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

HIV can compromise the immune system; persons with HIV (PWH), especially those not receiving antiretroviral therapy (ART), might be vulnerable to SARS-CoV-2 infection. Studies have reported an increased risk for [...]

ObjectivesWe examined whether molecular cluster membership was associated with public health identification of HIV transmission potential among named partners in Chicago.DesignHistorical cohort study.MethodsWe matched and analyzed HIV surveillance and partner services data from HIV diagnoses (2012-2016) prior to implementation of cluster detection and response interventions. We constructed molecular clusters using HIV-TRACE at a pairwise genetic distance threshold of 0.5% and identified clusters exhibiting recent and rapid growth according to the Centers for Disease Control and Prevention definition (three new cases diagnosed in past year). Factors associated with identification of partners with HIV transmission potential were examined using multivariable Poisson regression.ResultsThere were 5208 newly diagnosed index clients over this time period. Average age of index clients in clusters was 28; 47% were Black, 29% Latinx/Hispanic, 6% female and 89% MSM. Of the 537 named partners, 191 (35.6%) were linked to index cases in a cluster and of those 16% were either new diagnoses or viremic. There was no statistically significant difference in the probability of identifying partners with HIV transmission potential among index clients in a rapidly growing cluster versus those not in a cluster [adjusted relative risk 1.82, (0.81-4.06)].ConclusionPartner services that were initiated from index clients in a molecular cluster yielded similar new HIV case finding or identification of those with viremia as did interviews with index clients not in clusters. It remains unclear whether these findings are due to temporal disconnects between diagnoses and cluster identification, unobserved cluster members, or challenges with partner services implementation.

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

HIV is associated with severe mpox. Sexually transmitted infections (STIs) could facilitate mpox transmission. We estimated HIV and STI frequency among patients with mpox and compared characteristics associated with mpox severity. Mpox cases during 1 June 2022 to 31 March 2023 were matched to Illinois HIV/AIDS surveillance data. Among 1124 patients with mpox, 489 (44%) had HIV and 786 (70%) had prior or concurrent STI; 307 (39%) had ≥3 STI episodes. More patients with mpox who were living with HIV were hospitalized than those without HIV (10.3% vs 4.1%, P <.001). STI screening visits are opportunities to vaccinate against mpox and provide HIV prophylaxis or treatment. [ABSTRACT FROM AUTHOR]

Background Syphilis rates in the United States have increased. Few studies have examined syphilis incidence and prevalence prospectively among young sexual and gender minorities (YSGM). Methods This study of YSGM assigned male at birth comes from a Chicago-based prospective cohort at 2 visits 6 months apart (N = 882). Syphilis cases were identified through serologic test results and self-reported history. Results In this sample, 25.1% had a lifetime prevalence, and 3.3% were incident cases with a crude incidence rate of 6.76 per 100 person-years. Conclusions Lifetime syphilis and incidence are high in this sample of YSGM relative to general population samples. [ABSTRACT FROM AUTHOR]

Background: Public STI clinics are safety net providers for uninsured and underinsured individuals but are at risk for closure due to declining budgets and shifting priorities. This study sought to assess changes in insurance status and access to preventive care among public STI clinic patients following immediate and long-term implementation of the Affordable Care Act (ACA).Materials and Methods: Patients receiving care in STI clinics administered by Chicago Department of Public Health were asked to complete an anonymous survey in 2013, 2014, and 2019. We estimated the prevalence rate ratio (PRR) of (1) being insured and (2) having access to preventive care over time, adjusted for age, race, and gender/sexual orientation, and employment status.Results: Among 1,711 respondents, compared to 2013 patients, patients were 1.41 (adjusted PRR) times more likely to report being insured in 2014 (95% CI: 1.11-1.77), and 1.24 (aPRR) times more likely to report being insured in 2019 (95% CI: 0.99-1.55). After adjusting for other significant variables (age, sex and orientation, and insurance status), reported access to preventive care increased by 34% among respondents in 2019 as compared to 2013 (aPRR = 1.34). Unsurprisingly, being insured was associated with increased preventive care access (aPRR = 1.78).Conclusions: Even after implementation of the ACA, survey of public STI clinic patients in Chicago found a sizeable proportion of individuals without insurance, and many lacked access to preventive care, highlighting the continued need for these safety net clinics to provide STI care. [ABSTRACT FROM AUTHOR]

Background: The Covid-19 pandemic set back efforts to end the HIV epidemic. Medical facilities were overwhelmed with Covid-19, and lockdowns kept people from receiving regular care. This analysis looked at frequency of provider visits to determine how Covid-19 lockdowns in Chicago affected HIV care. Method: HIV surveillance data reported to the Chicago Department of Public Health (CDPH) were analyzed. Care labs are quantitative viral load (VL), CD4s, and HIV genotypes. Data from 13,650 HIV+ individuals with care visits in 2019 were analyzed to determine if they missed provider visits for a calendar year in 2020 and 2021. VL results were categorized: Suppressed (< = 199copies/ML); High (200 to 1500copies/ML), Very high (VH) (>= 1501copies/ML). Associations between not having a provider visit(s) for a calendar year, VH VL were analyzed using Chi-square and logistic regression. Results: As of June 2022, out of 19,116 HIV+ individuals residing in Chicago, 71.4% (13,650) had care visits in 2019. Among individuals who saw a provider in 2020 and 2021, 6.3% had VH VL results on their next provider visit; individuals who did not have any visits in 2020 or 2021- 13.6% had VH VL results. Hardship Index (HI) and age were significantly associated with VH VL after a year or more of missing provider visits during the lockdown period. HIV+ individuals in the age group 20 to 29 [OR=3.132; 95% CI:2.213-4.434], 30 to 39 [OR=2.533; 95% CI:1.92-3.342], and 40 to 49 [1.705; 95% CI:1.228-2.341] were more likely than individuals in age group 50+ plus to have a VH VL result if they missed a year of provider visits in 2020 or 2021. Individuals living in high HI areas [OR=1.688; 95% CI:1.228-2.322] were more likely to have a VH VL than those living in low HI areas. Conclusion: Age and HI are significantly associated with VH VL results after missing provider appointments for a year or more. Our findings indicate that providers should use innovative approaches to manage clients' care during public health emergencies. [ABSTRACT FROM AUTHOR]