Browsing by Subject "sexually transmitted infections"
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Item Area-level incarceration and STI risk among a cohort of justice-involved adolescents and adults(2014-11) Wiehe, Sarah E.; Rosenman, Marc; Scanlon, Michael L.; Fortenberry, J. Dennis; Aalsma, Matthew C.Background: Living in areas of high incarceration is associated with increased risk of STI; however, STI risk with respect to both this area-level exposure and an individual’s involvement with the justice system is not known. Objective: Among individuals before and after arrest or incarceration, assess the association between area-level incarceration rates and risk of chlamydia, gonorrhea, or syphilis. Methods: Retrospective cohort study of individuals living in Marion County (Indianapolis), Indiana who were arrested or in jail, prison, juvenile detention, or juvenile prison between 2005-2008 (N=97,765). Area-level incarceration exposure was defined by the proportion of person-days incarcerated among the total population*365 within a census block group. A 1-year period was assessed before and after a randomly-selected arrest/incarceration per person. Multivariable logistic regression, controlling for age, race, STI history, and year, was performed to assess chlamydia, gonorrhea, or syphilis risk by quartile area-level incarceration exposure, adjusting for individual clustering and stratifying by gender. Results: Area-level incarceration was associated with increased odds of each STI, with a dose response relationship particularly among those with an arrest or jail stay. Women with a history of arrest or jail/prison stay and living in high incarceration areas had higher odds of STI, compared to men with comparable incarceration history and living in similar areas.Item Evaluation of Clinical, Gram Stain, and Microbiological Cure Outcomes in Men Receiving Azithromycin for Acute Nongonococcal Urethritis: Discordant Cures Are Associated With Mycoplasma genitalium Infection(Wolters Kluwer, 2022-01) Toh, Evelyn; Gao, Xiang; Williams, James A.; Batteiger, Teresa A.; Coss, Lisa A.; LaPradd, Michelle; Ren, Jie; Geisler, William M.; Xing, Yue; Dong, Qunfeng; Nelson, David E.; Jordan, Stephen J.; Microbiology and Immunology, School of MedicineBackground In men with nongonococcal urethritis (NGU), clinicians and patients rely on clinical cure to guide the need for additional testing/treatment and when to resume sex, respectively; however, discordant clinical and microbiological cure outcomes do occur. How accurately clinical cure reflects microbiological cure in specific sexually transmitted infections (STIs) is unclear. Methods Men with NGU were tested for Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis, urethrotropic Neisseria meningitidis ST-11 clade strains, and Ureaplasma urealyticum (UU). Men received azithromycin 1 g and returned for a 1-month test-of-cure visit. In MG infections, we evaluated for the presence of macrolide resistance-mediating mutations (MRMs) and investigated alternate hypotheses for microbiological treatment failure using in situ shotgun metagenomic sequencing, phylogenetic analysis, multilocus sequence typing analyses, and quantitative PCR. Results Of 280 men with NGU, 121 were included in this analysis. In the monoinfection group, 52 had CT, 16 had MG, 7 had UU, 10 had mixed infection, and 36 men had idiopathic NGU. Clinical cure rates were 85% for CT, 100% for UU, 50% for MG, and 67% for idiopathic NGU. Clinical cure accurately predicted microbiological cure for all STIs, except MG. Discordant results were significantly associated with MG-NGU and predominantly reflected microbiological failure in men with clinical cure. Mycoplasma genitalium MRMs, but not MG load or strain, were strongly associated with microbiological failure. Conclusions In azithromycin-treated NGU, clinical cure predicts microbiological cure for all STIs, except MG. Nongonococcal urethritis management should include MG testing and confirmation of microbiological cure in azithromycin-treated MG-NGU when MRM testing is unavailable.Item Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey(BMJ Journals, 2017-09-11) Shapiro, Gilla K; Perez, Samara; Naz, Anila; Tatar, Ovidiu; Guichon, Juliet R; Amsel, Rhonda; Zimet, Gregory D; Rosberger, Zeev; Pediatrics, School of MedicineIntroduction Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada’s National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. Methods and analysis Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August–September 2016 and June–July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. Ethics and dissemination The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16–219). The study will adopt a multimodal approach to disseminate the study’s findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.Item A