Publications by authors named "Gail Bolan"

70 Publications

Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020.

MMWR Recomm Rep 2020 01 3;68(5):1-20. Epub 2020 Jan 3.

This report (hereafter referred to as STD QCS) provides CDC recommendations to U.S. health care providers regarding quality clinical services for sexually transmitted diseases (STDs) for primary care and STD specialty care settings. These recommendations complement CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015 (hereafter referred to as the STD Guidelines), a comprehensive, evidence-based reference for prevention, diagnosis, and treatment of STDs. STD QCS differs from the STD Guidelines by specifying operational determinants of quality services in different types of clinical settings, describing on-site treatment and partner services, and indicating when STD-related conditions should be managed through consultation with or referral to a specialist. These recommendations might also help in the development of clinic-level policies (e.g., standing orders, express visits, specimen panels, and reflex testing) that can facilitate implementation of the STD Guidelines. CDC organized the recommendations for STD QCS into eight sections: 1) sexual history and physical examination, 2) prevention, 3) screening, 4) partner services, 5) evaluation of STD-related conditions, 6) laboratory, 7) treatment, and 8) referral to a specialist for complex STD or STD-related conditions.CDC developed the recommendations by synthesizing relevant, evidence-based guidelines and recommendations issued by other experts; reviewing current practice in the United States; soliciting Delphi ratings by subject matter experts on STD care in primary care and STD specialty care settings; discussing the scientific evidence supporting the proposed recommendations at a consultation meeting of experts and institutional stakeholders held November 20, 2015, in Atlanta, Georgia; conducting peer reviews of draft recommendations and supporting evidence; and discussing draft recommendations and supporting evidence during meetings of the CDC/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment STD Work Group. These recommendations are intended to help health care providers in primary care or STD specialty care settings offer STD services at their clinical settings and to help the persons seeking care live safer, healthier lives by preventing and treating STDs and related complications.
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http://dx.doi.org/10.15585/mmwr.rr6805a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950496PMC
January 2020

World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts.

Sex Health 2019 09;16(5):412-425

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious public health problem, compromising the management and control of gonorrhoea globally. Resistance in N. gonorrhoeae to ceftriaxone, the last option for first-line empirical monotherapy of gonorrhoea, has been reported from many countries globally, and sporadic failures to cure especially pharyngeal gonorrhoea with ceftriaxone monotherapy and dual antimicrobial therapies (ceftriaxone plus azithromycin or doxycycline) have been confirmed in several countries. In 2018, the first gonococcal isolates with ceftriaxone resistance plus high-level azithromycin resistance were identified in England and Australia. The World Health Organization (WHO) Global Gonococcal Antimicrobial Surveillance Program (GASP) is essential to monitor AMR trends, identify emerging AMR and provide evidence for refinements of treatment guidelines and public health policy globally. Herein we describe the WHO GASP data from 67 countries in 2015-16, confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, and international collaborative actions and research efforts essential for the effective management and control of gonorrhoea. In most countries, resistance to ciprofloxacin is exceedingly high, azithromycin resistance is present and decreased susceptibility or resistance to ceftriaxone has emerged. Enhanced global collaborative actions are crucial for the control of gonorrhoea, including improved prevention, early diagnosis, treatment of index patient and partner (including test-of-cure), improved and expanded AMR surveillance (including surveillance of antimicrobial use and treatment failures), increased knowledge of correct antimicrobial use and the pharmacokinetics and pharmacodynamics of antimicrobials and effective drug regulations and prescription policies (including antimicrobial stewardship). Ultimately, rapid, accurate and affordable point-of-care diagnostic tests (ideally also predicting AMR and/or susceptibility), new therapeutic antimicrobials and, the only sustainable solution, gonococcal vaccine(s) are imperative.
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http://dx.doi.org/10.1071/SH19023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035961PMC
September 2019

The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers Turns 40-A Look Back, a Look Ahead.

Sex Transm Dis 2019 08;46(8):487-492

Centers for Disease Control and Prevention, Atlanta, GA.

