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Background Increases in life expectancy, the availability of sexual performance enhancing medication, and changes in sexual partnering suggest that sexually transmitted infections (STIs) among older persons could be on the rise, yet there have been relatively few studies examining STIs in this demographic. Our systematic review aimed to further characterize the incidence and prevalence of chlamydia, gonorrhea, and syphilis, along with associated risk factors among older adults (45 years or older) in the United States. Methods We searched five electronic databases (PubMed, Embase, Cinahl, Web of Science, and Global Health) for data published from inception to January 2021. The retrieved articles were screened based on eligibility criteria, and subsequent review of relevant article bibliographies was conducted. Results Of 4748 articles identified, 23 studies met our inclusion criteria and one additional article was identified through bibliography review. Of the 23 included articles, only 3 (11.5%) were focused exclusively on evaluating STIs in an older population. We found prevalence to be the following ranges: syphilis (0–18%), chlamydia (0–14.2%) and gonorrhea (0–15%). Few studies specifically investigated risk factors in this demographic. Conclusions The understudied burden of STIs in the older adult population substantiates the need to recognize issues surrounding sexuality in this demographic.

PurposeIncentivized peer referral (IPR) has been shown to be an effective method of recruitment for men who have sex with men but has not been studied extensively in men who have sex with women (MSW), particularly among Black MSW. We aimed to determine if IPR was more effective than uncompensated peer referral for recruiting young Black men into a community STI screening study.MethodsWe used data from the Check It study, a chlamydia (Ct) screening and treatment program for young Black men ages 15-26 in New Orleans, LA. Enrollment was compared before and after IPR was implemented using Multiple Series Analysis (MTSA). IPR was introduced to increase recruitment that had been severely diminished because of the COVID-19 shutdown.ResultsOf 1527 men enrolled, 1399 (91.6%) were enrolled pre-IPR and 128 (8.4%) were enrolled post-IPR. The percentage of men referred by a friend or peer was higher in the post-IPR period than in the pre-IPR period (45.7% vs. 19.7%, pp=0.285, 95% CI (−0.0146, 0.0493)) with less recruitment decay in the post-IPR compared to pre-IPR.ConclusionsIPR may be an effective means of engaging young Black men in community based STI research and prevention programs, particularly when clinic access is limited.

OBJECTIVES: To estimate the impact of the Check It program, a novel community-based chlamydia seek, test and treat program for young Black men who have sex with women, on test positivity rates for chlamydia in young Black women. METHODS: We used a synthetic control model to compare chlamydia test positivity rates in Orleans Parish (intervention site) to other similar parishes (control sites) in Louisiana. We estimated a model that used all other parishes as potential contributors to a synthetic control for Louisiana as well as a sample limited to the 40 parishes in Louisiana with the largest Black populations. RESULTS: The Check It program was associated with a 1.69 percentage point decline in chlamydia positivity in the first full year of operation and a 2.44 percentage point decline in chlamydia positivity in the second full year of operation compared to control sites with the largest Black populations (p = 0.05). Results were similar when the treatment site was compared to all other sites in Louisiana. CONCLUSIONS: The Check It program was associated with a significant decline in chlamydia testing positivity rates among women in Orleans Parish compared to control sites. Screening of young Black men who have sex with women can decrease rates in women living in the same community. Future recommendations for chlamydia screening of young men should be considered.

BACKGROUND In a randomized controlled trial of 2 g (single-dose) metronidazole (MTZ) versus 500 mg twice daily for 7-days (multi-dose) for T. vaginalis treatment, multi-dose was superior. We examined if the effect was similar by select clinical factors to determine if treatment recommendations could be targeted. METHODS The primary outcome was T. vaginalis repeat infection at test-of-cure (TOC) 4-weeks post-completion of therapy. Analyses were stratified by T. vaginalis history, baseline genital symptoms, and concurrent diagnosis of bacterial vaginosis (BV) per Nugent score at baseline. RESULTS Women who returned for TOC (n = 540) were included. At baseline, 52.9% had a self-reported history of T. vaginalis, 79.3% genital symptoms, 5.8% a gonorrhea diagnosis, and 47.5% BV. During follow-up, 97.4% took all MTZ as instructed and 34.5% had interval condomless sex with a baseline partner. At TOC, 14.8% tested positive for T. vaginalis. In stratified analysis, women randomized to single-dose MTZ had a higher rate of TOC T. vaginalis positivity than those randomized to multi-dose if they were symptomatic at baseline (21.4% vs. 10.8%, p = 0.003) or had a reported history of T. vaginalis (24.1% vs. 12.6%, p = 0.01). TOC T. vaginalis positivity was higher for women receiving single-dose (18.9%) versus multi-dose (10.8%), irrespective of baseline BV status (p > 0.06). In multivariable analysis, only a history of T. vaginalis and single-dose MTZ were independently associated with a positive TOC for T. vaginalis. CONCLUSION While multi-dose MTZ is recommended for all women with T. vaginalis, it is especially important for women with a T. vaginalis history and, given high post-treatment infection rates, a TOC should be performed.

Despite decades of medical, diagnostic, and public health advances related to diagnosis and management of sexually transmitted infections (STI), rates of reportable STIs continue to grow. A 2021 National Academies of Sciences, Engineering, and Medicine report on the current state of STI management and prevention in the United States, entitled Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, offers recommendations on future public health programs, policy, and research. This new report builds upon the 1997 Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, and provides eleven recommendations organized under four action areas: 1) Adopt a sexual health paradigm; 2) Broaden ownership and accountability for responding to STIs; 3) Bolster existing systems and programs for responding to STIs; and 4) Embrace innovation and policy change to improve sexual health. We present our interpretive synopsis of this report, highlighting elements of particular interest to STI and sexual health practitioners, including clinicians, researchers, disease intervention specialists, community outreach workers and public health staff. The report asserts that it is possible to create a healthier and more equitable future where fewer adolescents and adults are infected, fewer babies are born with STIs, and people entering their sexual debut and continuing throughout the life span are taught the language and skills to conceptualize and enact their own vision for what it means to be sexually healthy.

Check It is a novel, bundled, community-based seek, test, and treat Chlamydia trachomatis (Ct) screening program for 15- to 24-year-old Black men in New Orleans who have sex with women. The program design addressed barriers and facilitators to Ct screening/treatment by enlisting trusted community partners, incorporating participant input, providing free index/partner expedited treatment, developing relatable marketing materials and an educational Web site, encouraging peer referral, and providing a modest monetary incentive.Areas of high poverty were identified using census data; ethnographic/key informant interviews identified sites in those areas where the target population congregated. Black youth informed Web site design and social marketing. Content was inspirational/educational/amusing and endorsed recruitment and brand awareness. A community advisory board, participant interviews, community partner feedback, and recruitment staff involvement in the process evaluation helped refine the program in an ongoing manner.During formative stages, 41 key informant/community advisory board members informed program refinement. Community partners provided venue locations (n = 65) and participant referrals. Between May 22, 2017, and February 28, 2020, 1890 men were enrolled (acceptance rate, 96.0%) with Ct infection rate of 10.2%. Overall study treatment was provided to 86.1% (71.4%-90.9%) of participants who tested positive and 28.5% (14.5%-41.5%) of their partners. Findings from in-depth interviews with participants (n = 43) led to increased treatment uptake.C. trachomatis community screening of young Black men was successful through collaboration with trusted community partners, by tailoring implements/marketing with participant input, reducing barriers to treatment, and providing modest monetary incentives. The Check It program can serve as a roadmap for reducing health disparities in this population.

