Sexually Transmitted Infections and Use of Contraceptives in Women Living with HIV in Denmark - The SHADE Cohort

BACKGROUND:

No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.

METHODS:

WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.

RESULTS:

In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.

CONCLUSION:

The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.

Full article at:   http://goo.gl/jR36Xj

By:  Thorsteinsson K1, Ladelund S2, Storgaard M3, Rønsholt FF4, Johansen IS5, Pedersen G6, Nielsen LN7, Bonde J8, Westh H9,10, Obel N4,9, Katzenstein TL4,9,Lebech AM11,9.

• 1Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. kristina.thorsteinsson@gmail.com.
• 2Clinical Research Center, Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark.
• 3Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
• 4Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
• 5Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
• 6Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
• 7Department of Infectious Diseases, Hillerød Hospital, Hillerød, Denmark.
• 8Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
• 9Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
• 10Department of Clinical Microbiology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
• 11Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
• BMC Infect Dis. 2016 Feb 16;16(1):81. doi: 10.1186/s12879-016-1412-7. 

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High Prevalence of Chlamydia Trachomatis & Neisseria Gonorrhoeae Infections in Anal & Pharyngeal Sites among Men Who Have Sex with Men & Transgender Women in Lima, Peru

OBJECTIVES:

This study aimed to characterise the epidemiology of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru.

PARTICIPANTS:

We recruited a group of 510 MSM and 208 TW for a subsequent community-based randomised controlled trial. The presence of CT and NG were evaluated using Aptima Combo2 in pharyngeal and anal swabs. We also explored correlates of these infections.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Study end points included overall prevalence of C. trachomatis and N. gonorrhoeae in anal and pharyngeal sites.

RESULTS:

Overall prevalence of CT was 19% (95% CI 16.1% to 22.1%) and 4.8% (95% CI 3.3% to 6.6%) in anal and pharyngeal sites, respectively, while prevalence of NG was 9.6% (95% CI 7.5% to 12.0%) and 6.5% (95% CI 4.8% to 8.5%) in anal and pharyngeal sites, respectively.

CONCLUSIONS:

The prevalence of each infection declined significantly among participants older than 34 years (p<0.05). Efforts towards prevention and treatment of extraurogenital chlamydial and gonococcal infections in high-risk populations like MSM and TW in Lima, Peru, are warranted.

Below:  Trends of prevalence of anal and pharyngeal infections over age group, satisfied by agent and sexual identity

Full article at:   http://goo.gl/fkxwMy

By:  Leon SR1, Segura ER2, Konda KA3, Flores JA4, Silva-Santisteban A4, Galea JT5, Coates TJ3, Klausner JD3, Caceres CF4.

• 1Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru Department of Global Health, University of Washington (http://globalhealth.washington.edu/), Seattle, Washington, USA Socios en Salud, Lima, Peru.
• 2Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
• 3Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
• 4Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru.
• 5Partners in Health, Boston, Massachusetts, USA. 
• BMJ Open. 2016 Jan 6;6(1):e008245. doi: 10.1136/bmjopen-2015-008245.

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Ease, Comfort, and Performance of the HerSwab Vaginal Self-Sampling Device for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae

BACKGROUND:

Many sexually transmitted diseases are asymptomatic in the lower genital tract and can cause upper tract complications if left untreated. Self-collected vaginal (SCV) swabs enable the accurate detection of many sexually transmitted infections and give women the option of collecting their own samples while providing them with privacy and convenience.

METHODS:

We compared SCV samples collected and transported dry using the HerSwab device to physician-collected vaginal (PCV) Aptima swabs for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), and measured patients' ease and comfort with self-collection. A total of 189 women aged 16 to 41 years were consented into the study and answered a standardized anonymized questionnaire regarding self-collection with the HerSwab device.

RESULTS:

Women reported self-collection with HerSwab to be easy (97.1%) and comfortable (88.3%). They preferred self-collection over physician collection (80.9%) and would consider using HerSwab for self-collection at home (79.7%). Samples of SCV and PCV showed an overall agreement of 94.7% (κ = 0.64) for CT and of 98.4% (κ = 0.56) for NG, and HerSwab collection detected 7 more positive patients than PCV collection. The overall prevalence of infection was 10.6% for CT and 2.6% for NG.

CONCLUSION:

HerSwab SCV samples are suitable for the diagnosis of CT and NG.

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By:  Arias M1, Jang D, Gilchrist J, Luinstra K, Li J, Smieja M, Chernesky MA.

• 1From the St Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada. 

