Is Mpox a Sexually Transmitted Infection? Why Narrowing the Scope of This Disease May Be Harmful.

The 2022 multinational mpox outbreak has been characterized by unprecedented spread among men who have sex with men outside of sub-Saharan Africa. Close contact during sex and intimacy has been well established as a key pathway for human-to-human transmission in the current outbreak. Discussions on whether to assign this illness as a sexually transmitted infection (STI) have been ongoing since the initiation of the outbreak. While sexual contact certainly appears to be a primary means of spread, classifying mpox as an STI is inaccurate based on its known transmission dynamics, yields potential unintended consequences, and ignores the historical impact of the disease in Central and West Africa. Rather than focusing our energy on disease categorization, more effort should be placed on destigmatizing this illness and empowering communities at risk to protect themselves from mpox.

Post-exposure prophylaxis for human immunodeficiency virus after sexual assault in a Midwestern U.S. emergency department.

BACKGROUND: Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims. METHODS: Retrospective analysis of sexual assault victims evaluated and offered HIV PEP in an urban academic ED between January 1, 2005 and January 1, 2018. Data on demographics, comorbidities, nature of sexual assault, initial ED care, subsequent healthcare utilization within 28 days of initial ED visit, and evidence of seroconversion within 6 months of the initial ED visit were obtained. Predictors of subsequent ED visit and follow-up in the infectious diseases clinic were evaluated using logistic regression analysis. RESULTS: Four hundred twenty-three ED visits met criteria for inclusion in this study. Median age at ED presentation was 25 years (IQR 21-34 years), with the majority of victims being female (95.5%), Black (63.4%), unemployed (66.3%) and uninsured (53.9%); psychiatric comorbidities (38.8%) and substance abuse (23.6%) were common. About 87% of the patients accepted HIV PEP (368 of 423 ED visits). Age (OR 0.97, 95% CI 0.94-0.99, p = 0.025) and sexual assault involving >1 assailant (OR 0.48, 95% CI 0.26-0.88, p = 0.018) were associated with lower likelihood of HIV PEP acceptance. Ten patients (2.7%) followed up with the infectious disease clinic within 28 days of starting HIV PEP; 70 patients (19%) returned to the ED for care during the same time period. Psychiatric comorbidity (OR 2.48, 95% CI 1.43-4.30, p = 0.001) and anal penetration (OR 2.02, 95% CI 1.10-3.70, p = 0.024) were associated with greater likelihood of repeat ED visit; female gender (OR 0.30, 95% CI 0.11-0.85, p = 0.023) was associated with lower likelihood of repeat visit. Completion of HIV PEP was documented for 14 (3.3%) individuals. CONCLUSIONS: While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP.

Human herpesvirus-6 encephalitis following chemotherapy induction for acute myelogenous leukemia.

We report a case of human herpesvirus-6 (HHV-6) encephalitis in a neutropenic patient who had undergone chemotherapy induction for acute myelogenous leukemia while on broad-spectrum antimicrobial therapy. The patient displayed symptoms of confusion, amnesia, and lethargy. Diagnosis was made via polymerase chain reaction analysis of cerebrospinal fluid. Electroencephalogram and magnetic resonance imaging of the brain were unremarkable. Following diagnosis, the patient was successfully treated with ganciclovir. HHV-6 encephalitis should be considered in immunocompromised patients who become encephalopathic.

Taking a Sexual History: Best Practices.

Recognizing the holistic definitions of sexual health, health-care providers must approach sexual health history taking with sensitivity, inclusivity, and a trauma-informed perspective. Many versions of what a sexual history should look like exist but certain principles are commonly found. Education of health-care providers on sexual history taking can involve reviewing the components of the sexual history but should also include the importance of using nonstigmatizing language, having a patient-centered approach, and practicing trauma-informed and culturally sensitive care.

Long-Term Mortality after Histoplasma Infection in People with HIV.

Histoplasmosis is a common opportunistic infection in people with HIV (PWH); however, no study has looked at factors associated with the long-term mortality of histoplasmosis in PWH. We conducted a single-center retrospective study on the long-term mortality of PWH diagnosed with histoplasmosis between 2002 and 2017. Patients were categorized into three groups based on length of survival after diagnosis: early mortality (death < 90 days), late mortality (death ≥ 90 days), and long-term survivors. Patients diagnosed during or after 2008 were considered part of the modern antiretroviral therapy (ART) era. Insurance type (private vs. public) was a surrogate indicator of socioeconomic status. Out of 54 PWH infected with histoplasmosis, overall mortality was 37%; 14.8% early mortality and 22.2% late mortality. There was no statistically significant difference in survival based on the availability of modern ART (p = 0.60). Insurance status reached statistical significance with 38% of survivors having private insurance versus only 8% having private insurance in the late mortality group (p = 0.05). High mortality persists despite the advent of modern ART, implicating a contribution from social determinants of health, such as private insurance. Larger studies are needed to elucidate the role of these factors in the mortality of PWH.

Transgender Health Medical Education Intervention and its Effects on Beliefs, Attitudes, Comfort, and Knowledge.

INTRODUCTION: Transgender health disparities have been well documented in the literature in recent years, as have the lack of transgender health issues in medical education programs across the country. METHODS: A prospective study was conducted with an hour-long didactic lecture on transgender health being given to faculty, medical students, and residents at the University of Kansas School of Medicine-Wichita. The didactic lecture included educational information and presentations by transgender persons. A pre-intervention and two post-intervention survey was given to assess attitudes, comfort level, knowledge, and beliefs regarding the treatment of transgendered persons and associated health concerns. A second post-intervention survey was given at 90 days. The question of what attendees planned to do differently as a result of the intervention was asked. RESULTS: The intervention provided a significant positive increase in attitudes, comfort levels, and knowledge with respect to transgender health issues between the pre- and post-intervention surveys, however, did not provide a significant positive increase in beliefs on transgender health issues. There was no significant change in attitude, comfort levels, knowledge, or beliefs from the post-survey after 90 days. Four categories of what attendees planned to do differently as a result of the intervention also were identified. CONCLUSIONS: A didactic lecture on transgender health issues can positively change attitudes, comfort levels, and knowledge on transgender health issues significantly with the changes sustaining after 90 days. Beliefs tend to be much harder to change.