systems utilize a similar automatized system to minimize gaps in care and reduce burden on strained ED systems. Disclosures All Authors: No reported disclosures

P-1383. Gap in Doxy PEP Prescription for People Living With HIV Compared with PrEP Users in a Primary Care Practice

Abstract Background Use of 200mg of doxycycline as post-exposure prophylaxis within 72 hours of a condomless sexual encounter (Doxy PEP) has been shown to reduce the risk of key sexually transmitted infections (STIs). Doxy PEP is effective both for people living with HIV (PLH) as well as those who do not have HIV. The goal of this analysis was to describe uptake of Doxy PEP in a primary care practice in Syracuse, NY, a Northeastern U.S. city serving a large population of PLH as well as people prescribed pre-exposure prophylaxis (PrEP) for HIV prevention. Methods Data were abstracted from the electronic medical record. Patients who were seen for HIV or PrEP care between 1 Jan and 31 December, 2023 who were transgender women (TGW) or cisgender men self-identified as gay, bisexual, or “other” sexual orientation (MSM) and had been diagnosed with chlamydia, gonorrhea or syphilis during 2023 were analyzed. Doxy PEP discussion and prescription were determined through medication review and office notes up through the first quarter of 2024. Factors associated with providers recommending and/or prescribing doxy PEP were evaluated using bivariable and multivariate logistic regression. Results A total of 602 MSM and 25 TGW were seen in the practice during 2023; 117 (18.7%) were diagnosed with at least one STI, specifically syphilis [37; (31.6%)], chlamydia [33 (28.2%)], gonorrhea [23 (19.7%)] or more than 1 of these [24 (20.5%)]. A total of 46 (39.3%) patients were prescribed doxy PEP; 11 (9.3%) declined, and 60 (51.3%) had no documented discussion or prescription. Most 35 (76.1%) prescriptions were in the 1st quarter of 2024; average days between STI diagnosis and doxy PEP prescription was 200 days. On multivariate analysis (MVA), only PrEP vs. HIV was associated with prescription (OR 13.3 p&amp;lt; 0.0001; this held even after excluding 4th quarter STI diagnoses to account for less frequent follow up of PLH vs. PrEP users (OR 17.5, p=0.001). Doxy PEP prescription was not associated with age, race or ethnicity, type or site of STI, provider, or time (days) since STI diagnosis. Conclusion Doxy PEP is a valuable tool for reducing STIs; it may be underutilized in people living with HIV despite ongoing risk, and methods to encourage prescription for PLH are warranted. Disclosures Elizabeth Asiago-Reddy, MD, Abbvie: Grant/Research Support|GSK/Viiv: Grant/Research Support|Pfizer: Grant/Research Support|Theratechnologies, Inc.: Grant/Research Support