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In New York City, 91% of sexually transmitted infection clinic patients reported preexposure prophylaxis (PrEP) use that matched the detection of PrEP in their serum. Self-report had 80% sensitivity and 96% specificity ( κ = 0.79) compared with measured PrEP. Our findings suggest that self-report may be a valid indicator of PrEP uptake.

As part of New York State's Ending the Epidemic (EtE) initiative, sexual health clinics (SHCs) in New York City invested in clinic enhancements and expanded their HIV-related services to increase access to HIV prevention interventions and treatment. The objective of this study was to estimate and describe the change in SHC operating costs related to clinic enhancements and expanded patient services implemented as part of the EtE initiative.A comprehensive microcosting approach was used to collect retrospective cost information from SHCs, broken down by category and programmatic activity. Cost information was collected from 8 clinics across New York City during two 6-month time periods before (2015) and during (2018-2019) EtE.Eight SHCs reported comprehensive cost data. Costs increased by $800,000 on average per clinic during the 6-month EtE period. The cost per visit at an SHC increased by $120 on average to $381 (ranging from $302 to $464) during the EtE period. Personnel costs accounted for 69.9% of EtE costs, and HIV-related medications accounted for 8.9% of costs. Employment of social workers and patient navigators increased costs by approximately $150,000 on average per clinic. Postexposure prophylaxis was the costliest medication with average expenditures of $103,800 per clinic.This study demonstrates the key drivers of cost increases when offering enhanced HIV services in SHCs. Documenting the changes in resources necessary to implement these services and their costs can inform other health departments on the viability of offering enhanced HIV services within their own clinics.

HIV-uninfected persons being evaluated for sexually transmitted infections (STIs) may be good HIV pre-exposure prophylaxis (PrEP) candidates. We measured PrEP use in a sentinel STI patient population.Cross-sectional study, New York City Sexual Health Clinics (January 2019-June 2019).Remnant serum samples from 644 HIV-uninfected men who have sex with men (MSM) and 97 women diagnosed with chlamydia, gonorrhea, and/or early syphilis were assayed for tenofovir and emtricitabine levels using a validated liquid chromatography-mass spectrometry assay. Using paired test results and medical records, we assessed (1) prevalence and (2) correlates of PrEP use on the day of STI diagnosis (adjusted prevalence ratios [aPRs]).PrEP use among 741 patients was 32.7% [95% confidence interval (CI): 29.3 to 36.0]; 37.3% for MSM and 2.1% for women. PrEP use was high among White MSM (46.8%) and lowest among women. Among MSM with rectal chlamydia/gonorrhea or early syphilis, PrEP use was associated with age [aPR = 1.7 (95% CI: 1.2 to 2.4) for ages 25-34 years and aPR = 2.0 (1.4 to 2.9) for ages 35-44 years, vs. 15 to 24 years]; number of recent sex partners [aPR = 1.4 (1.0 to 2.0) for 3-5 partners, aPR = 2.1 (1.5 to 3.0) for 6-10 partners, aPR = 2.2 (1.6 to 3.1) for10 partners, vs. ≤2 partners]; having sex/needle-sharing partners with HIV [aPR = 1.4 (1.1-1.7)]; and inconsistent condom use [aPR = 3.3 (1.8-6.1)]. Race/ethnicity, past-year STI diagnosis, and postexposure prophylaxis use were not associated.One in 3 people with newly diagnosed STIs had detectable serum PrEP, and PrEP use was exceedingly rare among women. Routinely collected remnant samples can be used to measure PrEP use in populations at high risk of HIV acquisition.

BACKGROUND: Declining antimicrobial susceptibility to current gonorrhoea antibiotic treatment and inadequate treatment options have raised the possibility of untreatable gonorrhoea. New prevention approaches, such as vaccination, are needed. Outer membrane vesicle meningococcal serogroup B vaccines might be protective against gonorrhoea. We evaluated the effectiveness of a serogroup B meningococcal outer membrane vesicle vaccine (MenB-4C) against gonorrhoea in individuals aged 16–23 years in two US cities. METHODS: We identified laboratory-confirmed gonorrhoea and chlamydia infections among individuals aged 16–23 years from sexually transmitted infection surveillance records in New York City and Philadelphia from 2016 to 2018. We linked gonorrhoea and chlamydia case records to immunisation registry records to determine MenB-4C vaccination status at infection, defined as complete vaccination (two MenB-4C doses administered 30–180 days apart), partial vaccination (single MenB-4C vaccine dose), or no vaccination (serogroup B meningococcal vaccine naive). Using log-binomial regression with generalised estimating equations to account for correlations between multiple infections per patient, we calculated adjusted prevalence ratios (APR) and 95% CIs to determine if vaccination was protective against gonorrhoea. We used individual-level data for descriptive analyses and infection-level data for regression analyses. FINDINGS: Between Jan 1, 2016, and Dec 31, 2018, we identified 167 706 infections (18 099 gonococcal infections, 124 876 chlamydial infections, and 24 731 gonococcal and chlamydial co-infections) among 109 737 individuals linked to the immunisation registries. 7692 individuals were vaccinated, of whom 4032 (52·4%) had received one dose, 3596 (46·7%) two doses, and 64 (

