Development and Evaluation of a Procedure to Identify Possible Gonorrhea Treatment Failure Cases in Illinois.

BACKGROUND: Cephalosporins are the last effective class of antibiotics to treat gonorrhea infections. In Illinois, gonorrhea cases have increased by 70.9% from 2015 to 2019. Because of the concern of antimicrobial resistance and the increasing number of cases, the Illinois Department of Public Health Sexually Transmitted Diseases Section established a procedure to identify possible gonorrhea treatment failure cases. MATERIALS AND METHODS: A procedure was developed that identifies patients who have had 2 gonorrhea cases in the last 60 days, and the first case was treated with the Centers for Disease Control and Prevention-recommended treatment. Interview records were faxed to the local health department (LHD) where the patient resides. Descriptive statistics were used to analyze interview record data. A process evaluation was conducted using telephone interviews with LHDs to obtain qualitative feedback on the procedure. RESULTS: A total of 310 interview records were sent for investigation in 2018 and 2019 with 263 returned. Of those returned, 140 identified reexposure, 104 were unable to be located, 12 refused to be interviewed, 6 had treatment reported incorrectly, and 1 had a possible treatment failure. From telephone interviews with 6 LHDs, 1 question was removed and 2 questions were added to the interview record. CONCLUSIONS: Antibiotic-resistant gonorrhea could occur in Illinois at any time. Monitoring for antibiotic-resistant gonorrhea cases is necessary as gonorrhea morbidity continues to increase. This procedure may prove to be a model for other states.

How the evolving epidemics of opioid misuse and HIV infection may be changing the risk of oral sexually transmitted infection risk through microbiome modulation.

The epidemiology of sexually transmitted infections (STI) is constantly evolving, and the mechanisms of infection risk in the oral cavity (OC) are poorly characterized. Evidence indicates that microbial community (microbiota) compositions vary widely between the OC, genitalia and the intestinal and rectal mucosa, and microbiome-associated STI susceptibility may also similarly vary. The opioid misuse epidemic is at an epidemic scale, with >11 million US residents misusing in the past 30 days. Opioids can substantially influence HIV progression, microbiota composition and immune function, and these three factors are all mutually influential via direct and indirect pathways. While many of these pathways have been explored independently, the supporting data are mostly derived from studies of gut and vaginal microbiotas and non-STI infectious agents. Our purpose is to describe what is known about the combination of these pathways, how they may influence microbiome composition, and how resultant oral STI susceptibility may change. A better understanding of how opioid misuse influences oral microbiomes and STI risk may inform better mechanisms for oral STI screening and intervention. Further, the principles of interaction described may well be applied to other aspects of disease risk of other health conditions which may be impacted by the opioid epidemic.