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Objectives: We evaluated 2 innovative approaches that supported COVID-19 case investigation and contact tracing (CI/CT) in Chicago communities: (1) early engagement of people diagnosed with COVID-19 by leveraging the existing Healthcare Alert Network to send automated telephone calls and text messages and (2) establishment of a network of on-site case investigators and contact tracers within partner health care facilities (HCFs) and community-based organizations (CBOs). Methods: The Chicago Department of Public Health used Healthcare Alert Network data to calculate the proportion of people with confirmed COVID-19 who successfully received an automated telephone call or text message during December 27, 2020–April 24, 2021. The department also used CI/CT data to calculate the proportion of cases successfully interviewed and named contacts successfully notified, as well as the time to successful case interview and to successful contact notification. Results: Of 67 882 people with COVID-19, 94.3% (n = 64 011) received an automated telephone call and 91.7% (n = 62 239) received a text message. Of the 65 470 COVID-19 cases pulled from CI/CT data, 24 450 (37.3%) interviews were completed, including 6212 (61.3%) of the 10 126 cases diagnosed in HCFs. The median time from testing to successful case interview was 3 days for Chicago Department of Public Health investigators and 4 days for HCF investigators. Overall, 34 083 contacts were named; 13 117 (38.5%) were successfully notified, including 9068 (36.6%) of the 24 761 contacts assigned to CBOs. The median time from contact elicitation to completed notification by CBOs was Conclusions: Partnerships with HCFs and CBOs helped deliver timely CI/CT during the COVID-19 pandemic, suggesting a potential benefit of engaging non–public health institutions in CI/CT for existing and emerging diseases.

High prevalences of HIV and other sexually transmitted infections (STIs) have been reported in the current global monkeypox outbreak, which has affected primarily gay, bisexual, and other men who have sex with men (MSM) (1-5). In previous monkeypox outbreaks in Nigeria, concurrent HIV infection was associated with poor monkeypox clinical outcomes (6,7). Monkeypox, HIV, and STI surveillance data from eight U.S. jurisdictions* were matched and analyzed to examine HIV and STI diagnoses among persons with monkeypox and assess differences in monkeypox clinical features according to HIV infection status. Among 1,969 persons with monkeypox during May 17-July 22, 2022, HIV prevalence was 38%, and 41% had received a diagnosis of one or more other reportable STIs in the preceding year. Among persons with monkeypox and diagnosed HIV infection, 94% had received HIV care in the preceding year, and 82% had an HIV viral load of200 copies/mL, indicating HIV viral suppression. Compared with persons without HIV infection, a higher proportion of persons with HIV infection were hospitalized (8% versus 3%). Persons with HIV infection or STIs are disproportionately represented among persons with monkeypox. It is important that public health officials leverage systems for delivering HIV and STI care and prevention to reduce monkeypox incidence in this population. Consideration should be given to prioritizing persons with HIV infection and STIs for vaccination against monkeypox. HIV and STI screening and other recommended preventive care should be routinely offered to persons evaluated for monkeypox, with linkage to HIV care or HIV preexposure prophylaxis (PrEP) as appropriate.

OBJECTIVES: We examined whether molecular cluster membership was associated with public health identification of HIV transmission potential among named partners in Chicago. DESIGN: Historical cohort study METHODS: We matched and analyzed HIV surveillance and partner services data from HIV diagnoses (2012–2016) prior to implementation of cluster detection and response interventions. We constructed molecular clusters using HIV-TRACE at a pairwise genetic distance threshold of 0·5% and identified clusters exhibiting recent and rapid growth according to the CDC’s definition (3 new cases diagnosed in past year). Factors associated with identification of partners with HIV transmission potential were examined using multivariable Poisson regression. RESULTS: There were 5,208 newly diagnosed index clients over this time period. Average age of index clients in clusters was 28; 47% were Black, 29% Latinx/Hispanic, 6% female and 89% men who have sex with men (MSM). Of the 537 named partners, 191 (35·6%) were linked to index cases in a cluster and of those 16% were either new diagnoses or viremic. There was no statistically significant difference in the probability of identifying partners with HIV transmission potential among index clients in a rapidly growing cluster versus those not in a cluster (adjusted Relative Risk 1·82, (0·81–4·06)). CONCLUSION: Partner services that were initiated from index clients in a molecular cluster yielded similar new HIV case finding or identification of those with viremia as did interviews with index clients not in clusters. It remains unclear whether these findings are due to temporal disconnects between diagnoses and cluster identification, unobserved cluster members, or challenges with partner services implementation.