Shigella species, which cause acute diarrheal disease, are transmitted via fecal-oral and sexual contact. To better understand the overlapping populations affected by Shigella infections and sexually transmitted infections (STIs) in the United States, we examined the occurrence of reported STIs within 24 months among shigellosis case-patients.Culture-confirmed Shigella cases diagnosed from 2007 to 2016 among residents of 6 US jurisdictions were matched to reports of STIs (chlamydia, gonorrhea, and all stages of syphilis) diagnosed 12 months before or after the shigellosis case. We examined epidemiologic characteristics and reported temporal trends of Shigella cases by sex and species.From 2007 to 2016, 10,430 shigellosis cases were reported. The annual number of reported shigellosis cases across jurisdictions increased 70%, from 821 cases in 2007 to 1398 cases in 2016; males saw a larger increase compared with females. Twenty percent of male shigellosis case-patients had an STI reported in the reference period versus 4% of female case-patients. The percentage of male shigellosis case-patients with an STI increased from 11% (2007) to 28% (2016); the overall percentage among females remained low.We highlight the substantial proportion of males with shigellosis who were diagnosed with STIs within 24 months and the benefit of matching data across programs. Sexually transmitted infection screening may be warranted for male shigellosis case-patients.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus testing among first responders and healthcare personnel who participated in a May 2020–August 2020 serosurvey that assessed spike protein antibodies provided an opportunity to assess reinfection. Methods Serology survey data were merged with virus testing results from Rhode Island (1 March 2020–17 February 2021) and New York City (10 March 2020–14 December 2020). Participants with a positive virus test ≥14 days before their serology test were included. Reinfection was defined as a second positive SARS-CoV-2 test ≥90 days after the first positive test. The association between serostatus and reinfection was assessed with a proportional hazards model. Results Among 1572 previously infected persons, 40 (2.5%) were reinfected. Reinfection differed by serostatus: 8.4% among seronegative vs 1.9% among seropositive participants (P Conclusions Reinfections were uncommon among previously infected persons over a 9-month period that preceded widespread variant circulation. Seropositivity decreased reinfection risk. Lower reinfection risk associated with exposure to a household member with COVID-19 may reflect subsequently reduced household transmission.

BACKGROUND Although most gonorrhea (GC) cases in the United States are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the Centers for Disease Control and Prevention demonstration project (Strengthening the US Response to Resistant Gonorrhea [SURRG]) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility. METHODS For sexually transmitted infection clinics in New York City, NY; San Francisco, CA; and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across 3 groups: (1) sex partners of persons with GC, (2) patients with symptoms (e.g., urethral or cervical discharge), (3) patients who had tested positive and were returning for GC treatment and compared it with positivity among all other patients. We then examined SURRG-period NAAT positivity among patients from whom a culture was or was not collected, and culture positivity, by specimen site and jurisdiction. RESULTS Pre-SURRG, NAAT positivity across the 3 select groups was at least twice that of patients who did not meet any criteria. SURRG-period NAAT positivity was higher among patients from whom a culture was also collected. Overall culture positivity was relatively high (New York City, 34.8%; San Francisco, 26.7%; Milwaukee, 24.8%); the proportion of specimens tested varied widely (range, 5.7%-26.5%) by jurisdiction. CONCLUSIONS Evaluation of NAAT data can inform the establishment of criteria for culture collection for AST. Routine evaluation and quality improvement activities related to culture collection/isolation techniques could increase NG isolation for AST.

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

OBJECTIVE The 'JumpstART' program in New York City (NYC) public Sexual Health Clinics (SHC) provides patients newly diagnosed with human immunodeficiency virus (HIV) with antiretroviral medication (ART) (1-month supply) on day of diagnosis and active linkage to HIV care (LTC). We examined viral suppression (VS) among patients who did and did not receive JumpstART services. DESIGN Retrospective cohort. METHODS Among newly diagnosed SHC patients (23 November 2016-30 September 2018) who were matched to the NYC HIV surveillance registry to obtain HIV laboratory test results through 30 June 2019, we compared 230 JumpstART and 73 non-JumpstART patients regarding timely LTC (≤30 days), probability of VS (viral load

We conducted a serologic survey in public service agencies in New York City, New York, USA, during May-July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2-specific antibodies. Seroprevalence for police and firefighters was similar to overall seroprevalence; seroprevalence was highest in correctional staff (39.2%) and emergency medical technicians (38.3%) and lowest in laboratory technicians (10.1%) and medicolegal death investigators (10.8%). Adjusted analyses demonstrated association between seropositivity and exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 3.52 [95% CI 3.19-3.87]), non-Hispanic Black race or ethnicity (aOR 1.50 [95% CI 1.33-1.68]), and severe obesity (aOR 1.31 [95% CI 1.05-1.65]). Consistent glove use (aOR 1.19 [95% CI 1.06-1.33]) increased likelihood of seropositivity; use of other personal protective equipment had no association. Infection control measures, including vaccination, should be prioritized for frontline workers.

Specialised sexual health clinics (SHCs) play an important role in addressing the staggering rates of STIs seen in many high-income nations. Despite increasing healthcare coverage in the US and nationalised health care in some countries, there is a continued need for SHCs to meet the needs of patients and the community, especially for high-priority populations: those at high risk of STI acquisition and/or groups historically marginalised and underserved in the traditional healthcare system. We need to mobilise resources to support a stronger clinical infrastructure in specialised SHCs. This review describes the importance of SHCs, their future role, and some of the innovative programs housed within SHCs in the US, Australia, and the Netherlands to address both STI and HIV prevention for the populations they serve.

To limit introduction of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), the United States restricted travel from China on February 2, 2020, and from Europe on March 13. To determine whether local transmission of SARS-CoV-2 could be detected, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) conducted deidentified sentinel surveillance at six NYC hospital emergency departments (EDs) during March 1-20. On March 8, while testing availability for SARS-CoV-2 was still limited, DOHMH announced sustained community transmission of SARS-CoV-2 (1). At this time, twenty-six NYC residents had confirmed COVID-19, and ED visits for influenza-like illness* increased, despite decreased influenza virus circulation.† The following week, on March 15, when only seven of the 56 (13%) patients with known exposure histories had exposure outside of NYC, the level of community SARS-CoV-2 transmission status was elevated from sustained community transmission to widespread community transmission (2). Through sentinel surveillance during March 1-20, DOHMH collected 544 specimens from patients with influenza-like symptoms (ILS)§ who had negative test results for influenza and, in some instances, other respiratory pathogens.¶ All 544 specimens were tested for SARS-CoV-2 at CDC; 36 (6.6%) tested positive. Using genetic sequencing, CDC determined that the sequences of most SARS-CoV-2-positive specimens resembled those circulating in Europe, suggesting probable introductions of SARS-CoV-2 from Europe, from other U.S. locations, and local introductions from within New York. These findings demonstrate that partnering with health care facilities and developing the systems needed for rapid implementation of sentinel surveillance, coupled with capacity for genetic sequencing before an outbreak, can help inform timely containment and mitigation strategies.

