Search

Background: With noninvasive specimen types, males can be more easily screened for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Long-standing universal screening of males attending New York City (NYC) sexually transmitted diseases (STD) clinics has yielded a substantial number of chlamydia cases. In 2005, screening was expanding to another large group at high risk for STD: males [less than or equal to] 35 years old entering 6 adult jails. Methods: Surveillance data and data from laboratory practice surveys were examined to evaluate changes in the reported burden of chlamydia and gonorrhea in NYC males over time. Citywide data for male chlamydia and gonorrhea cases were analyzed by report year and provider type (STD clinic, adult jail, juvenile detention, private-sector provider) from 2004 through 2006. Results: In the first year of the adult jail screening program, the number of chlamydia cases among males [less than or equal to]35 years old reported from the jails increased by 1636%, surpassing all other providers in numbers of cases contributed, and increasing the citywide reported male chlamydia case rate by 59%. Adult jails reported 40% more cases than all 10 NYC public STD clinics combined. In 2006, adult jails continued to contribute a similar proportion to citywide male chlamydia case reports. In the first year of the jail screening program, there was an approximately 10-fold increase in the number of gonorrhea cases reported from jails. Conclusions: Young men in adult jails have a large burden of chlamydial infection. Correctional screening and treatment programs present an important opportunity to improve the health of inmates and interrupt disease transmission.

Background: COVID-19 mortality studies have primarily focused on persons aged ≥ 65 years; less is known about decedents aged <65 years. Methods: We conducted a case-control study among NYC residents aged 21–64 years hospitalized with COVID-19 diagnosed March 13–April 9, 2020, to determine risk factors for death. Case-patients (n=343) were hospitalized decedents with COVID-19 and control-patients (n=686) were discharged from hospitalization with COVID-19 and matched 2:1 to case-patients on age and residential neighborhood. Conditional logistic regression models were adjusted for patient sex, insurance status, and marital status. Matched adjusted odds ratios (aORs) were calculated for selected underlying conditions, combinations of conditions, and race/ethnic group. Results: Median age of both case-patients and control-patients was 56 years (range: 23–64 years). Having ≥ 1 selected underlying condition increased odds of death 4.45-fold (95% CI: 2.33–8.49). Patients with diabetes; morbid obesity; heart, kidney, or lung disease; cancer; neurologic/neurodevelopmental conditions; mental health conditions; or HIV had significantly increased odds of death. Compared with having neither condition, having both diabetes and obesity or diabetes and heart disease was associated with approximately threefold odds of death. Five select underlying conditions were more prevalent among non-Hispanic Black control-patients than among control-patients of other races/ethnicities. Conclusions and Relevance: Selected underlying conditions were risk factors for death, and most prevalent among racial/ethnic minorities. Social services; health care resources, including vaccination; and tailored public health messaging are important for COVID-19 prevention. Strengthening these strategies for racial/ethnic minority groups could minimize COVID-19 racial/ethnic disparities.

Background: Persons reporting sexual identity that is discordant with their sexual behavior may engage in riskier sexual behaviors than those with concordant identity and behavior. The former group could play an important role in the spread of sexually transmitted diseases. Objective: To describe discordance between self-described sexual identity and behavior among men who have sex with men and associations between identity-behavior and risk behaviors. Design: Cross-sectional, random digit-dialed telephone survey of health status and risk behaviors. Setting: New York City. Participants: Population-based sample of 4193 men. Measurements: Concurrent measures of sexual identity and sexual behaviors, including number and sex of sex partners, condom use during last sexual encounter, and recent testing for HIV infection. Sex partner information was ascertained in a separate section from sexual identity; all participants were asked about the number of male sex partners and then were asked about the number of female sex partners in the past year. Results: Of New York City men reporting a sexual identity, 12% reported sex with other men. Men who had sex with men exclusively but self-identified as heterosexual were more likely than their gay-identified counterparts to belong to minority racial or ethnic groups, be foreign-born, have lower education and income levels, and be married. These men were more likely than gay-identified men who have sex with men to report having only 1 sexual partner in the previous year. However, they were less likely to have been tested for HIV infection during that Lime (adjusted prevalence ratio, 0.6 [95% Cl, 0.4 to 0.9]) and less likely to have used condoms during their last sexual encounter (adjusted prevalence ratio, 0.5 [Cl, 0.3 to 1.0]). Limitations: The survey did not sample groups that cannot be reached by using residential telephone services. Conclusions: Many New York City men who have sex with men do not identify as gay. Medical providers cannot rely on patients' self-reported identities to appropriately assess risk for HIV infection and sexually transmitted diseases; they must inquire about behavior. Public health prevention messages should target risky sexual activities rather than a person's sexual identity.