In 2019, heterosexual sex accounted for 23% of new HIV diagnoses in the United States and six dependent areas (1). Although preexposure prophylaxis (PrEP) can safely reduce the risk for HIV infection among heterosexual persons, this group is underrepresented in PrEP research (2). CDC analyzed National HIV Behavioral Surveillance (NHBS) data to describe PrEP awareness among heterosexually active adults in cities with high HIV prevalence. Overall, although 32.3% of heterosexually active adults who were eligible were aware of PrEP

BACKGROUND We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender men who have sex with men (MSM) using specimens collected through the Centers for Disease Control and Prevention's enhanced Gonococcal Isolate Surveillance Project and Strengthening the US Response to Resistant Gonorrhea. METHODS During the period January 1, 2018-December 31, 2019, 12 enhanced Gonococcal Isolate Surveillance Project and 8 Strengthening the US Response to Resistant Gonorrhea sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in sexually transmitted disease clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs), and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites. RESULTS Participating clinics collected 3974 urethral, 1553 rectal, and 1049 pharyngeal isolates from 5456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared with anogenital isolates (P < 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥0.125 μg/mL) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (P < 0.05). CONCLUSIONS Based on data collected from multijurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of Neisseria gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time.

The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain.State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative.The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity.Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019.HIV case-finding resulting from APS in the United States is low.

Background: Assisted partner services (APS) are a longstanding component of public health efforts to control HIV in the United States, but their contemporary effectiveness is uncertain. Methods: The study surveyed U.S. state and local health departments that reported > 300 new HIV diagnoses in 2018 and were participating in phase 1 of the Ending the Epidemic Initiative. The study collected data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined the APS continuum, contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS), and estimated staff case-finding productivity. Findings: Fifteen (79%) of 19 jurisdictions responded to the survey, providing APS outcome data for 13 (68%) areas. Most health departments integrated APS with efforts to link index cases and partners to HIV care (93%) and pre-exposure prophylaxis (86%). A total of 18,833 persons were newly diagnosed with HIV in the 13 areas. Health departments initiated APS investigations on 13,899 (74%) cases and offered and provided APS to 12,338 (66%) and 9,733 (52%) index cases, respectively. Cases named 6,704 partners (contact index=0.69), of whom 2,650 (39%) had previously diagnosed HIV, 2,134 (32%) tested HIV negative, 516 (7.7% of named and 19% of tested partners) were newly diagnosed with HIV, and 2,239 (33%) were not known to have tested. Across all jurisdictions, the case-finding index was 0.053 (median=0.047, range 0.015-0.10). Health departments employed 288 full-time equivalent staff to provide APS. These staff interviewed a mean of 43 index cases annually, identifying a median of 1.8 new HIV infections in partners per staff per year. APS accounted for 2.7% of new diagnoses in 2019. Interpretation: HIV case-finding resulting from APS in the U.S. is low, reflecting low contact elicitation and attrition at each step along the continuum from case initiation to partner testing. Funding Information: Research was supported by NIH award AI027757. Declaration of Interests: None to declare. Ethics Approval Statement: The University of Washington institutional review board (IRB) defined the study as exempt from the need for IRB review.