Background Genomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown. Methods We analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the New York City (NYC) Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012–2013. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 nonrecombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context. Results The NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (P < .001) and race/ethnicity (P < .001). Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (P < .001) and white heterosexuals compared to black heterosexuals (P < .01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin, and comprised isolates from patients across demographic groups. Conclusions All large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission., We used Neisseria gonorrhoeae genomes together with clinical and demographic data to study transmission in New York City. Our results indicate transmission across demographic groups and suggest that antibiotic resistance is not the main driver of gonorrhea spread.

BACKGROUND Clinics providing sexual health care pose unique opportunities to implement HIV pre-exposure prophylaxis (PrEP) programs. The PrEP program at New York City's Sexual Health Clinics provides intensive on-site navigation for linkage to PrEP care. We assessed uptake of this intervention. METHODS We categorized men who have sex with men (MSM) without HIV hierarchically as having had (1) HIV post-exposure prophylaxis (PEP) use (past year); or (2) selected sexually transmitted infections (STI) (past year); or (3) HIV-diagnosed sex/needle-sharing partners (past 6 months); or (4) expressed interest in PrEP (day of clinic visit). We constructed PrEP cascades and used multivariable regression to examine acceptance of PrEP navigation, referral to a PrEP provider, linkage (

Background Extragenital gonorrhea (GC) and chlamydia (CT) are usually asymptomatic and only detected through screening. Ceftriaxone plus azithromycin is the recommended GC treatment; monotherapy (azithromycin or doxycycline) is recommended for CT. In urethral CT-positive/urethral GC-negative persons who are not screened extragenitally, CT monotherapy can lead to GC undertreatment and may foster the development of gonococcal antimicrobial resistance. We assessed urethral and extragenital GC and CT positivity among men who have sex with men (MSM) attending sexually transmitted disease clinics. Methods We included visit data for MSM tested for GC and CT at 30 sexually transmitted disease clinics in 10 jurisdictions during January 1, 2015, and June 30, 2019. Using an inverse-variance random effects model to account for heterogeneity between jurisdictions, we calculated weighted test visit positivity estimates and 95% confidence intervals (CI) for GC and CT at urethral and extragenital sites, and extragenital GC among urethral CT-positive/GC-negative test visits. Results Of 139,718 GC and CT test visits, we calculated overall positivity (GC, 16.7% [95% CI, 14.4-19.1]; CT, 13.3% [95% CI, 12.7-13.9]); urethral positivity (GC, 7.5% [95% CI, 5.7-9.3]; CT, 5.2% [95% CI, 4.6-5.8]); rectal positivity (GC, 11.8% [95% CI, 10.4-13.2]; CT, 12.6% [95% CI, 11.8-13.4]); and pharyngeal positivity (GC, 9.1% [95% CI, 7.9-10.3]; CT, 1.8% [95% CI, 1.6-2.0]). Of 4566 urethral CT-positive/GC-negative test visits with extragenital testing, extragenital GC positivity was 12.5% (95% CI, 10.9-14.1). Conclusions Extragenital GC and CT were common among MSM. Without extragenital screening of MSM with urethral CT, extragenital GC would have been undetected and undertreated in approximately 13% of these men. Undertreatment could potentially select for antimicrobial resistance. These findings underscore the importance of extragenital screening in MSM.

BACKGROUND Sexual networks are difficult to construct because of incomplete sexual partner data. The proximity of people within a network may be inferred from genetically similar infections. We explored genomic data combined with partner services investigation (PSI) data to extend our understanding of sexual networks affected by Neisseria gonorrhoeae (NG). METHODS We used 2017-2019 PSI and whole-genome sequencing (WGS) data from 8 jurisdictions participating in Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) project. Clusters were identified from sexual contacts and through genetically similar NG isolates. Sexual mixing patterns were characterized by describing the clusters by the individual's gender and gender of their sex partners. RESULTS Our study included 4627 diagnoses of NG infection (81% sequenced), 2455 people received a PSI, 393 people were negative contacts of cases, and 495 were contacts with an unknown NG status. We identified 823 distinct clusters using PSI data combined with WGS data. Of cases that were not linked to any other case using PSI data, 37% were linked when using WGS data. Overall, 40% of PSI cases were allocated to a larger cluster when PSI and WGS data were combined compared with PSI data alone. Mixed clusters containing women, men who report sex with women, and men who report sex with men were common when using the WGS data either alone or in combination with the PSI data. CONCLUSIONS Combining PSI and WGS data improves our understanding of sexual network connectivity.

Early in the coronavirus disease 2019 (COVID-19) crisis, a statewide executive order (PAUSE) severely restricted the movement of New Yorkers from 23 March to 7 June 2020. We used New York City surveillance data for human immunodeficiency virus (HIV), chlamydia, gonorrhea, and syphilis to describe trends in diagnosis and reporting surrounding PAUSE. During PAUSE, the volume of positive HIV/sexually transmitted infection tests, and diagnoses of HIV, chlamydia, gonorrhea, and syphilis declined substantially, reaching a nadir in April before rebounding. Some shifts in characteristics of reported cases were identified.

