Publications by authors named "Karen A Wendel"

14 Publications

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Medicaid Expansion and Rates of Reportable Sexually Transmitted Infections in the United States A County-Level Analysis.

Sex Transm Dis 2021 Mar 16. Epub 2021 Mar 16.

1Rietmeijer Consulting, LLC 2Denver Public Health Department, Denver Health and Hospital 3Colorado School of Public Health, University of Colorado Denver.

Chlamydia, gonorrhea, and primary/secondary syphilis rates in 2018 were significantly higher in counties located in states without Medicaid expansion compared to those with Medicaid expansion. For STI combined, 59.9% of counties without Medicaid expansion were in the highest two STI rate quartiles compared to 42.2% of counties with Medicaid expansion (p<0.0001).
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http://dx.doi.org/10.1097/OLQ.0000000000001422DOI Listing
March 2021

Detection of Severe Acute Respiratory Syndrome Coronavirus 2 on Self-Collected Saliva or Anterior Nasal Specimens Compared With Healthcare Personnel-Collected Nasopharyngeal Specimens.

Clin Infect Dis 2021 07;73(Suppl 1):S65-S73

Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.

Background: Nasopharyngeal specimens (NPS) are commonly used for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing but can be uncomfortable for patients. Self-collected saliva specimens (SS) or anterior nasal specimens (ANS) for SARS-CoV-2 detection are less invasive, but the sensitivity of these specimen types has not been thoroughly evaluated.

Methods: During September-November 2020, 730 adults undergoing SARS-CoV-2 testing at community testing events and homeless shelters in Denver provided self-collected SS and ANS before NPS collection and answered a short survey about symptoms and specimen preference. Specimens were tested for SARS-CoV-2 by means of real-time reverse-transcription polymerase chain reaction (rRT-PCR); viral culture was performed on a subset of specimens positive by rRT-PCR. The sensitivity of SS and ANS for SARS-CoV-2 detection by rRT-PCR was measured against that of NPS. Subgroup analyses included test outcomes by symptom status and culture results.

Results: Sensitivity for SARS-CoV-2 detection by rRT-PCR appeared higher for SS than for ANS (85% vs 80%) and higher among symptomatic participants than among those without symptoms (94% vs 29% for SS; 87% vs 50% for ANS). Among participants with culture-positive SARS-CoV-2 by any specimen type, the sensitivities of SS and ANS by rRT-PCR were 94% and 100%, respectively. SS and ANS were equally preferred by participants; most would undergo NPS collection again despite this method's being the least preferred.

Conclusions: SS were slightly more sensitive than ANS for SARS-CoV-2 detection with rRT-PCR. With both SS and ANS, SARS-CoV-2 was reliably detected among participants with symptoms. Self-collected SS and ANS offer practical advantages, are preferred by patients, and might be most useful for testing people with coronavirus disease 2019 symptoms.
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http://dx.doi.org/10.1093/cid/ciab330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135412PMC
July 2021

Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care.

Open Forum Infect Dis 2019 Jul 27;6(7):ofz310. Epub 2019 Jun 27.

Denver Public Health, Denver Health and Hospital Authority, Colorado.

Objective: Strategies to increase pre-exposure prophylaxis (PrEP) uptake are needed. We hypothesized that same-day PrEP initiation in a sexually transmitted diseases (STD) clinic would be acceptable, feasible, and safe, and that individuals would engage in ongoing PrEP care.

Method: Individuals aged ≥ 18 years were evaluated for PrEP. Exclusion criteria were HIV, history of renal dysfunction or chronic hepatitis B infection, pregnancy, indications for HIV post-exposure prophylaxis, or positive screen for acute HIV symptoms. One hundred individuals received a free 30-day PrEP starter pack and met with a patient navigator to establish ongoing care. Bivariate analysis and multivariable logistic regression were used to compare individuals who did and did not attend at least 1 PrEP follow-up appointment within 180 days of enrollment. Client satisfaction surveys were given 3 months after enrollment.

Results: The majority (78%) of participants completed at least 1 PrEP follow-up appointment, and 57% attended at least 2 follow-up appointments. After adjusting for race and ethnicity, age, health insurance status, and annual income, only income was associated with follow-up appointment attendance. Each additional $10,000 increase in income was associated with a 1.7-fold increase in the odds of attending a PrEP follow-up appointment (95% confidence interval, 1.07-2.66, = .02). The majority (54%) of individuals completed the satisfaction survey and all respondents liked the option of same-day PrEP initiation.