BACKGROUND Sexually transmitted infections (STIs) pose a significant public health challenge in the United States. Traditional surveillance systems are adversely affected by data quality issues, underreporting of cases, and reporting delays, resulting in missed prevention opportunities to respond to trends in disease prevalence. Search engine data can potentially facilitate an efficient and economical enhancement to surveillance reporting systems established for STIs. OBJECTIVE We aimed to develop and train a predictive model using reported STI case data from Chicago, Illinois, and to investigate the model’s predictive capacity, timeliness, and ability to target interventions to subpopulations using Google Trends data. METHODS Deidentified STI case data for chlamydia, gonorrhea, and primary and secondary syphilis from 2011-2017 were obtained from the Chicago Department of Public Health. The data set included race/ethnicity, age, and birth sex. Google Correlate was used to identify the top 100 correlated search terms with “STD symptoms,” and an autocrawler was established using Google Health Application Programming Interface to collect the search volume for each term. Elastic net regression was used to evaluate prediction accuracy, and cross-correlation analysis was used to identify timeliness of prediction. Subgroup elastic net regression analysis was performed for race, sex, and age. RESULTS For gonorrhea and chlamydia, actual and predicted STI values correlated moderately in 2011 (chlamydia: r=0.65; gonorrhea: r=0.72) but correlated highly (chlamydia: r=0.90; gonorrhea: r=0.94) from 2012 to 2017. However, for primary and secondary syphilis, the high correlation was observed only for 2012 (r=0.79), 2013 (r=0.77), 2016 (0.80), and 2017 (r=0.84), with 2011, 2014, and 2015 showing moderate correlations (r=0.55-0.70). Model performance was the most accurate (highest correlation and lowest mean absolute error) for gonorrhea. Subgroup analyses improved model fit across disease and year. Regression models using search terms selected from the cross-correlation analysis improved the prediction accuracy and timeliness across diseases and years. CONCLUSIONS Integrating nowcasting with Google Trends in surveillance activities can potentially enhance the prediction and timeliness of outbreak detection and response as well as target interventions to subpopulations. Future studies should prospectively examine the utility of Google Trends applied to STI surveillance and response.

OBJECTIVE: To estimate new human immunodeficiency virus (HIV) diagnosis rates among HIV negative men who have sex with men (MSM) who are repeatedly tested for HIV in sexually transmitted disease (STD) clinics and assess the impact of demographic and disease-specific characteristics that are associated with higher HIV diagnosis rates. STUDY DESIGN: Retrospective analysis using 2010 to 2013 data from the STD Surveillance Network (SSuN), a sentinel surveillance system comprised of health departments in 12 cities conducting sentinel surveillance in 40 STD clinics. We analyzed data from all MSM repeatedly (≥2 times) tested for HIV, with an initial negative HIV test required for staggered cohort entry. Follow-up time was accrued from the date of the first negative HIV test to the most recent negative test or the first positive HIV test. The STD diagnoses during the follow-up period were reviewed. We estimated HIV diagnoses rates (number of HIV diagnoses/total number of person-years [PY] at risk) by demographic and clinical characteristics with 95% confidence intervals (CI) using an inverse variance weighted random effects model, adjusting for heterogeneity between SSuN jurisdictions. RESULTS: Overall, 640 HIV diagnoses occurred among 14,824 individuals and 20,951.6 PYof observation, for an adjusted incidence of HIV diagnosis of 3.0 per 100 PY (95% CI, 2.6–3.4). Rates varied across race/ethnicity groups with the highest rate among Blacks (4.7/100 PY; 95% CI, 4.1–5.3) followed by Hispanics, whites, and persons of other races/ethnicities. Men who have sex with men having a diagnosis of primary or secondary (P&S) syphilis on or after the first negative HIV test had a higher new HIV diagnosis rate (7.2/100 PY; 95% CI, 5.8–9.0) compared with MSM who did not have a P&S syphilis diagnosis (2.8/100 PY; 95% CI, 2.6–3.1). Men who have sex with men who tested positive for rectal gonorrhea (6.3/100 PY; 95% CI, 5.7–6.9) or rectal chlamydia (5.6/100 PY; 95% CI, 4.6–6.6) had higher rates of new HIV diagnosis when compared to those with negative test results. CONCLUSIONS: Men who have sex with men attending SSuN STD clinics have high rates of new HIV diagnoses, particularly those with a previous diagnosis of P&S syphilis, rectal chlamydia, and/or gonorrhea. Sexually transmitted disease clinics continue to be important clinical setting for diagnosing HIV among MSM populations.