Background New York City (NYC) was the US epicenter of the spring 2020 coronavirus disease 2019 (COVID-19) pandemic. We present the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and correlates of seropositivity immediately after the first wave. Methods From a serosurvey of adult NYC residents (13 May to 21 July 2020), we calculated the prevalence of SARS-CoV-2 antibodies stratified by participant demographics, symptom history, health status, and employment industry. We used multivariable regression models to assess associations between participant characteristics and seropositivity. Results The seroprevalence among 45 367 participants was 23.6% (95% confidence interval, 23.2%–24.0%). High seroprevalence (>30%) was observed among black and Hispanic individuals, people from high poverty neighborhoods, and people in healthcare or essential worker industry sectors. COVID-19 symptom history was associated with seropositivity (adjusted relative risk, 2.76; 95% confidence interval, 2.65–2.88). Other risk factors included sex, age, race/ethnicity, residential area, employment sector, working outside the home, contact with a COVID-19 case, obesity, and increasing numbers of household members. Conclusions Based on a large serosurvey in a single US jurisdiction, we estimate that just under one-quarter of NYC adults were infected in the first few months of the COVID-19 epidemic. Given disparities in infection risk, effective interventions for at-risk groups are needed during ongoing transmission.

Outcomes among people living with HIV (PLWH) in New York City (NYC) remain suboptimal. To assess the potential role of the city's sexual health clinics (SHCs) in improving HIV outcomes and reducing HIV transmission, we examined HIV care status and its correlates among HIV-positive SHC patients in NYC. Clinic electronic medical records were merged with longitudinal NYC HIV surveillance data to identify HIV-positive patients and derive their retrospective and prospective HIV care status. Evidence of HIV care and viral load suppression (VLS) after clinic visit were considered outcomes. Logistic regression models were used to assess their correlates. A third of the 1045 PLWH who visited NYC SHCs in 2012 were out of HIV care (OOC) in the 12 months preceding the clinic visit, and were less likely than those previously in HIV care (IC) to have subsequent evidence of HIV care (42% vs. 72%) or VLS in the 12 months after the visit (39% vs. 76%). VLS was particularly low among patients diagnosed with ≥2 sexually transmitted infections (46%). The odds of VLS were lowest among those OOC before the clinic visit [versus those IC, adjusted odds ratio (aOR): 0.21, 95% confidence interval (CI): 0.16–0.29], non-Hispanic blacks (versus non-Hispanic whites, aOR: 0.58, 95% CI: 0.37–0.90), and residents of high-poverty neighborhoods (>30% vs.

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.

Using a representative sample of gonorrhea cases in select jurisdictions, we estimated the proportion of eligible men who have sex with men reporting being prescribed preexposure prophylaxis (PrEP) to prevent HIV infection. In 2016, half (51.3%) of the estimated 33,165 eligible men who have sex with men reported being prescribed PrEP by their health care provider.

BACKGROUND Linkage/relinkage to HIV care for virally unsuppressed people with new sexually transmitted infections is critical for ending the HIV epidemic. We quantified HIV care continuum gaps and viral suppression among HIV-positive patients attending New York City (NYC) sexual health clinics (SHCs). METHODS One thousand six hundred forty-nine HIV-positive patients and a 10% sample of 11,954 patients with unknown HIV status on clinic visit date (DOV) were matched against the NYC HIV registry. Using registry diagnosis dates, we categorized matched HIV-positive patients as "new-positives" (newly diagnosed on DOV), "recent-positives (diagnosed ≤90 days before DOV), "prevalent-positives" (diagnosed >90 days before DOV), and "unknown-positives" (previously diagnosed but status unknown to clinic on DOV). We assessed HIV care continuum outcomes before and after DOV for new-positives, prevalent-positives, and unknown-positives using registry laboratory data. RESULTS In addition to 1626 known HIV-positive patients, 5% of the unknown sample (63/1196) matched to the registry, signifying that approximately 630 additional HIV-positive patients attended SHCs. Of new-positives, 65% were linked to care after DOV. Of prevalent-positives, 66% were in care on DOV; 43% of the out-of-care patients were relinked after DOV. Of unknown-positives, 40% were in care on DOV; 21% of the out-of-care patients relinked after DOV. Viral suppression was achieved by 88% of in-care unknown-positives, 76% in-care prevalent-positives, 50% new-positives, 42% out-of-care prevalent-positives, and 16% out-of-care unknown-positives. CONCLUSIONS Many HIV-positive people, including those with uncontrolled HIV infection, attend SHCs and potentially contribute to HIV spread. However, HIV status often is not known to staff, resulting in missed linkage/relinkage to care opportunities. Better outcomes could be facilitated by real-time ascertainment of HIV status and HIV care status.

We conducted a cross-sectional analysis using sexually transmitted disease clinic data to determine test of cure rates among persons diagnosed with pharyngeal gonococcal infections who were treated with a nonceftriaxone, nonazithromycin therapy. Less than 10% returned for a test of cure, highlighting the need to understand factors that can lead to improved compliance.

COVID-19 mortality studies have primarily focused on persons aged ≥ 65 years; less is known about decedents aged

Background Inequalities in Neisseria gonorrhoeae (gonorrhea) burden by sexual minority status in the United States are difficult to quantify. Sex of sex partner is not routinely collected for reported cases. Population estimates of men who have sex with men (MSM) necessary to calculate case rates have not been available until recently. For these reasons, trends in reported gonorrhea rates among MSM have not been described across multiple jurisdictions. Methods We estimated of the number of MSM cases reported in 6 jurisdictions continuously participating in the STD Surveillance Network 2010-2015 based on interviews with a random sample of cases. Data were obtained for Baltimore, Philadelphia, New York City, San Francisco, California (excluding San Francisco), and Washington State. Estimates of the MSM, heterosexual male (MSW) and female populations were obtained from recently published estimates and census data. Case rates and rate-ratios were calculated comparing trends in reported cases among MSM, heterosexual males and women. Results The proportion of male gonorrhea cases among MSM varied by jurisdiction (range: 20% to 98%). Estimated MSM rate increased from 1369 cases per 100,000 in 2010 to 3435 cases per 100,000 in 2015. Between 2010 and 2015, the MSM-to-Women gonorrhea rate ratio increased from 13:1 to 24:1, and the MSM-to-MSW gonorrhea rate ratio increased from 16:1 to 31:1. Conclusions Estimated gonorrhea rate among MSM increased in a network of 6 geographically diverse US jurisdictions. Estimating the size of this population, determining MSM among reported cases and estimating rates are essential first steps for better understanding the changing epidemiology of gonorrhea.