Conclusions: Our study suggests STD clinic-based, same-day PrEP initiation is acceptable, feasible, safe, and links a high proportion of individuals into ongoing PrEP care. Additional resources may be needed to support low-income individuals' retention in care.
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http://dx.doi.org/10.1093/ofid/ofz310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641790PMC
July 2019

Rapid Syphilis Testing for Men Who Have Sex With Men in Outreach Settings: Evaluation of Test Performance and Impact on Time to Treatment.

Sex Transm Dis 2019 03;46(3):191-195

Colorado Department of Public Health and Environment, Division of Molecular Science and Public Health Microbiology, Denver, CO.

Background: Rapid syphilis tests (RST) may shorten time to syphilis diagnosis and treatment while enhancing access to testing in outreach settings. There are limited data on the performance of RST in outreach settings in the US.

Methods: We offered RST (Syphilis Health Check) at 6 outreach sites to men who reported having sex with men and no prior history of syphilis. Clients accepting RST were also tested with laboratory-based rapid plasma reagin (RPR) and reflex Treponema pallidum particle agglutination (TPPA) assay when RPR or RST were positive. Clients with positive RST were immediately referred to a sexually transmitted infection clinic. Those declining RST were screened with RPR and reflex TPPA only. The validity of the RST-based algorithm was compared with the RPR-based algorithm among participants receiving both. Time to treatment for those accepting RST was compared with those declining RST and to a historical control group screened in outreach settings with RPR and reflex TPPA before the availability of RST.

Results: Rapid syphilis test was accepted by 690 (64%) of 1081 eligible clients. Compared with RPR-based algorithm, RST sensitivity was 90%; specificity, 98.5%; positive predictive value, 47.4%; and negative predictive value, 98.5. The single false-negative case by RST was determined to be a late latent case by RPR/TPPA. Median time to treatment was 1 day (range, 0-6 days) for 9 of 690 accepting RST, compared to 9 days (range, 7-13 days) for 3 of 391 declining RST, and 9 days (range, 6-21 days) for 25 of 1229 historical controls (P < 0.0001).

Conclusion: Compared with an RPR-based algorithm, RST identified all early syphilis cases. Although RST had high specificity and negative predictive value, the low positive predictive value resulted in additional assessments in a sexually transmitted infection clinic for some patients. However, RST use in outreach settings significantly decreased time to treatment for new syphilis cases.
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http://dx.doi.org/10.1097/OLQ.0000000000000932DOI Listing
March 2019

A New Resource for STD Clinical Providers: The Sexually Transmitted Diseases Clinical Consultation Network.

Sex Transm Dis 2017 08;44(8):510-512

From the *Denver Public Health Department, Denver Health and Hospital, Denver, CO; †Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO; ‡Gilead Sciences, Foster City, CA; §Denver Public Health, Denver, CO; ¶Colorado School of Public Health, University of Colorado, Denver, CO; ∥Rietmeijer Consulting, Denver, CO.

An online consultation tool, the Sexually Transmitted Diseases Clinical Consultation Network is a new resource for sexually transmitted disease clinicians and clinic managers. An initial evaluation shows that most requests (29%) were from medical doctors, followed by nurse practitioners (22%). Syphilis queries comprised 39% of consults followed by gonorrhea (12%) and chlamydia (11%).
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http://dx.doi.org/10.1097/OLQ.0000000000000632DOI Listing
August 2017

Trichomoniasis: challenges to appropriate management.

Clin Infect Dis 2007 Apr;44 Suppl 3:S123-9

Division of Infectious Diseases, University of Colorado Health Science Center, Denver, CO, USA.

Trichomonas vaginalis infection is a common cause of vaginal irritation in women and is the most common nonviral sexually transmitted disease in the world. It has been associated with serious sequelae, the most notable of which are prematurity, low birth weight, and increases in human immunodeficiency virus transmission. We review advances in diagnosis and treatment and the current controversies regarding management.
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http://dx.doi.org/10.1086/511425DOI Listing
April 2007

Trichomoniasis and its treatment.

Expert Rev Anti Infect Ther 2006 Feb;4(1):125-35

Department of Medicine, Oklahoma University Health Science Center, Oklahoma City, OK, USA.