Background Extragenital gonococcal infections are common among men who have sex with men (MSM); however, data comparing antimicrobial susceptibilities of urogenital and extragenital Neisseria gonorrhoeae isolates are limited. We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender MSM using specimens collected through CDC’s enhanced Gonococcal Isolate Surveillance Project (eGISP) and Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). Methods During January 1, 2018–December 31, 2019, 12 eGISP and 8 SURRG sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in STD clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs) and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites. Results Participating clinics collected 3,974 urethral, 1,553 rectal, and 1,049 pharyngeal isolates from 5,456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared to anogenital isolates (p< 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥ 0.125 µg/ml) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (p< 0.05). Conclusion Based on data collected from multi-jurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of N. gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time. Disclosures Olusegun O. Soge, PhD, Hologic Inc. (Grant/Research Support)SpeeDx Inc. (Grant/Research Support) Stephanie N. Taylor, MD, GARDP - GC Antibiotic Development (Scientific Research Study Investigator, To my institution.)GlaxoSmithKline (Grant/Research Support, Funds to my institution.)

Background In 2017, 11,730 gonorrhea (GC) cases were reported to Chicago Department of Public Health (CDPH), a 33% increase from 2015 (8,786 cases). CDPH conducted enhanced GC surveillance to identify factors that may inform interventions. Methods A 33% random sample was selected for further investigation from lab-confirmed GC cases reported August - December 2018 (N=3,337), through Illinois National Electronic Disease Surveillance System. Enhanced surveillance data came from: (1) case telephone interviews, (2) provider case reports, and (3) web-based provider survey. Results From October 2018 - February 2019, enhanced surveillance data was obtained from 459 cases (171 interviews, 399 provider reports; 111 with both), representing 68% of 672 cases with attempted contact, and 14% of all GC cases during the period. Survey respondents were representative of all reported cases: 68% male, median age 27 years, 53% Non-Hispanic Black, 22% Non-Hispanic White, 22% Hispanic. Prior GC infection was documented in 30% of cases, and was more prevalent among males (adjusted prevalence rate ratio [aPRR]= 1.90) and HIV infected persons (aPRR = 1.64). Adolescents and young adults (AYA; aged 13–24 years) comprised 47% of all reported GC cases. Compared to adults, AYA were less likely male (47% vs 80%, p Conclusion Prior GC infection and HIV co-infection were prevalent, without discriminative factors, indicating innovative measures are needed. AYA differ substantially from adults in risk profile, and may have less complete case management. Age-specific and risk-targeted interventions are needed to optimally manage GC and interrupt transmission. Disclosure No significant relationships.

Background Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis (CT) serovars L1–L3. The most recent US outbreak of LGV was in 2016 in Michigan in men who have sex with men (MSM) living with HIV. Methods To better understand LGV epidemiology in Chicago and increase provider awareness, in 2016, the Chicago Department of Public Health (CDPH) introduced a case-based reporting system for MSM with suspected LGV proctitis. Providers were asked to complete standard forms for adult MSM demonstrating symptoms of proctitis. Demographic/clinical and behavioral risk factors data were abstracted from 7/21/16 - 4/30/17. Rectal specimens found to be positive for CT on nucleic acid amplification testing were submitted for LGV laboratory confirmation. Results A total of 50 suspect LGV cases were reported to CDPH; 47 specimens were submitted to for further molecular testing: 19 were confirmed to be LGV, 10 were non-LGV/CT positive, 2 had indeterminate results and 16 were CT-negative. All confirmed cases were from rectal swabs: 21% (4/19) were non-Hispanic Black, 42% (8/19) were non-Hispanic white, 32% (6/19) were Hispanic, and 5% (1/19) were non-Hispanic Asian. The median age was 35 years (range = 21–46 years). Of 19 confirmed cases, 84% (N=16) were HIV (+), and in two cases, HIV was diagnosed at the time of LGV infection. The median CD4 count was 613 cells/ml (range = 311–1170 cells/ml, IQR=238); HIV RNA was Conclusion LGV may be suspected in MSM presenting with proctitis symptoms. These data likely underestimate the true local prevalence of LGV in Chicago since reporting was restricted to symptomatic MSM. Improvements in chlamydia case-based surveillance in key populations are critical given the association with LGV and HIV. Disclosure No significant relationships.