Background Extragenital gonorrhea (GC) is often asymptomatic, detected through screening of anatomic sites of exposure. Antimicrobial therapy with ceftriaxone plus azithromycin is the recommended GC treatment; monotherapy (azithromycin or doxycycline) is recommended for chlamydia (CT). In urethral CT-positive patients who are urethral GC-negative and not screened at extragenital sites, CT monotherapy may lead to GC undertreatment. We assessed urethral and extragenital GC positivity among MSM seeking care in STD clinics. Methods Data were obtained from 30 STD clinics in 10 local health jurisdictions included in the STD Surveillance Network. Participants were adult MSM with ≥1 clinic visit between 1/1/2015–12/31/2017. Data were analyzed by clinic visit. Using an inverse-variance random effects model to account for heterogeneity between jurisdictions, weighted positivity estimates and 95% confidence intervals (CI) were calculated for overall, urethral, rectal, and pharyngeal GC among all MSM, and rectal and pharyngeal GC among MSM who were both urethral CT-positive and urethral GC-negative. Results Of 100,613 GC and CT testing visits, overall GC positivity (positivity at any site) was 16.8% (95% CI=14.6–19.0). By anatomic site, urethral GC positivity was 7.7% (95% CI=5.9–9.5), rectal GC positivity was 12.5% (95% CI=11.1–13.9), and pharyngeal GC positivity was 9.2% (95% CI=8.0–10.4). Of 3,981 testing visits among urethral CT-positive and urethral GC-negative MSM who were tested at extragenital sites (rectum and/or pharynx), extragenital GC positivity was 10.1% (95% C.I=8.7–11.5), rectal GC positivity was 5.3% (95% CI=4.3–6.3%), and pharyngeal GC positivity was 6.9% (95% CI=5.7–8.1). Conclusion Extragenital GC was fairly common among MSM. Without extragenital screening, ∼10% of extragenital gonococcal infections would have been missed and consequently undertreated in urethral CT-positive/urethral GC-negative MSM. In addition to potentially failing to cure GC and facilitating ongoing transmission, undertreatment with azithromycin 1g or doxycycline could potentially select for resistance. These findings underscore the importance of extragenital screening in MSM per CDC guidelines. Disclosure No significant relationships.

Background Bacterial vaginosis (BV) is a common condition among women and is associated with HIV/STI acquisition and adverse pregnancy outcomes. We describe the prevalence of BV diagnoses and repeat BV diagnoses among women attending New York City (NYC) public sexual health clinics (SHC) and examine demographic characteristics associated with BV. Methods Using electronic medical record data for patients who were assigned female sex at birth (“women”), we identified BV diagnoses made during clinician visits at NYC SHC during January 2017–April 2018, and recurrent BV during a six-month follow-up period through October 2018. BV diagnosis was defined as a physician diagnosis of BV with a vaginal pH ≥4.5, and positive whiff-amine test. We used chi-square tests to compare characteristics of women with and without a BV diagnosis. Results Of 13,153 women with ≥1 visits to the SHC, 34% (4,449) were diagnosed with BV. There were significant differences in BV prevalence by race/ethnicity: 39.5% (95% CI: [38.7–40.3%]) of non-Hispanic black women versus 29.6% ([28.3–30.9%]) Hispanic, 21.2% ([19.1–23.3%]) non-Hispanic white, and 19.7% ([16.5–22.9%]) non-Hispanic Asian women. Women of HIV-negative/unknown HIV status had higher BV prevalence than HIV-positive women (33.9% vs 23.4%, p=0.02). Women reporting sex with both men and women had higher BV prevalence (42.0%, 95% CI: [37.5–46.5%]) than women reporting sex with men only (34.5%, [34.2–34.8%]) or women reporting sex with women only (28.1%, [22.2–34.0%]). Among women with BV, 4,404 (99%) received treatment and 1588 (36.1%) of those had another clinician visit within 6 months. Among returning women, 282 (17.8%) were given another BV diagnosis within 3 months, and 601 (37.8%) within 6 months. Conclusion One-third of women attending NYC SHC were diagnosed with BV, and recurrent BV was common. Additional research is needed to identify effective therapies to reduce the high prevalence and recurrence rates of BV. Disclosure No significant relationships.

Background Since late 2016, the PrEP program in New York City’s 8 sexual health clinics (SHCs) has evolved from a model of active referral to external PrEP providers to on-site PrEP initiation (providing one month of PrEP and provider referral); this was implemented, clinic by clinic, over time. We hypothesized that HIV incidence would be lower for patients who received PrEP medication in SHCs. Methods We matched the following groups of men-who-have-sex-with-men (MSM) who received SHC PrEP services (12/2016-06/2017) to citywide HIV and STI registries: (1) same-day PrEP initiators, (2) referred-only for PrEP, (3) never-referred (not interested in starting PrEP). We calculated HIV incidence after SHC PrEP service date, using HIV surveillance data through 06/30/2018. We assessed factors associated with HIV diagnosis using Cox models that included initiation vs referred-only status, linkage, age, race/ethnicity, incident STI (chlamydia/gonorrhea/primary or secondary syphilis), and 3-month history of condomless receptive anal sex and number of sex partners. Results There were 267 initiators, 607 referred-only, and 96 never-referred patients; 40% of both initiated and referred-only patients linked to PrEP providers. Of all MSM (n=970; 1215 person-years [PY] of follow-up), 18 were newly diagnosed with HIV (median time to diagnosis 221 days; range 23-468). HIV incidence was 1.5/100PY (95%CI 0.9–2.3) and not significantly different by group: 1.8/100PY among initiators (linked: 1.6, non-linked: 2.0); 1.3/100PY referred-only (linked: 0.0, non-linked: 2.2); 1.8/100PY never-referred. HIV risk did not differ for initiators versus referred-only patients, but was higher among non-linked than linked (aHR 5.6; 95%CI 1.3–25.0) and those with STI versus no STI (aHR 10.1; 95%CI 2.3–44.7). Conclusion This examination of PrEP initiation in an episodic care setting did not find on-site PrEP provision to be associated with improved linkage and HIV outcomes. Understanding barriers to ongoing PrEP care is critical to improving linkage, and maximizing resources and the benefit of immediate PrEP access. Disclosure No significant relationships.

