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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.

Trichomonas vaginalis infections in men are traditionally considered to be benign and consequently have been overlooked. However, men with this common sexually transmitted infection can experience urethritis, prostatitis, reduced fertility, and amplified human immunodeficiency virus risk. In addition, men are often asymptomatic and can unknowingly spread the infection to their female sexual partners. With advances in T. vaginalis diagnostics, more men are being diagnosed, yet the optimal method of treatment in men remains unknown. The purpose of this review is to discuss the epidemiology, natural history, diagnosis, and treatment of T. vaginalis among men.

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

Racial and ethnic diversity among study participants is associated with improved generalizability of clinical trial results and may address inequities in evidence that informs public health strategies. Novel strategies are needed for equitable access and recruitment of diverse clinical trial populations.To investigate demographic and geographical location data for participants in 2 remote COVID-19 clinical trials with online recruitment and compare with those of a contemporaneous clinic-based COVID-19 study.This cohort study was conducted using data from 3 completed, prospective randomized clinical trials conducted at the same time: 2 remotely conducted studies (the Early Treatment Study and Hydroxychloroquine COVID-19 Postexposure Prophylaxis [PEP] Study) and 1 clinic-based study of convalescent plasma (the Expanded Access to Convalescent Plasma for the Treatment of Patients With COVID-19 study). Data were collected from March to August 2020 with 1 to 28 days of participant follow-up. All studies had clinical sites in Seattle, Washington; the 2 remote trials also had collaborating sites in New York, New York; Syracuse, New York; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; New Orleans, Louisiana; and Los Angeles, California. Two remote trials with inclusive social media strategies enrolled 929 participants with recent SARS-CoV-2 exposure (Hydroxychloroquine COVID-19 PEP Trial) and 231 participants with COVID-19 infection (Early Treatment Study); the clinic-based Expanded Access to Convalescent Plasma for the Treatment of Patients With COVID-19 study enrolled 250 participants with recent COVID-19 infection. Data were analyzed from April to August 2021.Remote trials used inclusive social media strategies and clinician referral for recruitment and telehealth, courier deliveries, and self-collected nasal swabs for remotely conducted study visits. For the clinic-based study, participants were recruited via clinician referral and attended in-person visits.Google Analytics data were used to measure online participant engagement and recruitment. Participant demographics and geographical location data from remote trials were pooled and compared with those of the clinic-based study. Statistical comparison of demographic data was limited to participants with COVID infections (ie, those in the remotely conducted Early Treatment Study vs those in the clinic-based study) to improve accuracy of comparison given that the Hydroxychloroquine COVID-19 PEP Trial enrolled participants with COVID-19 exposures and thus had different enrollment criteria.A total of 1410 participants were included. Among 1160 participants in remote trials and 250 participants in the clinic-based trial, the mean (range) age of participants was 39 (18-80) years vs 50 (19-79) years and 676 individuals (58.3%) vs 131 individuals (52.4%) reported female sex. The Early Treatment Study with inclusive social media strategies enrolled 231 participants in 41 US states with increased rates of racial, ethnic, and geographic diversity compared with participants in the clinic-based study. Among 228 participants in the remotely conducted Early Treatment Study with race data vs participants in the clinic-based study, 39 individuals (17.1%) vs 1 individual (0.4%) identified as Alaska Native or American Indian, 11 individuals (4.8%) vs 22 individuals (8.8%) identified as Asian, 26 individuals (11.4%) vs 4 individuals (1.6%) identified as Black, 3 individuals (1.3%) vs 1 individual identified as Native Hawaiian or Pacific Islander, 117 individuals (51.3%) vs 214 individuals (85.6%) identified as White, and 32 individuals (14.0%) vs 8 individuals (3.2%) identified as other race (P .001). Among 230 individuals in the Early Treatment Study vs 236 individuals in the clinic-based trial with ethnicity data, 71 individuals (30.9%) vs 11 individuals (4.7%) identified as Hispanic or Latinx (P.001). There were 29 individuals in the Early Treatment Study with nonurban residences (ie, rural, small town, or peri-urban; 12.6%) vs 6 of 248 individuals in the clinic-based trial with residence data (2.4%) (P .001). In remote trial online recruitment, the highest engagement was with advertisements on social media platforms; among 125 147 unique users with age demographics who clicked on online recruitment advertisements, 84 188 individuals (67.3%) engaged via Facebook.These findings suggest that remote clinical trials with online advertising may be considered as a strategy to improve diversity among clinical trial participants.

PURPOSE OF THE REVIEW: The purpose of this review is to update information on treatment of T. vaginalis. Trichomonas vaginalis is estimated to be the most common treatable sexually transmitted infection (STI) In the world and is associated with poor birth outcomes, cervical cancer, sperm motility and morphology issues, and HIV acquisition and transmission. RECENT FINDINGS: The efficacy of the recommended 2 gram oral single-dose metronidazole (MTZ) for the treatment of T. vaginalis in women has recently been challenged. Two recent multi-centered randomized trials and a meta-analysis have demonstrated that the 7-day dose of MTZ 500 mg twice daily was nearly two times more efficacious at clearing infection compared to the 2 gram dose. Partner treatment is also essential, since up to 70% of male sexual partners can be infected and rescreening of treated women at 3-months is also recommended given the high repeat infection rates. Future studies should examine the importance of treating asymptomatic T. vaginalis, best treatment for men, the influence of the microbiome on treatment efficacy, and different formulations of intra-vaginal treatments for hypersensitivity. SUMMARY: 7 day 500 mg twice daily MTZ should be used as the first line treatment for T. vaginalis infected women.

