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Los Angeles County has experienced a rapid increase in early syphilis among men who have sex with men (MSM) in recent years, with the number of cases rising from 126 in 2000 to 809 in 2005. As part of the public health response to this outbreak, a sustained social marketing campaign was launched in 2002, with the objectives of increasing syphilis testing, knowledge, and awareness among MSM in Los Angeles. This campaign, as implemented, exemplified key principles of social marketing, including market research, audience segmentation, and branding. A cross-sectional study conducted in 2004 to evaluate the campaign found that those MSM who were aware of the campaign were nearly twice as likely to have tested for syphilis in the past 6 months as those MSM who were not aware of the campaign. Those MSM who were aware of the campaign also had more syphilis awareness and knowledge in key areas. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the risk factors associated with repeat syphilis infection among men who have sex with men (MSM) in San Francisco, California. The study has evaluated data gathered from a retrospective cohort of all cases of syphilis among MSM diagnosed in 2001 and 2002 to identify reinfection that took place within one year after prior syphilis infection and treatment. The study has found that 42 of the 624 reported cases had syphilis reinfection within one year. The study has also observed that HIV infection was associated with the increased risk of syphilis reinfection among MSM.

The article investigates the risk factors for gonorrhea among heterosexuals in San Francisco, California in 2006. Analysis of the survey answers of 225 respondents revealed that among men, the risk factors for gonococcal infection were black race, having had multiple partners, anonymous partners and a long-term partnership. Among women, risk factors include being black or having a black partner, having had a recently incarcerated partner and meeting partners on the street. It concludes that prevention and control efforts should be focused on blacks and incarcerated populations.

The article presents a study on the impact of chlamydia screening and treatment program of San Francisco jails in California on the decrease in chlamydia positivity among females attending neighborhood medical clinics. It states that jail testing density from year 1997 to 2004 was compared by neighborhood, and chlamydia positivity among females aged 15 to 25 were compared at two clinics serving areas with different jail testing densities. Results showed that of persons offered screening at intake, 89% accepted.

The article presents a study to examine the rectal prevalence of Trichomonas vaginalis and Mycoplasma genitalium in a population of men who have sex with men (MSM) in San Francisco, California from November 11, 2005 to January 4, 2006. The researchers identified 5.4% positive rectal specimens for M. genitalium, 0.6% for T. vaginalis, 10% for Chlamydia trachomatis, and 11.4% for Neisseria gonorrhoeae cases. They conclude that asymptomatic infections could be an important reservoir for continued spread of sexually transmitted infections (STIs) and increased HIV transmission.

The article examines routinely collected demographic and partner notification outcome data among HIV-positive persons in San Francisco, California with acute and nonacute incident HIV infection between 2004 and 2006 and among long-standing cases between July 2005 and December 2006. According to the authors, partner notification was acceptable and can successfully identify new HIV infections.

The article describes the development, implementation and evaluations of the Healthy Penis campaign, which launched during the annual San Francisco Lesbian Gay Bisexual Transgender Parade in June 2002 in California. The campaign was developed because of a rapid rise of syphilis between 1999 and 2002 among men who have sex with men. Here, the authors presented a simple method to evaluate the immediate and long-term effectiveness of a public health media campaign designed to change behavior.

The article discusses on the use of methamphetamine and evaluates the sexual behavior HIV-infected patients in the San Francisco, California. There is a high prevalence rate of methamphetamine use among HIV-positive persons in medical care in San Francisco regardless of sexual orientation and gender, and associations of this use with having sexual intercourse and multiple sex partners.

Background. The incidence of syphilis has been increasing in the United States since reaching a nadir in 2000. Several clinical trials have demonstrated that treatment with oral azithromycin may be useful for syphilis control. After reports of azithromycin treatment failures in San Francisco, we investigated the clinical and epidemiologic characteristics of patients with syphilis due to azithromycin-resistant Treponema pallidum infection. Methods. We reviewed city-wide case reports and conducted molecular screening for patients seen at the San Francisco metropolitan STD clinic (San Francisco City Clinic) to identify patients who did not respond to azithromycin treatment for syphilis or who were infected with azithromycin-resistant T. pallidum. We conducted an epidemiologic investigation and retrospective case-control study to identify risk factors for acquiring syphilis due to azithromycin-resistant T. pallidum. Results. From January 2000 through December 2004, molecular screening of 124 samples identified 46 azithromycin-resistant T. pallidum isolates and 72 wild-type T. pallidum isolates. Six instances of treatment failure were identified through record review. In total, we identified 52 case patients (one of whom had 2 episodes) and 72 control patients. All case patients were male and either gay or bisexual, and 31% (16 of 52) were infected with human immunodeficiency virus. Investigation of patient-partner links and a retrospective case-control study did not reveal a sexual network or demographic differences between cases and controls. However, 7 case patients had recently used azithromycin, compared with 1 control patient. Surveillance data demonstrated that azithromycin-resistant T. pallidum prevalence increased from 0% in 2000 to 56% in 2004 among syphilis cases observed at the San Francisco City Clinic. Conclusions. Azithromycin-resistant T. pallidum is widespread in San Francisco. We recommend against using azithromycin for the management of syphilis in communities where macrolide-resistant T. pallidum is present and recommend active surveillance for resistance in sites where azithromycin is used. [ABSTRACT FROM AUTHOR]