BACKGROUND: COVID-19 stay-at-home orders enacted in New Orleans, LA on 3/16/2020, may have caused changes in the way young men interacted with sex partners. METHODS: An online sub-study was conducted (5/21/2020-6/9/2020) among Black men who have sex with women, >18 years old, and who had previously enrolled in the parent study Check It (5/17/2017-3/16/2020) to assess changes in sexual behavior during the stay-at-home orders. RESULTS: Among 111 participants, from enrollment in Check It to during stay-at-home orders, recent vaginal sex declined from 96.4% to 47.8% (p

BACKGROUND: People experiencing homelessness are disproportionately infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In response to COVID-19, cities nationwide temporarily housed people experiencing homelessness in unused hotels. One such initiative in New Orleans also enacted a screening, counseling, and linkage-to-care model for HIV and HCV treatment for this temporarily housed population between May and July 2020. METHODS: A non-concurrent cohort study was performed assessing follow up in the treatment of HIV and HCV for this population. Outcome data was collected on seropositive patients' electronic medical record to assess patient progression through the treatment cascade. RESULTS: Of 102 unhoused residents, 25 (24.5%) tested HCV seropositive. Of the HCV positive 21/25 (84%) were connected to the associated clinic for follow up care and 10 (40%) obtained HCV treatment medication. Furthermore, all three patients who tested seropositive for HIV either started or re-initiated anti-viral treatment. The greatest barrier to providing medication for the HCV seropositive patients, once care was initiated, was loss-to-follow-up. CONCLUSION: Targeting homeless persons living in temporary residences for HCV and HIV screening can be effective at promoting access to care for those infected due to this population's high HCV seropositivity especially significant if the patient has a history of intravenous drug use or is over the age of 40. However, continued outreach strategies are needed to assist patients in retention of care.

Trichomonas vaginalis (TV) is a parasitic protozoan responsible for the sexually transmitted infection trichomoniasis. Trichomonas vaginalis virus (TVV) is a nonsegmented, 4.5–5 kbp, double-stranded RNA virus, from the Totiviridae family, which inhabits TV. A capsid protein consisting of 120 subunits is covered in channels aiding in RNA release. TVV is closely associated with the Golgi complex and is transmitted vertically. TVV has four subspecies, TVV1, TVV2, TVV3, and TVV4. The clinical significance of TVV and its effect on the pathogenicity of TV is not well known. We performed a systematic review of the literature on TVV to better understand its clinical significance and its role in the pathogenesis of TV.

The objectives of this study were to (1) describe the quantity and quality of social support networks of Latino immigrants living in a new receiving environment, and (2) to determine the role such networks play in their HIV/STI risk behaviors, including substance use. Double incentivized convenience sampling was used to collect egocentric social support network data on 144 Latino immigrants. Latent class analysis was used for data reduction and to identify items best suited to measure quality and quantity of social support. Moderate and high quantity and quality of social support were protective of HIV/STI sexual risk behavior compared to low quantity and quality of support, after adjustment for gender, years in New Orleans and residing with family. Neither measure of social support was associated with binge drinking. The findings suggest that increased quantity and quality of social support decrease HIV/STI sexual risk behaviors but do not influence binge drinking. Interventions that improve the quantity and quality of social support are needed for Latino immigrants.

The 2015 Centers for Disease Control Sexually Transmitted Disease treatment guidelines currently recommend a single 2-g dose of oral metronidazole as the preferred regimen for treatment of trichomoniasis in human immunodeficiency virus (HIV)-negative women. Mounting recent evidence has shown that the 7-day oral metronidazole dosing regimen is more efficacious than the single 2-g dose. This commentary reviews the implications associated with these new data and discusses issues surrounding it that should be considered moving forward.

BACKGROUND –: The optimal timing for nucleic acid amplification testing (NAAT) post-treatment for Trichomonas vaginalis has not been fully established. Testing too soon post-treatment may detect remnant nucleic acid that is not from viable organisms, falsely misclassifying person as infected. The purpose of this study was to examine how long T. vaginalis nucleic acid is detectable post metronidazole (MTZ) treatment. METHODS –: Women diagnosed with T. vaginalis treated with MTZ (2 g single-dose or 500 mg twice daily for 7 days multi-dose) self-collected a vaginal swab for NAAT at baseline and each week post completion of treatment through test of cure (TOC) at week 4, when a culture was also performed. Women who reported interim sexual exposure or who were culture positive at 4 weeks were excluded. Time to first negative NAAT was examined using Kaplan Meier analysis. RESULTS –: All women receiving multi-dose metronidazole were NAAT negative by 21 days and those receiving single-dose by 28 days post completion of treatment. Though over half (60.7%) of the cohort reinitiated sex during follow-up¸ all reported using condoms during sex or that they and their partner were treated prior to sex. Six of 89 (6.7%) had a positive NAAT following their first negative NAAT. CONCLUSIONS –: The optimal timing for T. vaginalis retesting after completion of treatment is three weeks for those receiving multi-dose MTZ and four weeks for those receiving single-dose, though sexual re-exposure and false negatives should be considered.

BACKGROUND Three recent prospective studies have suggested that the 1-g dose of azithromycin for Chlamydia trachomatis (Ct) was less effective than expected, reporting a wide range of treatment failure rates (5.8%-22.6%). Reasons for the disparate results could be attributed to geographic or methodological differences. The purpose of this study was to reexamine the studies and attempt to harmonize methodologies to reduce misclassification as a result of false positives from early test-of-cure (TOC) or reinfection as a result of sexual exposure rather than treatment failure. METHODS Men who had sex with women, who received 1-g azithromycin under directly observed therapy for presumptive treatment of nongonococcal urethritis with confirmed Ct were included. Baseline screening was performed on urethral swabs or urine, and TOC screening was performed on urine using nucleic acid amplification tests. Posttreatment vaginal sexual exposure was elicited at TOC. Data from the 3 studies were obtained and reanalyzed. Rates of Ct retest positive were examined for all cases, and a sensitivity analysis was conducted to either reclassify potential false positives/reinfections as negative or remove them from the analysis. RESULTS The crude treatment failure rate was 12.8% (31/242). The rate when potential false positives/reinfections were reclassified as negative was 6.2% (15/242) or when these were excluded from analysis was 10.9% (15/138). CONCLUSIONS In these samples of men who have sex with women with Ct-related nongonococcal urethritis, azithromycin treatment failure was between 6.2% and 12.8%. This range of failure is lower than previously published but higher than the desired World Health Organization's target chlamydia treatment failure rate of < 5%.