Background Trends in congenital syphilis (CS) usually parallel those of primary and secondary (P&S) syphilis in women. Chicago has invested in a multi-pronged approach to address the syphilis epidemic in the city. Between 2010 and 2017, the total number of female P&S syphilis cases in Chicago decreased by 37% (from 87 to 55 cases) in parallel with a decrease in the number of CS cases (from 19 to 11). At the same time, national rates of CS increased 140%, from 9.7 per 100,000 live births in 2010, to a high of 23.3 per 100,000 live births in 2017. Methods A retrospective analysis of surveillance data from 2010 through 2017 was performed on female cases of P&S syphilis (n=483) reported to the Chicago Department of Public Health. Results Of 483 cases reported during this time, 382 (79.1%) were non-Hispanic black, 34 (7.0%) Hispanic, 27 (5.6%) non-Hispanic white, and 40 (8.3%) other or unknown ethnicity. Approximately 7% (32) of females were co-infected with HIV. The median age was 27 and did not change significantly over time, ranging from 24 to 32. Overall, 23% of interviewed females reported having sex while intoxicated with alcohol or drugs, and 15% reported having sex with anonymous partners. Only 6.2% of females diagnosed with P&S syphilis reported exchanging drugs for sex or money and Conclusion Our findings suggest that certain sexual behaviors, in particular anonymous sex and sex while intoxicated, are more frequently reported by women infected with syphilis. To curb the spread of CS further, there is a need to enhance surveillance and collect comprehensive behavioral risk factor data for females. Future interventions should focus on provider and public education, media campaigns targeted towards these sexual behaviors, and expansion of screening programs among females of reproductive age. Disclosure No significant relationships.

Background Sexually transmitted infections (STIs) pose a significant public health challenge in the United States. Traditional surveillance systems are adversely affected by data quality issues, underreporting of cases, and reporting delays, resulting in missed prevention opportunities to respond to trends in disease prevalence. Search engine data can potentially facilitate an efficient and economical enhancement to surveillance reporting systems established for STIs. Objective We aimed to develop and train a predictive model using reported STI case data from Chicago, Illinois, and to investigate the model’s predictive capacity, timeliness, and ability to target interventions to subpopulations using Google Trends data. Methods Deidentified STI case data for chlamydia, gonorrhea, and primary and secondary syphilis from 2011-2017 were obtained from the Chicago Department of Public Health. The data set included race/ethnicity, age, and birth sex. Google Correlate was used to identify the top 100 correlated search terms with “STD symptoms,” and an autocrawler was established using Google Health Application Programming Interface to collect the search volume for each term. Elastic net regression was used to evaluate prediction accuracy, and cross-correlation analysis was used to identify timeliness of prediction. Subgroup elastic net regression analysis was performed for race, sex, and age. Results For gonorrhea and chlamydia, actual and predicted STI values correlated moderately in 2011 (chlamydia: r=0.65; gonorrhea: r=0.72) but correlated highly (chlamydia: r=0.90; gonorrhea: r=0.94) from 2012 to 2017. However, for primary and secondary syphilis, the high correlation was observed only for 2012 (r=0.79), 2013 (r=0.77), 2016 (0.80), and 2017 (r=0.84), with 2011, 2014, and 2015 showing moderate correlations (r=0.55-0.70). Model performance was the most accurate (highest correlation and lowest mean absolute error) for gonorrhea. Subgroup analyses improved model fit across disease and year. Regression models using search terms selected from the cross-correlation analysis improved the prediction accuracy and timeliness across diseases and years. Conclusions Integrating nowcasting with Google Trends in surveillance activities can potentially enhance the prediction and timeliness of outbreak detection and response as well as target interventions to subpopulations. Future studies should prospectively examine the utility of Google Trends applied to STI surveillance and response.