Supplemental Digital Content is available in the text

ABSTRACTU.S. surveillance for Neisseria gonorrhoeaeantimicrobial susceptibilities is based exclusively on male urethral isolates. These data inform gonorrhea treatment guidelines, including recommendations for the treatment of extragenital infections, but data on the susceptibilities of extragenital isolates are limited. We compared the antimicrobial susceptibilities of pharyngeal, rectal, and urethral gonococcal isolates collected from men who have sex with men (MSM), at five sentinel sites throughout the United States. MICs were determined by the agar dilution method. Generalized linear models were used to compare (i) the proportions of isolates with elevated MICs and (ii) geometric mean MICs according to anatomic site, adjusted for city. In December 2011 to September 2013, totals of 205 pharyngeal, 261 rectal, and 976 urethral isolates were obtained. The proportions of isolates with elevated ceftriaxone MICs (≥0.125 μg/ml) did not differ according to anatomic site (0.5% of pharyngeal isolates, 1.5% of rectal isolates, and 1.7% of urethral isolates, with a city-adjusted odds ratio [aOR] of 0.4 [95% confidence interval {CI}, 0.0 to 3.9] for pharyngeal versus urethral isolates and an aOR of 0.9 [95% CI, 0.2 to 4.2] for rectal versus urethral isolates). The city-adjusted geometric mean ceftriaxone MICs of pharyngeal (0.0153 μg/ml) and rectal (0.0157 μg/ml) isolates did not differ from that of urethral isolates (0.0150 μg/ml) (ratios of geometric mean MICs of 1.02 [95% CI, 0.90 to 1.17] and 1.05 [95% CI, 0.93 to 1.19], respectively). Similar results were observed for other antimicrobials, including cefixime and azithromycin. These findings suggest that, at the population level, gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSM adequately reflects the susceptibilities of N. gonorrhoeaestrains circulating among MSM.

Objective. Staff at public New York City sexually transmitted disease (STD) clinics screen patients for acute HIV infection (AHI) using pooled nucleic acid amplification tests. AHI screening is expensive but important for populations at high risk of acquiring HIV. We analyzed if targeting AHI screening in STD clinics could reduce program costs while maintaining AHI case detection.Methods. From January 2009 through May 2010, we screened all patients with negative rapid HIV tests for AHI. Using risk information on cases detected during this universal screening period, we developed criteria for targeted AHI screening and compared case yields and testing costs during 12 months of universal screening (June 2009 through May 2010) vs. 12 months of targeted screening (June 2010 through May 2011).Results. During the defined period of universal screening, we identified 40 AHI cases, and during targeted screening, we identified 35 AHI cases. Because of targeting efforts, the number needed to test to find one AHI case dropped from 1,631 to 254. With targeted screening, it cost an average of $4,535 per case detected and 39.3 cases were detected per 10,000 specimens; using universal screening, $29,088 was spent per case detected and 6.1 cases were detected per 10,000 specimens processed.Conclusion. Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost.

Objective. Statistical modeling has suggested that the prevalence of false matches in data matching declines as the events become rarer or the number of matches increases. We examined the effect of case rate and coinfection rate in the population on the positive predictive value (PPV) of a matching algorithm for HIV/AIDS and sexually transmitted disease (STD) surveillance registry data.Methods. We used LinkPlus™, a probabilistic data-matching program, to match HIV/AIDS cases diagnosed in New York City (NYC) from 1981 to March 31, 2012, and reported to the NYC HIV/AIDS surveillance registry against syphilis and chlamydia cases diagnosed in NYC from January 1 to June 30, 2010, and reported to the NYC STD registry. Match results were manually reviewed to determine true matches.Results. With an agreement/disagreement comparison score cutoff value of 10.0, LinkPlus identified 3,013 matches, of which 1,582 were determined to be true by manual review. PPV varied greatly in subpopulations with different case rates and coinfection rates. PPV was the highest (91.6%) in male syphilis cases, who had a relatively low case rate but a high HIV coinfection rate, and lowest (18.0%) in female chlamydia cases, who had a high case rate but a low HIV coinfection rate. When the cutoff value was increased to 15.0, PPVs in male syphilis and female chlamydia cases increased to 98.3% and 90.5%, respectively.Conclusions. Case rates and coinfection rates have a significant effect on the PPV of a registry data-matching algorithm: PPV decreases as the case rate increases and coinfection rate decreases. Before conducting registry data matching, program staff should assess the case rate and coinfection rate of the population included in the data matching and select an appropriate matching algorithm.

