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BACKGROUND: The association between illicit opioid use and prescription opioid misuse and sexually transmitted infections (STIs) has not been examined recently. Our study aimed to explore differences in STI/HIV care, and delivery of recommended testing and diagnoses among patients with and without opioid use disorder (OUD). METHODS: Using 2019 MarketScan commercial claims data, we identified 15- to 44-year-old male and female patients, to assess the percentages of STI/HIV diagnoses (using International Classification of Diseases, Tenth Revision, Clinical Modification ) and screening (using Current Procedure Terminology codes) among patients with or without OUD diagnoses codes. We further assessed STI/HIV testing and diagnoses by demographic factors. RESULTS: We identified 24,724 patients with OUD codes among 7.31 million patients. Both STI/HIV testing and diagnoses were significantly ( P < 0.05) higher among patients with OUD codes versus without: testing percentages were 16.81% versus 12.93% for chlamydia, 22.31% versus 16.62% for gonorrhea, 15.26% versus 7.61% for syphilis, and 18.18% versus 7.60% for HIV; diagnoses were 0.80% versus 0.35% for chlamydia, 0.30% versus 0.11% for gonorrhea, 0.23% versus 0.07% for syphilis, and 0.74% versus 0.33% for HIV. Similarly, among 0.53 million 15- to 24-year-old females who received services suggestive of sexual activity, chlamydia testing was significantly ( P < 0.05) higher among patients with OUD codes versus without (59.78% vs. 55.66%). CONCLUSIONS: Patients with OUD codes have higher percentages of STI/HIV testing and diagnoses codes compared with those without OUD codes. Clinicians may want to consider a comprehensive multidisciplinary (OUD and STI prevention) approach in patient care and provide recommended STI/HIV screening among patients with OUD if not performed.
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Infecciones por VIH , Prueba de VIH , Trastornos Relacionados con Opioides , Enfermedades de Transmisión Sexual , Humanos , Masculino , Femenino , Adulto , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/complicaciones , Enfermedades de Transmisión Sexual/diagnóstico , Adulto Joven , Infecciones por VIH/diagnóstico , Infecciones por VIH/complicaciones , Adolescente , Prueba de VIH/estadística & datos numéricos , Tamizaje Masivo , Estados Unidos/epidemiología , Gonorrea/diagnósticoRESUMEN
BACKGROUND: Routine sexually transmitted infection and human immunodeficiency virus (STI/HIV) testing and HIV pre-exposure prophylaxis (PrEP) use are recommended for men who have sex with men (MSM) at increased risk of HIV. METHODS: Using Healthverity, a large administrative dataset in the United States, we assessed STI/HIV testing, chlamydia and gonorrhea positivity by specimen type, and HIV PrEP use among MSM and men who have sex with men and women (MSMW) at their first visits (index date) for those at increased risk of HIV and STIs from 2019 through 2022. RESULTS: Among 81,716 MSM and MSMW aged 15-64 years at their index date visit, STI testing rates were 57.9% for chlamydia, 58.1% for gonorrhea, and 52.2% for syphilis testing, respectively; 55.5%, 30.9%, and 18.1% had HIV testing, HIV PrEP use, and PrEP initiation, respectively, among the patients who did not have HIV. Of patients with chlamydia and gonorrhea testing, 48% were tested from the genital site only and 25% from three anatomic sites (rectal, pharyngeal, and urogenital). Chlamydia and gonorrhea positivity was 9.8% for chlamydia rectal infection, 7.3% for gonorrhea rectal infection, and 5.3% for gonorrhea pharyngeal infection. CONCLUSION: Our results present current medical services provided during initial clinic visits for MSM and MSMW in private outpatient settings. Our study suggests that the assessment of STI/HIV testing is periodically needed due to the high prevalence of infection, and efforts to promote HIV PrEP for MSM and MSMW in private settings are urgently needed.