mixed methods approach to assess the likelihood of testing for STI using self-collected samples among behaviourally bisexual women(BMJ, 2015-08) Schick, Vanessa; Van Der Pol, Barbara; Dodge, Brian; Baldwin, Aleta; Fortenberry, J. Dennis; Department of Pediatrics, IU School of MedicineObjectives Behaviourally bisexual women (women who have sex with women and men (WSWM)) are more likely to report a history of sexually transmitted infections (STI) than women who have sex exclusively with men or exclusively with women. Barriers to care may prohibit WSWM from seeking STI testing. The present study investigated participant willingness to self-collect oral, vaginal and anal samples for STI testing. Methods Eighty WSWM were recruited from two midwestern locations. After completing an online questionnaire, a subset of the participants were interviewed (n=54) and provided the option to self-collect oral, vaginal and/or anal samples to screen for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Results Over two-thirds (67.5%, n=54) of the participants completed the baseline scheduled and attended the interview. The majority of these participants provided vaginal (87.0%, n=47), oral (85.2%, n=46) and/or anal (61.1%, n=33) samples. Participants with a history of anal play were significantly more likely to provide an anal sample. C. trachomatis infection was identified in the samples of 6.8% (n=3) of the participants including 4.5% (n=2) of the vaginal samples and 3.3% (n=1) of the anal samples. None of the samples were positive for N. gonorrhoeae or T. vaginalis. Participants who reported a recent history of anal sexual behaviour with a male partner were significantly more likely to self-collect an anal sample. Conclusions Given the comparatively high STI rates among WSWM, self-sampling in non-traditional settings may present a unique opportunity to provide needed care to this underserved population of women.Item Redefining the Social Geography of Community STI Risk: An Ecological Study of the Association, Mediators, and Moderators of Area-Level Prostitution Arrests(2012-03) Wiehe, Sarah E.; Roth, Alexis M.; Burgess, Aaron; Arno, Janet N.; Fortenberry, J. DennisBackground: Core groups such as sex workers have been implicated in contributing to higher area STI risk but no studies have analyzed mediators and moderators of this relationship using population data. Objectives: Assess the overall association of area-level prostitution and STI risk, and mediators and moderators of the relationship. Methods: Point-level prostitution and drug arrests were geocoded and aggregated by Census blockgroup. Chlamydia (CT), gonorrhea (GC), syphilis and incident HIV positive test results were aggregated by blockgroup after eliminating same-organism positive tests within 14 days of an initial positive test. Census data also defined moderators: blockgroups with >75% black and >20% Latino (top decile) and >60% below 200% of the federal poverty line (top quartile). Negative binomial and zero-inflated negative binomial regressions were used to estimate incident rate ratios (IRR) of each STI. Results: There was a dose-response relationship between prostitution arrest blockgroup quintiles and IRR of each STI. In models including drug arrest data, this association was completely eliminated. Though % black blockgroup composition had significant interaction with prostitution arrest rates and with respect to its relationship with STI IRR, % Latino did not consistently have this association. Blockgroups with proportions of low minority and low poverty had highest drug arrest IRR for each STI. In these areas, prostitution arrest IRR were only significant for CT and GC and were consistently lower than drug arrest IRRs. Conclusions: Though prostitution arrests are associated with STI risk, this relationship is mediated by drug arrests. Associations of both arrest rates are strongest in low minority, low poverty communities, indicating that high baseline STI prevalence is not moderated by levels of drug and prostitution arrests. Implications for Programs, Policy, and Research: These data suggest that important relationships exist for prostitution and, to a greater degree, drug arrests within communities traditionally defined as ‘low-risk’.Item Sexually transmitted infections in association with area-level prostitution and drug-related arrests(Wolters Kluwer, 2020-12-15) Magee, Lauren A.; Fortenberry, J. Dennis; Nelson, Tammie; Roth, Alexis; Arno, Janet; Wiehe, Sarah E.; School of Public and Environmental AffairsObjectives: Examine the mediators and moderators of area-level prostitution arrests and sexually transmitted infections (STI) using population level data. Methods Using justice and public health STI/HIV data in Marion County (Indianapolis), Indiana, over an 18-year period, we assessed the overall association of