The development of chronic inflammation, called inflammaging, contributes to the pathogenesis of age-related diseases. Although it is known that both B and T lymphocyte compartments of the adaptive immune system deteriorate with advancing age, the impact of aging on immune functions of Th17-type CD161-expressing innate immune cells and their role in inflammaging remain incompletely understood. Here, utilizing the nonhuman primate model of rhesus macaques, we report that a dysregulated Th17-type effector function of CD161(+) immune cells is associated with leaky gut and inflammatory phenotype of aging. Higher plasma levels of inflammatory cytokines IL-6, TNF-α, IL-1β, GM-CSF, IL-12, and Eotaxin correlated with elevated markers of gut permeability including LPS-binding protein (LBP), intestinal fatty acid binding protein (I-FABP), and sCD14 in aging macaques. Further, older macaques displayed significantly lower frequencies of circulating Th17-type immune cells comprised of CD161(+) T cell subsets, NK cells, and innate lymphoid cells. Corresponding with the increased markers of gut permeability, production of the type-17 cytokines IL-17 and IL-22 was impaired in CD161(+) T cell subsets and NK cells, along with a skewing towards IFN-γ cytokine production. These findings suggest that reduced frequencies of CD161(+) immune cells along with a specific loss in Th17-type effector functions contribute to impaired gut barrier integrity and systemic inflammation in aging macaques. Modulating type-17 immune cell functions via cytokine therapy or dietary interventions towards reducing chronic inflammation in inflammaging individuals may have the potential to prevent or delay age-related chronic diseases and improve immune responses in the elderly population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11357-019-00099-7) contains supplementary material, which is available to authorized users.

While detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by diagnostic reverse-transcription polymerase chain reaction (RT-PCR) is highly sensitive for viral RNA, the nucleic acid amplification of subgenomic RNAs (sgRNAs) that are the product of viral replication may more accurately identify replication. We characterized the diagnostic RNA and sgRNA detection by RT-PCR from nasal swab samples collected daily by participants in postexposure prophylaxis or treatment studies for SARS-CoV-2. Among 1932 RT-PCR–positive swab samples with sgRNA tests, 40% (767) had detectable sgRNA. Above a diagnostic RNA viral load (VL) threshold of 5.1 log10 copies/mL, 96% of samples had detectable sgRNA with VLs that followed a linear trend. The trajectories of diagnostic RNA and sgRNA VLs differed, with 80% peaking on the same day but duration of sgRNA detection being shorter (8 vs 14 days). With a large sample of daily swab samples we provide comparative sgRNA kinetics and a diagnostic RNA threshold that correlates with replicating virus independent of symptoms or duration of illness.

ImportanceSARS-CoV-2 viral trajectory has not been well-characterized in documented incident infections. These data will inform SARS-CoV-2 natural history, transmission dynamics, prevention practices, and therapeutic development.ObjectiveTo prospectively characterize early SARS-CoV-2 viral shedding in persons with incident infection.DesignProspective cohort study.SettingSecondary data analysis from a multicenter study in the U.S.ParticipantsThe samples derived from a randomized controlled trial of 829 community-based asymptomatic participants recently exposed (ExposureLaboratory-confirmed SARS-CoV-2 infection.Main outcomes and measuresThe observed SARS-CoV-2 viral shedding characteristics were summarized and shedding trajectories were examined using a piece-wise linear mixed-effects modeling. Whole viral genome sequencing was performed on samples with cycle threshold (Ct)ResultsNinety-seven persons (57% women, median age 37-years) developed incident infections during 14-days of follow-up. Two-hundred fifteen sequenced samples were assigned to 15 lineages that belonged to the G614 variant. Forty-two (43%), 18(19%), and 31(32%) participants had viral shedding for 1 day, 2-6 days, and ≥7 days, with median peak viral load Ct of 38.5, 36.7, and 18.3, respectively. Six (6%) participants had 1–6 days of observed viral shedding with censored duration. The peak average viral load was observed on day 3 of viral shedding. The average Ct value was lower, indicating higher viral load, in persons reporting COVID-19 symptoms than asymptomatic. Using the statistical model, the median time from shedding onset to peak viral load was 1.4 days followed by a median of 9.7 days before clearance.Conclusions and RelevanceIncident SARS-CoV-2 G614 infection resulted in a rapid viral load peak followed by slower decay and positive correlation between peak viral load and shedding duration; duration of shedding was heterogeneous. This longitudinal evaluation of the SARS-CoV-2 G614 variant with frequent molecular testing may serve as a reference for comparing emergent viral lineages to inform clinical trial designs and public health strategies to contain the spread of the virus.KEY POINTSQuestionWhat are the early SARS-CoV-2 G614 viral shedding characteristics in persons with incident infection?FindingsIn this prospective cohort of 97 community-based participants who collected daily mid-turbinate swabs for SARS-CoV-2 detection after recent exposure to SARS-CoV-2, viral trajectory was characterized by a rapid peak followed by slower decay. Peak viral load correlated positively with symptoms. The duration of shedding was heterogeneous.MeaningA detailed description of the SARS-CoV-2 G614 viral shedding trajectory serves as baseline for comparison to new viral variants of concern and inform models for the planning of clinical trials and transmission dynamics to end this pandemic.