Background Transgender women and transgender men are disproportionately affected by human immunodeficiency virus (HIV) infection and may be vulnerable to other sexually transmitted diseases (STDs), but the lack of surveillance data inclusive of gender identity hinders prevention and intervention strategies. Methods We analyzed data from 506 transgender women (1045 total visits) and 120 transgender men (209 total visits) who attended 26 publicly funded clinics that provide STD services in 6 US cities during a 3.5-year observation period. We used clinical and laboratory data to examine the proportion of transgender women and transgender men who tested positive for urogenital and extragenital chlamydial or gonococcal infections and who self-reported or tested positive for HIV infection during the observation period. Results Of the transgender women tested, 13.1% tested positive for chlamydia and 12.6% tested positive for gonorrhea at 1 or more anatomic sites, and 14.2% were HIV-infected. Of transgender men tested, 7.7% and 10.5% tested positive for chlamydia and gonorrhea at 1 or more anatomic sites, and 8.3% were HIV-infected. Most transgender women (86.0% and 80.9%, respectively) and more than a quarter of transgender men (28.6% and 28.6%, respectively) with an extragenital chlamydial or gonococcal infection had a negative urogenital test at the same visit. Conclusions Publicly funded clinics providing STD services are likely an important source of STD care for transgender persons. More data are needed to understand the most effective screening approaches for urogenital, rectal, and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infections in transgender populations.

BACKGROUND: For many individuals, the implementation of the US Affordable Care Act will involve a transition from public to private health care venues for sexually transmitted infection (STI) care and prevention. To anticipate challenges primary care providers may face and to inform the future role of publicly funded STI clinics, it is useful to consider their current functions. METHODS: Data collected by 40 STI clinics that are a part of the Sexually Transmitted Disease Surveillance Network were used to describe patient demographic and behavioral characteristics, STI diagnoses, and laboratory testing data in 2010 and 2011. RESULTS: A total of 608,536 clinic visits were made by 363,607 unique patients. Most patients (61.9%) were male; 21.9% of men reported sex with men (MSM). Roughly half of patients were 20 to 29 years old (47.1%) and non-Hispanic black (56.2%). There were 212,765 STI diagnoses (mostly nonreportable) that required clinical examinations. A high volume of chlamydia, gonorrhea, and HIV testing was performed (>350,000 tests); the prevalence was 11.5% for chlamydia, 5.8% for gonorrhea, 0.9% for HIV, and varied greatly by sex and MSM status. Among MSM with chlamydia or gonorrhea, 40.1% (1811/4448) of chlamydial and 46.2% (3370/7300) of gonococcal infections were detected at extragenital sites. CONCLUSIONS: Sexually Transmitted Disease Surveillance Network clinics served populations with high STI rates. Given experience with diagnoses of both nonreportable and reportable STIs and extragenital chlamydia and gonorrhea testing, STI clinics comprise a critical specialty network in STI diagnosis, treatment, and prevention.

UNLABELLED There was a 13% increase in the number of insured patients in Chicago sexually transmitted disease clinics 1 year after Affordable Care Act implementation. Major disparities in being insured persisted among those at higher risk for sexually transmitted diseases. ABSTRACT There was a 13% increase in the number of insured patients in Chicago sexually transmitted disease clinics 1 year after Affordable Care Act implementation. Insured patients were more likely to report having access to preventive (65% vs. 36%, P < 0.01) and sick care (72% vs. 44%, P < 0.01). Major disparities in being insured persisted among men, those aged 26 to 45 years, and racial minorities.

We used data from the STD Surveillance Network to estimate HIV testing among patients being tested or treated for gonorrhea. Of 1,845 gonorrhea-infected patients identified through nationally notifiable disease data, only 51% were tested for HIV when they were tested or treated for gonorrhea. Among the 10 geographic sites in this analysis, the percentage of patients tested for HIV ranged from 22-63% for men and 20-79% for women. Nearly 33% of the un-tested patients had never been previously HIV-tested. STD clinic patients were more likely to be HIV-tested than those in other practice settings.

