The Epidemiology of Syphilis in New York City: Historic Trends and the Current Outbreak Among Men Who Have Sex With Men, 2016.

BACKGROUND: Male primary and secondary (P&S) and early latent syphilis cases have increased markedly in New York City (NYC) after a historic nadir in 1998. The majority of cases are among men who have sex with men (MSM). We describe the epidemiology of syphilis among NYC males to provide a model of how 1 jurisdiction collects, analyzes, interprets, uses, and disseminates local data to guide programmatic activities directed at syphilis control. METHODS: We analyzed trends in reported infectious syphilis cases using routinely collected surveillance and case investigation data. Human immunodeficiency virus (HIV) coinfection status was ascertained by routine deterministic match between sexually transmitted infection and HIV surveillance registries, and self-report. We mapped diagnosing facilities to display the relative contribution of different public/private facilities. Characteristics of male syphilis cases diagnosed in public sexual health (SH) clinics were compared to those diagnosed elsewhere. RESULTS: During 2012 to 2016, male P&S syphilis case rates increased 81%, from 24.8 to 44.8/100,000 (1832 cases in 2016); the highest rates were among black non-Hispanic men. Overall, 87.6% (902/1030) of interviewed men in 2016 disclosed 1 or more male partner. The HIV coinfection rates are high among MSM with P&S syphilis (43.4%; 394/907 in 2016), but appear to be decreasing (from 54.1% in 2012). Maps highlight SH clinics' contribution to diagnosing P&S syphilis cases among men of color. HIV coinfection rates were lower among men with P&S syphilis diagnosed in SH clinics than among those diagnosed elsewhere (34%, SH clinics vs 49%; other settings, P < 0.0001). CONCLUSIONS: Syphilis infections continue to increase among MSM in NYC. Novel interventions responsive to the drivers of the current outbreak are needed.

Sentinel Surveillance for Expedited Partner Therapy Prescriptions Using Pharmacy Data, in 2 New York City Neighborhoods, 2015.

BACKGROUND: Expedited partner therapy (EPT) for Chlamydia trachomatis (Ct) is the practice of providing Ct-infected patients with medication, or prescription (prescription-EPT) to deliver to their sex partners without first examining those partners. New York City (NYC) providers commonly use prescription-EPT, yet NYC pharmacists report only occasional receipt of EPT prescriptions. This project assessed the frequency of EPT prescriptions filled in 2 NYC neighborhoods. METHODS: The 2 NYC facilities reporting the most frequent use of prescription-EPT were identified from Ct provider case reports and contacted to ascertain their EPT practices. Providers at the first facility (facility 1) prescribed two 1-g doses of azithromycin, including sex partner treatment on the index patient's electronic prescription. Providers at the second facility (facility 2) gave patients paper prescriptions for sex partners. We reviewed prescriptions filled in 2015 for azithromycin, 1 or 2 g at pharmacies near these facilities; prescriptions indicating partner therapy were classified "EPT prescriptions". RESULTS: Facility 1 providers submitted 112 Ct case reports indicating prescription-EPT, compared with 114 submitted by facility 2 providers. Twelve of 26 identified pharmacies agreed to participate. At 7 pharmacies near facility 1, we found 61 EPT prescriptions from facility 1 and 37 from other facilities. At 5 pharmacies near facility 2, we found only 1 EPT prescription from facility 2 and 3 from other facilities. CONCLUSIONS: Expedited partner therapy prescriptions were received in NYC pharmacies near to EPT-prescribing facilities, but with great variability and at a lower frequency than suggested by provider case reports. Provider EPT prescribing practices may impact the likelihood that partners receive medication and should be further evaluated.

The Expedited Partner Therapy Continuum: A Conceptual Framework to Guide Programmatic Efforts to Increase Partner Treatment.