Purpose The U.S. Centers for Disease Control and Prevention recommend screening young women for chlamydia but not young men. One reason young men have not been a focus for chlamydia screening is due to the perceived difficulty of accessing these men. Peers are among the most influential people in a young person’s life. We hypothesized that incentivized peer referral (IPR) could assist in increasing enrollment in this screening study. Methods The Check it Program in New Orleans is a community-based screening program for young Black men aged 15–24. Peer referral was monitored between 3/7/2018–11/28/2020. IPR started on 8/29/2020 during which men enrolled in the parent study were offered $5 for each peer they referred and were successfully enrolled in the study. Results Of 1457 men enrolled in the study, 44 were enrolled after IPR was initiated. The percentage of men who said they were referred by a friend was higher in the post-IPR compared to the pre-IPR period (40.9% vs. 20.0%, P Conclusion Incentivized peer referral significantly increased study enrollment and can serve as a method for increasing screening rates in community-based chlamydia screening programs for young Black men who have sex with women.

Background Health behaviors in young people tend to cluster. The objective of this study was to determine if condomless sex among young Black men who have sex with women was associated with non-adherence to COVID-19 prevention behaviors. Methods Men previously enrolled in a community-based chlamydia screening program for Black men who have sex with women, aged 15-24, were enrolled in a sub-study between May-June, 2020 and asked about adherence to the City of New Orleans requirements for proper hand-washing, maskwearing, social-distancing, staying-at-home and condomless vaginal sex while COVID-19 restrictions were in place. Results Of 105 men included in analysis, the mean age was 20.5 (s.d.2.0) and 17.3% previously tested positive for chlamydia in the parent study. During COVID-19 stay-at-home orders, 37.1% engaged in at least one act of condomless sex and responded sometime/never to the following: hand-washing for 20 seconds (8.1%), physical-distancing (21.6%), maskwearing (18.8%) and staying-at-home except for essential needs (24.3%). Some men were not able to get PPE (36.9%) or thought a homemade mask would subject them to discrimination (14.4%). Men who engaged in condomless sex were more likely than those who either did use condoms/did not have vaginal sex to not wash their hands properly (19.4% vs. 3.0%, p 0.40). Conclusion Overall, adherence to disease prevention behaviors was high. Non-adherent behaviors such as condomless sex, lack of mask-wearing and lack of hand-washing were associated. Men with one non-adherent behavior may benefit from counseling in other potentially non-adherent behaviors..

BACKGROUND Trichomoniasis commonly affects women of childbearing age and has been linked to several adverse birth outcomes. OBJECTIVE To elucidate the association between trichomoniasis in pregnant women and adverse birth outcomes, including preterm delivery, prelabour rupture of membranes and low birthweight. SEARCH STRATEGY MEDLINE, EMBASE and ClinicalTrials.gov were systematically searched in December 2020 without time or language restrictions. SELECTION CRITERIA Original research studies were included if they assessed at least one of the specified adverse birth outcomes in pregnant women with laboratory-diagnosed trichomoniasis. DATA COLLECTION AND ANALYSIS Estimates from included articles were either extracted or calculated and then pooled to produce a combined estimate of the association of trichomoniasis with each adverse birth outcome using the random effects model. Heterogeneity was assessed using the I2 statistic and Cochran's Q test. MAIN RESULTS Literature search produced 1658 publications after removal of duplicates (n = 770), with five additional publications identified by hand search. After screening titles and abstracts for relevance, full text of 84 studies was reviewed and 19 met inclusion criteria for meta-analysis. Significant associations were found between trichomoniasis and preterm delivery (OR 1.27; 95% CI 1.08-1.50), prelabour rupture of membranes (OR 1.87; 95% CI 1.53-2.29) and low birthweight (OR 2.12; 95% CI 1.15-3.91). CONCLUSIONS Trichomoniasis in pregnant women is associated with preterm delivery, prelabour rupture of membranes and low birthweight. Rigorous studies are needed to determine the impact of universal trichomoniasis screening and treatment during pregnancy on reducing perinatal morbidity. TWEETABLE ABSTRACT This systematic review and meta-analysis found that in the setting of pregnancy, trichomoniasis is significantly associated with multiple adverse birth outcomes, including preterm delivery, low birthweight, and prelabour rupture of membranes.

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.