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BACKGROUND: In the United States, most chlamydia cases are reported from non-sexually transmitted disease clinics, and there is limited information focusing on the reasons for chlamydia testing in private settings. These analyses describe clinical visits to primary care providers where chlamydia testing was performed to help discern between screening and diagnostic testing for chlamydia. METHODS: Using the largest primary care clinical registry in the United States, the PRIME registry, chlamydia tests were identified using Current Procedural Terminology procedure codes and categorized as diagnostic testing for sexually transmitted infection (STI)-related symptoms, screening for chlamydia, or "other," based on Classification of Diseases, Tenth Revision Evaluation and Management codes selected for visits. RESULTS: Of 120,013 clinical visits with chlamydia testing between January 1, 2019, and December 31, 2022, 70.4% were women; 20.6% were with STI-related symptoms, 59.9% were for screening, and 19.5% for "other" reasons. Of those 120,013 clinical visits with chlamydia testing, the logit model showed that patients were significantly more likely to have STI-related symptoms if they were female than male, non-Hispanic Black than non-Hispanic White, aged 15 to 24 years than aged ≥45 years, and resided in the South than in the Northeast. CONCLUSION: It is important to know what proportion of chlamydial infections is identified through screening programs and to have this information stratified by demographics. The inclusion of laboratory results could further facilitate a better understanding of the impact of chlamydia screening programs on the identification and treatment of chlamydia in private office settings in the United States.
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Infecciones por Chlamydia , Tamizaje Masivo , Atención Primaria de Salud , Humanos , Femenino , Estados Unidos , Masculino , Infecciones por Chlamydia/diagnóstico , Adulto , Adolescente , Adulto Joven , Persona de Mediana Edad , Sistema de RegistrosRESUMEN
BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the 2 most common sexually transmitted infections (STIs) in the United States. The Centers for Disease Control and Prevention regularly publishes and updates STI Treatment Guidelines. The purpose of this study was to measure and compare treatment rates for CT and GC among public and private providers. METHODS: Data from multiple sources, including electronic health records and Medicaid claims, were linked and integrated. Cases observed during 2016-2020 were defined based on positive laboratory results. We calculated descriptive statistics and odd ratios based on characteristics of providers and patients, stratifying by public versus private providers. Univariate logistic regression models were used to examine the factors associated with recommended treatment. RESULTS: Overall, we found that 82.2% and 63.0% of initial CT and GC episodes, respectively, received Centers for Disease Control and Prevention-recommended treatment. The public STI clinic treated more than 90% of CT and GC cases consistently across the 5-year period. Private providers were significantly less likely to treat first episodes for CT (79.6%) and GC (53.3%; P < 0.01). Other factors associated with a higher likelihood of recommended treatment included being male, being HIV positive, and identifying as Black or multiracial. Among GC cases, 10.8% received nonrecommended treatment; all CT cases with treatment occurred per guidelines. CONCLUSIONS: Although these treatment rates are higher than previous studies, there remain significant gaps in STI treatment that require intervention from public health.
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Infecciones por Chlamydia , Gonorrea , Enfermedades de Transmisión Sexual , Humanos , Masculino , Estados Unidos/epidemiología , Femenino , Neisseria gonorrhoeae , Chlamydia trachomatis , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Gonorrea/prevención & control , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Enfermedades de Transmisión Sexual/prevención & control , Estudios de Cohortes , PrevalenciaRESUMEN
BACKGROUND: National guidelines recommend sexually active women younger than 25 years be screened annually for chlamydia. Our objective was to estimate the chlamydia screening rate of sexually active women aged 16 to 24 years from 2011 to 2020. METHODS: We analyzed the chlamydia screening rates among sexually active women aged 16 to 24 years from 2011 to 2020 using the chlamydia measures in the Healthcare Effectiveness Data and Information Set data set. The annual national chlamydia screening rates were further stratified by census region and by patient age. RESULTS: Chlamydia screening rates among sexually active women aged 16 to 24 years ranged from 55.0% to 61.8% in Medicaid health plans and from 46.9% to 52.4% in commercial health plans during 2011-2020. The Northeast consistently had the highest screening rates among 4 geographic regions. The chlamydia screening rate among sexually active women aged 16 to 24 years decreased from 2019 to 2020: from 61.8% to 57.9% in Medicaid plans and from 52.4% to 48.4% in commercial health plans. The number of sexually active women aged 16 to 24 years covered by commercial health plans decreased from 2019 to 2020, but the number covered by Medicaid increased from 2019 to 2020. CONCLUSIONS: The chlamydia screening rates in the target population have increased little from 2011 to 2019. The decrease in chlamydia screening rates between 2019 and 2020 could be related to the COVID-19 pandemic and the reduced use of health services during that period. With recently suboptimal chlamydia screening rates in the United States, interventions of improving and assessing chlamydia screening rates are needed.