BACKGROUND Expansion of antimicrobial resistance in Neisseria gonorrhoeae requires rapid adaptation of treatment guidelines and responsive provider practice. We evaluated patient factors associated with provider adherence to the Centers for Disease Control and Prevention gonococcal treatment recommendations among Chicago providers in 2011 to 2012. METHODS Laboratory-confirmed cases of uncomplicated urogenital gonorrhea were classified via surveillance data as originating from Chicago Department of Public Health (CDPH) or non-CDPH providers. Recommended treatment was determined according to the Centers for Disease Control and Prevention sexually transmitted disease treatment guidelines: April 2011-July 2012 (period 1) and August-December 2012 (period 2, after August 2012 revision). Multivariable log-binomial regression identified factors associated with recommended treatment over time, stratified by provider type. RESULTS April 2011 through December 2012, 16,646 laboratory-confirmed gonorrhea cases were identified, of which 9597 (57.7%) had treatment information: 2169 CDPH cases and 7428 non-CDPH cases. Documented recommended treatment increased for CDPH (period 1: 71.3%, period 2: 80.8%; P < 0.01) and non-CDPH providers (period 1: 63.5%, period 2: 68.9%; P < 0.01). Among CDPH cases, statistically significant factors associated with recommended treatment were male sex (adjusted prevalence rate ratio [aPRR], 1.16) white versus black race (aPRR, 0.68), same-day treatment (aPRR, 1.07), and period 2 (aPRR, 1.11). Among non-CDPH cases, statistically significant factors were as follows: male sex (aPRR, 1.10), other versus black race (aPRR, 0.91), same-day treatment (aPRR, 1.31), greater number of within-facility reported cases (aPRRs ranging from 1.22 to 1.41), and at least 50% within-facility missing treatment data (aPRR, 0.84). CONCLUSIONS Recommended treatment improved over time, yet remains suboptimal. Efforts to reduce variability and improve provider adherence to recommended treatment are urgently needed.

We surveyed selected public sexually transmitted disease clinics in the United States regarding human papillomavirus vaccine availability, target populations, funding sources, and barriers. Although nearly all had experience offering other vaccines, only 7 of 42 clinics (17%) offered human papillomavirus vaccine. Vaccine cost, staff time, and follow-up issues were commonly reported barriers.

Gonorrhea (GC) and chlamydia (CT) are the most commonly reported notifiable diseases in the United States. The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) be screened for urogenital GC/CT, rectal GC/CT, and pharyngeal GC. We describe extragenital GC/CT testing and infections among MSM attending sexually transmitted disease (STD) clinics.The STD Surveillance Network collects patient data from 42 STD clinics. We assessed the proportion of MSM attending these clinics during July 2011-June 2012 who were tested and positive for extragenital GC/CT at their most recent visit or in the preceding 12 months and the number of extragenital infections that would have remained undetected with urethral screening alone.Of 21 994 MSM, 83.9% were tested for urogenital GC, 65.9% for pharyngeal GC, 50.4% for rectal GC, 81.4% for urogenital CT, 31.7% for pharyngeal CT, and 45.9% for rectal CT. Of MSM tested, 11.1% tested positive for urogenital GC, 7.9% for pharyngeal GC, 10.2% for rectal GC, 8.4% for urogenital CT, 2.9% for pharyngeal CT, and 14.1% for rectal CT. More than 70% of extragenital GC infections and 85% of extragenital CT infections were associated with negative urethral tests at the same visit and would not have been detected with urethral screening alone.Extragenital GC/CT was common among MSM attending STD clinics, but many MSM were not tested. Most extragenital infections would not have been identified, and likely would have remained untreated, with urethral screening alone. Efforts are needed to facilitate implementation of extragenital GC/CT screening recommendations for MSM.

BACKGROUND: A quadrivalent vaccine that prevents genital warts (GWs) has been recommended by the Advisory Committee on Immunization Practices for women since 2007 and for men since 2011. National estimates of GW burden in sexually transmitted disease (STD) clinic settings are useful to provide a baseline assessment to monitor and evaluate reductions in GW and serve as an important early measure of human papillomavirus (HPV) vaccine impact in this population. METHODS: Genital wart prevalence among STD clinic patients from January 2010 to December 2011 was determined from a cross-sectional analysis of all patients attending STD clinics in the STD Surveillance Network (SSuN). We conducted bivariate analyses for women, men who have sex with women (MSW), and men who have sex with men (MSM) separately, using χ(2) statistics for the association between GW diagnosis and demographic, behavioral, and clinical characteristics. RESULTS: Among 241,630 STD clinic patients, 13,063 (5.4%) had GWs. Wide regional differences were observed across SSuN sites. The prevalence of GW was as follows: 7.5% among MSW (range by SSuN site, 3.9–15.2), 7.5% among MSM (range, 3.3–20.6), and 2.4% among women (range, 1.2–5.4). The highest rate was among 25- to 29-year-old MSW (9.8%). Non-Hispanic black women and MSW had a lower prevalence of GWs than did women and MSW in other racial/ethnic groups. CONCLUSIONS: There is a significant burden of GW in STD clinic populations, most notably in men. Given the opportunity for prevention with a quadrivalent HPV vaccine, STD clinics may be an ideal setting for monitoring trends in GW prevalence among men (MSW and MSM). However, given the observed low GW prevalence among female STD clinic patients, STD clinics may not provide an appropriate setting to monitor the impact of HPV vaccine among women.