Expedited partner therapy (EPT) for Chlamydia trachomatis (Ct) is the practice of providing Ct-infected patients with medication, or prescription (prescription-EPT) to deliver to their sex partners without first examining those partners. New York City (NYC) providers commonly use prescription-EPT, yet NYC pharmacists report only occasional receipt of EPT prescriptions. This project assessed the frequency of EPT prescriptions filled in 2 NYC neighborhoods.The 2 NYC facilities reporting the most frequent use of prescription-EPT were identified from Ct provider case reports and contacted to ascertain their EPT practices. Providers at the first facility (facility 1) prescribed two 1-g doses of azithromycin, including sex partner treatment on the index patient's electronic prescription. Providers at the second facility (facility 2) gave patients paper prescriptions for sex partners. We reviewed prescriptions filled in 2015 for azithromycin, 1 or 2 g at pharmacies near these facilities; prescriptions indicating partner therapy were classified "EPT prescriptions".Facility 1 providers submitted 112 Ct case reports indicating prescription-EPT, compared with 114 submitted by facility 2 providers. Twelve of 26 identified pharmacies agreed to participate. At 7 pharmacies near facility 1, we found 61 EPT prescriptions from facility 1 and 37 from other facilities. At 5 pharmacies near facility 2, we found only 1 EPT prescription from facility 2 and 3 from other facilities.Expedited partner therapy prescriptions were received in NYC pharmacies near to EPT-prescribing facilities, but with great variability and at a lower frequency than suggested by provider case reports. Provider EPT prescribing practices may impact the likelihood that partners receive medication and should be further evaluated.

Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.

Trichomonas vaginalis is the most common curable sexually transmitted infection worldwide. Although the Centers for Disease Control and Prevention and the World Health Organization recommend a single 2-g dose of metronidazole for the first line of treatment for T. vaginalis among human immunodeficiency virus (HIV) negative women, high rates of repeat infections are found. The purpose of this meta-analysis was to compare treatment failure between single versus multidose metronidazole for the treatment of T. vaginalis.A systematic literature search was performed using search terms including metronidazole AND trichomoniasis AND women. Embase, MEDLINE, and Clinicaltrials.gov were used to search for relevant studies as well as hand searching relevant articles. These databases were last searched on January 25, 2016. To be included in this meta-analysis, the study had to be a clinical trial, evaluate T. vaginalis, use oral metronidazole, and compare single dose metronidazole to multidose metronidazole.There were 487 articles that were assessed for relevance and quality. Of these articles, 6 met the eligibility criteria and were included in the final results. The pooled risk ratio indicated higher treatment failure for single dose compared to multidose 1.87 (95% confidence interval, 1.23-2.82; P0.01). When the one study that included HIV+ women was excluded from analysis, the findings were similar with a pooled risk ratio of 1.80 (95% confidence interval, 1.07-3.02; P0.03).Centers for Disease Control and Prevention recently changed treatment recommendations for HIV+ women to multidose rather than single-dose. These data suggest that those recommendations should be considered for all women.

Repeat STIs cause a significant amount of reproductive morbidity and an important percentage of repeat infections are caused by re-infection from untreated sex partners.1 Expedited partner therapy (EPT), or the provision of medicine to a sex partner of a persons infected with an STI without the requirement of a clinical exam, was conceived to accelerate and facilitate partner treatment, thus reducing the chance of re-infection to the index person. EPT was endorsed by the Centers for Disease Control and Prevention (CDC) in 2006 as a useful option for partner management for selected STDs among heterosexuals. To date, at least 26 RCTs have been conducted to evaluate EPT. A recent meta-analysis of these RCTs found that EPT reduced repeat infections by 20–29% depending on the STD and the demographics of the index person and resulted in more partners being treated when compared to standard partner referral by the index patient.2 So there is good evidence that, in randomized trials, EPT is efficacious for reducing repeat STIs. In this edition of Sexually Transmitted Diseases, Vaidya et al. evaluated acceptance of patient-delivered partner therapy (PDPT), a form of EPT, in New York City STD clinics.3 Their findings were highly encouraging, in that, under the best circumstances (i.e. when legal, with funding, when offered by the provider) half of eligible index patients accept PDPT to bring to their sex partners. And for the majority of those who don’t accept, their reason for not accepting was that either their partner had already been treated or the partner was no longer accessible to the index person. So in essence, most partners who could or should get EPT, likely got it. This adds to the growing literature indicating that index patients will accept EPT if offered.4–6 The situation in NYC is a great model for how EPT could work. Unfortunately, in many parts of the U.S., EPT is still not widely used because of barriers that are further upstream in the EPT cascade such as legality, funding, policy and provider reticence. The cascade depicted in Figure 1 shows the steps that are needed for the partner to actually get treated via EPT. These steps are discussed below. Figure 1 EPT cascade

Summary We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006–2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90–180 days and 181–395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of $30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.

Multiple sexual partnerships (MSP), both concurrent and serial short gap, are thought to increase the risk of HIV and sexually transmitted infection (STI) acquisition and transmission. In this study we evaluate potential individual and environmental risk factors for engaging in MSP in a cohort of newly arrived Latino migrant men (LMM) in New Orleans, LA, USA. Participants were surveyed at three time points over a nine-month period to examine factors associated with MSP. Of the 113 men, 32.5 % reported ever MSP. In 290 observations, 19.5 % of men had concurrent, and 15.0 % had serial short gap partnerships in at least one interviews. Substance was associated with MSP, OR (95 % CI) 2.00 (1.16, 3.45) whereas belonging to a community organization was found to be protective, OR 0.32 (0.17, 0.59). Interventions to reduce substance use and promote social connection are needed to prevent a potential HIV/STI epidemic in this population.

There is growing interest in the application of propensity scores (PS) in epidemiologic studies, especially within the field of reproductive epidemiology. This retrospective cohort study assesses the impact of a short interpregnancy interval (IPI) on preterm birth and compares the results of the conventional logistic regression analysis with analyses utilizing a PS. The study included 96,378 singleton infants from Louisiana birth certificate data (1995-2007). Five regression models designed for methods comparison are presented. Ten percent (10.17 %) of all births were preterm; 26.83 % of births were from a short IPI. The PS-adjusted model produced a more conservative estimate of the exposure variable compared to the conventional logistic regression method (β-coefficient: 0.21 vs. 0.43), as well as a smaller standard error (0.024 vs. 0.028), odds ratio and 95 % confidence intervals [1.15 (1.09, 1.20) vs. 1.23 (1.17, 1.30)]. The inclusion of more covariate and interaction terms in the PS did not change the estimates of the exposure variable. This analysis indicates that PS-adjusted regression may be appropriate for validation of conventional methods in a large dataset with a fairly common outcome. PS's may be beneficial in producing more precise estimates, especially for models with many confounders and effect modifiers and where conventional adjustment with logistic regression is unsatisfactory. Short intervals between pregnancies are associated with preterm birth in this population, according to either technique. Birth spacing is an issue that women have some control over. Educational interventions, including birth control, should be applied during prenatal visits and following delivery.

