Characteristics of the Largest Network Component of Individuals With or Exposed to Early Syphilis in Central Indiana: 2016 to 2017.

BACKGROUND: The surge of syphilis infections in the United States continues. This study examined the sexual networks of early syphilis cases to determine whether repeat infection, demographics, or behaviors differed among network components (groups of connected persons). METHODS: We examined a retrospective cohort of all early syphilis cases in Central Indiana reported from January, 1, 2016, to January 24, 2018, in the state's reporting database. Cases were linked to their sexual partners and analyzed using UCINET and NetDraw. Attributes of network members were derived from disease intervention specialist interviews. Repeat cases were defined as those who also had ≥1 early syphilis infection at any time between 2011 and 2017. The resulting network included 1140 unique individuals, 436 cases and 704 contacts. We compared members of the main component, that is, the largest one, with the rest of the network using multiple logistic regression and network analyses. RESULTS: The network formed 197 separate components. The main component contained 473 individuals (41% of the cohort). Main component members were more likely to have repeat early syphilis, gonorrhea, Black race, male sex, and a history of methamphetamine use, and be HIV positive by multiple logistic regression. Results from multiple centrality measures indicated persons who might be most effective at disseminating information or fragmenting the main component. CONCLUSIONS: Network analysis identified a group of linked individuals most likely to be reinfected with syphilis in Central Indiana. Further investigation is needed to determine whether engaging such a high-risk group could better focus resources and decrease infections.

Ending the HIV Epidemic: Contributions Resulting From Syphilis Partner Services.

BACKGROUND: There is a high level of coinfection with human immunodeficiency virus (HIV) among persons diagnosed with syphilis in the United States. Public health workers at state and local health departments help inform exposed partners to sexually transmitted disease (STD)/HIV infections to facilitate early testing and treatment (partner services). The federal initiative, Ending the HIV Epidemic (EHE), identifies 4 key strategies: diagnose, treat, prevent, and respond. This study describes the contributions of syphilis partner services to the EHE strategies in a county prioritized by the EHE plan. METHODS: A retrospective record review of reported early syphilis cases (less than 1 year's duration) between 2016 and 2018 in the Indianapolis area was conducted to determine the extent of new HIV diagnoses, retention in HIV care, and other evidence-based HIV prevention interventions occurring after provision of syphilis partner services. RESULTS: A total of 752 partners to early syphilis were attempted to be notified of exposure. There were 1,457 case patients and partners that received STD/HIV prevention counseling; 400 partners received STD treatment, 352 partners learned their HIV status, and 22 received new HIV diagnoses, with 68% retained in medical care and 60% virally suppressed. Two thirds of partner services were completed within 21 days. New HIV positivity among partners to HIV-negative syphilis case patients was 3.5% and 14% among HIV-positive syphilis case patients. CONCLUSIONS: Partner services for syphilis was an effective method of addressing the EHE strategies, resulting in persons at risk tested, STD treatment provided, behavioral prevention counseling provided, and new HIV cases identified, leading to retention in medical care and viral suppression.

Increased Risk of Stroke Among Young Adults With Serious Traumatic Brain Injury.

OBJECTIVE: To quantify the risk of acute ischemic stroke (AIS) following traumatic brain injury (TBI) according to severity. SETTING: Indiana Network for Patient Care, including medical records from more than 100 Indiana hospitals and affiliated practices. PARTICIPANTS: Individuals 18 years and older with TBI from 2005 to 2014. DESIGN: Retrospective cohort. MAIN MEASURES: AIS incidence in the first 30, 31 to 180, and 181 days after TBI. Time to AIS using a stratified Cox proportional hazards model. RESULTS: Among 58 294 patients with TBI, AIS risk was greatest in the first 30 days (incidence rate = 23.3 per 1000 person-months), declining to 3.1 and 1.3 per 1000 person-months after 31 to 180 and 181 days or more, respectively. Cervical artery dissection increased the risk of AIS in the first 30 days (incidence rate = 170.9 per 1000 person-months). In the first 30 days, serious TBI increased risk for all age groups, with the largest effect observed among those aged 18 to 24 years. Over time, serious TBI modified the effect of age on AIS only for those aged 18 to 24 years. CONCLUSIONS: These findings add to a growing body of work demonstrating that the acute and postacute stages of TBI play an accelerative role in AIS risk, particularly among younger patients, cervical artery dissection, and serious TBI.