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COVID-19 , Infecciones por Chlamydia , Estados Unidos/epidemiología , Femenino , Humanos , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Pandemias , COVID-19/diagnóstico , COVID-19/epidemiología , Medicaid , Chlamydia trachomatis , Tamizaje MasivoRESUMEN
BACKGROUND: Centers for Disease Control recommends that the decision to provide sexually transmitted infection (STI)/human immunodeficiency virus (HIV) testing and presumptive treatment to patients who report sexual assault and abuse (SAA) be made on an individual basis. METHODS: The 2019 Centers for Medicare & Medicaid Services national Medicaid data set was used. The SAA visits were identified by International Classification of Diseases 10th Revision Clinical Modification (O9A4 for pregnancy-related sexual abuse, T74.2 for confirmed sexual abuse, and Z04.4 for alleged rape). The initial SAA visit was defined as the patient's first SAA-related visit. Medical services were identified by International Classification of Diseases 10th Revision Clinical Modification codes, Current Procedural Terminology codes, and National Drug Code codes. RESULTS: Of 55,113 patients at their initial SAA visits, 86.2% were female; 63.4% aged ≥13 years; 59.2% visited emergency department (ED); all STI/HIV tests were provided in ≤20% of visits; presumptive gonorrhea and chlamydia treatment was provided in 9.7% and 3.4% of visits, respectively; pregnancy test was provided in 15.7% of visits and contraception services was provided in 9.4% of visits; and diagnosed anxiety was provided in 6.4% of visits. Patients who visited ED were less likely to have STI testing and anxiety than those visited non-ED facilities, but more likely to receive presumptive treatment for gonorrhea, testing for pregnancy, and contraceptive services. About 14.2% of patients had follow-up SAA visits within 60 days after the initial SAA visit. Of 7821 patients with the follow-up SAA visits within 60 days, most medical services provided were chlamydia testing (13.8%), gonorrhea testing (13.5%), syphilis testing (12.8%), HIV testing (14.0%); diagnosed anxiety (15.0%), and posttraumatic stress disorder (9.8%). CONCLUSIONS: Current medical services during SAA visits for Medicaid patients are described in this evaluation. More collaboration with staff who handle SAA will improve SAA-related medical services.
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Infecciones por Chlamydia , Gonorrea , Infecciones por VIH , Delitos Sexuales , Enfermedades de Transmisión Sexual , Embarazo , Humanos , Anciano , Femenino , Estados Unidos/epidemiología , Masculino , Gonorrea/diagnóstico , Gonorrea/epidemiología , VIH , Medicaid , Salud Mental , Medicare , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiologíaRESUMEN
BACKGROUND: With the potential impact of the COVID-19 pandemic on HIV preexposure prophylaxis (PrEP) care management, we assessed the number of PrEP users and sexually transmitted infection (STI) testing-eligible PrEP users, STI testing rates, and prevalence between prepandemic (January 1, 2018-March 31, 2020) and early-pandemic (April 1, 2020-September 30, 2020) periods. METHODS: In this retrospective cohort study, a PrEP user for a given quarter is defined as either a previous PrEP user or a PrEP initiator who has at least 1-day coverage of tenofovir/emtricitabine in the given quarter. The STI testing-eligible PrEP users for a given quarter were defined as those persons whose runout date (previous dispense date + days of tenofovir/emtricitabine supply) was in the given quarter. RESULTS: The quarterly number of PrEP users increased from the first quarter of 2018 to the first quarter of 2020 and then decreased in the second and third quarter of 2020. Among STI testing-eligible PrEP users who had ≤14 days between runout and next refill date, gonorrhea and chlamydia screening testing rates were 95.1% for prepandemic and 93.4% for early pandemic ( P = 0.1011). Among all STI testing-eligible PrEP users who were tested for gonorrhea and chlamydia, gonorrhea prevalence was 6.7% for prepandemic and 5.7% for early pandemic ( P = 0.3096), and chlamydia prevalence was 7.0% for prepandemic and 5.8% for early pandemic ( P = 0.2158). CONCLUSIONS: Although the early COVID-19 pandemic resulted in lower numbers of PrEP users and PrEP initiators, individuals who remained continuous users of PrEP maintained extremely high rates of bacterial STI screening. With high STI prevalence among PrEP users, assessments of PrEP care management are continuously needed.