Since 1979, the National Network of Sexually Transmitted Disease (STD) Clinical Prevention Training Centers (NNPTC) has provided state-of-the-art clinical and laboratory training for STD prevention across the United States. This article provides an overview of the history and activities of the NNPTC from its inception to present day, and emphasizes the important role the network continues to play in maintaining a high-quality STD clinical workforce. Over time, the NNPTC has responded to changing STD epidemiological patterns, technological advances, and increasing private-sector care-seeking for STDs. Its current structure of integrated regional and national training centers allows NNPTC members to provide dynamic, tailored responses to STD training needs across the country.
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http://dx.doi.org/10.1097/OLQ.0000000000001018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713229PMC
August 2019

Developing a Topology of Syphilis in the United States.

Sex Transm Dis 2018 09;45(9S Suppl 1):S1-S6

From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Background: In the United States, reported rates of syphilis continue to increase. Co-occurring epidemics of syphilis among men who have sex with men (MSM) and heterosexual populations create challenges for the prioritization of resources and the implementation of context-specific interventions.

Methods: State was the unit of analysis and was restricted to the 44 states with the most complete data of sex or sex partners for their reported adult syphilis cases. States were classified as high, medium, or low for reported congenital syphilis (CS) and MSM primary and secondary (P&S) syphilis rates. Average values of a range of ecologic state level variables were examined among the 9 categories created through the cross-tabulation of CS and MSM P&S syphilis rates. Patterns among ecologic factors were assessed across the 9 categories of states' syphilis rates.

Results: Among the 44 states categorized, 4 states had high rates of both CS and MSM P&S syphilis in 2015, whereas 12 states fell into the medium/medium category and 7 into the low category. Six states had high CS and medium MSM syphilis and 4 states had medium CS but high MSM syphilis. Several area-level factors, including violent crime, poverty, insurance status, household structure and income, showed qualitative patterns with higher rates of CS and MSM P&S syphilis. Higher proportions of urban population were found among states with higher CS rates; no trend was seen with respect to urbanity and MSM P&S syphilis.

Conclusions: Several area-level factors were associated with CS and MSM P&S syphilis in similar ways, whereas other ecologic factors functioned differently with respect to the 2 epidemics. Explorations of community and area-level factors may shed light on novel opportunities for population specific prevention of syphilis.
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http://dx.doi.org/10.1097/OLQ.0000000000000817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713900PMC
September 2018

Performance of Treponemal Tests for the Diagnosis of Syphilis.

Clin Infect Dis 2019 03;68(6):913-918

Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

Background: Treponemal immunoassays are increasingly used for syphilis screening with the reverse sequence algorithm. There are few data describing performance of treponemal immunoassays compared to traditional treponemal tests in patients with and without syphilis.

Methods: We calculated sensitivity and specificity of 7 treponemal assays: (1) ADVIA Centaur (chemiluminescence immunoassay [CIA]); (2) Bioplex 2200 (microbead immunoassay); (3) fluorescent treponemal antibody absorption test (FTA-ABS); (4) INNO-LIA (line immunoassay); (5) LIAISON CIA; (6) Treponema pallidum particle agglutination assay (TPPA); and (7) Trep-Sure (enzyme immunoassay [EIA]), using a reference standard combining clinical diagnosis and serology results. Sera were collected between May 2012-January 2013. Cases were characterized as: (1) current clinical diagnosis of syphilis: primary, secondary, early latent, late latent; (2) prior treated syphilis only; (3) no evidence of current syphilis, no prior history of syphilis, and at least 4 of 7 treponemal tests negative.

Results: Among 959 participants, 262 had current syphilis, 294 had prior syphilis, and 403 did not have syphilis. FTA-ABS was less sensitive for primary syphilis (78.2%) than the immunoassays or TPPA (94.5%-96.4%) (all P ≤ .01). All immunoassays were 100% sensitive for secondary syphilis, 95.2%-100% sensitive for early latent disease, and 86.8%-98.5% sensitive in late latent disease. TPPA had 100% specificity.

Conclusions: Treponemal immunoassays demonstrated excellent sensitivity for secondary, early latent, and seropositive primary syphilis. Sensitivity of FTA-ABS in primary syphilis was poor. Given its high specificity and superior sensitivity, TPPA is preferred to adjudicate discordant results with the reverse sequence algorithm over the FTA-ABS.
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http://dx.doi.org/10.1093/cid/ciy558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326891PMC
March 2019

Syphilis Elimination: Lessons Learned Again.

Sex Transm Dis 2018 09;45(9S Suppl 1):S80-S85

Division of STD Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA.