Trichomonas vaginalis has long been recognized as a cause of infectious vaginitis in women. More recently, studies have demonstrated a significant burden of disease in men with urethritis or men at high risk for sexually transmitted diseases. There is increasing interest in this pathogen as more data accumulates linking it to HIV transmission and perinatal morbidity. New diagnostic methods have emerged that may increase sensitivity of diagnosis or improve point-of-care access to testing. Nitroimidazoles remain the mainstay of therapy. Metronidazole and tinidazole are highly effective as single-dose therapy. Unfortunately, despite the link between T. vaginalis infection and perinatal morbidity, nitroimidazole therapy during pregnancy remains controversial. Although metronidazole resistance is currently uncommon, pharmacological features and nitroimidazole resistance patterns suggest that tinidazole may be more effective in treating patients with metronidazole treatment failure. Alternatives to nitroimidazole therapy are few, and most have limited efficacy and significant toxicity.
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http://dx.doi.org/10.1586/14787210.4.1.125DOI Listing
February 2006

Use of an immunochromatographic assay for rapid detection of Trichomonas vaginalis in vaginal specimens.

J Clin Microbiol 2005 Feb;43(2):684-7

Division of Adolescent Medicine (ML 4000), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.

Trichomonas vaginalis infection is estimated to be the most widely prevalent nonviral sexually transmitted infection in the world. Wet-mount microscopy is the most common diagnostic method, although it is less sensitive than culture. The OSOM Trichomonas Rapid Test (Genzyme Diagnostics, Cambridge, Mass.) (referred to here as OSOM) is a new point-of-care diagnostic assay for T. vaginalis that uses an immunochromatographic capillary flow (dipstick) assay and provides results in 10 min. The purpose of this study was to determine the test characteristics of OSOM compared to those of a composite reference standard (CRS) comprised of wet-mount microscopy and T. vaginalis culture. This multicenter cross-sectional study enrolled sexually active women > or =18 years of age who presented with symptoms of vaginitis, exposure to T. vaginalis, or multiple sexual partners. Vaginal-swab specimens were obtained for T. vaginalis culture, wet mount, and rapid testing. The prevalence of T. vaginalis in this sample was 23.4% (105 of 449) by the CRS. The sensitivity and specificity of OSOM vaginal-swab specimens were 83.3 and 98.8%, respectively, while wet mount had a sensitivity and specificity of 71.4 and 100%, respectively, compared to the CRS. OSOM performed significantly better than wet mount (P = 0.004) and detected T. vaginalis in samples that required 48 to 72 h of incubation prior to becoming culture positive. The performance of the rapid test was not affected by the presence of coinfections with chlamydia and gonorrhea. The OSOM Trichomonas Rapid Test is a simple, objective test that can be expected to improve the diagnosis of T. vaginalis, especially where microscopy and culture are unavailable.
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http://dx.doi.org/10.1128/JCM.43.2.684-687.2005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC548056PMC
February 2005

Review of antiviral therapy for herpes labialis, genital herpes and herpes zoster.

Expert Rev Anti Infect Ther 2003 Aug;1(2):283-95

Oklahoma University Health Science Center Department of Internal Medicine, Section Infectious Diseases, Oklahoma City, OK, USA.

Acyclovir (Zovirax) was approved for the treatment of herpesvirus infections almost two decades ago. It was the first agent in a novel group of antiviral medications that now include valacyclovir (Valtrex), penciclovir (Denavir and famciclovir (Famvir). These agents have made a dramatic impact on the morbidity associated with herpes simplex virus infections and herpes zoster. Topical and oral antiviral use have shown modest but statistically significant efficacy in treating herpes labialis with most studies demonstrating a significant reduction in episode length and/or healing time. Oral acyclovir, valacyclovir and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes and are useful as suppressive therapy for individuals with frequent genital herpes recurrences. In addition, high doses of oral acyclovir, valacyclovir and famciclovir have been shown to speed the healing of herpes zoster, and data suggests that these agents also decrease associated acute and chronic pain in people of 50 years of age or older. Further research is required to clarify the safety of these agents in pregnant women with genital herpes, the role of antiviral therapy in decreasing the sexual transmission of genital herpes, and the efficacy and cost-effectiveness of these agents in treating herpes zoster in people below the age of 50 years.
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http://dx.doi.org/10.1586/14787210.1.2.283DOI Listing
August 2003

Acute meningoencephalitis in chronic human immunodeficiency virus (HIV) infection: putative central nervous system escape of HIV replication.

Clin Infect Dis 2003 Oct 24;37(8):1107-11. Epub 2003 Sep 24.

Division of Infectious Diseases, Oklahoma University Health Science Center, Oklahoma City, OK 73104, USA.