BackgroundTrichomonas vaginalis virus (TVV) is a non-segmented, 4.5–5.5 kilo-base pair (kbp), double-stranded RNA virus infecting T. vaginalis. The objectives of this study were to examine the TVV prevalence in US Trichomonas vaginalis isolates and TVV’s associations with patient demographics, clinical outcomes, and metronidazole resistance.MethodsArchived T. vaginalis isolates from the enrollment visits of 355 women participating in a T. vaginalis treatment trial in Birmingham, Alabama, were thawed and grown in culture. Their total RNA was extracted using a Trizol reagent. Contaminating, single-stranded RNA was precipitated using 4.0 M Lithium Chloride and centrifugation. The samples were analyzed by gel electrophoresis to visualize a 4.5 kbp band representative of TVV. In vitro testing for metronidazole resistance was also performed on 25/47 isolates obtained from the women’s test of cure visits.ResultsTVV was detected in 142/355 (40%) isolates at the enrollment visit. Women with TVV-positive (TVV+) isolates were significantly older (P = .01), more likely to smoke (P = .04), and less likely to report a history of gonorrhea (P = .04). There was no association between the presence of clinical symptoms or repeat T. vaginalis infections with TVV+ isolates (P = .14 and P = .44, respectively). Of 25 test of cure isolates tested for metronidazole resistance, 0/10 TVV+ isolates demonstrated resistance, while 2/15 TVV-negative isolates demonstrated mild to moderate resistance (P = .23).ConclusionsOf 355 T. vaginalis isolates tested for TVV, T. vaginalis isolates tested for TVV, the prevalence was 40%. However, there was no association of TVV+ isolates with clinical symptoms, repeat infections, or metronidazole resistance. These results suggest that TVV may be commensal to T. vaginalis.

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.

This is the accepted manuscript version of the work published in its final form asBershteyn, A., Schwartz, M. D., Thorpe, L. E., Paasche-orlow, M. K., Kissinger, P., Karita, H. C. S., Laufer, M. K., Hoffman, R. M., Landovitz, R. J., Paolino, K., & Ruanne V. Barnabas. (2021). Taking a stand against the politicization of medical research: How 'swinging the pendulum' poses a hazard to clinical trials, study participants, and the progress of science.Expert Review of Clinical Immunology,17(1), 101-103. https://doi.org/10.1080/1744666x.2020.1860758 Deposited byshareyourpaper.organdopenaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailinghelp@openaccessbutton.org. &nbsp

OBJECTIVE: This study aimed to explore the transmission of COVID-19 in a U.S. state psychiatric hospital setting. METHODS: Symptomatic and asymptomatic patients were tested throughout a large psychiatric hospital to determine penetrance. The hospital followed initial Centers for Disease Control and Prevention (CDC) guidelines. RESULTS: Seventy-eight percent (N=51 of 65) of tested patients in the building where the first positive patient was housed (building zero) tested positive for COVID-19. Eighty-eight percent (N=14 of 16) of tested asymptomatic patients in building zero were positive, compared with 12% (N=6 of 51) of randomly selected asymptomatic patients in a sample from the rest of the hospital. CONCLUSIONS: A high percentage of patients can become positive for COVID-19 despite following initial CDC guidelines. As such, use of masks by all patients in close-quarter settings prior to the first positive case appears warranted. Recent CDC guidelines align with this strategy.

The purpose of this study was to examine the association between institution-delivered sex education given under real-world conditions and sexually transmitted infection (STI) rates, STI fatalism, and prior STI testing among African American men aged 15–24 who have sex with women. Participants were tested at community venues for Chlamydia and gonorrhoea and undertook a survey to elicit history of sex education and sexual health information. Among 1196 participants, 73.0% reported having received institution-delivered sex education topics including STI information (90.5%), condoms (89.2%), pregnancy/birth (72.1%) and birth control (67.1%). Among a subset of participants asked about the quality of sex education, 85.7% reported it was ‘very good’ or ‘OK’. Prevalence rate for Chlamydia and/or gonorrhoea was 10.5%. Those who received sex education were more likely to have lower STI fatalism (51.0% vs. 42.4%, p=0.01) and more likely to report previous Chlamydia screening (44.1% vs. 31.6%, p

BackgroundTrichomonas vaginalisis the most common non-viral sexually transmitted infection. 5-Nitroimidazoles [metronidazole (MTZ) and tinidazole (TDZ)] are FDA-approved treatments. To better understand treatment failure, we conducted a systematic review on mechanisms of 5-nitroimidazole resistance.MethodsPubMed, ScienceDirect and EMBASE databases were searched using keywordsTrichomonas vaginalis, trichomoniasis, 5-nitroimidazole, metronidazole, tinidazole and drug resistance. Non-English language articles and articles on other treatments were excluded.ResultsThe search yielded 606 articles, of which 550 were excluded, leaving 58 articles.Trichomonas vaginalisresistance varies and is higher with MTZ (2.2–9.6%) than TDZ (0–2%). Resistance can be aerobic or anaerobic and is relative rather than absolute. Differential expression of enzymes involved in trichomonad energy production and antioxidant defenses affects 5-nitroimidazole drug activation; reduced expression of pyruvate:ferredoxin oxidoreductase, ferredoxin, nitroreductase, hydrogenase, thioredoxin reductase and flavin reductase are implicated in drug resistance.Trichomonas vaginalisinfection withMycoplasma hominisorT. vaginalisvirus has also been associated with resistance.Trichomonas vaginalishas two genotypes, with greater resistance seen in type 2 (vstype 1) populations.Discussion5-Nitroimidazole resistance results from differential expression of enzymes involved in energy production or antioxidant defenses, along with genetic mutations in theT. vaginalisgenome. Alternative treatments outside of the 5-nitroimidazole class are needed.