It is estimated that approximately 20 million new sexually transmitted infections (STIs) occur each year in the United States. The federally funded sexually transmitted disease prevention program implemented by Centers for Disease Control and Prevention is primarily focused on the prevention and control of the three most common bacterial STIs: syphilis, gonorrhea, and chlamydia. A range of factors facilitate the transmission and acquisition of STIs, including syphilis. In 1999, Centers for Disease Control and Prevention launched the National Campaign to Eliminate Syphilis from the United States. The strategies were familiar to public health in general and to sexually transmitted disease control in particular: (1) enhanced surveillance, (2) expanded clinical and laboratory services, ((3) enhanced health promotion, (4) strengthened community involvement and partnerships, and (5) rapid outbreak response. This national commitment to syphilis elimination was not the first effort, and like others before it too did not succeed. However, the lessons learned from this most recent campaign can inform the way forward to a more comprehensive approach to the prevention and control of STIs and improvement in the nation's health.
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http://dx.doi.org/10.1097/OLQ.0000000000000842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750736PMC
September 2018

Use of National Syphilis Surveillance Data to Develop a Congenital Syphilis Prevention Cascade and Estimate the Number of Potential Congenital Syphilis Cases Averted.

Sex Transm Dis 2018 09;45(9S Suppl 1):S23-S28

From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Background: Recent increases in reported congenital syphilis have led to an urgent need to identify interventions that will have the greatest impact on congenital syphilis prevention. We sought to create a congenital syphilis prevention cascade using national syphilis surveillance data to (1) estimate the proportion of potential congenital syphilis cases averted with current prevention efforts and (2) develop a classification framework to better describe why reported cases were not averted.

Methods: We reviewed national syphilis and congenital syphilis case report data from 2016, including pregnancy status of all reported female syphilis cases and data on prenatal care, testing, and treatment status of mothers of reported congenital syphilis cases to derive estimates of the proportion of pregnant women with syphilis who received prenatal care, syphilis testing, and adequate syphilis treatment at least 30 days before delivery, as well as the proportion of potential congenital syphilis cases averted.

Results: Among the 2508 pregnant women who were reported to have syphilis, an estimated 88.0% received prenatal care at least 30 days before delivery, 89.4% were tested for syphilis at least 30 days before delivery, and 76.9% received an adequate treatment regimen that began at least 30 days before delivery. Overall, an estimated 1928 (75.0%) potential congenital syphilis cases in the United States were successfully averted. Among states that reported at least 10 syphilis cases among pregnant women, the estimated proportion of potential congenital syphilis cases averted ranged from 55.0% to 92.3%.

Conclusions: Although the majority of potential congenital syphilis cases in the United States were averted in 2016, there was substantial geographic variation, and significant gaps in delivering timely prenatal care, syphilis testing, and adequate treatment to pregnant women with syphilis were identified. The congenital syphilis prevention cascade is a useful tool to quantify programmatic successes and identify where improvements are needed.
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http://dx.doi.org/10.1097/OLQ.0000000000000838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737534PMC
September 2018

Re-emerging and newly recognized sexually transmitted infections: Can prior experiences shed light on future identification and control?

PLoS Med 2017 12 27;14(12):e1002474. Epub 2017 Dec 27.

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

How do we spot the next sexually transmitted infection? Kyle Bernstein and colleagues look for lessons from past discovery.
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http://dx.doi.org/10.1371/journal.pmed.1002474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744912PMC
December 2017

Developing a Public Health Response to Mycoplasma genitalium.

J Infect Dis 2017 07;216(suppl_2):S420-S426

Centers for Disease Control and Prevention, Atlanta, Georgia.

Although Mycoplasma genitalium is increasingly recognized as a sexually transmitted pathogen, at present there is no defined public health response to this relatively newly identified sexually transmitted infection. Currently available data are insufficient to justify routinely screening any defined population for M. genitalium infection. More effective therapies, data on acceptability of screening and its impact on clinical outcomes, and better information on the natural history of infection will likely be required before the value of potential screening programs can be adequately assessed. Insofar as diagnostic tests are available or become available in the near future, clinicians and public health agencies should consider integrating M. genitalium testing into the management of persons with sexually transmitted infection (STI) syndromes associated with the infection (ie urethritis, cervicitis, and pelvic inflammatory disease) and their sex partners. Antimicrobial-resistant M. genitalium is a significant problem and may require clinicians and public health authorities to reconsider the management of STI syndromes in an effort to prevent the emergence of ever more resistant M. genitalium infections.
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http://dx.doi.org/10.1093/infdis/jix200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853686PMC
July 2017

Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action.