High rates of sex and drug risk behaviors have been documented among Latino migrant men in the US. Whether these behaviors were established in the migrants’ home countries or were adopted in the US has not been described and has implications for prevention strategies. Quarterly surveys were conducted to gather information on selected sex and drug risk practices of Latino migrant men who arrived in New Orleans after Hurricane Katrina seeking work. Both kappa scores and McNemar’s tests were performed to determine if practice of these behaviors in home country was similar to practice post-emigration to the US. Female sex worker (FSW) patronage, same sex encounters (MSM), and crack cocaine use was more likely to occur post- rather than pre-emigration. Of those who ever engaged in these selected behaviors, most adopted the behavior in the US (i.e., 75.8 % of FSW patrons, 72.7 % of MSM participants, and 85.7 % of crack cocaine users), with the exception of binge drinking (26.8 %). Men who were living with a family member were less likely to adopt FSW patronage OR = 0.27, CI = 0.10–0.76, whereas men who earned >$465 per week were more likely to adopt crack cocaine use OR = 6.29 CI = 1.29, 30.57. Interventions that facilitate the maintenance of family cohesion and provide strategies for financial management may be useful for reducing sex and drug risk among newly arrived migrants.

Background The reliance on Latino migrant day labor in the U.S. is increasing. Prospective data on day laborers' work and health experience in non-agriculture settings are lacking and outcomes are generally restricted to injury rates. Methods An ambidirectional study was conducted to quantify the number of job and job task changes held over 12 months in a cohort of 73 migrant day laborers and assessed the relation between work type, health symptoms, and blood lead level. Results On average, participants worked 2.4 different jobs over the past year averaging 41.5 hr per week. Construction work was associated with a twofold increase in sino-nasal and respiratory symptoms in both adjusted and unadjusted models and was associated with increased blood lead levels. Conclusions Despite day labor status, workers had relatively stable employment. Respiratory symptoms were common and often improved when away from work suggesting that workplace irritant exposure is likely. Migrant day laborers working construction are vulnerable to adverse health effects associated with irritant and lead exposure. Am. J. Ind. Med. 54:366–374, 2011. © 2010 Wiley-Liss, Inc.

Trichomonas vaginalis (TV) is a common parasitic sexually transmitted infection found among human immunodeficiency virus (HIV)-infected women with prevalence rates ranging from 6% to 44% in this population.1–6 TV in women is associated with vaginitis, cervicitis, urethritis, and pelvic inflammatory disease.7 Among HIV-infected women, the presence of TV infection may amplify HIV transmission through increased shedding of HIV in vaginal fluids8,9 implicating TV infection as a source of sexual and perinatal transmission of HIV.10–12 Two studies have shown that treatment for TV can result in a reduction of HIV vaginal shedding.13,14 Therefore, prevention of TV infections, including repeat infections, among HIV-infected women can provide not only a clinical, but also a public health benefit.15 The rates of repeat TV infections among HIV-infected women range from 18% to 36%,4,16,17 which is much higher than the 8% repeat infection rate for non-HIV infected women.18 Repeat TV infections can result from nonadherence to treatment by the index patient, reinfection by an untreated sexual partner, infection by a new sexual partner, or treatment failure.16,19 Expedited partner therapy (EPT) is the practice of treating the sex partners of persons with curable sexually transmitted infections without requiring the partners to first obtain a medical evaluation.20 EPT generally consists of a practice called patient-delivered partner therapy or treatment (PDPT), where the patient is given a medication or prescription to deliver to their sex partner(s). PDPT has been recommended for the prevention of recurrent infections with Chlamydia trachomatis and Neisseria gonorrhoeae among women and heterosexual men. However, the Centers for Disease Control and Prevention has declared that there is insufficient evidence to support recommending PDPT for partner management among patients with TV.21 We found some evidence that PDPT may be helpful among HIV-infected women. In our prior cohort of HIVinfected women with TV who were given PDPT, we found that most repeat infections (55%) were attributed to treatment failure16 suggesting that PDPT does prevent reinfection. The purpose of the current study was to evaluate in more depth adherence to PDPT, and possible causes of repeat TV infection in a different cohort of HIV-infected women to determine whether our prior findings are reproducible.

Post-traumatic stress disorder (PTSD) is a common psychological outcome of any disaster. The purpose of this study was to examine the effects of PTSD on disease progression among HIV-infected persons in metropolitan New Orleans post-hurricane Katrina. One-year post-storm, a convenience sample of 145 HIV-infected patients who returned to care at the HIV Outpatient Program clinic in New Orleans were interviewed. Clinical factors pre and one and two years post-disaster were abstracted from medical records and compared by PTSD status. Of the 145 participants, 37.2% had PTSD. Those with PTSD were more likely than those without PTSD to have detectable plasma viral loads at both follow-up time points post-disaster and more likely to have CD4 cell counts200/mm(3) two years post-disaster. They were also more likely to have had medication interruptions immediately post-disaster. Our findings corroborate the findings of others that PTSD accelerates HIV disease progression. Disaster planners should consider the special counseling and medication safeguards needs of HIV-infected persons.

Objective: The Hurricane Katrina disaster caused rapid displacement of over a million persons in metropolitan New Orleans. The purpose of this study was to describe changes in sexual behavior and access to reproductive care pre- and postrapid displacement among a cohort of young women receiving family planning services before displacement. Methods: Women 16 to 24 years old, who were attending 2 public family planning clinics and enrolled in a vaginal douching prevention study, were located 5 to 6 months after Katrina and interviewed by telephone to elicit information about sexual behavior and access to reproductive care. Results: Women who were located were interviewed (N = 55). Of these, 96% were black, 62% were employed before the disaster, and the mean age was 22.1 (SD 2.1). In the 5 to 6 months after disaster, 86% lived in 3 or more places, 31% had returned to New Orleans, 17% needed health care but could not access it, 40% had not used birth control, and 2 (4%) experienced an unintended pregnancy as a result of lack of access to care. When compared with baseline, after the hurricane, women were less likely to have attended family planning services, to have used birth control, to have >1 sex partner, to have a vaginal odor or discharge. Conclusion: Relief efforts for disasters causing rapid displacement of impoverished women should include reproductive care such as provision of contraception, condoms, and STI services, as well as linking women back into care.

To examine correlates of HIV disclosure, a convenience sample of 273 HIV-infected persons throughout rural Louisiana were interviewed. Disclosure to sexual partners at time of initial HIV-positive diagnosis and the time of the study interview was ascertained (an average of 5.76 years later). The prevalence of disclosure to past and current sex partners was 57.2% and 80.7% respectively. Those who reinitiated sex with their partner since testing positive for HIV and those who received partner notification were more likely to disclose to past partners. Non-African Americans and those with only one partner were more likely to disclose to present sex partners. Much like urban settings, disclosure is not universal, and interventions such as disclosure skills building and/or ongoing partner notification services may be needed to facilitate disclosure.