Patterns and correlates of substance use among urban African American young women (ages 18–19, n = 459) were examined. Four patterns were identified: no/infrequent alcohol and marijuana use (64.9%)...

Background: Treatment options for outpatients with COVID-19 could reduce morbidity and prevent SARS-CoV-2 transmission. Methods: In this randomized, double-blind, three-arm (1:1:1) placebo-equivalent control trial conducted remotely throughout the United States, adult outpatients with laboratory-confirmed SARS-CoV-2 infection were recruited. Participants were randomly assigned to receive HCQ (400mg BID x1day, followed by 200mg BID x9days) or placebo-equivalent (ascorbic acid) and AZ (500mg, then 250mg daily x4days) or placebo-equivalent (folic acid), stratified by risk for progression to severe COVID-19 (high-risk vs. low-risk). Self-collected mid-turbinate nasal swabs for SARS-CoV-2 PCR, FLUPro symptom surveys, EKGs and vital signs collected daily. Primary endpoints were: (a) 14-day progression to lower respiratory tract infection (LRTI), 28-day COVID-19 related hospitalization, or death; (b) 14-day time to viral clearance; secondary endpoints included time to symptom resolution (ClinicalTrials.gov: NCT04354428). Due to the low rate of clinical outcomes, the study was terminated for operational futility. Findings: Between 15th April and 27th July 2020, 231 participants were enrolled and 219 initiated medication a median of 5.9 days after symptom onset. Incident LRTI occurred in six participants (two control, four HCQ/AZ) and COVID-19 related hospitalization in nine (four control, two HCQ, three HCQ/AZ). There were no deaths. Median time to clearance was 5 days (95% CI=4-6) in HCQ, 6 days (95% CI=4-8) in HCQ/AZ, and 8 days (95% CI=6-10) in control. HCQ but not HCQ/AZ had faster time to viral clearance (HR=1.62, 95% CI=1.01-2.60, p=0.047 & HR=1.25, 95% CI=0.75-2.07, p=0.39) compared to control. Among 197 participants who met the COVID-19 definition at enrollment, time to symptom resolution did not differ by group. Interpretation: Neither HCQ nor HCQ/AZ shortened the clinical course of outpatients with COVID-19, and HCQ, but not HCQ/AZ, had only a modest effect on SARS-CoV-2 viral shedding. HCQ and HCQ/AZ are not effective therapies for outpatient treatment of SARV-CoV-2 infection. Trial Registration Number: ClinicalTrials.gov: NCT04354428 Funding: The COVID-19 Early Treatment Study was funded by the Bill & Melinda Gates Foundation (INV-017062) through the COVID-19 Therapeutics Accelerator. University of Washington Institute of Translational Health Science (ITHS) grant support (UL1 TR002319), KL2 TR002317, and TL1 TR002318 from NCATS/NIH funded REDCap. The content is solely the responsibility of the authors and does not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. PAN and MJA were supported by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program. Conflict of Interest: Declaration of interests: CJ reports grants from BMGF for conduct of the study, and grants from CDC and NIH outside of the submitted work. HSK reports funding from NIH. PAN and MJA have a potential financial relationship with AliveCor related to QT assessment using the device, however the investigators would receive no financial benefit for use of the technology for patients at Mayo Clinic or for its use in the current study. AB reports consulting for Gates Ventures and grants from BMGF and NIH outside of the submitted work. HYC reports consulting for BMGF, Pfizer, Ellume, and Merck, and grants from Gates Ventures, NIH, CDC, BMGF, DARPA, Apple Inc., Sanofi-Pasteur, and Roche-Genentech, outside of the submitted work. Ethical Approval: Study visits were conducted via Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine. The Western Institutional Review Board (WIRB) approved this study with reliance agreements with collaborating institutions.

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.