PLoS Med 2017 Jul 7;14(7):e1002344. Epub 2017 Jul 7.

World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden.

In a Policy Forum, Teodora Wi and colleagues discuss the challenges of antimicrobial resistance in gonococci.
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http://dx.doi.org/10.1371/journal.pmed.1002344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501266PMC
July 2017

Screening for Syphilis and Other Sexually Transmitted Infections in Pregnant Women - Guam, 2014.

MMWR Morb Mortal Wkly Rep 2017 Jun 23;66(24):644-648. Epub 2017 Jun 23.

Prenatal screening and treatment for sexually transmitted infections (STIs) can prevent adverse perinatal outcomes. In Guam, the largest of the three U.S. territories in the Pacific, primary and secondary syphilis rates among women increased 473%, from 1.1 to 6.3 per 100,000 during 2009-2013 (1). In 2013, the first congenital syphilis case after no cases since 2008 was reported (1,2). Little is known about STI screening coverage and factors associated with inadequate screening among pregnant women in Guam. This study evaluated the prevalence of screening for syphilis, human immunodeficiency virus (HIV), chlamydia, and gonorrhea, and examined correlates of inadequate screening among pregnant women in Guam. Data came from the medical records of a randomly selected sample of mothers with live births in 2014 at a large public hospital. Bivariate analyses and multivariable models using Poisson regression were conducted to determine factors associated with inadequate screening for syphilis and other STIs. Although most (93.5%) women received syphilis screening during pregnancy, 26.8% were not screened sufficiently early to prevent adverse pregnancy outcomes. Many women were not screened for HIV infection (31.1%), chlamydia (25.3%), or gonorrhea (25.7%). Prenatal care and insurance were important factors affecting STI screening during pregnancy. Prenatal care providers play an important role in preventing congenital infections. Policies and programs increasing STI and HIV services for pregnant women and improved access to and use of prenatal care are essential for promoting healthy mothers and infants.
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http://dx.doi.org/10.15585/mmwr.mm6624a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657798PMC
June 2017

The global roadmap for advancing development of vaccines against sexually transmitted infections: Update and next steps.

Vaccine 2016 06 19;34(26):2939-2947. Epub 2016 Apr 19.

World Health Organization, Geneva, Switzerland.

In 2014, the World Health Organization, the US National Institutes of Health, and global technical partners published a comprehensive roadmap for development of new vaccines against sexually transmitted infections (STIs). Since its publication, progress has been made in several roadmap activities: obtaining better epidemiologic data to establish the public health rationale for STI vaccines, modeling the theoretical impact of future vaccines, advancing basic science research, defining preferred product characteristics for first-generation vaccines, and encouraging investment in STI vaccine development. This article reviews these overarching roadmap activities, provides updates on research and development of individual vaccines against herpes simplex virus, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, and discusses important next steps to advance the global roadmap for STI vaccine development.
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http://dx.doi.org/10.1016/j.vaccine.2016.03.111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759054PMC
June 2016

Sexually transmitted diseases treatment guidelines, 2015.

MMWR Recomm Rep 2015 Jun;64(RR-03):1-137

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885289PMC
June 2015

Cost-effectiveness of Chlamydia vaccination programs for young women.

Emerg Infect Dis 2015 Jun;21(6):960-8

We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15-24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15-24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective.
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http://dx.doi.org/10.3201/eid2106.141270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451885PMC
June 2015

Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines.

Vaccine 2014 Mar 25;32(14):1527-35. Epub 2014 Feb 25.

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.
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http://dx.doi.org/10.1016/j.vaccine.2013.07.087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794147PMC
March 2014

Dual contraceptive use among adolescents and young adults: correlates and implications for condom use and sexually transmitted infection outcomes.

J Fam Plann Reprod Health Care 2014 Jul 29;40(3):200-7. Epub 2013 Nov 29.

Chief, STD Control Branch, California Department of Public Health, Richmond, CA, USA.

Background: Simultaneous condom and hormonal contraception usage ('dual method use') maximises protection against pregnancy and sexually transmitted infection (STI), although there is concern that promotion of this strategy could result in diminished condom use and inadvertently increase STI risk. In this study, we (1) assessed how the use of dual methods, versus condoms alone, related to STI and consistency of condom use and (2) described the correlates of dual use.

