Treatment of Mpox with Suspected Tecovirimat Resistance in Immunocompromised Patient, United States, 2022.

Reports of tecovirimat-resistant mpox have emerged after widespread use of antiviral therapy during the 2022 mpox outbreak. Optimal management of patients with persistent infection with or without suspected resistance is yet to be established. We report a successfully treated case of severe mpox in California, USA, that had suspected tecovirimat resistance.

Monkeypox (Mpox) Vaccine Hesitancy Among Mpox Cases: A Qualitative Study.

Human mpox has been an increasing concern in the United States and California since late 2022. While the Jynneos vaccine offers a degree of cross-protection against the disease, vaccine hesitancy is common among those recommended for vaccination. The purpose of this study was to assess vaccine knowledge, facilitators, and barriers to vaccine uptake among individuals previously diagnosed with mpox, or mpox cases, in Santa Clara County, California. In-depth interviews were conducted by public health department staff among mpox cases diagnosed in Santa Clara County between July and September 2022. Responses were analyzed using a grounded theory data analysis approach. Among the 47 participants, 36 (77%) had heard of mpox before diagnosis, and of these, 20 (56%) did not think they were at risk of developing mpox, and 28 (78%) were aware that a vaccine was available. Those who did not receive the vaccine stated vaccine access and availability were the main barriers. Among the six participants not interested in the vaccine, the main hesitancies were lack of perceived risk, stigma of being branded by scarring and labeled gay, and vaccine safety. Overall, the following themes were attributed to reasons for vaccine hesitancy: (a) lack of awareness of the disease and vaccine, including perceived risks; (b) lack of vaccine availability and accessibility; and (c) stigma associated with receiving the vaccine, including being publicly labeled as "gay" and the scarring on forearm potentially seen as branding. We recommend tailoring outreach and educational campaigns to address reasons for mpox vaccine hesitancy.

Sexually Transmitted Human Papillomavirus: Update in Epidemiology, Prevention, and Management.

This review presents the epidemiology, pathophysiology, prevention, and management of sexually transmitted human papillomavirus (HPV) and its associated diseases. HPV is the most common sexually transmitted infection worldwide. Prevalence varies regionally. Low-risk strains cause anogenital warts, which can be managed with patient- or provider-applied therapies. High-risk strains cause lower anogenital cancers. Primary and secondary prevention strategies include vaccination and screening for precancerous lesions, respectively. Management of abnormal screening results vary by test result, anatomic site, and individual cancer risk. Approaches include close rescreening, high-resolution visualization with biopsy, and-when biopsy-proven precancer is identified-removal or destruction of the lesion.

Delivering on the Promise: Exploring Training Characteristics and Graduate Career Pursuits of Primary Care Internal Medicine Residency Programs and Tracks.

BACKGROUND: Specialized primary care internal medicine (PC IM) residency programs and tracks aim to provide dedicated PC training. How programs deliver this is unclear. OBJECTIVE: We explored how PC IM programs and tracks provide ambulatory training. METHODS: We conducted a cross-sectional survey from 2012 to 2013 of PC IM program and track leaders via a search of national databases and program websites. We reported PC IM curricular content, clinical experiences, and graduate career pursuits, and assessed correlation between career pursuits and curricular content and clinical experiences. RESULTS: Forty-five of 70 (64%) identified PC IM programs and tracks completed the survey. PC IM programs provide a breadth of curricular content and clinical experiences, including a mean 22.8 weeks ambulatory training and a mean 69.4 continuity clinics per year. Of PC IM graduates within 5 years, 55.8% pursue PC or general internal medicine (GIM) careers and 23.1% pursue traditional subspecialty fellowship training. Curricular content and clinical experiences correlate weakly with career choices. PC IM graduates pursuing PC or GIM careers correlated with ambulatory rotation in women's health (correlation coefficient [rho] = 0.36, P = .034) and mental health (rho = 0.38, P = .023) and curricular content in teaching and medical education (rho = 0.35, P = .035). PC IM graduates pursuing subspecialty fellowship negatively correlated with curricular content in leadership and teams (rho = -0.48, P = .003) and ambulatory training time (rho = -0.38, P = .024). CONCLUSIONS: PC IM programs and tracks largely deliver on the promise to provide PC training and education and produce graduates engaged in PC and GIM.