Background Despite interventions to reduce Chlamydia trachomatis (Ct) rates in women, rates have increased or remained stable, particularly for African American (AA) women. Men could be a potential reservoir of infection yet the Centers for Disease Control and Prevention do not recommend screening men stating lack of evidence for feasibility and potential to reduce infection in women. The purpose of this study was to explore if venue-based screening is feasible and has high-yield. Methods Venue-based screening (e.g. barbershops, colleges, community events) was conducted between March–December 2018 among AA men aged 15–24 who had sex with at least one woman in the last two months and spent most of their time in New Orleans. Men were offered a modest incentive, were screened for Ct via urine NAAT and underwent an audio/computer-assisted self-administered survey eliciting information about sexual partners Results Of 599 men screened, 590 (98.5%) enrolled. Men enrolled received Medicaid (60.9%), were Ct tested in the last year (29.3%), reported a history of Ct (12.7%), were asymptomatic (97.1%) and 9.3% were Ct+. Men reported 873 partners (average 2.2, s.d. 1.4). Most of these partners were someone he knew for a long time (69.9%) or met through people in his social network (14.4%), were able to be re-contacted (80.1%), and with whom future sexual contact was planned 61.4%. In over one-third of partnerships (35.4%) men believed that their partner was having sex with one of his friends. Most men (53.3%) found out about the program from someone in their social network. Conclusion Venue-based screening of young AA heterosexual men is feasible, detected a high rate of Ct infection, most partners were from social networks and could be re-contacted. Screening of young AA men has the potential to identify infected sexual networks and ultimately could reduce Ct disparities among men and women. Disclosure No significant relationships.

Background Young African American (AA) heterosexual men have high rates of sexually transmitted infections (STIs). Consistent condom use effectively prevents STIs, but condom use decisions are made in the context of individual sexual relationships. This analysis describes partnership characteristics and condom use among young AA men. Methods AA men aged 15–24 who lived or spent most of their time in New Orleans, Louisiana and had vaginal sex in the past 2 months were screened at non-clinical venues for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) using nucleic acid amplification testing. Men provided information on sexual partnerships including perception of risk behaviors on an audio computer-assisted self-interview. Generalized estimating equation is used to fit a marginal model to account for multiple partnerships. Results Participants (n=1152) reported characteristics of 1733 partnerships. In partnerships where condoms were not always used, men were more likely to be committed to the partner (47% vs 28%, p Conclusion STI rates are high, especially for those in partnerships where condoms are not always used. Consistent condom use is lower in committed, closer partnerships, suggesting that prevention interventions should focus on condom use among this group. Disclosure No significant relationships.

Background High rates of repeat T. vaginalis infections post-treatment have been reported. It is essential to understand the origin of these infections (i.e. treatment failure or reinfection) to determine the best secondary prevention measures. Self-reported sexual behavior and medication adherence can be subject to bias. The purpose of this study is to examine the origins of early repeat T. vaginalis infections in women using clinical versus genotype-informed criteria. Methods Women with T. vaginalis confirmed by culture or nucleic acid amplification test (NAAT), who were randomized to receive 2 g or 7-day 500 mg BID metronidazole (MTZ), were retested 3–12 weeks post treatment at test-of-cure (TOC). Viable isolates from women who were TOC TV+ were genotyped (baseline and TOC isolates) and MTZ susceptibility (TOC only) was evaluated. Sexual and treatment adherence histories were elicited by computer-assisted self-administered survey. Treatment failure was defined using two criteria: 1) clinical (a combination of MTZ adherent per self-report+ no follow-up sexual exposure per self-report + no MTZ resistance), and 2) genotype-informed (concordant baseline and TOC genotype with no follow-up sexual exposure per self-report). Results Of 80 repeat positives, 78 were evaluated using clinical and 49 using genotype-informed criteria. Per clinical criteria, 87.2% were treatment failure, 7.7% were reinfection and 5.1% were new infection. Per genotype-informed criteria, 51.0% were treatment failure, 10.2% were reinfection and 38.3% were new infection. In subset analysis, comparing the 49 with both clinical and genotype-informed assessments, 61.2% agreed and 38.8% disagreed (kappa 0.29 indicating poor reliability). Of 44 women who denied having a new partner during follow-up, 14 (31.8%) had a discordant genotype. Conclusion Using either criteria, most TOC T. vaginalis positives were treatment failure rather than re-infections. Clinical and genotype-informed classification were not well correlated. Possible explanations for this will be discussed. Disclosure No significant relationships.

Background Most research on partner treatment for chlamydia has been done with female index cases or with clinic-based populations, thus less is known about optimal approaches for community screened men. The purpose of this study is to compare contact-tracing versus patient-delivered partner-treatment (PDPT) for rates of index and partner treatment among chlamydia infected-young heterosexual African American men (AA) diagnosed by screening at community venues. Methods ‘Check It’ is a community chlamydia screening program for AA men aged 15–24. Initially, index and partner treatment was done by a disease intervention specialist (DIS) using a contact-tracing approach where contacted index and partners could get azithromycin treatment at no cost at participating pharmacies. In month 14 of the program, in response to the findings of in-depth interviews with men enrolled in the program, contacted index men were offered PDPT that could be picked up at a participating pharmacy or mailed to the index. Index and partner treatment outcomes were compared. Results In-depth interviews revealed concerns about giving DIS contact partner information and issues with transportation, thus, PDPT and direct-mailing of azithromycin were added to treatment options. There were 102 screened men in the contact-tracing-phase and 22 in the PDPT-phase. Of these 124 Ct+ men, 83.9% were contacted and 62.9% were treated and they reported 204 baseline partners. Treatment rates were higher in the PDPT-phase versus the contact-tracing-phase for index (86.4% vs 57.8%, p-value Conclusion Expedited index and PDPT using local pharmacies or mailed-treatment resulted in significantly higher index and partner treatment rates and shorter time-to-treatment among AA young men screened for Ct in the community. Disclosure No significant relationships.