In 1999, the Centers for Disease Control and Prevention launched the National Plan to Eliminate Syphilis. From 1999 to 2003 in San Francisco, early syphilis was epidemic, increasing from 44 cases to 522 cases a year. Syphilis cases were more likely to be in gay or bisexual men, those with human immunodeficiency virus (HIV) infection, those who had anonymous partners, and those who met sex partners on the Internet. Increases in sexual activity and sexual risk behavior in men who have sex with men during this period have been attributed to the improved physical health of HIV-infected men on highly active antiretroviral therapy, HIV treatment optimism, increases in methamphetamine use, and the use of Viagra. The San Francisco Department of Public Health's response to the epidemic included enhanced surveillance, expanded clinical and testing services, provider and community mobilization and sexual health education, and risk factor identification and abatement through investigations, public health advocacy, and treatment. Collaborations with community-based organizations and local businesses were key to the successful implementation of disease-control efforts. A multitude of converging risk factors and new environments contributed to the syphilis epidemic, requiring a comprehensive, innovative, and flexible disease-control strategy. [ABSTRACT FROM AUTHOR]

Background: Between 1999 and 2002, San Francisco experienced a sharp increase in early syphilis among gay and bisexual men. In response, the San Francisco Department of Public Health launched a social marketing campaign to increase testing for syphilis, and awareness and knowledge about syphilis among gay and bisexual men. Methods: A convenience sample of 244 gay and bisexual men (18–60 years of age) were surveyed to evaluate the effectiveness of the campaign. Respondents were interviewed to elicit unaided and aided awareness about the campaign, knowledge about syphilis, recent sexual behaviors, and syphilis testing behavior. Results: After controlling for other potential confounders, unaided campaign awareness was a significant correlate of having a syphilis test in the last 6 months (odds ratio, 3.21; 95% confidence Interval, 1.30–7.97) compared with no awareness of the campaign. A comparison of respondents aware of the campaign with those not aware also revealed significant increases in awareness and knowledge about syphilis. Conclusions: The Healthy Penis 2002 campaign achieved its primary objective of increasing syphilis testing, and awareness and knowledge about syphilis among gay and bisexual men in San Francisco. [ABSTRACT FROM AUTHOR]

Objective: Passive retrospective cohorts composed of persons who have tested 2 or more times for a sexually transmitted infection (STI) of interest during clinical visits have been used to estimate STI incidence. We hypothesized that the analytic period of a passive cohort might affect the estimate of STI incidence, with shorter periods yielding higher estimates of incidences of infection.Study: We analyzed data collected from women, 12 to 24 years of age, tested for chlamydia 2 or more times at 6 sites in San Francisco between January 1997 and December 2000. Incidence was calculated for 10 different analytic periods.Results: The calculated incidence of chlamydial infection during 1997 was 16.8 (95% confidence interval [CI], 10.9-24.0) per 1000 person-months of follow up. The calculated incidence dropped markedly as the analytic period lengthened, with the incidence estimated to be 9.7 (95% CI, 8.6-10.9) using a study period of 4 years (1997-2000). Estimates of incidence were similar when using the same analytic period, regardless of calendar year, and there was a similar decline in estimated incidence using longer analytic periods.Conclusions: Estimates of STI incidence based on passive cohort data may have limited epidemiologic value because incidence measures may be highly dependent on the analytic period. [ABSTRACT FROM AUTHOR]

Objectives: Sexually transmitted infection (STI) screening in correctional facilities provides access to people at high risk for STIs who might not be screened elsewhere. These screening programmes are becoming more widespread, but with decreasing funding for STI control, maximising screening impact has become increasingly important. We aimed to make recommendations about the impact of age and sex targeted screening in correctional facilities. Methods: We compared the prevalence of chlamydia and gonorrhoea for January 2003-July 2005 among different age groups of females and males screened in San Francisco correctional facilities-youth detention (12–17 years) and adult jail (18–35 years). Results: 16 975 chlamydia tests and 13 443 gonorrhoea tests were performed. The age specific chlamydia test positivity among females aged 12–17 years, 18–25 years, and 26–30 years, respectively, was 9.6% (105⁄1092), 9.4% (196⁄2088), and 6.3% (40⁄639), compared with 3.3% (100⁄3065), 6.2% (400⁄6470), and 3.9% (118⁄3046) among males. The age specific gonorrhoea test positivity among females in these same age groups was 3.2% (34⁄1062), 2.7% (57⁄2082), and 2.4% (15⁄635), compared with 0.7% (7⁄1026), 1.2% (67⁄5507), and 1.0% (25⁄2555) among males, Of the 1198 STIs identified, 1020 (85.1%) were treated. Conclusions: On the basis of this report and national data, STI control programmes with limited funds should prioritise screening females in youth detention first, women aged ⩽30 years in adult jail second, and men aged ⩽25 years in adult jail third. Males in youth detention should have a lower priority than young adults in jails. [ABSTRACT FROM AUTHOR]

Determines the feasibility of chlamydia and gonorrhea screening among high school students in San Francisco, California. Increase rate of pregnancy and sexually transmitted disease (STD) in teenage girls; Benefits of STD screening; Prevalence of chlamydia infection in students.