Methods: A sample of 1450 young people aged 12-25 years were surveyed and screened for chlamydia and gonorrhoea at non-clinical sites in two high morbidity Californian counties in 2002-2003. Differences in STI prevalence and reported consistency of condom use were assessed for 'condom only' and 'dual method' users. Correlates of dual use were analysed via multivariate polytomous logistic regression.

Results: Condom only and dual method users did not significantly differ in terms of STI prevalence or reported consistency of condom use. Sex, age, race and relationship tenure were significant correlates of dual use.

Discussion: In these observational data, dual method use did not detrimentally affect STI risk. If interpreted alongside each subgroups' risk patterns for STI and unplanned pregnancy, the correlates of dual use can inform STI and pregnancy prevention interventions.
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http://dx.doi.org/10.1136/jfprhc-2012-100295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424102PMC
July 2014

Trends in antimicrobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project (GISP), January 2006-June 2012.

Sex Transm Infect 2013 Dec;89 Suppl 4:iv5-10

Division of STD Prevention, Centers for Disease Control and Prevention, , Atlanta, Georgia, USA.

Background: Neisseria gonorrhoeae has progressively developed resistance to sulfonamides, penicillin, tetracycline and fluoroquinolones, and gonococcal susceptibility to cephalosporins has been declining worldwide.

Methods: We described trends in gonococcal antimicrobial susceptibility in the USA from January 2006 through June 2012. Susceptibility data for cefixime, ceftriaxone, azithromycin, penicillin, tetracycline and ciprofloxacin were obtained from the Gonococcal Isolate Surveillance Project (GISP), a sentinel surveillance system that monitors antimicrobial susceptibility in urethral gonococcal isolates collected from symptomatic men at 25-30 sexually transmitted disease clinics throughout the USA.

Results: The percentage of isolates with elevated cefixime minimum inhibitory concentrations (MICs) (≥ 0.25 µg/mL) increased from 0.1% in 2006 to 1.4% in 2010-2011 and was 1.1% in the first 6 months of 2012. The percentage with elevated ceftriaxone MICs (≥ 0.125 µg/mL) increased from 0.1% in 2006 to 0.3%-0.4% during 2009 through the first 6 months of 2012. There were no temporal trends in the prevalence of elevated azithromycin MICs (≥ 2 µg/mL) (0.2%-0.5%). The prevalence of resistance remained high for penicillin (11.2%-13.2%), tetracycline (16.7%-22.8%) and ciprofloxacin (9.6%-14.8%).

Conclusions: The proportion of gonococcal isolates with elevated cephalosporin MICs increased from 2006 to 2010, but plateaued during 2011 and the first 6 months of 2012. Resistance to previously recommended antimicrobials has persisted. As the number of antimicrobials available for gonorrhoea treatment dwindles, surveillance systems such as GISP will be critical to detect emerging resistance trends and guide treatment decisions.
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http://dx.doi.org/10.1136/sextrans-2013-051162DOI Listing
December 2013

Neisseria gonorrhoeae outbreak: unintended consequences of electronic medical records and using an out-of-state laboratory-California, July 2009-February 2010.

Sex Transm Dis 2013 Jul;40(7):556-8

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Twenty of 37 gonorrhea cases identified during an outbreak were diagnosed at one health care organization that used an out-of-state laboratory. The results were transmitted into electronic medical records without provider notification. Delays in treatment and reporting were identified. Systems should be implemented to ensure provider notification of electronic laboratory results.
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http://dx.doi.org/10.1097/OLQ.0b013e3182927c8cDOI Listing
July 2013

Neisseria gonorrhoeae antimicrobial resistance among men who have sex with men and men who have sex exclusively with women: the Gonococcal Isolate Surveillance Project, 2005-2010.

Ann Intern Med 2013 Mar;158(5 Pt 1):321-8

Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-02, Atlanta, GA 30333, USA.

Background: Gonorrhea treatment has been complicated by antimicrobial resistance in Neisseria gonorrhoeae. Gonococcal fluoroquinolone resistance emerged more rapidly among men who have sex with men (MSM) than men who have sex exclusively with women (MSW).

Objective: To determine whether N. gonorrhoeae urethral isolates from MSM were more likely than isolates from MSW to exhibit resistance to or elevated minimum inhibitory concentrations (MICs) of antimicrobials used to treat gonorrhea.

Design: 6 years of surveillance data from the Gonococcal Isolate Surveillance Project.

