How Good Is Your Rule of Thumb? Validating Male-to-Female Case Ratio as a Proxy for Men Who Have Sex With Men Involvement in N. gonorrhoeae Incidence at the County Level.

BACKGROUND: Lacking information on men who have sex with men (MSM) for most reported cases, sexually transmitted disease (STD) programs in the United States have used crude measures such as male-to-female case ratios (MFCR) as a rule of thumb to gauge MSM involvement at the local level, primarily with respect to syphilis cases in the past. Suitability of this measure for gonorrhea incidence has not previously been investigated. METHODS: A random sample of gonorrhea cases reported from January 2010 through June 2013 were interviewed in selected counties participating in the STD Surveillance Network to obtain gender of sex partners and history of transactional sex. Weighted estimates of proportion of cases among MSM and proportion reporting transactional sex were developed; correlation between MFCR and proportion MSM was assessed. RESULTS: Male-to-female case ratio ranged from 0.66 to 8.7, and the proportion of cases occurring among MSM varied from 2.5% to 62.3%. The MFCR was strongly correlated with proportion of cases among MSM after controlling for transactional sex (Pearson partial r = 0.754, P < 0.0001). CONCLUSIONS: Male-to-female case ratio for gonorrhea at the county level is a reliable proxy measure indicating MSM involvement in gonorrhea case incidence and should be used by STD programs to tailor their programmatic mix to include MSM-specific interventions.

Gonorrhea treatment practices in the STD Surveillance Network, 2010-2012.

BACKGROUND: Replacing oral treatments with ceftriaxone is a central component of public health efforts to slow the emergence of cephalosporin-resistant Neisseria gonorrhoeae in the United States; US gonorrhea treatment guidelines were revised accordingly in 2010. However, current US gonorrhea treatment practices have not been well characterized. METHODS: Six city and state health departments in Cycle II of the STD Surveillance Network (SSuN) contributed data on all gonorrhea cases reported in 101 counties and independent cities. Treatment data were obtained through local public health surveillance and interviews with a random sample of patients. Cases were weighted to adjust for site-specific sample fractions and for differential nonresponse by age, sex, and provider type. RESULTS: From 2010 to 2012, 135,984 gonorrhea cases were reported in participating areas, 15,246 (11.2%) of which were randomly sampled. Of these, 7,851 (51.5%) patients were interviewed. Among patients with complete treatment data, 76.8% received ceftriaxone, 16.4% received an oral cephalosporin, and 6.9% did not receive a cephalosporin; 51.9% of persons were treated with a regimen containing ceftriaxone and either doxycycline or azithromycin. Ceftriaxone treatment increased significantly by year (64.1% of patients in 2010, 79.3% in 2011, 85.4% in 2012; P = 0.0001). Ceftriaxone use varied widely by STD Surveillance Network site (from 44.6% to 95.1% in 2012). CONCLUSIONS: Most persons diagnosed as having gonorrhea between 2010 and 2012 in the United States received ceftriaxone, and its use has increased since the release of the 2010 Centers for Disease Control and Prevention STD Treatment Guidelines.

Neighborhoods at risk: estimating risk of higher Neisseria gonorrhoeae incidence among women at the census tract level.

BACKGROUND: The association between area-based social factors and sexually transmitted diseases has been demonstrated in numerous studies. Such associations have not previously been explored for their potential to quantify likelihood of higher transmission of gonorrhea in small geographic areas. METHODS: Aggregate census tract-level sociodemographic factors in 4 domains (demographics, educational attainment, household income, and housing characteristics) were merged with female gonorrhea incidence data from 113 counties in 10 US states. Multivariate models were constructed, and a tract-level composite gonorrhea risk index was calculated. This composite risk index was validated against gonorrhea incidence among women from 2 independent states. RESULTS: Seven tract-level factors were found to be most strongly correlated with female gonorrhea incidence: educational attainment, proportion of female headed households, annual household income below US $20,000, proportion of population non-Hispanic black, proportion of housing units currently vacant, proportion of population reporting moving in last year, and proportion of households that are nonfamily units. Composite index was highly correlated with female gonorrhea in the study area and validated with independent data. CONCLUSIONS: Social factors predict gonorrhea incidence at the census tract level and identify small areas at risk for higher morbidity. These data may be used by health departments and health care practices to develop geographically based disease prevention and control efforts. This is especially useful because gonorrhea incidence data are not routinely available below the county level in many states.

Incidencia del sindrome de Down en la maternidad del Hospital Clínico de la Universidad de Chile: un registro de 25 años: 1972-1997 / Incidence of Down syndrom at a University Hospital Maternity

Background: The main function of ECLAMC (Latin American Congenital Malformations Collaborative Study) is to monitor congenital malformations in Latin American countries. Down syndrome, due to its medical and social importance, has received special concern. Aim: To measure the rates of incidence of Down syndrome in an University hospital maternity and to compare demographic variables of children born with the syndrome and healthy children. Material and methods: Between 1990 and 1997, all children born with Down syndrome were registered, and the next healthy newborn of the same sex was considered as control. Also, using previous registers, the prevalence of newborns with Down syndrome and the mean maternal age from 1972 to 1997 were compared, using regression equations. Results: During the 7 years study period, 53 Down syndrome patients were born (66 percent female, two stillbirths). Thirty percent had congenital heart disease, forty seven had a regular 21 trisomy, one had a Robertsonian translocation, two had mosaicism for 21 trisomy, one was 48, XXX+21 and one was 48, XXY+21. Compared to controls, these children had lower gestational age and birth weight, mean maternal and paternal ages were higher, previous abortions were more frequent and the intergenesic period more prolonged. From 1972 to 1997, both the birth rate of Down syndrome and mean maternal age increased significantly with slopes of 0.13 years of age per year and 0.05/1000 born alive per year, respectively. Comparing both rates, the prevalence rate of Down syndrome increased in 0.31 per 1000 born alive per year of increment in maternal age. Father's age had no influence on this prevalence. Conclusions: In the period 1990-1197, a higher prevalence rate of Down syndrome than in previous periods in the same maternity, was found. The influence of maternal age on this prevalence was clearly established