We examine the role of alcohol consumption on sexual risk behavior among a cohort of 187 sexually active HIV-infected women (aged 18-61) in care at an urban ambulatory clinic in New Orleans, Louisiana, U.S. Sexual risk behavior among women on and off antiretroviral therapy (ART) and the relationship between alcohol use, ART, and behavior was also explored. One-fourth of respondents were classified as binge drinkers and the average number of drinking occasions per week ranged from none to 10-12. Approximately 60% were prescribed ART and self-reported adherence was 90%. One-third of the women reported no condom use at last vaginal sex, 62% reported inconsistent condom use for vaginal sex, and 7% had multiple male sex partners in the last month. Binge alcohol users and women on ART were significantly more likely to participate in each sexual risk outcome examined. Partner refusal of condom use was also significantly associated with binge drinking patterns. Results lend strength to the equivocal literature on the relationship between both alcohol and prescription of ART and sexual behavior. Enhanced detection of alcohol abuse, coupled with risk reduction counseling especially among women prescribed ART are important clinical practices in treating women with HIV.

Objectives: Cervicovaginal lavage (CVL) is often used for research and may be easier and more accurate than vaginal swabs as a specimen collection method. Goal: The goal of this study was to compare (CVL) with vaginal swabs for the detection of bacterial vaginosis (BV) and Trichomonas vaginalis (TV). Study: CVL and vaginal swabs were collected from 216 HIV-infected women. Clinical assessments were made using wet mount for TV and Amsel's criteria for BV through CVL and swab collection methods. Laboratory gold standards used were Nugent's criteria for BV and InPouch (Biomed Diagnostics, San Jose, CA) culture for TV collected by swab. Results: The prevalence by gold standards for BV was 49.3% and for TV was 25.2%. Sensitivities for direct microscopy versus culture for TV were 72.2 for CVL and 52.8 for vaginal swab (P

The goal of this study was to determine the period prevalence of mother-child separation (i. e., living apart from mother) and factors associated with separation between women infected with HIV type 1 and their children (17 years old or younger). A retrospective cohort study was conducted, based on routinely collected data by the Family Advocacy, Care and Education Services (FACES) of Children's Hospital (New Orleans, Louisiana) on children (n 586) of 231 HIV-infected mothers followed from July 1, 2001 to March 20, 2003. The 3-month period prevalence of separation from mother ranged between 12.7% and 21.2% over the course of follow-up. At baseline, 14% of children were separated from their mothers. Over the course of follow-up, older children (6 to 17 years), those with mothers who used illegal drugs and/or alcohol and who suffered from mental health problem(s), those whose mothers did not live at a permanent residence, and children with mothers who had a CD4 cell count below 200 cells per microliter were more likely to be separated from their mother. No significant differences in substance use, mental health, CD4 count, or other sociodemographics were identified between women lost to follow-up and those who remained in care. Substance use and mental health problems played a role in maternal-child separation among the HIV-positive women in this sample, even after clinical status and socioeconomic factors were taken into account. Providing additional resources for substance use and mental health treatment may help to prevent or reduce maternal-child separation among similar populations.

Trichomonas vaginalis (Tv) is a common sexually transmitted disease (STD) among HIV-infected populations. The relationship between Tv and immune status and HIV viral load as affected by protease inhibitor (PI) use has not been well examined.The goals were to evaluate the association between Tv and both immune status and PI use among HIV-infected women, and to characterize factors associated with Tv among HIV-infected women.We used a retrospective cohort study conducted between 1990 and 2000.Of 1578 women, the majority was under 35 years, black (AA), and infected heterosexually or with unidentified risk. Thirty percent (30.2%) had Tv at least once, and 36.9% had at least one subsequent positive test; Tv was more common than chlamydia, gonorrhea, genital warts, or syphilis. After adjusting for follow-up time, young age, AA race, substance use, and other sexually transmitted diseases (STDs) were associated with initial Tv infection, but pregnancy, immune status, and PI use were not associated. After adjusting for follow-up time, having other STDs was associated with and pregnancy was protective of subsequent Tv positivity, but immune status and PI use were not associated; neither were age, race, or substance use.Tv is a common STD among HIV-infected women and does not appear to be associated with immune status or PI use. Aggressive screening might represent a means of reducing the incidence and prevalence of Tv.

Background and objective A study of HIV-positive individuals in New Orleans, Louisiana, found that the majority of patients disclosed to their main partners and family members, but less than one fourth disclosed to any casual sex partner. Older age and lower CD4 cell counts were associated with disclosure. Goal The goal was to describe patterns of HIV serostatus disclosure among a diverse sample of patients at an HIV outpatient clinic in New Orleans, Louisiana. Study design A convenience sample of HIV-seropositive patients provided information about disclosure of seropositivity, demographics, date of HIV diagnosis, CD4 cell count, mode of HIV acquisition, and sexual activity since HIV diagnosis. Results The 269 persons disclosed their HIV status to people in the following categories: main sex partner (74.2%), casual sex partner (24.8%), immediate family member (69.8%), other relative (27.0%), or friend (26.4%). Adolescents were less likely than adults to disclose to a main partner, immediate family member, or a friend. Immunosuppressed persons were more likely than nonimmunosuppressed persons to disclose to a main partner, immediate family member, or another relative. Conclusion Many HIV-infected individuals delay disclosure until their disease has progressed. Interventions such as partner notification and skill-building to facilitate appropriate HIV disclosure are needed.

Repeated infection with C trachomatis increases the risk for serious sequelae: pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain. A substantial proportion of women treated for C trachomatis infection are reinfected by an untreated male sex partner in the first several months after treatment. Effective strategies to ensure partner treatment are needed.The goal of the study was to determine whether repeated infections with C trachomatis can be reduced by giving women doses of azithromycin to deliver to male sex partners.A multicenter randomized controlled trial was conducted among 1,787 women aged 14 to 34 years with uncomplicated C trachomatis genital infection diagnosed at family planning, adolescent, sexually transmitted disease, and primary care clinics or emergency or other hospital departments in five US cities. Women treated for infection were randomized to one of two groups: patient-delivered partner treatment (in which they were given a dose of azithromycin to deliver to each sex partner) or self-referral (in which they were asked to refer their sex partners for treatment). The main outcome measure was C trachomatis DNA detected by urine ligase chain reaction (LCR) or polymerase chain reaction (PCR) by 4 months after treatment.The characteristics of study participants enrolled in each arm were similar except for a small difference in the age distribution. Risk of reinfection was 20% lower among women in the patient-delivered partner treatment arm (87/728; 12%) than among those in the self-referral arm (106/726; 15%); however, this difference was not statistically significant (odds ratio, 0.80; 95% confidence interval, 0.62-1.05; = 0.102). Women in the patient-delivered partner treatment arm reported high compliance with the intervention (82%).Patient-delivered partner treatment for prevention of repeated infection among women is comparable to self-referral and may be an appropriate option for some patients.

The purpose of this study was to measure the accuracy of HIV-infected persons' knowledge of their sexual partners' HIV infection status. HIV-infected persons at two public health clinics reported their knowledge of the HIV infection status of their sexual partners. Actual HIV test results for sexual partners were then linked to survey responses. The association between reported knowledge and actual infection status of partners was estimated by kappa scores and percent agreement. Sixty-four percent (14/22) of partners thought to be infected were actually uninfected, and 42% (8/19) of partners thought to be uninfected were actually infected. The overall percent agreement was 46% (kappa = -0.06), less than that expected by random chance alone. Individuals in committed partnerships were less likely to have accurate knowledge than those in casual partnerships. In conclusion, HIV-infected individuals have poor knowledge regarding their partners' infection status. This may influence sexual behaviors that result in increased transmission.