Background Sexually transmitted disease clinics are well-suited to deliver PEP; few provide full courses (28 days) due to cost. Since 2016, NYC Sexual Health Clinic (SHC) staff have provided full-course PEP to eligible HIV-negative patients, and thereafter attempt linkage to PrEP. We examined HIV incidence and patterns of PrEP/PEP use among a PEP cohort. Methods We matched men-who-have-sex-with-men (MSM) who received PEP at SHC (09/2016-05/2017) to the citywide HIV surveillance registry to identify new HIV diagnoses between last PEP event during this interval and 06/30/2018. We calculated HIV incidence with time-at-risk starting 28 days after PEP provision; periods of additional PEP supplied at SHC during follow-up were excluded from time-at-risk. We examined subsequent PrEP and repeat PEP use during follow-up. For MSM without PrEP/repeat PEP, we calculated the number-needed-to-treat (NNT) with PrEP for one year to prevent 1 HIV infection (assumed 73% efficacy with 90% adherence). Results Eleven HIV diagnoses occurred among 520 MSM with 652 person-years (PY) follow-up; HIV incidence was 1.7/100PY (95%CI: 0.8–3.0), and highest among Hispanic MSM (2.6/100PY) and MSM aged Conclusion Despite PrEP availability, fewer than half of PEP patients took up PrEP and a substantial proportion took PEP repeatedly; research to elucidate underlying reasons for PrEP and PEP use patterns (insurance/cost, convenience, self-perceived risk) is warranted. Disclosure No significant relationships.

Objective To identify best practices for combining public health data for multi-jurisdiction surveillance projects. Introduction Sentinel surveillance, where selected jurisdictions follow standardized protocols to collect and report enhanced public health data not available through other routine surveillance efforts, is a key part of national surveillance of sexually transmitted diseases (STDs). Although four STDs are nationally notifiable conditions (chlamydia, gonorrhea, syphilis and chancroid), the burden of these conditions (over 2.3 million cases were reported in 2017) limits the amount of detailed clinical and demographic data available for all cases. Sentinel surveillance in clinical settings serving at-risk populations, such as STD clinics, provides an opportunity to collect enhanced data elements on persons seeking STD-related services, such as sex of sex partners and anatomic site of infection. However, there are challenges in combining data across jurisdictions as estimated effect measures may vary by jurisdiction (e.g., some may have higher observed burden of disease among certain populations) and the amount of data contributed by jurisdiction may vary; combined this could lead to biased estimates if heterogeneity is not taken into account. Methods Using data from the STD Surveillance Network (SSuN), a sentinel surveillance project implemented in 10 jurisdictions, we investigated the effect of using different statistical methods to combine data across jurisdictions. We evaluated 5 methodologies: ● “Fully stratified” where estimates were provided separately for each jurisdiction; ● “Aggregated” where numerators and denominators were summed across jurisdictions without weighting; ● “Mean estimate” where the mean of the jurisdiction-specific estimates was estimated; ● “Random effects” where jurisdiction-specific estimates were combined using an inverse variance weighted random effects model to adjust for heterogeneity between jurisdictions; and ● “Stratified random effects” where a possible effect modifier was identified and used to group jurisdictions prior to calculating the estimate from the random effects model. Through SSuN, jurisdictions collect visit-level data on patients attending selected STD clinics and report clinical and demographic data. As an illustrative example, we estimated rectal gonorrhea positivity among gay, bisexual, and other men who have sex with men (MSM) attending participating clinics. Jurisdiction-specific positivity was estimated as the # of unique MSM testing positive at least once for rectal gonorrhea divided by all MSM tested 1 or more times for rectal gonorrhea in all of the clinics in the jurisdiction. The stratifying variable for the stratified random effects method was the percent of MSM screened in the jurisdiction’s clinics, as low screening coverage may reflect targeted testing of MSM likely to be infected which may inflate observed positivity. For each of the five methods, we estimated rectal gonorrhea positivity and the corresponding 95% confidence interval (CI). Results In 2017, 123,210 patients attended 30 STD clinics participating in the 10 SSuN jurisdictions, of which 31,052 (25.2%) were identified as MSM (jurisdiction-specific range: 8.8% to 70.0%). (Table 1) One jurisdiction (I) accounted for 39% of all MSM included in the analysis while one jurisdiction (J) accounted for only 1.6% of MSM included. The proportion of MSM tested for rectal gonorrhea at least once varied by jurisdiction, ranging from 44.3% to 76.9%. The fully stratified method identified differences in rectal gonorrhea positivity across jurisdictions, with jurisdiction-specific positivity ranging from 9.9% to 24.1%. Aggregating across jurisdictions masked this heterogeneity and provided a single summary estimate of 15.2% (95% CI: 14.7, 15.7). Taking the mean across the jurisdiction-specific estimates also provided a summary estimate; however, the uncertainty of the estimate increased (15.8%, 95% CI: 13.3, 18.7). Accounting for the heterogeneity by using a random effects model resulted in an estimate of 15.5% (95% CI: 13.9, 17.2). After stratifying by a likely confounder (% of MSM screened); the random effects estimate among 3 jurisdictions with lower screening coverage (