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COVID-19 , Gonorrea , Infecciones por VIH , Profilaxis Pre-Exposición , Enfermedades de Transmisión Sexual , Masculino , Humanos , Gonorrea/diagnóstico , Gonorrea/epidemiología , Gonorrea/tratamiento farmacológico , Pandemias/prevención & control , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Estudios Retrospectivos , Homosexualidad Masculina , COVID-19/epidemiología , COVID-19/prevención & control , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Tenofovir/uso terapéutico , Emtricitabina , Profilaxis Pre-Exposición/métodosRESUMEN
Ongoing symptoms might follow acute COVID-19. Using electronic health information, we compared preâ and postâCOVID-19 diagnostic codes to identify symptoms that had higher encounter incidence in the postâCOVID-19 period as sequelae. This method can be used for hypothesis generation and ongoing monitoring of sequelae of COVID-19 and future emerging diseases.
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COVID-19 , Coronavirus del Síndrome Respiratorio de Oriente Medio , Humanos , SARS-CoV-2RESUMEN
ABSTRACT: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the 2 most common reported sexually transmitted infections in the United States. Current recommendations are to presumptively treat CT and/or GC in persons with symptoms or known contact. This review characterizes the literature around studies with presumptive treatment, including identifying rates of presumptive treatment and overtreatment and undertreatment rates. Of the 18 articles that met our inclusion criteria, 6 pertained to outpatient settings. In the outpatient setting, presumptive treatment rates, for both asymptomatic and symptomic patients, varied from 12% to 100%, and the percent positive of those presumptively treated ranged from 25% to 46%. Three studies also reported data on positive results in patients not presumptively treated, which ranged from 2% to 9%. Two studies reported median follow-up time for untreated, which was roughly 9 days. The remaining 12 articles pertained to the emergency setting where presumptive treatment rates, for both asymptomatic and symptomic patients, varied from 16% to 91%, the percent positive following presumptive treatment ranged from 14% to 59%. Positive results without presumptive treatment ranged from 4% to 52%. Two studies reported the percent positive without any treatment (6% and 32%, respectively) and one reported follow-up time for untreated infections (median, 4.8 days). Rates of presumptive treatment, as well as rates of overtreatment or undertreatment vary widely across studies and within care settings. Given the large variability in presumptive treatment, the focus on urban settings, and minimal focus on social determinants of health, additional studies are needed to guide treatment practices for CT and GC in outpatient and emergency settings.
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Infecciones por Chlamydia , Gonorrea , Enfermedades de Transmisión Sexual , Humanos , Estados Unidos/epidemiología , Neisseria gonorrhoeae , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/epidemiología , Estudios Retrospectivos , Chlamydia trachomatisRESUMEN
Homelessness poses a direct threat to public health in the US as many individuals face debilitating health outcomes and barriers to adequate health care. Access to STI care for the homeless Medicaid population of USA has not been well-studied using administrative claims data. Our study aims to compare health services utilization, STI screening and diagnoses among people experiencing homelessness (PEH) vs. those who are non-PEH using ICD10 codes. We used 2019 MarketScan Medicaid claims data to analyze men and women aged 15-44 years with a diagnosis code for PEH (Z59.0), non-PEH (without Z59.0) and assessed their emergency department and outpatient visits and STI/HIV diagnoses and screening rates. We identified 5135 PEH men and 3571 PEH women among 1.3 million men and 2.1 million women in the 2019 US Medicaid database. PEH patients were more likely to have ED visits (94.80% vs 33.04%) and ≥ 20 outpatient clinic visits (60.29% vs 16.16%) than non-PEH patients in 2019. Higher diagnoses were observed for syphilis 1.57% (CI 1.32-1.86) vs 0.11% (CI 0.11-0.11), HIV 3.93% (CI 3.53-4.36) vs 0.41% (CI 0.41-0.42), chlamydia 1.94% (CI 1.66-2.25) vs 0.85% (CI 0.84-0.86) and gonorrhea 1.26% (CI 1.04-1.52) vs. 0.33% (CI 0.33-0.34) (p < 0.0001) among PEH compared to non-PEH. Among PEH, higher STI/HIV diagnoses rates indicate an increase in STI burden and suboptimal STI testing indicates an underutilization of STI services despite having a higher percentage of health care visits compared to non-PEH patients. Focused STI/HIV interventions are needed to address health care needs of PEH patients.