Background An estimated 21% of 1.1 million HIV-infected US residents do not know they are infected and may unknowingly transmit HIV. Because people with sexually transmitted diseases (STDs) are at increased risk of HIV, CDC recommends HIV screening for patients seeking STD treatment. We investigated whether patients given a diagnosis of Neisseria gonorrhoeae during January 2009-June 2010 were concurrently tested for HIV. Methods We used data from interviews with randomly selected gonorrhoea-infected patients in the 12 state and local health jurisdictions constituting the STD Surveillance Network. We compared the prevalence of HIV testing concurrent with gonorrhoea testing or treatment among patients seeking care in STD clinics and patients in other practice settings (emergency rooms, public and private outpatient facilities, hospitals, and family planning clinics). Results Of 6658 eligible patients, 3462 (52%) were successfully interviewed. Complete data were available for 1845/3462 (53%). Of these, 51% were tested for HIV when they were tested or treated for gonorrhoea. The proportion of gonorrhoea patients tested for HIV ranged from 22% to 74% by jurisdiction. STD clinic patients were more likely to be tested for HIV than those in other practice settings (61% vs 46%, p Conclusions HIV testing among gonorrhoea-infected patients is sub-optimal. While patients are more likely to be HIV-tested in STD clinics than in other practice settings, even STD clinics miss many opportunities to test high risk groups such as MSM, who are less likely than women to be HIV tested in this setting. Interventions are urgently needed to increase HIV testing among STD patients.

Background STD clinics routinely provide diagnostic and treatment services for anogenital warts. With the availability and increasing use of a highly effective quadrivalent vaccine against the HPV types associated with 90% of anogenital warts, the impact on patients presenting with anogenital warts to STD clinics may be significant. To be positioned to estimate the population-level impact of HPV vaccine on STD clinics, we conducted a baseline cross sectional analysis of patients with anogenital wart-related visits. Methods We reviewed STD clinic data collected on patients seen by a clinician from 1 January 2010 to 30 September 2010 in 11 sites (38 clinics) participating in the STD Surveillance Network (SSuN)—Seattle, WA (1 clinic); San Francisco, CA (1); Los Angeles, CA (12); Denver, CO (1); Chicago, IL (5); New Orleans, LA (1); Birmingham, AL (1); Richmond, VA (3); Baltimore, MD (2); Philadelphia, PA (2); New York City, NY (9). SSuN uses a collaboratively developed protocol to collect demographic, risk behaviour, and clinical data on all patients with anogenital warts at participating STD clinics. The unit of analysis was unique patients; patients were considered to have anogenital warts if warts were identified at any visit. Results Among SSuN sites, 3–13% (median 4%) of STD clinic patients had anogenital wart-related visits, with 5063 patients presenting for 6989 visits. Among patients with anogenital warts, 20% of the patients had multiple anogenital warts-related visits (range 2–26 visits). Overall, the median prevalence rate was 2% (range 1–5%) for women and 6% (range 4–22%) for men. By age and sex, median prevalence rates were highest among women aged 20–24 at 3% (range 1–7%) and among men aged 25–29 at 8% (range 5–25%). Among men who have sex with men (MSM), the median prevalence was 7% (range 4–18%) and among men who have sex with women only (MSW) it was 6% (range 3–23%). Of patients with anogenital warts, 40% were African American, 32% were white, 21% were Hispanic compared to all clinic patients who were 58% African American, 18% white, and 18% Hispanic. 59% received treatment and most treatment (97%) was provider applied. Conclusions The prevalence of anogenital warts among women is low in STD clinics. It may thus be difficult to monitor the impact of the HPV vaccine in women in these settings. However, the higher prevalence in MSM and MSW suggest that these clinics may provide settings in which to monitor anogenital warts in men.