We describe 3 patients with chronic human immunodeficiency virus (HIV) infection who presented with syndromes compatible with acute meningoencephalitis secondary to HIV; these syndromes were characterized by elevated cerebrospinal spinal fluid (CSF) HIV viral loads and T2-weighted signal abnormalities on magnetic resonance imaging of the brain. After the initiation of or a change in highly active antiretroviral therapy (HAART), each of the patients had significant and rapid improvement in neurologic symptoms and dramatic reductions in CSF HIV viral loads. Although further investigation is needed, these findings suggest that measurement of CSF HIV viral load and treatment with central nervous system-penetrating HAART should be considered for patients with acute neurologic complaints, chronic HIV infection, and no other identifiable cause of neurologic illness.
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http://dx.doi.org/10.1086/378300DOI Listing
October 2003

Trichomoniasis: What's New?

Authors:
Karen A. Wendel

Curr Infect Dis Rep 2003 Apr;5(2):129-134

Division of Infectious Diseases, Oklahoma University Health Science Center, 921 NE 13th Street (111C), Oklahoma City, OK 73104, USA.

Trichomonas vaginalis is the most common nonviral sexually transmitted disease in the world. Recent research has elucidated several virulence factors that allow T. vaginalis to adhere to extracellular host proteins and evade the host immune system. Further investigation is needed to determine the mechanisms responsible for the perinatal morbidity associated with trichomoniasis and to evaluate the interactions between trichomoniasis and HIV infection. An effort to decrease T. vaginalis associated with perinatal morbidity by metronidazole treatment in pregnancy was unsuccessful. However, more sensitive tools for diagnosis such as polymerase chain reaction may further facilitate future understanding of the epidemiology and risk factors of disease and improve approaches to control this widespread infection. Treatment has remained highly efficacious with single-dose metronidazole, although concern regarding drug resistance has led to more systematic evaluations of the prevalence of metronidazole resistance and alternatives to metronidazole treatment.
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http://dx.doi.org/10.1007/s11908-003-0049-zDOI Listing
April 2003

Double-stranded RNA viral infection of Trichomonas vaginalis infecting patients attending a sexually transmitted diseases clinic.

J Infect Dis 2002 Aug 19;186(4):558-61. Epub 2002 Jul 19.

Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Trichomonas vaginalis (TV) can be infected with double-stranded RNA (dsRNA) viruses that may have important implications for trichomonal virulence and disease pathogenesis. A cross-sectional study was conducted in a sexually transmitted diseases clinic to determine the prevalence and clinical significance of dsRNA viral infection of TV infecting men and women. Overall, dsRNA virus was present in 21 (75%) of 28 TV isolates (95% confidence interval [CI], 55%-89%). dsRNA viral infection of TV was not associated with the presence of discharge, dysuria, genital pruritus, or genital irritation or odor. However, patients with virus-positive isolates were significantly older than patients with virus-negative isolates (median age, 38 vs. 23 years; P=.003), and virus-positive isolates were more prevalent among women (19 [86%] of 22 isolates; 95% CI, 65%-97%) than among men (2 [33%] of 6 isolates; P=.02). The age and sex specificity of virus-positive isolates may aid in understanding the differences in chronicity and clinical presentation of TV in men and women.
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http://dx.doi.org/10.1086/341832DOI Listing
August 2002

Trichomonas vaginalis polymerase chain reaction compared with standard diagnostic and therapeutic protocols for detection and treatment of vaginal trichomoniasis.

Clin Infect Dis 2002 Sep 6;35(5):576-80. Epub 2002 Aug 6.

Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Wet preparation has limited sensitivity for diagnosis of Trichomonas vaginalis (TV) infection. An observational study of 337 women was conducted to evaluate a new polymerase chain reaction (PCR) test for TV. The sensitivities of wet preparation and TV culture were 52% (95% confidence interval [CI], 41-62) and 78% (95% CI, 69-86), respectively. TV PCR had a sensitivity of 84% (95% CI, 75-90) and a specificity of 94% (95% CI, 90-97). Metronidazole was provided to 67 (69%) of 97 women with TV because of TV on wet preparation, exposure to TV, or a diagnosis of bacterial vaginosis or pelvic inflammatory disease; however, if TV PCR had been used for diagnosis, 81 (84%) of 97 women with TV would have been treated (P=.02). TV is significantly undertreated using standard algorithms for metronidazole therapy. Given the association of trichomoniasis with perinatal morbidity and HIV transmission, women in high-risk groups may benefit from TV PCR.
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http://dx.doi.org/10.1086/342060DOI Listing
September 2002

Tuberculosis and HIV.

AIDS Clin Care 2002 Feb;14(2):9-15

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February 2002