BACKGROUND: Expedited partner therapy (EPT) is a partner treatment strategy wherein health care providers give patients antibiotics or a prescription to deliver to their sex partners as treatment, without an intervening medical evaluation. METHODS: We used PubMed and the Cochrane database to systematically identify published articles about EPT after 2006 and randomized controlled trials before that date; we also sought conference abstracts and unpublished data from 2013 to 2014. We described key steps in a hypothetical "EPT continuum," beginning with diagnosis of Chlamydia trachomatis or Neisseria gonorrhoeae in a patient and ending with treatment for the patient's sex partner(s) with EPT. All reports were abstracted for a set of defined measures and related interventions. RESULTS: We reviewed 100 published articles, unpublished data reports, and conference abstracts; 42 met the inclusion criteria and provided measures of the following: provider uptake and offer of EPT, patient acceptance and receipt of EPT, patient delivery of EPT to sex partners, and partner receipt of EPT and treatment. Implementation phase, populations, settings, and methodologies varied across reports. Providers' uptake and offer of EPT are rate-limiting steps in the EPT continuum and were the focus of all 5 programmatic interventions we identified. There were 7 population-based measures of patient receipt of EPT; however, several of the patient populations overlapped. CONCLUSIONS: A heterogenous body of literature describes EPT, and variation in study population, setting, and metrics limit generalizability. Programs seeking to increase partner treatment should focus their efforts on provider uptake and offer and should use population-based measures to monitor EPT use.

Prevalence of Neisseria Gonorrhoeae among men screened for Chlamydia Trachomatis in four United States cities, 1999-2003.

OBJECTIVES: Neisseria gonorrhoeae infections are the second most commonly reported disease in the United States and cause significant morbidity. We describe the prevalence of gonorrhea in a large sample of men tested for gonorrhea and Chlamydia trachomatis in Baltimore, Denver, San Francisco, and Seattle. METHODS: Gonorrhea prevalence was measured among 17,712 men tested in a variety of non-sexually transmitted disease (STD) clinic venues using urine-based nucleic acid amplification tests. RESULTS: Among 16,850 asymptomatic men, prevalence ranged from 0% to 1.5% by city (P=0.20): Baltimore 1.3%, Denver 1.5%, San Francisco 1.5%, and Seattle 0%. Among 862 symptomatic men, the gonorrhea prevalence varied from 0.0% to 28.3% by city (P<0.01). CONCLUSIONS: The high prevalence of gonorrhea in symptomatic men supports the importance of testing for symptomatic men. The prevalence of gonorrhea among asymptomatic men is low, and routine screening cannot be recommended when screening is performed for chlamydia, unless a substantial local prevalence of gonorrhea can be documented in specific targeted venues or population groups.

Prevalence of Chlamydia trachomatis infection among men screened in 4 U.S. cities.

OBJECTIVE: The objective of this study was to measure the prevalence of Chlamydia trachomatis (CT) infection among men in clinical and nonclinical settings across the United States. GOAL: The goal of this study was to obtain data to inform recommendations regarding male CT screening. STUDY: The authors conducted a cross-sectional study of CT prevalence among adolescent and adult men in 4 U.S. cities (Baltimore, Denver, San Francisco, and Seattle). CT was detected using urine-based testing, and prevalence was calculated for first testing event. RESULTS: Over 23,000 men were tested for CT over a 3 1/2-year period. The majority (96%) were asymptomatic. Overall, prevalence was 7% and varied significantly between cities (range: Seattle, 1%; Baltimore, 12%), by age (peak prevalence at age 20-24 years, 9%), and between venues where CT testing was offered. CONCLUSIONS: At 7%, the prevalence of CT is moderately high among men opportunistically tested in nonclinical and clinical settings.

National seroprevalence and trends in herpes simplex virus type 1 in the United States, 1976-1994.

OBJECTIVES: The objectives of this study were to estimate national seroprevalence of herpes simplex virus type 1 (HSV-1), describe trends in seroprevalence, and examine correlates of infection. GOAL: The goal of this study was to measure the burden of HSV-1 infection in the U.S. population. STUDY: We tested serum samples for HSV-1 antibody and analyzed questionnaire data collected for the second and third National Health and Nutrition Surveys (NHANES II, 1976-80; NHANES III, 1988-94). Seroprevalence estimates were weighted to represent the total U.S. population. RESULTS: At the time of NHANES III, two thirds (68%) of the U.S. population 12 years and older had HSV-1 antibody. Prevalence increased with age and varied by race/ethnicity; the majority of persons in all race/ethnic groups were HSV-1-seropositive by age 30. Overall, the national seroprevalence of HSV-1 decreased nonsignificantly by 2% in the years between NHANES II and III; decreases in HSV-1 seroprevalence in some population subgroups were balanced by increases in other groups. CONCLUSIONS: There was no overall change in the seroprevalence of HSV-1 in the U.S. population between NHANES II and III.