Purpose Human papillomavirus (HPV) vaccine is recommended for adolescents. By the end of 2013, 64% of female and 40% of male New York City residents aged 13–18 years had received ≥1 HPV vaccine dose. Adolescents attending sexually transmitted disease (STD) clinics are at high risk for HPV exposure and could benefit from vaccination. Our objective was to estimate HPV vaccination coverage for this population. Methods We matched records of New York City's STD clinic patients aged 13–18 years during 2010–2013 with the Citywide Immunization Registry. We assessed HPV vaccine initiation (≥1 dose) and series completion (≥3 doses among those who initiated) as of clinic visit date and by patient demographics. We compared receipt of ≥1 dose for HPV, tetanus-diphtheria-acellular pertussis, and meningococcal conjugate vaccine. Results Eighty-two percent of clinic attendees (13,505/16,364) had records in the Citywide Immunization Registry. Receipt of ≥1 HPV dose increased during 2010–2013 (females: 57.6%–69.7%; males: 1.5%–36.3%). Among females, ≥1-dose coverage was lowest among whites (53.4%) and highest among Hispanics (73.3%); among males, ≥1-dose coverage was lowest among whites (6.9%) and highest among Asians (20.9%). Series completion averaged 57.7% (females) and 28.0% (males), with little variation by race/ethnicity or poverty level. Receipt of ≥1 dose was 59.7% for HPV, 82% for tetanus-diphtheria-acellular pertussis, and 76% for meningococcal conjugate vaccines. Conclusions HPV vaccine initiation and completion were low among adolescent STD clinic patients; coverage was lower compared with other recommended vaccines. STD clinics may be good venues for delivering HPV vaccine, thereby enhancing efforts to improve HPV vaccination.

The development of noninvasive nucleic acid amplification tests for chlamydia and gonorrhea has facilitated innovation in moving sexually transmitted disease (STD) screening to nonclinical settings. However, limited data are available to inform local STD programs on evidence-based approaches to STD screening in nonclinical settings in the United States.We conducted a systematic review of the literature published since 2000 related to chlamydia, gonorrhea, and syphilis screening in US correctional settings, bathhouses and sex venues, self-collected at-home testing, and other nonclinical sites.Sixty-four articles met eligibility criteria and were reviewed. Although data on testing volume and positivity were available, there were scarce data on the proportion of new positives treated and the programmatic costs for the various screening programs. Screening in correctional settings identified a sizable amount of asymptomatic infections. The value and sustainability of screening in the other nonclinical settings examined was not clear from the published literature.Local and state health departments should explore the development of sustainable jail and juvenile detention screening programs for STDs. Furthermore, local programs should pilot outreach and home-based STD screening programs to determine if they are identifying asymptomatic persons who would not have otherwise been found. Local programs are encouraged to present and publish their findings related to non-clinic-based screening to enhance the limited body of literature; data on the proportion of new infections treated and the local program costs are needed.

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.

Using Chlamydia trachomatis anorectal specimens routinely tested for lymphogranuloma venereum (LGV) (2008-2011) and samples of archived specimens tested for LGV (2012-2015), we observed increased LGV positivity among men who have sex with men attending NYC Sexual Health Clinics. Using clinical data, we determined predictors of anorectal LGV that may guide clinical management.

OBJECTIVE: To examine the prevalence and treatment of rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among women reporting receptive anal intercourse in a network of sexually transmitted disease or sexual health clinics and estimate the proportion of missed infections if women were tested at the genital site only. METHODS: We conducted a cross-sectional analysis of C trachomatis and N gonorrhoeae test results from female patients reporting receptive anal intercourse in the preceding 3 months during visits to 24 sexually transmitted disease clinics from 2015 to 2016. Primary outcomes of interest were 1) anatomic site-specific C trachomatis and N gonorrhoeae testing and positivity among women attending selected U.S. sexually transmitted disease clinics who reported receptive anal inter-course and 2) the proportion of rectal infections that would have remained undetected if only genital sites were tested. RESULTS: Overall, 7.4% (3,743/50,785) of women reported receptive anal intercourse during the 2 years. Of the 2,818 women tested at both the genital and rectal sites for C trachomatis, 292 women were positive (61 genital only, 60 rectal only, and 171 at both sites). Of the 2,829 women tested at both the genital and rectal sites for N gonorrhoeae, 128 women were positive (31 genital only, 23 rectal only, and 74 at both sites). Among women tested at both anatomic sites, the proportion of missed C trachomatis infections would have been 20.5% and for N gonorrhoeae infections, 18.0%. CONCLUSION: Genital testing alone misses approximately one fifth of C trachomatis and N gonorrhoeae infections in women reporting receptive anal intercourse in our study population. Missed rectal infections may result in ongoing transmission to other sexual partners and reinfection.