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Infecciones por Chlamydia , Gonorrea , Infecciones por VIH , Personas con Mala Vivienda , Enfermedades de Transmisión Sexual , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Atención a la Salud , Femenino , Gonorrea/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Masculino , Medicaid , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Adulto JovenRESUMEN
BACKGROUND: Initial and follow-up sexually transmitted infection (STI) and human immunodeficiency virus (HIV) testing are recommended when taking HIV preexposure prophylaxis (PrEP). We assessed STI services before and after PrEP initiation among persons 18 years or older. METHODS: We conducted this retrospective cohort study at a US integrated healthcare delivery system. We measured HIV/STI testing rates, STI prevalence and treatment at 3 time points: (1) at PrEP initiation, (2) at 120 days, and (3) at 210 days. RESULTS: Of 685 PrEP initiators, 67.2% continued PrEP use at 120 days and 49.5% at 210 days. Of PrEP users, HIV and STI testing were greater than 85% and greater than 80%, respectively, at all 3 time points. Prevalence for any chlamydia, rectal chlamydia, and any gonorrhea, rectal gonorrhea, or pharyngeal gonorrhea was always high at the 120 days and 210 days (eg, 6.9%, 10.5%, 6.7%, 5.0%, and 5.2%, respectively, at the 120 days for continuous PrEP users). Over 90% of all individuals who tested positive for chlamydia and gonorrhea received antibiotic pharmacy fills within 7 days at 120 and 210 days. Monthly PrEP-related pharmacy cost was about $2259 to $2659. The proportion of the total medical cost that was PrEP-related pharmacy was about 82% for PrEP continuous users. CONCLUSIONS: Although HIV/STI testing rates were high, they can still be improved during HIV PrEP management. High STI prevalence after PrEP initiation in this study suggests that patients taking PrEP are at risk of acquiring an STI. Interventions to improve STI services during PrEP management are continuously needed.
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Prestación Integrada de Atención de Salud , Gonorrea , Infecciones por VIH , Profilaxis Pre-Exposición , Enfermedades de Transmisión Sexual , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
To assess healthcare provider awareness of the Food and Drug Administration (FDA) 2019 approval of nucleic acid amplification tests (NAAT) using extragenital specimens for chlamydia and gonorrhea, several questions were included in fall 2020 Porter Novelli's DocStyles survey, a US nationally representative semi-annual web-based survey of healthcare providers. There were 1502 respondents included in this study, 1000 family practitioners/internists as primary care physicians (PCPs), 251 obstetricians/gynecologists (OBs/GYNs), and 251 nurse practitioners/physician assistants (NP/PA). Awareness of this FDA approval was 34.3% overall and significantly varied by provider specialty: 45.0% for OB/GYN versus 23.5% for NP/PA, p < 0.01. OB/GYN had the lowest rate of ordering any extragenital gonorrhea and chlamydia tests in the past 12 months (31.6%) versus the other providers (ranging from 46.2% for NP/PA to 60.7% for PCP). The respondents were more likely to be aware of the FDA approval if they had ordered extragenital chlamydia or gonorrhea testing for men who have sex with men (MSM) than those who did not order the tests for MSM (72.3% versus 43.7%, p < 0.01). Of 1502 respondents, lack of reimbursement as a barrier to ordering extragenital tests for chlamydia and gonorrhea was most mentioned (16.6%) overall and did not significantly vary by provider's specialty. Further outreach is needed to educate healthcare providers on the changes in the FDA approval for extragenital gonorrhea and chlamydia testing so that they can provide comprehensive care to their patients and to reduce the potential for antimicrobial resistance.