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Unexpectedly High HIV Prevalence among Female Sex Workers in Bangkok, Thailand

The pattern of sex work in Thailand has shifted substantially over the last two decades from direct commercial establishments to indirect venues and non-venue-based settings. This respondent-driven sampling survey was conducted in Bangkok in 2007 among female sex workers (FSW) in non-venue-based settings to pilot a new approach to surveillance among this hidden population. Fifteen initial participants recruited 707 consenting participants who completed a behavioural questionnaire, and provided oral fluid for HIV testing, and urine for sexually transmitted infection (STI) testing. 

Overall HIV prevalence was 20.2%. Three-quarters of women were street-based (75.8%) who had an especially high HIV prevalence (22.7%); about 10 times higher than that found in routine sentinel surveillance among venue-based FSW (2.5%). STI prevalence (Chlamydia trachomatis and Neisseria gonorrhoeae) was 8.7% and 1.0%, respectively. Lower price per sex act and a current STI infection were independently associated with HIV infection. 

High HIV prevalence found among FSW participating in the survey, particularly non-venue-based FSW, identifies need for further prevention efforts. In addition, it identifies a higher-risk segment of FSW not reached through routine sentinel surveillance but accessible through this survey method.

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By:  Manopaiboon C¹, Prybylski D, Subhachaturas W, Tanpradech S, Suksripanich O, Siangphoe U, Johnston LG, Akarasewi P, Anand A, Fox KK, Whitehead SJ.

¹Global AIDS Program, Thailand/Asia Regional Office, Thailand MOPH-U.S. CDC Collaboration, Ministry of Public Health, Nonthabhuri.

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Sexually Transmitted Infections: Experience in a Multidisciplinary Clinic in a Tertiary Hospital in Spain (2010-2013)

INTRODUCTION:

The number of consultations for sexually transmitted infections (STIs) is increasing in Spain. The aim of this study was to describe and analyze the epidemiological, behavioral, clinical, and microbiological characteristics of patients registered at the STI unit of a tertiary hospital.

METHODS:

This was a retrospective, single-center descriptive study carried out between 2010 and 2013 in a multidisciplinary unit specialized in STIs, situated in a tertiary hospital. Epidemiological, clinical, and behavioral data were gathered using a face-to-face interview and a standardized questionnaire. Samples were collected for microbiology analysis.

RESULTS:

The study included 546 patients: 96% were men, 41% had human immunodeficiency virus (HIV) infection, and 56% were men who have sex with men. The reasons for consultation were the following: urethritis; genital, anal, or perianal ulcers; proctitis; oral ulcers; sexual contact with a person with a known STI; and high-risk sexual contact. The most common microbiological diagnoses were Neisseria gonorrhoeae in urethritis, Treponema pallidum in genital and anal or perianal ulcers, and Chlamydia trachomatis lymphogranuloma venereum serovars in proctitis. The highest prevalences of the main STIs studied occurred in homosexual men with HIV infection.

CONCLUSION:

This study confirms the increase in the incidence of STIs in recent years and the epidemiological characteristics of the HIV/STI epidemic in Spain.

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By:   Moreno-Ribera N¹, Fuertes-de Vega I¹, Blanco-Arévalo JL², Bosch-Mestres J³, González-Cordón A², Estrach-Panella T¹, García-de Olalla P⁴, Alsina-Gibert M⁵.

¹Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

²Servicio de Enfermedades Infecciosas, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

³Servicio de Microbiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

⁴Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, Barcelona, España.

⁵Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España. Electronic address: malsina@clinic.ub.es.

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Prevalence of Seven Sexually Transmitted Organisms by Multiplex Real-Time PCR in Fallopian Tube Specimens Collected from Saudi Women With & Without Ectopic Pregnancy

BACKGROUND:

Ectopic pregnancy (EP) is associated with maternal morbidity and occasionally mortality during the first trimester. A history of sexually transmitted infection (STI) and pelvic inflammatory disease have been implicated as major risk factors for EP. Our aim was to measure the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium (MG), Ureaplasma parvum/urealyticum, Gardnerella vaginalis, Trichomonas vaginalis and herpes simplex virus (HSV)-1&2 in Fallopian tubes collected from EP and the results were compared with those obtained from total abdominal hysterectomy (TAH) and tubal ligation.

METHODS:

This was a prospective case-control study and tubal samples were collected from 135 Saudi women recruited from 3 centres in the Western region as follow: 84 EPs, 20 TAH and 31 tubal ligations. Multiplex TaqMan PCR was performed using an IVD CE kit for the simultaneous detection of candidate pathogens following DNA extraction.