The objective of this meta-analysis was to determine the effect of behavioral interventions in reducing risky sexual behavior and incident sexually transmitted infections (STI) among Latina women living in the United States. Studies were found by systematically searching the MEDLINE, EMBASE, and PsychInfo databases without language restriction. Two independent reviewers screened abstracts and full texts of articles to find randomized control trials testing the effects of behavioral interventions aimed at changing risky sexual behavior among Latinas. Articles were selected using prespecified inclusion criteria. Two independent reviewers extracted data from the included trials in duplicate using a standardized data extraction form. Six randomized control trials met the inclusion criteria for a total of 2,909 participants. Using random effects models with inverse variance weighting, we found a protective effect of the behavioral intervention on reported risky sexual behavior (odds ratio = 0.52; 95% confidence interval = 0.42, 0.64) and on incident nonviral STI (odds ratio = 0.65; 95% confidence interval = 0.46, 0.93). Behavioral interventions targeted toward Latina populations are effective in reducing risky sexual behaviors and incident STI and should be considered by policymakers as a potential tool for HIV/STI prevention in this population.

Background and Objectives: The presence of sexually transmitted infections (STIs) may facilitate transmission of HIV to uninfected partners. Goal: To describe the incidence of reinfection with Trichomonas vaginalis in HIV-infected women and to assess predictors of reinfection. Study Design: A retrospective cohort study using data abstracted from medical records of HIV-infected women with at least one diagnosis of trichomoniasis. Results: Approximately one third (36%) of the study population was reinfected with T vaginalis during the follow-up period, with an incidence of 16.4 reinfections per 100 person years. Significant predictors of reinfection included history of another STI (hazard ratio, 1.52; 95% CI, 1.08-2.14) and becoming pregnant during the follow-up period (hazard ratio, 0.59; 95% CI, 0.39-0.87). Conclusions: There is a high rate of reinfection with T vaginalis in HIV-infected women. Further research that includes information on sexual partners should be conducted to better describe the reinfection patterns of trichomoniasis.

Chlamydia trachomatis (CT) and neisseria gonorrhoeae (GC) are the 2 most common sexually transmitted infections in the United States.1 Among women, repeated infections with CT and GC are associated with serious reproductive outcomes such as pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility.2-6 Because men often spontaneously clear infection7,8 and do not have the same adverse outcomes as women, less attention has been paid to repeated infections among men. However, the burden of repeat infections among men is high. The average repeat infection rates of CT and GC among men (11% and 7%)9 are close to those reported among women (10.7% and 3.6%).10 Repeatedly infected men are reservoirs of infection for women,11,12 thus preventing repeat infections among men is an important public health measure. Understanding whether these repeat infections result from reexposure to a baseline partner, infection from a new partner, or treatment failure is important in understanding the most effective interventions. Centers for Disease Control and Prevention (CDC) suggests expedited partner treatment (EPT) or the provision of medication or prescriptions for index persons to deliver to their sex partners if there is concern that their partner will not seek care.13 The basic assumption of this approach is that most repeat infections are due to reexposure and treating the source of exposure will reduce the repeat infection. Although the efficacy of EPT for preventing repeat infections among men has been demonstrated in several studies, repeat infection rates among men given EPT remain high (10%–14%).14,15 This suggests that, among men, some of the repeat infections may be due to factors other than reexposure and that rescreening in addition to the provision of EPT may be needed. As an additional prevention measure among women, the CDC strongly encourages rescreening of women 3 months posttreatment. Suggestions for men are more nebulous. The CDC states that there is a lack of evidence to support rescreening among men.16 The purpose of this article is to examine the possible origin of infection among heterosexual men who rescreen positive for CT and/or GC.

Background and objectives Differences in sociodemographic attributes and healthcare access may explain differences in regional sexually transmitted disease rates but don't fully explain why syphilis persists disproportionately in certain populations. Goal of this study To understand the behavioral epidemiology of syphilis, we conducted a social network analysis of persons with syphilis and their contacts and developed and applied a definition of core transmitters. Study design We interviewed 10 index persons with primary or secondary untreated syphilis and 80 of their named sexual and social contacts. Results Fourteen (16%) of 90 interviewed persons met the definition of core transmitters, 9 of whom had past or current syphilis. The other interviewed persons had only moderately risky behaviors. Seventy-eight (42%) of the network sexual contacts were connected directly or indirectly to a core transmitter. Conclusion This analysis suggests that syphilis transmission is maintained by a community with a small percentage of high-risk persons centrally placed amidst a larger group with moderately risky behavior.

THE QUESTION OF WHETHER systemic hormonal therapies can effect genital tract HIV-1 RNA shedding is plausible since selected cytokine production in the genital tract, which can be influenced by the hormonal milieu, may modulate the replication of HIV-1.1 The observation that genital tract HIV-1 RNA s

The purpose of this study was to describe the clinical profile of end-stage AIDS in patients 12 months before death. A cross-sectional examination of HIV-infected patients who attended a public HIV outpatient clinic between 1990 and 1996 and who died was conducted. The prevalence and first-time acquisition of AIDS-defining conditions 12 months before death were evaluated. The AIDS-defining conditions with the highest percentages of first-time acquisition in the last 12 months of life were progressive multifocal leukoencephalopathy (100%), lymphoma (96%), dementia (78.6%), Mycobacterium avium complex (MAC) infection (74.0%), toxoplasmosis (72.6%), and cytomegalovirus (CMV) infection (69.6%). Of the concomitant conditions studied, those with the highest percentages of first-time acquisition in the last 12 months of life were CMV with MAC (99%) and CMV with wasting (88%). Patients who acquire these AIDS-defining conditions may be eligible to receive information about end-stage options, such as hospice care. However, administration of aggressive antiretroviral treatments, such as the protease inhibitors, may affect this profile in the future, as the majority of the patients in this study were receiving the standard antiretroviral treatments of the time, primarily zidovudine.

The objective of this study is to describe the characteristics associated with a history of sexual abuse among HIV-infected women enrolled in a public inner-city HIV outpatient clinic. A retrospective chart review of 238 women of childbearing age enrolled in the HIV outpatient clinic between 1987 and 1995 was performed. Characteristics of the study population were 83% African American, 69% single, and 53% finished high school or were still in school. The mean age was 25.7 years. Of the 238 women, 32% had a history of sexual abuse. Factors associated with sexual abuse history after controlling for age included living in a nonpermanent situation (OR=4.8), history of non-intravenous drug use (OR=4.65), and having dropped out of school (OR=2.2). HIV-infected women should be screened for a history of sexual abuse and carefully counselled regarding their reproductive choices and drug treatment.