area-level prostitution and drug-related arrests and STI /HIV, and mediators and moderators of the relationship. Point-level arrests were geocoded and aggregated by census block group. Results: Results indicate a positive relationship between numbers of prostitution arrests and area-level STI rates. There was a dose-response relationship between prostitution arrests and STI rates when accounting for drug-related arrests. The highest quintile block groups had significantly higher rates of reported chlamydia (IRR: 3.29, 95% CI: 2.82, 3.84), gonorrhea (IRR: 4.73, 95% CI: 3.90, 5.57), syphilis (IRR: 4.28, 95% CI: 3:47, 5.29), and HIV (IRR: 2.76, 95% CI: 2.24, 3.39) compared with the lowest quintile. When including drug arrests, the second (IRR: 1.19, 95% CI: 1.03, 1.38) and the third (IRR: 1.20, 95% CI: 1.02, 1.41) highest quintile block groups had lower IRR for reported rates of chlamydia, indicating that drug arrests mediated the prostitution arrest effect. Conclusions: These findings inform public health agencies and community-based organizations that conduct outreach in these areas to expand their efforts to include harm reduction and HIV/STI testing for both sex workers and individuals experiencing substance use disorder. Another implication of these data is the importance of greater collaboration in public health and policing efforts to address overlapping epidemics that engage both health and legal intervention.Item Study of sexual partner accrual patterns among adolescent women via Generalized Additive Mixed Models(Office of the Vice Chancellor for Research, 2014-04-11) Harezlak, Jaroslaw; He, Fei; Fortenberry, J. DennisThe number of lifetime partners is a consistently identified epidemiological risk factor for sexually transmitted infections (STIs). Higher rate of partner accrual during adolescence has been associated with increased STI rates among adolescent women. To study sexual partner accrual pattern among adolescent females, we applied generalized additive mixed models (GAMM) to the data obtained from a longitudinal STI study. GAMM regression components included a bivariate function enabling separation of cohort (“age at study entry”) and longitudinal (“follow-up years”) effects on partner accrual while the correlation was accounted for by the subject-specific random components. Longitudinal effect partial derivative was used to estimate within-subject rates of partner accrual and their standard errors. The results show that slowing of partner accrual depends more on the prior sexual experience and less on the females’ chronological age. Our modeling approach combining the GAMM flexibility and the time covariates’ of interest definition enabled clear differentiation between the cohort (chronological age) and longitudinal (follow-up time) effects, thus providing the estimates of both between-subject differences and within-subject trajectories of partner accrual.Item Time From First Intercourse to First Sexually Transmitted Infection Diagnosis Among Adolescent Women(2009-12) Tu, Wanzhu; Batteiger, Byron E.; Wiehe, Sarah E.; Ofner, Susan; Van Der Pol, Barbara; Katz, Barry P.; Orr, Donald P.; Fortenberry, J. DennisObjective To determine the time between first intercourse and first sexually transmitted infection (STI) with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis and time between repeated infections. Design Observational study. Setting Three adolescent medicine clinics. Participants A cohort of 386 urban young women aged 14 to 17 years at enrollment. Main Outcome Measures Age at first intercourse; organism-specific interval between first intercourse and first STI diagnosis; interval between repeated infections; and age at first STI test prior to study participation. Results Participants had first intercourse at a young age (first, second, and third quartiles were 13, 14, and 15 years of age, respectively). By age 15 years, 25% of the women acquired their first STI, most often C trachomatis. Median interval between first intercourse and first STI diagnosis was 2 years. Within 1 year of first intercourse, 25% had their first C trachomatis infection. Repeated infections were common; within 3.6, 6, and 4.8 months, 25% of the women with prior C trachomatis, N gonorrhoeae, and T vaginalis infection were reinfected with the respective organisms. Considerable delay in STI testing was found for those who began sex at a younger age. The median interval between first sex and first test were 4.9, 3.5, 2.1, 1.8, and 1.2 years for those who had first sex at ages 10, 11, 12, 13, and 14 years, respectively. Conclusions Timely screening and treatment are important for prevention of STI sequelae. For urban adolescent women, STI screening (especially for C trachomatis) should begin within a year after first intercourse and infected individuals should be retested every 3 to 4 months.