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Infecciones por Chlamydia , Gonorrea , Minorías Sexuales y de Género , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis , Pruebas Diagnósticas de Rutina , Gonorrea/diagnóstico , Personal de Salud , Homosexualidad Masculina , Humanos , Masculino , Prevalencia , Recto , Estados Unidos , United States Food and Drug AdministrationRESUMEN
BACKGROUND: During the COVID-19 pandemic, disruptions were anticipated in the US health care system for routine preventive and other nonemergency care, including sexually transmitted infection care. METHODS: Using a large national laboratory data set, we assessed the impact of the COVID-19 pandemic on the weekly numbers and percent positivity of chlamydia and gonorrhea tests ordered from the 5th week of 2019 to the 52nd week of 2020 in the United States. We compared weekly 2020 values for test volume, percent positive, and number of positives with the same week in 2019. We also examined the potential impact of stay-at-home orders for the month of April 2020. RESULTS: Immediately after the declaration of a national emergency for COVID-19 (week 11, 2020), the weekly number of gonorrhea and chlamydia tests steeply decreased. Tests then rebounded toward the 2019 pre-COVID-19 level beginning the 15th week of 2020. The weekly percent positive of chlamydia and gonorrhea remained consistently higher in 2020. In April 2020, the overall number of chlamydia tests was reduced by 53.0% (54.1% in states with stay-at-home orders vs. 45.5% in states without stay-at-home orders), whereas the percent positive of chlamydia and gonorrhea tests increased by 23.5% and 79.1%, respectively. CONCLUSIONS: To limit the impact of the pandemic on control of chlamydia and gonorrhea, public health officials and health care providers can assess measures put in place during the pandemic and develop new interventions to enable care for sexually transmitted infections to be delivered under pandemic and other emergency conditions. The assessment like this study is continuously needed.
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COVID-19 , Infecciones por Chlamydia , Gonorrea , Enfermedades de Transmisión Sexual , COVID-19/diagnóstico , COVID-19/epidemiología , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Gonorrea/diagnóstico , Gonorrea/epidemiología , Gonorrea/prevención & control , Humanos , Pandemias/prevención & control , Enfermedades de Transmisión Sexual/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Previous studies have shown that sexually transmitted infections (STI) and human immunodeficiency virus (HIV) testing has varied, but STI prevalence was not estimated among patients during their health care visits in which a high-risk sexual partnership was documented. This study estimated gonorrhea, chlamydia, syphilis, and HIV testing rates and chlamydia and gonorrhea prevalence. METHODS: From the de-identified commercial claims data of OptumLabs Data Warehouse, we identified men and women aged 15-60 years classified as having high-risk sexual relationships as diagnosis codes: Z72.51 for opposite-sex, Z72.52 for same-sex, and Z72.53 for same-and-opposite-sex relationships, stratified by gender, age group, region, type of health plan, and HIV status. We estimated STI testing rate and prevalence for chlamydia and gonorrhea among patients with high-risk sexual relationships. HIV testing was assessed only in high-risk sexual relationship patients without HIV. RESULTS: Among 8.2 million females and 7.3 million males aged 15-60 years in the database from 2016 to 2019, 115,884 patients (0.7% of female, 0.8% of male) including 3,535 patients with HIV were diagnosed with high-risk sexual relationships. The testing rates for gonorrhea, chlamydia, syphilis, and HIV were 69.4% (confidence interval [CI]: 69.1-69.7), 68.9% (CI: 68.6-69.2), 43.4% (CI: 43.1-43.7), and 41.7% (CI: 41.4-42.0), respectively. Among patients with valid chlamydia and gonorrhea tests, 7.2% (CI: 7.0-7.5) and 2.6% (CI: 2.4-2.8) had positive chlamydia and gonorrhea test results, respectively, and varied by type of high-risk sexual relationship. CONCLUSIONS: Our study findings of suboptimal STI screening among patient in high-risk sexual relationships are consistent with previous studies. Administrative records confirmed by lab results indicate a need for STI counseling, testing, and treatment among patients who are diagnosed with high-risk sexual relationships with same-sex, opposite-sex, or same-and-opposite sex partners.