BACKGROUND. Approximately 90% of genital warts are caused by human papillomavirus (HPV) types 6 and 11. In the United States, HPV vaccination has been recommended for girls and women aged ≤26 years, and since 2011, for boys and men aged ≤21 years and for gay, bisexual, and other men who have sex with men (MSM) aged ≤26 years. METHODS. Data were obtained from 27 clinics participating in the STD Surveillance Network. Trends in the annual prevalence of anogenital warts (AGW) from 2010–2016 were described by sex and by the sex of sex partners. RESULTS. During 2010–2016, significant declines in the prevalence of AGW were observed in women aged

Male primary and secondary (PS) and early latent syphilis cases have increased markedly in New York City (NYC) after a historic nadir in 1998. The majority of cases are among men who have sex with men (MSM). We describe the epidemiology of syphilis among NYC males to provide a model of how 1 jurisdiction collects, analyzes, interprets, uses, and disseminates local data to guide programmatic activities directed at syphilis control.We analyzed trends in reported infectious syphilis cases using routinely collected surveillance and case investigation data. Human immunodeficiency virus (HIV) coinfection status was ascertained by routine deterministic match between sexually transmitted infection and HIV surveillance registries, and self-report. We mapped diagnosing facilities to display the relative contribution of different public/private facilities. Characteristics of male syphilis cases diagnosed in public sexual health (SH) clinics were compared to those diagnosed elsewhere.During 2012 to 2016, male PS syphilis case rates increased 81%, from 24.8 to 44.8/100,000 (1832 cases in 2016); the highest rates were among black non-Hispanic men. Overall, 87.6% (902/1030) of interviewed men in 2016 disclosed 1 or more male partner. The HIV coinfection rates are high among MSM with PS syphilis (43.4%; 394/907 in 2016), but appear to be decreasing (from 54.1% in 2012). Maps highlight SH clinics' contribution to diagnosing PS syphilis cases among men of color. HIV coinfection rates were lower among men with PS syphilis diagnosed in SH clinics than among those diagnosed elsewhere (34%, SH clinics vs 49%; other settings, P0.0001).Syphilis infections continue to increase among MSM in NYC. Novel interventions responsive to the drivers of the current outbreak are needed.

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.

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

Introduction Men-who-have- sex-with-men (MSM) may modify sexual practices to reduce HIV and sexually transmitted infection (STI) risk. HIV pre-exposure prophylaxis (PrEP) may impact risk behaviour and STI acquisition. Methods We matched HIV-negative MSM attending New York City (NYC) sexual health clinics during 2011–2015 to the NYC HIV registry in 01/2017. We used visit-level data to assess trends in condom use during anal sex (consistent, inconsistent, no use; referent period=3 months), overall and by sexual positioning behaviour. We examined associations between condomless (inconsistent/no use) insertive, condomless receptive, and condomless versatile sex and incident HIV or STI (chlamydia/gonorrhoea/early syphilis). We used regression with generalised estimating equations (referent group=anal sex with condoms), controlling for demographics, partner number, and STI history. Results The proportion of visits with reported consistent condom use decreased from 2011–2015 (39% to 31%%, p Conclusion We documented increases in condomless sex among a sentinel high risk group prior to and during the PrEP era. Insertive sex, perhaps perceived as a safer strategy, was associated with substantial STI risk when condoms were not consistently used. Assuring PrEP access for black MSM is critical.

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

Trichomonas vaginalis is the most prevalent curable sexually transmitted infection in the world.1 In the United States, according to the 2000 to 2004 National Health and Nutrition Examination Survey, an estimated 3.1% of women of reproductive age are infected with T. vaginalis, making this parasitic infection more prevalent than either chlamydia or gonorrhea.2,3 A disproportionately high burden of disease has been observed among older women and non-Hispanic black women.2,4 Infection with T. vaginalis has been associated with serious adverse outcomes such as pelvic inflammatory disease5,6 and 1.5 to 2.7 times greater risks of HIV acquisition and transmission.7–10 An estimated 70% to 85% of infected women are asymptomatic.2,11 Symptoms of trichomoniasis range from mild to severe inflammation and genital pruritis and may also include cervicovaginal and/or urethral discharge. A single oral dose of a nitroimidazole antimicrobial (ie, 2 g of metronidazole or tinidazole) is generally sufficient treatment to cure infection.12 Although in vitro antimicrobial resistance has been documented in 4% of vaginal culture specimens collected from sexually transmitted disease (STD) clinics, in vivo antimicrobial resistance has remained infrequent to date.13,14 The Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines recommend that all women seeking care for symptoms of vaginal discharge should be tested for T. vaginalis infection.12 As for screening asymptomatic persons, however, these guidelines recommend routine annual screening only among HIV-infected women and currently do not include specific recommendations for T. vaginalis screening among the general population or among other high-risk groups.12 Although approximately 71% of male sexual partners of women with trichomoniasis are also infected with T. vaginalis, clinical testing for this parasite is not commonly conducted for male patients.15 Traditional diagnostic testing is by wet mount microscopy, in which a specimen of genital (eg, cervicovaginal) fluid is collected by a clinician during a pelvic examination and interpreted at the point of care; the test is inexpensive but operator dependent, and sensitivity is generally poor at 51% to 65%.16,17 Additional testing options include culture, which does not provide immediate results and is less commonly performed; recently developed rapid antigen tests, which may be performed at the point of care; and nucleic acid amplification tests (NAATs), the first of which was cleared for use in symptomatic or asymptomatic women by the US Food and Drug Administration in 2011, with high sensitivity (95%–100%) and specificity (95%–100%) for detecting T. vaginalis in urine specimens, endocervical swabs, or vaginal swabs.16,18,19 Little is known about current diagnostic testing and screening practices for this very common STD among persons presumably at high risk for infection, such as patients presenting at STD clinics.20 The objective of this analysis was to assess T. vaginalis prevalence among symptomatic and asymptomatic women tested or screened at a diverse group of STD clinics in the United States.

We examined five annual cohorts (2007-2011) of men who have sex with men (MSM) attending New York City STD clinics who had negative HIV-1 nucleic acid amplification tests (NAATs) on the day of clinic visit. Annual HIV incidence was calculated using HIV diagnoses within 1 year of negative NAAT, determined by matching with the citywide HIV registry. Predictors (demographic; behavioral; bacterial STD from citywide STD registry match) of all new HIV diagnoses through 2012 were calculated from Cox proportional hazards models. Among 10,487 HIV NAAT-negative MSM, 371 had an HIV diagnosis within 1 year. Annual incidence was 2.4/100 person-years, and highest among non-Hispanic black MSM (4.1/100 person-years) and MSM aged

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.