Approach to Human Immunodeficiency Virus/Sexually Transmitted Infection Testing for Men at an Urban Urgent Care Center.

BACKGROUND AND OBJECTIVES: Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center. METHODS: Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906). Chief complaints relevant to STIs were defined as genitourinary or sexual complaints. Odds ratios and χ analyses were used to assess association between STI testing, chief complaint, and sexual history. RESULTS: Of the 10,983 visits, 10% (n = 1118) had a complaint relevant to STIs, and 5% (n = 505) had STI testing ordered. Of these tests, 4% were positive for syphilis (n = 11), 13% for chlamydia (n = 29), 6% for gonorrhea (n = 13), and 0.5% for human immunodeficiency virus (n = 1). Sexually transmitted infection testing was more likely to be ordered for STI-relevant chief complaints than unrelated complaints (odds ratio, 16.2, P < 0.01). Sexual history was documented for 8% of visits (n = 72) and was associated with STI testing (P <0.01). DISCUSSION: Sexually transmitted infections are diagnosed in men seen at urgent care centers more often when clients present with relevant symptoms. However, given the low rates of sexual history taking and the asymptomatic nature of most STIs, concern is raised about missing opportunities to identify, treat, and lower community burden of disease. Urgent care visits may represent opportunities for increased testing and treatment of STIs.

Antiretroviral therapy in HIV-infected adolescents: clinical and pharmacologic challenges.

INTRODUCTION: With the currently available combined antiretroviral therapy regimens, durable suppression of viral replication, preservation of immune function and normalizing life expectancy, are all becoming achievable goals. Teenagers and young adults living with HIV present unique clinical and pharmacologic challenges to optimizing antiretroviral treatment outcomes. Areas covered: In this expert review of the topic, we examine recent clinical trial data and draw on our program's 25 year experience working with both perinatally and behaviorally HIV infected adolescents. Expert commentary: In order to be effective, the antiretrovirals we provide must be combined with multidisciplinary interventions and ongoing socio-behavioral support to ensure treatment adherence and prevent the emergence of viral resistance.

Social Media Use and its Association with Sexual Risk and Parental Monitoring among a Primarily Hispanic Adolescent Population.

STUDY OBJECTIVE: In this study we assessed the association between social media (SM) use with sexual risk, and with parental monitoring among Hispanic adolescents. DESIGN: Self-administered anonymous survey. SETTING: Urban primary care clinics. PARTICIPANTS: Primarily Hispanic adolescents ages 13-21 years old. INTERVENTIONS AND MAIN OUTCOME MEASURES: Chi-square and regression analyses controlling for age and gender were used to assess associations between SM use or sexting and sexual behaviors (kissing, touching genitals, vaginal oral, and anal sex), sexual risk (≥4 lifetime partners, >1 recent partner, inconsistent condom use, and history of sexually transmitted infection diagnosis) and contraceptive use. Similar analyses were used to assess relationships between adolescent-reported parental monitoring and SM use, and sexting. RESULTS: Participants with frequent SM use (social networking sites or apps) had greater odds of all sexual activity. Ever sexters had greater odds of penetrative sex only (oral, vaginal, and anal sex) as well as use of hormonal contraception (except long-acting reversible contraception). Approximately half of the participants reported parental access to profiles on SM. Female participants had higher odds of parental access to online profiles and having a parental discussion of privacy settings. Those having privacy discussions had greater odds of "private" profiles on SM and lower odds of ever sexting. CONCLUSION: Frequent SM use and sexting was associated with an increase in all types of sexual behaviors; sexting alone was associated with more lifetime and recent sexual partners. Parental discussion of privacy settings was found to be protective. Providers and parents should be aware of the effect of SM use on sexual behaviors.