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Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Infecciones por VIH/diagnóstico , Parejas Sexuales , Sífilis/epidemiología , Adolescente , Adulto , Trazado de Contacto , Recolección de Datos , Femenino , Prueba de VIH , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: The number of congenital syphilis (CS) cases in the United States are increasing. Effective prevention of CS requires routine serologic testing and treatment of infected pregnant women. The Centers for Disease Control and Prevention (CDC) recommends testing all pregnant women at their first prenatal visit and subsequent testing at 28 weeks gestation and delivery for women at increased risk. METHODS: We conducted a cross-sectional cohort study of syphilis testing among pregnant women with a livebirth delivery from January 2014 to December 2016 in Marion County, Indiana. We extracted and linked maternal and infant data from the vital records in a local health department to electronic health records available in a regional health information exchange. We examined syphilis testing rates and factors associated with non-testing among women with livebirth delivery. We further examined these rates and factors among women who reside in syphilis prevalent areas. RESULTS: Among 21260 pregnancies that resulted in livebirths, syphilis testing in any trimester, including delivery, increased from 71.7% in 2014 to 86.6% in 2016. The number of maternal syphilis tests administered only at delivery decreased from 16.6% in 2014 to 4.04% in 2016. Among women living in areas with high syphilis rates, syphilis screening rates increased from 79.6% in 2014 to 94.2% in 2016. CONCLUSION: Improvement in prenatal syphilis screening is apparent and encouraging, yet roughly 1-in-10 women do not receive syphilis screening during pregnancy. Adherence to recommendations set out by CDC improved over time. Given increasing congenital syphilis cases, the need for timely diagnoses and prevention of transmission from mother to fetus remains a priority for public health.
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Adhesión a Directriz , Guías como Asunto , Complicaciones Infecciosas del Embarazo/diagnóstico , Diagnóstico Prenatal/estadística & datos numéricos , Serodiagnóstico de la Sífilis/estadística & datos numéricos , Sífilis/diagnóstico , Adolescente , Adulto , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Indiana/epidemiología , Nacimiento Vivo/epidemiología , Embarazo , Adulto JovenRESUMEN
BACKGROUND: Pelvic inflammatory disease (PID) is an infection of the upper genital tract that has important reproductive consequences to women. We describe the burden of and trends in PID among reproductive-aged women in the United States during 2006-2016. METHODS: We used data from 2 nationally representative probability surveys collecting self-reported PID history (National Health and Nutrition Examination Survey, National Survey of Family Growth); 5 datasets containing International Classification of Diseases, Ninth/Tenth Revision codes indicating diagnosed PID (Healthcare Utilization Project; National Hospital Ambulatory Medical Care Survey, emergency department component; National Ambulatory Medical Care Survey; National Disease Therapeutic Index; MarketScan); and data from a network of sexually transmitted infection (STI) clinics (Sexually Transmitted Disease Surveillance Network). Trends during 2006-2016 were estimated overall, by age group and, if available, race/ethnicity, region, and prior STIs. RESULTS: An estimated 2 million reproductive-aged women self-reported a history of PID. Three of 4 nationally representative data sources showed overall declines in a self-reported PID history, and PID emergency department and physician office visits, with small increases observed in nearly all data sources starting around 2015. CONCLUSIONS: The burden of PID in the United States is high. Despite declines in burden over time, there is evidence of an increase in recent years.
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Costo de Enfermedad , Enfermedad Inflamatoria Pélvica/epidemiología , Adolescente , Adulto , Servicio de Urgencia en Hospital , Femenino , Humanos , Encuestas Nutricionales , Conducta Sexual , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Congenital syphilis (CS) is on the rise in the United States and is a growing public health concern. CS is an infection with Treponema pallidum in an infant or fetus, acquired via transplacental transmission when a pregnant woman has untreated or inadequately treated syphilis. Pregnant women with untreated syphilis are more likely to experience pregnancies complicated by stillbirth, prematurity, low birth weight, and early infant death, while their children can develop clinical manifestations of CS such as hepatosplenomegaly, bone abnormalities, developmental delays, and hearing loss. One of the ways CS can be prevented is by identifying and treating infected women during pregnancy with a benzathine penicillin G regimen that is both appropriate for the maternal stage of syphilis and initiated at least 30 days prior to delivery. In this article we discuss many of the challenges faced by both public health and healthcare systems with regards to this preventable infection, summarize missed opportunities for CS prevention, and provide practical solutions for future CS prevention strategies.