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%.

Background A previous case report of West Nile virus (WNV) illness during pregnancy suggested that WNV could be a cause of congenital defects. We performed a prospective, longitudinal cohort study of pregnant women with WNV illness to increase our knowledge of the effects of WNV illness during pregnancy. Methods Participants were enrolled in 2005 to 2008 from pregnant women with serologically confirmed WNV illness reported to the Centers for Disease Control and Prevention. Comparison was made to WNV-uninfected women, matched on maternal age and enrollment month. Pregnancy and newborn data were collected; cord blood WNV serology was obtained. Pediatric exams and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) were performed. Results Twenty-eight WNV-infected mothers and 25 WNV-uninfected mothers participated. Maternal demographics were similar except for a higher rate of planned pregnancies, education, and household income in the WNV-uninfected mothers. There were no differences in pregnancy and delivery characteristics except that infected mothers had a higher incidence of febrile illnesses and used more medications. Birth weight, length, head circumference, and rate of congenital malformations were similar in babies born to WNV-infected and -uninfected mothers. Follow-up physical exams were generally normal. The Bayley-III assessments, available for 17 children born to mothers with WNV illness, showed performance at or above age level across domains. Conclusion The risk for adverse pregnancy and newborn outcomes in women experiencing WNV illness in pregnancy appears to be low, but future studies with larger numbers are needed to rule out a small risk. Birth Defects Research (Part A) 106:716–723, 2016. © 2016 Wiley Periodicals, Inc.

Among women, trichomoniasis is the most common non-viral sexually transmitted infection worldwide, and is associated with serious reproductive morbidity, poor birth outcomes, and amplified HIV transmission. Single-dose metronidazole is the first-line treatment for trichomoniasis. However, bacterial vaginosis can alter treatment efficacy in HIV-infected women, and single-dose metronidazole treatment might not always clear infection. We compared single-dose metronidazole with a 7-day dose for the treatment of trichomoniasis among HIV-uninfected, non-pregnant women and tested whether efficacy was modified by bacterial vaginosis.In this multicentre, open-label, randomised controlled trial, participants were recruited at three sexual health clinics in the USA. We included women positive for Trichomonas vaginalis infection according to clinical screening. Participants were randomly assigned (1:1) to receive either a single dose of 2 g of metronidazole (single-dose group) or 500 mg of metronidazole twice daily for 7 days (7-day-dose group). The randomisation was done by blocks of four or six for each site. Patients and investigators were aware of treatment assignment. The primary outcome was T vaginalis infection by intention to treat, at test-of-cure 4 weeks after completion of treatment. The analysis of the primary outcome per nucleic acid amplification test or culture was also stratified by bacterial vaginosis status. This trial is registered with ClinicalTrials.gov, number NCT01018095, and with the US Food and Drug Administration, number IND118276, and is closed to accrual.Participants were recruited from Oct 6, 2014, to April 26, 2017. Of the 1028 patients assessed for eligibility, 623 women were randomly assigned to treatment groups (311 women in the single-dose group and 312 women in the 7-day-dose group; intention-to-treat population). Although planned enrolment had been 1664 women, the study was stopped early because of funding limitations. Patients in the 7-day-dose group were less likely to be T vaginalis positive at test-of-cure than those in the single-dose group (34 [11%] of 312 vs 58 [19%] of 311, relative risk 0·55, 95% CI 0·34-0·70; p0·0001). Bacterial vaginosis status had no significant effect on relative risk (p=0·17). Self-reported adherence was 96% in the 7-day-dose group and 99% in the single-dose group. Side-effects were similar by group; the most common side-effect was nausea (124 [23%]), followed by headache (38 [7%]) and vomiting (19 [4%]).The 7-day-dose metronidazole should be the preferred treatment for trichomoniasis among women.National Institutes of Health.

OBJECTIVES/SPECIFIC AIMS: The objective of this study is to assess differences in outcomes between African Americans (AAs) and whites along the HCV care cascade. Primary outcome was retention in the HCV care cascade, measured in two ways. For viral RNA confirmation, retention was a percentage of those having screened antibody reactive. For hepatic ultrasound, primary care, HCV specialty clinic, treatment initiation, and sustained viral load (SVR), retention was a percentage of those found chronically infected by positive RNA viral load. Secondary outcome was time to follow-up from antibody screening to each subsequent step in the care cascade. METHODS/STUDY POPULATION: A retrospective cohort study was performed. AA and white patients who tested HCV antibody reactive from March to October 2015 at the University Medical Center (UMC) Emergency Department in New Orleans, LA were included in this study. Outcomes were assessed using the HCV Continuum of Care model, delineating successive stages of care from identification to cure. RESULTS/ANTICIPATED RESULTS: A total of 728 patients screened HCV antibody reactive, including 446 AAs and 282 whites. AAs (53.5 years, SD 10.2) were disproportionately older than whites (46.7 years, SD 11.9) (p