Setting: Publicly funded sexually transmitted disease clinics in 30 U.S. cities.

Patients: Men with a total of 34 600 episodes of symptomatic urethral gonorrhea.

Measurements: Percentage of isolates exhibiting resistance or elevated MICs and adjusted odds ratios for resistance or elevated MICs among isolates from MSM compared with isolates from MSW.

Results: In all U.S. regions except the West, isolates from MSM were significantly more likely to exhibit elevated MICs of ceftriaxone and azithromycin than isolates from MSW (P < 0.050). Isolates from MSM had a high prevalence of resistance to ciprofloxacin, penicillin, and tetracycline and were significantly more likely to exhibit antimicrobial resistance than isolates from MSW (P < 0.001).

Limitations: Sentinel surveillance may not be representative of all patients with gonorrhea. HIV status, travel history, and antimicrobial use data were missing for some patients.

Conclusion: Men who have sex with men are vulnerable to the emerging threat of antimicrobial-resistant N. gonorrhoeae. Because antimicrobial susceptibility testing is not routinely done in clinical practice, clinicians should monitor for treatment failures among MSM diagnosed with gonorrhea. Strengthened prevention strategies for MSM and new antimicrobial treatment options are needed.
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http://dx.doi.org/10.7326/0003-4819-158-5-201303050-00004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697257PMC
March 2013

A Trich-y question: should Trichomonas vaginalis infection be reportable?

Sex Transm Dis 2013 Feb;40(2):113-6

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

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http://dx.doi.org/10.1097/OLQ.0b013e31827c08c3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024551PMC
February 2013

Sex, drugs (methamphetamines), and the Internet: increasing syphilis among men who have sex with men in California, 2004-2008.

Am J Public Health 2013 Aug 15;103(8):1450-6. Epub 2012 Nov 15.

California Department of Public Health, STD Control Branch, 850 Marina Bay Parkway, Bldg P, 2nd Floor, Richmond, CA 94804, USA.

Objectives: We examined primary and secondary syphilis cases among men who have sex with men (MSM) in California, and the association of methamphetamine use and Internet use to meet sex partners (Internet use) with number of sex partners.

Methods: We analyzed California surveillance data for MSM who were diagnosed with syphilis between 2004 and 2008, to assess differences in the mean number of sex partners by methamphetamine use and mutually exclusive groups of patients reporting Internet use (Internet users).

Results: Large proportions of patients reported methamphetamine use (19.2%) and Internet use (36.4%). From 2006 through 2008, Adam4Adam was the most frequently reported Web site statewide, despite temporal and regional differences in Web site usage. Methamphetamine users reported more sex partners (mean = 11.7) than nonmethamphetamine users (mean = 5.6; P < .001). Internet users reported more sex partners (mean = 9.8) than non-Internet users (mean = 5.0; P < .001). Multivariable analysis of variance confirmed an independent association of methamphetamine and Internet use with increased numbers of sex partners.

Conclusions: Higher numbers of partners among MSM syphilis patients were associated with methamphetamine and Internet use. Collaboration between currently stand-alone interventions targeting methamphetamine users and Internet users may offer potential advances in sexually transmitted disease control efforts.
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http://dx.doi.org/10.2105/AJPH.2012.300808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007854PMC
August 2013

Syphilis outbreak at a California men's prison, 2007-2008: propagation by lapses in clinical management, case management, and public health surveillance.

J Correct Health Care 2013 Jan 18;19(1):54-64. Epub 2012 Sep 18.

Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA 94804, USA.

This field report describes an investigation to identify cases to control a syphilis outbreak in a prison and determine whether clinical, case management, and surveillance practices influenced the outbreak occurrence, detection, or management. Key performance measures were assessed to evaluate timeliness and quality of clinical and case management activities and surveillance practices. Thirty cases were found. Prior to the investigation, median times for clinical and reporting/surveillance measures were 15 days from primary and secondary (P&S) symptom onset to exam, 7 days from P&S exam to treatment, and 63 days from serologic test to the state's receipt of case. After the investigation, these measures improved to 8, 4.5, and 28 days, respectively. Lack of adherence to surveillance and clinical management protocols likely contributed to this outbreak, which was curtailed by aggressive control measures.
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http://dx.doi.org/10.1177/1078345812458088DOI Listing
January 2013

The emerging threat of untreatable gonococcal infection.

N Engl J Med 2012 Feb;366(6):485-7

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA.