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Complicaciones Infecciosas del Embarazo , Sífilis Congénita , Sífilis , Niño , Femenino , Humanos , Lactante , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Mortinato , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/epidemiología , Sífilis Congénita/tratamiento farmacológico , Sífilis Congénita/epidemiología , Sífilis Congénita/prevención & control , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) case surveillance relies on reported positive laboratory results. Changes in reported cases may represent changes in testing practice or infection prevalence. This study evaluated changes over time for CT and NG positivity and testing rates of pregnant persons. METHODS: Prenatal testing results from persons aged 16 to 40 years tested by a national reference clinical laboratory were analyzed for CT and NG testing and positivity from 2010 to 2018 (n = 3,270,610). RESULTS: Testing rates increased among pregnant persons for CT (from 56.3% in 2010 to 64.1% in 2018, P < 0.001) and NG (from 55.6% to 63.2%, P < 0.001). Higher CT testing rates were found in Black non-Hispanic (adjusted odds ratio [AOR], 1.58; 95% confidence interval [CI], 1.57-1.60) and Hispanic (AOR, 1.19; 95% CI, 1.18-1.20) persons. NG and CT testing rates were virtually identical. Significant increasing trends in CT positivity were observed for each age group studied (P < 0.001 for all): 16-19 (from 11.7% to 13.0%), 20-24 (from 6.4% to 6.7%), 25-30 (from 1.9% to 2.4%), and 31-40 years (from 0.76% to 0.92%). Black non-Hispanic persons had the highest positivity for CT (AOR, 2.52; 95% CI, 2.46-2.57) and NG (AOR, 5.42; 95% CI, 5.05-5.82). CONCLUSIONS: Testing and adjusted positivity for both CT and NG among pregnant persons increased from 2010 to 2018. Higher testing rates were observed in Black non-Hispanic and Hispanic persons (even in persons younger than 25 years), suggesting some testing decisions may have been based on perceived risk, in contrast to many guidelines recommending screening all pregnant persons younger than 25 years.
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Infecciones por Chlamydia , Gonorrea , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Neisseria gonorrhoeae , Embarazo , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Late sequelae of COVID-19 have been reported; however, few studies have investigated the time course or incidence of late new COVID-19-related health conditions (post-COVID conditions) after COVID-19 diagnosis. Studies distinguishing post-COVID conditions from late conditions caused by other etiologies are lacking. Using data from a large administrative all-payer database, we assessed type, association, and timing of post-COVID conditions following COVID-19 diagnosis. METHODS: Using the Premier Healthcare Database Special COVID-19 Release (release date, 20 October 2020) data, during March-June 2020, 27 589 inpatients and 46 857 outpatients diagnosed with COVID-19 (case-patients) were 1:1 matched with patients without COVID-19 through the 4-month follow-up period (control-patients) by using propensity score matching. In this matched-cohort study, adjusted ORs were calculated to assess for late conditions that were more common in case-patients than control-patients. Incidence proportion was calculated for conditions that were more common in case-patients than control-patients during 31-120 days following a COVID-19 encounter. RESULTS: During 31-120 days after an initial COVID-19 inpatient hospitalization, 7.0% of adults experienced ≥1 of 5 post-COVID conditions. Among adult outpatients with COVID-19, 7.7% experienced ≥1 of 10 post-COVID conditions. During 31-60 days after an initial outpatient encounter, adults with COVID-19 were 2.8 times as likely to experience acute pulmonary embolism as outpatient control-patients and also more likely to experience a range of conditions affecting multiple body systems (eg, nonspecific chest pain, fatigue, headache, and respiratory, nervous, circulatory, and gastrointestinal symptoms) than outpatient control-patients. CONCLUSIONS: These findings add to the evidence of late health conditions possibly related to COVID-19 in adults following COVID-19 diagnosis and can inform healthcare practice and resource planning for follow-up COVID-19 care.
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COVID-19 , Pacientes Ambulatorios , Adulto , Prueba de COVID-19 , Estudios de Cohortes , Humanos , Pacientes Internos , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance. METHODS: We analyzed data from the IBM MarketScan Research Database to identify persons aged 18-64 years who initiated PrEP between 2012 and 2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills > 30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with nonpersistence. RESULTS: We studied 11 807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for a median time of 13.7 months (95% confidence interval [CI], 13.3-14.1), compared to 6.8 months (95% CI, 6.1-7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (hazard ratio [HR], 1.81 [95% CI, 1.56-2.11]) and younger age (18-24 years: HR, 2.38 [95% CI, 2.11-2.69]) predicted nonpersistence. CONCLUSIONS: More than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for nonpersistence is important to support persistent PrEP use and to develop interventions designed for the diverse needs of at-risk populations.