Introduction A recent meta-analysis demonstrated superiority of multi-dose metronidazole (MTZ) over the CDC and WHO recommended 2 g dose for the treatment of T. vaginalis (TV). Another study among HIV+ women with TV found higher test-of-cure (TOC)+ rates among women who had asymptomatic bacterial vaginosis (BV) than those without BV. The purpose of this study was to measure the TOC TV+ rate and to examine if the presence of BV influenced that rate. Methods HIV-/TV+ women treated with 2 g oral directly observed MTZ and who completed their TOC visit 3–12 weeks post treatment were included. Women were tested for TV using NAAT and surveyed via computer at baseline and TOC. Nugent scores≥7, calculated from vaginal gram stain, were considered BV+. MTZ susceptibility testing was performed on TOC TV+ specimens. Results Of 227 TV+ women included baseline the mean age was 31.3 (S.D. 9.9), 95.2% were African American, 39.3% had multiple male partners in the prior 3 months, 32.3% regularly smoked, 19.4% were binge drinkers, 48.9% had BV and 5.4% had yeast on the gram stain. At TOC, 19.8% were NAAT TV+. Of the 45 TOC-TV+ women, 44 provided sexual exposure information and 10/44 (24.4%) reported sexual re-exposure to baseline partner or sexual exposure to a new partner. Two of 26 (7.7%) TOC+ specimens that underwent susceptibility testing had low to moderate MTZ resistance (50–100 ug/ml). There were no differences in TOC NAAT+ rates by BV, sexual re-exposure to a baseline partner, sexual exposure to a new partner, regular smoking, binge drinking, or by the presence of yeast (p>0.22). Conclusion TOC NAAT+ rate after 2 g MTZ dose was high (19.8%) and isolates from these women were susceptible to MTZ (94.3%). Most TOC+ women (75.6%) reported no sexual exposure/re-exposure during follow-up suggesting that most cases were treatment failures. Selected behavioural factors and BV did not did not appear to influence TV treatment. The 2 g MTZ dose for TV recommended by CDC and WHO, should be reevaluated in light of more sensitive NAAT.

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.

T. vaginalis, first thought to be a commensal, then a nuisance sexually transmitted infection (STI), is now gaining more recognition as an important contributor to reproductive morbidity and has been associated with HIV acquisition and transmission. T. vaginalis increases recruitment of CD4 cells in vaginal epithelium, disrupts epithelial barrier integrity, and alters vaginal microbiota, increasing risk for HIV transmission. Many persons with T. vaginalis are asymptomatic. Women who have symptoms typically have a vaginal discharge that is frothy, malodorous and yellow-green, as well as dysuria, itching, and/or vulvar irritation. Men who have symptoms exhibit urethritis. While T. vaginalis is not a reportable disease in the United States (US), some risk factors have been identified including increasing age, African American race, incarceration, and HIV infection. HIV-infected women have higher prevalence and recurrence rates of T. vaginalis compared to HIV-uninfected women, thus HIV-infected women should be screened regularly and those who test positive should be rescreened 3 months after treatment. Treatment recommendations are different for HIV-infected women; while the 2 g single dose metronidazole (MTZ) is recommended for HIV-uninfected women, the 7-day multi-dose of 500 mg twice daily is recommended for HIV-infected women. Differences in treatment response may be due to the high rate of comorbidity with bacterial vaginosis (BV), interactions between MTZ and anti-retroviral therapy or other hosts factors. T. vaginalis is generally susceptible to MTZ. HIV-infected persons with T. vaginalis are more likely to shed HIV in genital fluids and treatment of T. vaginalis reduces this HIV shedding, thus T. vaginalis control among HIV-infected persons is also of public health significance.

Background West Nile virus (WNV) infection is associated with acute morbidity and mortality in adults and children. Information on the effects of maternal WNV illness during pregnancy on early childhood development is limited. This study was designed to examine the relationship between maternal WNV illness during pregnancy and birth and developmental outcomes at age 3 years. Methods Mother-child participants were identified using a national surveillance registry for women with WNV illness during pregnancy. Maternal and infant health data and relevant family characteristics were obtained through medical record reviews and maternal questionnaires. All infants received ophthalmologic examinations. Child development was evaluated at age 3 years using the Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III). Results As a group, the children's (N = 11) birth weight, head circumference, and infant ophthalmologic examination results were within age expectations; one child was born preterm (gestational age 36 weeks). Mean (SD) age at the time of Bayley-III testing was 36.7 (3.8) months. The group's mean performance on the Bayley-III was at or above age level in all domains, but one child showed a mild delay in the Adaptive domain. The variability observed in this sample (1/53 [1.9%] Domain scores < −2.0 SDs) was consistent with expectations based upon the distribution of Bayley-III Domain scores in the general population. Conclusion Maternal WNV infection does not appear to be associated with global developmental delays in young children. These results are preliminary, however, and require confirmation in future research. Birth Defects Research (Part A) 100:792–796, 2014. © 2014 Wiley Periodicals, Inc.

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