RESULTS:

Infections were detected in 31.8 % of the 135 participants either as single (11.1 %) or co-infections (20.7 %) and the frequencies were significantly higher in EP (42.85 %) compared with control (13.72 %). The rates of CT (27.4 %; P = 0.001); MG (20.2 %; P = 0.009) and HSV-1/2 (21.4 %; P = 0.01) were significantly higher in EP. No significant difference between the study groups was observed for the other pathogens (P > 0.05). Binary logistic regression also showed that infection with ≥ 2 pathogens (OR 4.9; 95 % CI: 2.2 - 11.6; P = 0.006), CT (OR 3.07; 95 % CI: 1.3 - 12.3; P = 0.002), MG (OR 2.3; 95 % CI: 1.1 - 8.6; P = 0.03) and HSV-1/2 (OR 1.7; 95 % CI: 0.75 - 5.7; P = 0.004) were associated with a significantly higher risk of developing EP.

CONCLUSIONS:

STIs are frequent in the upper genital tract of Saudi women during the reproductive age and, CT, MG and HSV-1/2 were more prevalent in EP. The observed high rates of co-infection advocate the necessity of establishing national guidelines and/or screening program utilising multiplex PCR approach for the detection of common STIs among high risk groups in the kingdom. Further studies are needed to measure the adverse reproductive outcomes associated with STIs in Saudi Arabia.

Table 1

Principle inclusion and exclusion criteria for the study groups

Control group		Case group
Inclusion criteria	Exclusion criteria	Inclusion criteria	Exclusion criteria
Saudi	Non-Saudi	Saudi	Non-Saudi
Patient age ≥ 18 and ≤ 42 years.	Patient age < 18 or > 42 years.	Patient age ≥ 18 and < 40 years.	Patient age < 18 or > 40 years.
Cyclic women with a history of previous intrauterine pregnancy and no history of hydrosalpinx or ectopic pregnancy	Women with abnormal menstrual cycle, history of infertility treatment, history of PID, endometriosis and previous ectopic pregnancy.	Ectopic pregnancy following spontaneous conception	Ectopic pregnancy following assisted conception, using IUD, History/symptoms of urogenital infection (e.g. vaginal discharge, dysuria, PID, etc.)
Clinical decision to undertake total abdominal hysterectomy (TAH) for benign disease not affecting the Fallopian tubes and endometrium	Vaginal or subtotal hysterectomy	Singleton pregnancy	Multiple/heterotopic pregnancy
Clinical decision to undertake tubal ligation for sterilisation	Use of IUD ≤ 1 year prior to operation	Clinical determination that the patient is haemodynamically stable	Symptoms and signs of hypovolemia

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By:   Ashshi AM1, Batwa SA2, Kutbi SY3, Malibary FA4, Batwa M5, Refaat B6.

• 1Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. aashshi@yhaoo.com.
• 2Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. sarahbatwa@hotmail.com.
• 3Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. seham.alkutbi@yahoo.com.
• 4Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. fzmilly12345@gmail.com.
• 5Al-Thager General Hospital, Jeddah, KSA. mbatwa@hotmail.com.
• 6Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. bassem.refaat@yahoo.co.uk. 

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Sexually transmitted infections in children as a marker of child sexual abuse and direction of future research

PURPOSE OF REVIEW:

This review considers recent evidence on sexually transmitted infections (STIs) as a marker of child sexual abuse (CSA), when diagnosed after the neonatal period. It also aims to identify if there are specific areas where additional research is required.

RECENT FINDINGS:

An evidence-based systematic review using strict inclusion criteria shows that CSA is a major cause of STIs in children. In children 12 years and below, 36-83% of Neisseria gonorrhoeae and 75-94% of Chlamydia trachomatis infections are due to CSA; for children 14 years and younger, 31-58% of anogenital warts are due to CSA. In child genital sampling, genital human papillomavirus (HPV) types were more common in those considered abused (13.7%) than nonabused (1.3%). HPV typing of genital warts in children were all of genital type 6. Subsequent research, into N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis and syphilis in children including ophthalmic infection, found that 13 of 15 cases were confirmed/likely due to CSA. Recent data indicate that bacterial vaginosis and Mycoplasma genitalium are related to sexual activity in adults but did not assess children.

SUMMARY:

STIs in children under 13-14 years may indicate CSA. Genital HPV types are associated with CSA. Research is required of sufficient standard to contribute to the evidence base.

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By:   Rogstad KE1, Wilkinson D, Robinson A.