High repeat infection rates (8% to 20%1-6) among women receiving 2 g dose of metronidazole (MTZ) for the treatment of Trichomonas vaginalis (TV) have brought into question the effectiveness of single dose treatment. Repeat infection rates appear to be particularly high among HIV+ women ranging from 18.3% to 36.9%,2,7,8, suggesting that some factors specific to HIV+ women may be interfering with single dose MTZ therapy. In our multi-centered randomized trial among HIV+ women attending two southern United States HIV outpatient clinics, we found that the 7 day 500 mg twice daily MTZ regimen was superior to the 2 g single dose regimen for TV infection.9 In a subsequent stratified analysis, we discovered that superiority of multi-dose over single-dose was restricted to women with BV suggesting that this condition interfered in some way with single dose MTZ therapy.10 In this issue of the journal, Balkus et al report their observations of TV treatment outcomes in a cohort of HIV- and HIV+ female sex workers in Kenya. They found that the 2 g single dose MTZ treatment success rate among HIV+ women, was significantly lower for those with bacterial vaginosis (BV), corroborating our findings. However, they also found that in addition to lower treatment success rates for women with BV, that women who were receiving antiretroviral therapy (ART) also had lower treatment success. To compare our finding to that of Balkus et al., we performed a secondary analysis of TV treatment outcomes for women randomized to the 2g MTZ arm in our published study. ART and BV status were determined at baseline. ART was elicited by abstracting prescribed medication from the medical records and then confirming with the patient’s self-report of whether or not they were taking the medicine. Patients’ were asked which HIV medications they used by a trained study staff person using a chart with pictures of medications available during the study time period (May, 2006 to July 2009). When ART status was discrepant between medical records and patient-report, the patient-report was used. BV was diagnosed in women who had a Nugent score of > 7. Women were tested for TV using InPouch culture at both baseline and at the 7 day post treatment test of cure visit (TOC) visit. Treatment was administered and directly observed at the clinic and all women were offered 2 g MTZ treatment to deliver to their sex partner(s). Of the 130 women in this arm, 113 (86.9%) returned for their TOC visit and had complete data for Nugent score, CD4 cell count, and ART and were included in the analyses. At baseline, 54.9% of the women had BV per Nugent score, CD4 counts were as follows : 500/mm3 (21.2%). Viral loads were as follows: 10,000 copies/mL (34.8%). Of the 76 (67.3%) women receiving ART, the classes of drugs as documented on the medical record and confirmed by the participant, were the following: NRTI (94.8%), NNRTI (31.1%) PI (58.1%), and other (2.0%). As a measure of ART adherence, we asked “did you take this medication as prescribed the day before” and 94.7% said yes to this question for each ART they were taking. Unlike the Balkus cohort, where all who were taking ART were receiving nevirapine-containing therapies, only 1 of our participants received nevirapine. At TOC, 18.6% of those included in the analysis were TV positive via culture. Those receiving ART were as likely as those not receiving ART to have re-initiated sex (24.3% vs. 14.5%, P-value=0.20). Women who were receiving ART were more likely to have CD4 cell count < 200/mm3 (32.9% vs. 10.8%, P =0.008) and viral loads < 50 copies/mL copies (54.7% vs. 21.6%, P=0.002) compared to women not receiving ART. These two factors were similar by BV status. In multivariable logistic regression, after adjusting for the presence of BV and CD4 cell count, women who were receiving ART were 4.58 times more likely to be TV+ at TOC than women not receiving ART (1.09-19.36, P-value= 0.038). After removing the 4 women who did not adhere to their ART regimen the day before from the analysis, the effect measures on ART did not change but had a slightly narrower confidence interval (O.R. 4.72, 95% C.I. 1.12 – 19.82, P-value 0.034). To examine if the association between ART and TV treatment failure could be explained by BV, a stratified analysis was performed. The association between ART and TV+ at TOC by BV status had a Cochrane’s chi-square of 3.69 (P-value= 0.06) demonstrating that after adjusting for BV, ART was associated with treatment failure. The Breslow-Day chi-square was 0.77 (P-value 0.38) indicating no interaction between BV and ART thus supporting an independent association of ART on the repeat infection rate. There were some differences between these two studies and our analyses address several of the limitations identified by Balkus et al. in their study. We used culture rather than the less sensitive wet prep for TV detectible and therefore likely included more asymptomatic women. Future studies should use more sensitive nucleic acid amplification techniques. Follow-up assessment in our study was 7 days post completion of treatment compared to 1 month post treatment in the Balkus study. Nearly 50% of Balkus cohort had sexual exposure compared to 20% in our cohort. This difference in sexual exposure is likely attributed to differences in the cohorts (Balkus cohort were sex workers) and a longer follow-up time between baseline and TOC visit (mean of 33 days vs. 10 days). Our study, therefore, was able to reduce, but not eliminate the confounding effect of sexual exposure. Since sexual exposure was similar by ART status in our study, we think confounding was minimal. Finally, a number of ARTs were used in our cohort compared to the Balkus cohort, which was exclusively nevirapine-containing therapies, demonstrating that the ART effect is not a phenomenon specific to nevirapine. While our study addresses some of the limitations of the Balkus et al study, neither study can establish causality since they both lacked experimentation. It is possible that ART may be a marker for some other factor that interferes with single dose MTZ treatment of TV. To better understand the mechanism whereby ART influences MTZ treatment, pharmacokinetic studies are necessary. In summary, our secondary analyses of a previously published study support the findings of Balkus et al. in a U.S. cohort with exposure to a wider variety of HIV retroviral drugs. Since 83.2% of our cohort was either receiving ART or had BV or both, the majority of our cohort would have been affected. These findings lend strength to the recommendation that the single 2 g MTZ regimen should not be used for treating HIV+ women.

Purpose: There is limited information regarding the clinical manifestations of human immunodeficiency virus (HIV) infection among adolescents. To better define the clinical presentation and course of HIV disease in this population, a retrospective review of all HIV-infected persons age 13–21 years at entry into a public, inner-city HIV outpatient clinic in New Orleans, Louisiana, was undertaken. Results: A total of 141 adolescents were included in this study. The cohort was predominantly female (65%) and African-American (83%), and acquired HIV infection through sexual contact (89%). As many as 75% of the females and 48% of the males were diagnosed with at least one sexually transmitted disease (STD), respectively, and young African-American females with a CD 4 cell count > 500/mm 3 were at highest risk. The proportions of female adolescents having a gravida ≥ 1 and 2 were 82% and 20%, respectively. A total of 55% of females were diagnosed with squamous intraepithelial lesions (SIL) at least once. Similar to adults, the majority of opportunistic processes occurred in adolescents with a CD 4 cell count 3 . Known HIV-related symptoms (oral hairy leukoplakia, thrush, and zoster) were significantly predictive ( p Conclusions: Although HIV-related symptoms and infections do not appear to be unique in the adolescent population, it is clear that STDs and pregnancies are common among female adolescents. Our results emphasize the need for aggressive STD and contraceptive protection counseling, and surveillance screening for STDs and cervical dysplasia.