In 2005, the Centers for Disease Control and Prevention established the STD Surveillance Network (SSuN), a sentinel surveillance system comprising local, enhanced sexually transmitted disease (STD) surveillance systems that follow common protocols. The purpose of SSuN is to improve the capacity of national, state, and local STD programs to detect, monitor, and respond rapidly to trends in STDs through enhanced collection, reporting, analysis, visualization, and interpretation of clinical, behavioral, and geographic information obtained from a geographically diverse sample of individuals diagnosed with STDs. To demonstrate the utility of a national sentinel surveillance network, this article reviews the lessons learned from the first three years of SSuN, which, through its enhanced gonorrhea and genital warts sentinel surveillance projects, has proved to be a useful adjunct to routine STD surveillance in the U.S. that can be expanded into other areas of STD public health interest.

IntroductionThere have been recent U.S. outbreaks of N. meningitidis(Nm) serogroup C among men who have sex with men (MSM). From 1/2012-6/2015, 1/3 of U.S. cases in MSM were from New York City (NYC); 65% were HIV+. Little is known about Nm carriage among MSM and potential sexual transmission of Nm.MethodsWe conducted a carriage study among a sample of MSM and transgender female patients at 2 NYC sexual health clinics (6/2016-2/2017). Clinicians collected oropharyngeal (OP), rectal, and urethral specimens for Nm culture and STD testing. We matched test results with patient self-administered questionnaire data on antibiotic use, meningococcal vaccine history, and sexual risk behaviours (past 30 days), and data extracted from clinic medical records and the NYC STD registry (past 3 months). We calculated carriage prevalence by serogroup (slide agglutination) and anatomic site; examined Nm-gonorrhoea (GC) co-infection; and assessed associations between patient characteristics and carriage at any site using logistic regression.ResultsOf 636 study patients, 146 (23%; 95% CI 20%–26%) were Nm carriers. Serogroup distribution of OP carriage (22.4%; 142/633) was: 59% non-groupable, 37% B, 1.4% C, 0.7% W, 1.4% Y. Of OP Nm carriers, 20 (14%) were OP GC-positive. Urethral (0.5%; 3/626) and anal (1%; 6/626) carriage prevalence were low. Any-site carriage was associated with: kissing (OR 3.2; 95% CI 1.1–9.3), performing oral sex (OR 2.0; 95% CI 1.1–3.6), attending bars/clubs (OR 1.6; 95% CI 1.1–2.6), and antibiotic use (OR 0.2; 95% CI 0.1–0.5); and not associated with HIV status, STD history, or vaccine status. In multivariable analyses, only antibiotic use was associated with carriage.ConclusionNm carriage in our large patient sample did not match Nm outbreak patterns (e.g., paucity of serogroup C, no link with HIV). The OP carriage rate was similar to that in prior studies, but with higher serogroup B. Low prevalence of urethral and rectal Nm carriage and lack of association with STD risk factors suggests that sexual transmission of Nm might be uncommon in this population.

IntroductionMen-who-have- sex-with-men (MSM) may modify sexual practices to reduce HIV and sexually transmitted infection (STI) risk. HIV pre-exposure prophylaxis (PrEP) may impact risk behaviour and STI acquisition.MethodsWe matched HIV-negative MSM attending New York City (NYC) sexual health clinics during 2011–2015 to the NYC HIV registry in 01/2017. We used visit-level data to assess trends in condom use during anal sex (consistent, inconsistent, no use; referent period=3 months), overall and by sexual positioning behaviour. We examined associations between condomless (inconsistent/no use) insertive, condomless receptive, and condomless versatile sex and incident HIV or STI (chlamydia/gonorrhoea/early syphilis). We used regression with generalised estimating equations (referent group=anal sex with condoms), controlling for demographics, partner number, and STI history. ResultsThe proportion of visits with reported consistent condom use decreased from 2011–2015 (39% to 31%%, p<0.001); inconsistent use increased (48% to 55%%), and no condom use was stable (13%–14%).There were significant declines in consistent condom use across all positioning categories. From all visits, MSM reported positioning as: 19% condomless insertive, 9% condomless receptive, 37% condomless versatile, 35% sex with condoms. For 25,216 STI testing visits that yielded 7438 diagnoses, all condomless-positioning categories were associated with incident STI; highest risk was with condomless insertive sex (aOR 1.8, 95% CI 1.6–1.9). For MSM tested for HIV at 9744 visits, condomless receptive (aOR 2.8; 95% CI 1.9–4.1) and condomless versatile sex (aOR 2.2; 95% CI 1.6–2.8) were associated with incident HIV. Black MSM (~25% of MSM) had the highest risk for STI and HIV (41% of 368 new HIV diagnoses).ConclusionWe documented increases in condomless sex among a sentinel high risk group prior to and during the PrEP era. Insertive sex, perhaps perceived as a safer strategy, was associated with substantial STI risk when condoms were not consistently used. Assuring PrEP access for black MSM is critical.