Evaluates chlamydia and gonorrhea screening criteria in San Francisco, California. Advent of more sensitive diagnostic screening technologies and competition in public healthcare spending; Prevalence by demographic group and symptom status.

Presents a letter to the editor published in the April 2003 issue of the journal 'Sexually Transmitted Diseases,' on the creation of policy recommendations for the screening for chlamydia and gonorrhea among high school students in San Francisco, California. Feasibility of the screening; Target for limited resources; Use of demographic and surveillance data.

Background: Substantial increases in syphilis among gay and bisexual men have been reported in San Francisco. Goal: To identify risk factors for early syphilis infection among gay and bisexual men attending the San Francisco municipal STD clinic (City Clinic). Study: Cross-sectional, self-administered, behavioral survey of gay and bisexual men attending City Clinic between November 2002 and March 2003 linked with electronic medical record data. Results: Among 1318 gay and bisexual men surveyed, 53 (4.0%) were diagnosed with early syphilis. The final multivariate model included nonwhite race (OR = 2.1 [1.1–4.4]), HIV-infection (OR = 3.9 [2.0–7.7]), using both methamphetamine and sildenafil (Viagra®) (OR = 6.2 [2.6– 14.9]), using methamphetamine without sildenafil (OR = 3.2 [1.3–7.6]), using sildenafil without methamphetamines (OR = 0.9 [0.3–2.9]), stronger gay community affiliation (OR = 2.3 [1.2–4.6]), and having recent Internet partners (OR = 2.1 [1.0–4.3]). Conclusions: Syphilis prevention efforts should address methamphetamine and sildenafil use among gay and bisexual men and require strong and substantive involvement with the gay community to address syphilis in San Francisco. [ABSTRACT FROM AUTHOR]

Background: Serologic testing for herpes simplex virus type-2 (HSV-2) is being implemented in sexually transmitted disease (STD) clinics.Goal: To determine the performance characteristics of two HSV-2 type-specific serologic assays in a public health laboratory.Study Design: Sera stored from a cross-sectional study were tested with the Meridian Diagnostics and Focus Technologies HSV-2 ELISA tests and a type-specific strip immunoblot assay (Chiron Corp.) was used as the reference standard.Results: Prevalence of HSV-2 infection in this sample was 44%. Compared to the reference standard, the sensitivity of the Meridian Diagnostics HSV-2 test was 95.5% (95% CI 83.3, 99.2) and specificity was 98.2% (95% CI 89.0, 99.9). The Focus Technologies test yielded 97.7% (95% CI 86.5, 99.9) sensitivity and 94.5% (95% CI 83.9, 98.6) specificity.Conclusions: The performance of these HSV-2 type-specific serologic assays was adequate to support their use in high prevalence populations, such as STD clinic patients. [ABSTRACT FROM AUTHOR]

The article discusses the sexually transmitted screening programs in San Francisco High Schools in California in 2007 and its results. The objective of the study is to provide chamydia and gonorrhoeae screening and treatment to adolescents assumed to be at high risk. The study was conducted among the 11th and 12th graders in San Francisco, California. On the 853 students present during the screening, 21 or 2% declined to participate and 537 or 63% returned a specimen for testing. No students tested was positive for gonorrhoeae, but 7 of the tested students were positive for chlamydia.

Background: Juvenile detention centers offer public health practitioners an opportunity to gain access to large numbers of adolescents at risk for chlamydia and gonorrhea., Goal: To describe the prevalence and coinfection of chlamydia and gonorrhea among adolescents in 14 US juvenile detention centers from 1997 to 2002., Study: We calculated the prevalence of chlamydia and gonorrhea in males and females, stratified by race/ethnicity, age group, and site. We also calculated the proportion of adolescents with chlamydia that were coinfected with gonorrhea and the proportion of those with gonorrhea that were coinfected with chlamydia., Results: The prevalence of chlamydia was 15.6% in 33,619 females and 5.9% in 98,296 males; gonorrhea prevalence was 5.1% in females and 1.3% in males. Of females with gonorrhea, 54% were coinfected with chlamydia, and 51% of males with gonorrhea were coinfected with chlamydia., Conclusions: Chlamydia and gonorrhea prevalence was very high in females in all project sites. In males, chlamydia prevalence was high in some areas; however, gonorrhea prevalence was substantially lower. These prevalence data justify screening for chlamydia and gonorrhea among female adolescents in juvenile detention centers nationally.