• 1aDepartment of Genitourinary Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield School of Medicine Sheffield bDepartment of Genitourinary Medicine, Jefferiss Wing Centre for Sexual Health, St Mary's Hospital, Imperial College Healthcare NHS Trust cDepartment of Genitourinary/HIV Medicine, CNWL NHS Foundation, Trust and UCL, London, UK. 

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Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. 

New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. 

For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. 

Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.

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By:  Seña AC1, Hsu KK2, Kellogg N3, Girardet R4, Christian CW5, Linden J6, Griffith W7, Marchant A8, Jenny C9, Hammerschlag MR10.

• 1Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill.
• 2Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain.
• 3Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio.
• 4Division of Child Protection Pediatrics, Department of Pediatrics, University of Texas Health Science Center at Houston.
• 5Child Abuse and Neglect Prevention, Children's Hospital of Philadelphia, Pennsylvania.
• 6Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
• 7Women's Emergency Services, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
• 8Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
• 9Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle.
• 10Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn. 

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Prevalent Bacterial Vaginosis Infection - A Risk Factor for Incident Sexually Transmitted Infections in Women in Durban, South Africa

The association between bacterial vaginosis (BV) and incident sexually transmitted infections (STIs) in a cohort of high-risk women from Durban, South Africa was investigated in this study. 

We undertook a secondary analysis of the Methods for Improving Reproductive Health in Africa trial that assessed effectiveness of the latex diaphragm and lubricant gel on HIV prevention among women. During study visits, urine specimens were collected for testing for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. The presence of BV was based on vaginal pH and wet mount test assessments. The association between BV and the risk for incident STIs was determined using Cox proportional hazards model. Prevalence of BV was 31% in a cohort of 435 women tested at baseline. Among these women, BV was significantly associated with incident Trichomonas vaginalis (14.6 per 100 PY, p = 0.03) and Chlamydia trachomatis infections (15.8 per 100 PY, p = 0.04). BV remained a significant predictor for Trichomonas vaginalis infections even after adjusting for potential confounders such as age and marital status (HR: 1.60, 95% CI: 1.00, 2.57, p = 0.04). 

Our study showed an association between baseline BV infections and incident Trichomonas vaginalis and Chlamydia trachomatis infections. Women with BV infections should be counselled on the use of condoms and the risk of new STIs.

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By: Abbai NS1, Reddy T2, Ramjee G3.

• 1HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa Nathlee.abbai@mrc.ac.za.
• 2Biostatistics Unit, South African Medical Research Council, Durban, South Africa.
• 3HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.  

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Neisseria Gonorrhoeae & Chlamydia Trachomatis among Women Reporting Extragenital Exposures

The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women.

All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections.

A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor of extragenital infections in women.

Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.

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By: Trebach JD1, Chaulk CP, Page KR, Tuddenham S, Ghanem KG.

• 1From the *Johns Hopkins University School of Medicine, Baltimore, MD; and †Baltimore City Health Department, Baltimore, MD.  

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A Novel Public Library-Based Sexually Transmitted Infection Screening Program for Younger High-Risk Groups in Omaha, Nebraska, USA

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the two most commonly reported sexually transmitted infections (STIs) in the United States (U.S.) and Douglas County, Nebraska has STI rates consistently above the U.S. average. 

The Douglas County Health Department (DCHD) developed an outreach CT and NG screening program in public libraries to address the problem beyond the traditional STI clinic setting. This study evaluates the effectiveness of the program and identifies factors predictive of CT and NG infections. 

A retrospective review of surveys of library patrons and DCHD traditional STI clinic clients who submitted urine tests for CT and NG from June 2010 through April 2014 was done. Chi square, Fisher exact, Student's t tests, univariate and multivariate logistic regression were conducted. A total of 977 library records and 4871 DCHD clinic records were reviewed. 

• The percent positive was lower in the library than in the traditional clinic for CT (9.9 vs. 11.2 %) and NG (2.74 vs. 5.3 %)
• Library clients were more likely to be 19 years and younger, Black, and asymptomatic compared to traditional clinic clients. 

The library STI screening program effectively reaches a younger, asymptomatic, and predominantly Black population compared to a traditional health department clinic site.

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By: Delair SF1, Lyden ER2, O'Keefe AL3, Simonsen KA4, Nared SR3, Berthold EA3, Watanabe-Galloway S5.

• 1Division of Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA. shirley.delair@unmc.edu.
• 2Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
• 3Douglas County Health Department, Omaha, NE, USA.
• 4Division of Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
• 5Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.  

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