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http://dx.doi.org/10.1056/NEJMp1112456DOI Listing
February 2012

Neisseria gonorrhoeae with high-level resistance to azithromycin: case report of the first isolate identified in the United States.

Clin Infect Dis 2012 Mar 19;54(6):841-3. Epub 2011 Dec 19.

Department of Public Health Sciences, John A Burns School of Medicine, University of Hawaii at Manoa, USA.

We report on the first Neisseria gonorrhoeae isolate in the United States identified with high-level resistance to azithromycin. This report discusses the epidemiologic case investigation, the molecular studies of resistance-associated mutations and N. gonorrhoeae multiantigen sequence typing, and challenges posed by emerging gonococcal antimicrobial resistance.
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http://dx.doi.org/10.1093/cid/cir929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746146PMC
March 2012

Repeat syphilis among men who have sex with men in California, 2002-2006: implications for syphilis elimination efforts.

Am J Public Health 2012 Jan 28;102(1):e1-8. Epub 2011 Nov 28.

Center for AIDS Prevention Studies, San Francisco, CA, USA.

Objectives: We examined rates of and risk factors for repeat syphilis infection among men who have sex with men (MSM) in California.

Methods: We analyzed 2002 to 2006 California syphilis surveillance system data.

Results: During the study period, a mean of 5.9% (range: 4.9%-7.1% per year) of MSM had a repeat primary or secondary (PS) syphilis infection within 2 years of an initial infection. There was no significant increase in the annual proportion of MSM with a repeat syphilis infection (P = .42). In a multivariable model, factors associated with repeat syphilis infection were HIV infection (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.14, 2.37), Black race (OR = 1.84; 95% CI = 1.12, 3.04), and 10 or more recent sex partners (OR = 1.99; 95% CI = 1.12, 3.50).

Conclusions: Approximately 6% of MSM in California have a repeat PS syphilis infection within 2 years of an initial infection. HIV infection, Black race, and having multiple sex partners are associated with increased odds of repeat infection. Syphilis elimination efforts should include messages about the risk for repeat infection and the importance of follow-up testing. Public health attention to individuals repeatedly infected with syphilis may help reduce local disease burdens.
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http://dx.doi.org/10.2105/AJPH.2011.300383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490561PMC
January 2012

Chlamydia partner services for females in California family planning clinics.

Sex Transm Dis 2011 Oct;38(10):913-8

California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Sexually Transmitted Disease Control Branch, Richmond, CA 94804, USA.

Background: Prompt treatment of exposed partners is critical for preventing further transmission of chlamydia, reinfection, and sequelae among females. Patient-delivered partner therapy (PDPT) has been allowable in California since 2001; however, few data are available regarding PDPT use and treatment outcomes.

Methods: Eight family planning clinics participated in a partner services evaluation from 2005 to 2006. Females aged 16 to 35 years with chlamydia were interviewed to determine the partner service received and partner treatment outcomes; a subset of partners was also interviewed. Determinants of reported partner treatment were assessed using multivariate logistic regression. Selected medical records were reviewed to assess reinfection rates.

Results: Overall, 743 female patients disclosed 952 partners; 58% of whom were identified as steady partners. Reported partner services included concurrent patient-partner treatment visits (15% of partners), PDPT (19%), patient referral (55%), health department referral (0.1%), and no partner management (11%). On the basis of patient report, 82% of partners were notified and 54% received treatment. Of the 166 (17%) partners interviewed, 139 (84%) reported that they had received treatment, which correlated well with patient report. Reported partner treatment was higher for concurrent treatment visits and PDPT (79% and 80%, respectively) compared to patient referral (44%, P < 0.0001). Adjusted for clinic and relationship status, partners managed with concurrent treatment visits or PDPT were more likely to receive treatment compared with partners managed with patient referral (adjusted odds ratios, 3.5; 95% confidence interval, 2.1-5.8 and adjusted odds ratios, 4.3; 95% confidence interval, 2.6-7.2, respectively). Among the patients retested within 6 months after treatment, 18% were reinfected; reinfection rates did not differ by type of partner service.

Conclusions: Although overall rates of reported partner treatment were low, concurrent patient-partner treatment visits and PDPT were associated with significantly higher rates of partner treatment. However, these methods may be underutilized in California family planning settings.
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http://dx.doi.org/10.1097/OLQ.0b013e3182240366DOI Listing
October 2011