BACKGROUND: Male clients of female sex workers (FSWs) serve as a potential bridge of human immunodeficiency virus (HIV) to the general population. Little is known about the characteristics and risk factors for HIV infection among male clients patronizing FSWs in Hekou County Yunnan Province in southern China bordering with Vietnam. METHODS: Male clients were recruited through outreach of study staff referrals by Vietnamese FSWs and their bosses and snowball sampling. Each participant completed a questionnaire survey and donated a blood specimen to test for HIV herpes simplex virus type 2 (HSV-2) and syphilis. Logistic regression models were fitted to identify factors associated with HIV infection. RESULTS: Among 306 participants 28 (9.2%) were HIV positive 81 (26.5%) were HSV-2 positive and none was infected with syphilis. Approximately half (n = 149 49.2%) reported always using condoms with sex workers in the past year; 36 (11.8%) reported a history of injection drug use (IDU). Compared with HIV-negative men HIV-positive men were more likely to have a history of IDU (64.3% vs. 6.5%) and be coinfected with HSV-2 (50.0% vs. 24.1%). CONCLUSIONS: IDU was the most salient risk factor for HIV infection in this study which suggests that male clients may acquire HIV from routes other than commercial sex but the significance of HSV-2 infection indicates that sexual transmission is also of concern. HIV prevention intervention programs for this often ignored and hard-to-reach risk group should be two-pronged addressing both drug use and commercial sex.

Partner treatment is an important component of sexually transmitted disease control. Several randomized controlled trials have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, whereas some found that EPT significantly lowered reinfection rates in index patients.We collected cost data to assess the payer-specific, health care system, and societal-level cost of EPT and SR. We used data on partner treatment and index patient reinfection rates from 2 randomized controlled trials examining EPT and SR for patients diagnosed with chlamydia or gonorrhea. Additional elements were estimated or drawn from the literature. We used a Monte Carlo simulation to assess the impact on cost and effectiveness of varying several variables simultaneously, and calculated threshold values for selected variables at which EPT and SR costs per patient were equal.From a health care system or societal perspective, EPT was less costly and it treated more partners than SR. From the perspective of an individual payer, EPT was less costly than SR if ≥32% to 37% of male index patients' female partners or ≥29% of female index patients' male partners received care from the same payer.EPT has a lower cost from a societal or health care system perspective than SR and treats more partners. Individual payers may find EPT to be more costly than SR, depending on how many of their patients' partners receive care from the same payer.

The purpose of this study was to examine patterns and predictors of HIV/STI risk over time among Latino migrant men in a new receiving community. Latino men (N = 125) were interviewed quarterly for 18 months and HIV/STI tested annually. Selected individual, environmental and cultural factors by partner type and condom use were explored longitudinally and in a cross-section. Sex with female sex workers (FSWs) and multiple partners decreased, sex with main partners and abstinence increased, while the number of casual partners remained stable. Consistent condom use was highest with FSWs, lowest with main partners and midrange with casual partners with no trends over time. STI morbidity was low; no HIV was detected. Drug use and high mobility were associated with inconsistent condom use with FSW, whereas having family in the household was protective. HIV/STI prevention efforts should focus on drug using Latino migrants who are highly mobile and should foster healthy social connections.

This study examined the prevalence and factors associated with Mycoplasma genitalium (MG) infection among HIV-positive women and the association between MG and vaginal HIV-1 RNA shedding. HIV-positive women attending an outpatient clinic in New Orleans, Louisiana, USA, from 2002 to 2005 were examined for a battery of sexually transmitted infections (STIs) and underwent a behavioural survey. A selected subset had a measurement of vaginal shedding analysed. Of the 324 HIV-positive women, 32 (9.9%) were infected with MG. HIV-positive women with MG were more likely to be co-infected with Neisseria gonorrhoeae and Chlamydia trachomatis and to have had ≥1 male sexual partners in the last month. In the subset ( n = 164), no differences were found in the presence of detectable vaginal HIV-1 RNA between women infected and not infected with MG (30.8% versus 34.8% shedding; P = 0.69). While MG was a common co-STI in this sample of HIV-positive women, it was not associated with vaginal HIV shedding.

Trichomonas vaginalis (TV) and bacterial vaginosis (BV) were examined among human immunodeficiency virus+ women. The prevalence rates were 28.0% for TV, 51.4% for BV, and 17.5% for TV/BV co-infection. Among human immunodeficiency virus+/TV+ women, the rate of BV was 61.0%. Research is needed to examine how BV affects the clinical course and treatment of T. vaginalis.

The objective of this research was to determine the factors associated with disclosure of three treatable sexually transmitted diseases (STDs). Data were obtained from two intervention trials to determine the ideal means of partner referral. Men diagnosed with urethritis and women diagnosed with trichomoniasis at public clinics in New Orleans, Louisiana were randomly assigned to partner referral (PR), booklet-enhanced partner referral (BEPR), or patient-delivered partner treatment (PDPT). Participants were asked about sex partners at baseline, then whether they disclosed to them at follow-up. The male trial was conducted from December 2001 to March 2004 and the female trial from December 2001 to August 2004. Data on men and women were analyzed separately. Nine hundred seventy-seven men and 463 women-reporting information on 1991 and 521 sex partners-were respectively enrolled in each trial. Disclosure occurred to 57.8% and 87.3% of their partners, respectively. Most men (68.3%) reported having two or more partners and disclosure was more likely to occur in: those who reported only one sex partner (adjusted odds ratio [aOR] 95% confidence interval [CI]: 1.54 [1.10, 2.16]); those in steady relationships (OR [95% CI]: 1.37 [1.08,1.74]); and those assigned PDPT [OR [95% CI]: 2.71 [1.93,3.82]). Most women reported having only one partner (86.8%) and disclosure was more likely to occur in steady relationships (OR [95% CI]: 2.65 [1.24,5.66]), and when sex was reinitiated with partners during the follow-up period (OR [95% CI]: 3.30 [1.54,7.09]). The provision of PDPT was associated with increased STD disclosure among men but not among women. Both men and women were less likely to disclose to casual partners. Women had high rates of disclosure irrespective of intervention arm.

The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend routine rapid HIV testing in labor and delivery (LD) for women with undocumented HIV status using an opt-out approach. Identifying factors associated with declining a rapid HIV test in LD will be helpful in developing strategies to improve rapid HIV testing uptake. Data from the Mother-Infant Rapid Intervention at Delivery study were analyzed. Women ≥24 weeks gestation, in labor, with undocumented HIV status were offered rapid HIV testing using informed consent. Women who declined rapid HIV testing (decliners) but agreed to be interviewed were compared to women who accepted testing (acceptors). 102 decliners and 478 acceptors met inclusion criteria for analysis. Decliners of rapid HIV testing were more likely to have had prenatal care (PNC), after adjusting for age, Hispanic ethnicity, high-school education and city of enrollment (adjusted OR 2.4, 95% CI 1.06-5.58). Having had PNC was collinear with prior HIV education and previous offer of an HIV test during the current pregnancy, so these factors were not part of the model. During PNC, standard informed consent may involve discussions that negatively affect later uptake of testing in LD. Therefore an opt-out approach to testing may improve testing rates. Furthermore, decliners may have felt that testing in LD was redundant because of previous testing during PNC; however, if previous testing occurred, this was undocumented at LD. Documentation and timely communication of HIV status is critical to provide appropriate HIV prophylaxis.