A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women.

Objective: Men who have sex with men (MSM) have higher rates of HIV and other sexually transmitted infections than women and heterosexual men. This elevated risk persists across age groups and reflects biological and behavioral factors; yet, there have been few direct comparisons of sexual behavior patterns between these populations.

Methods: We compared sexual behavior patterns of MSM and male and female heterosexuals aged 18-39 using 4 population-based random digit dialing surveys.

HIV disclosure and subsequent sexual behaviors among men who have sex with men who meet online.

To assess HIV disclosure discussions and related sexual behaviors among men who have sex with men (MSM) who meet sex partners online, 28 qualitative interviews with Seattle-area MSM were analyzed using grounded theory methods and themes and behavior patterns were identified. MSM found a greater ease in communicating and could prescreen partners through the Internet. However, no consistent relationship was found between HIV disclosure and subsequent behaviors: some were safer based on disclosure while perceived HIV status led others to risky behaviors.

Cost-effectiveness and population outcomes of general population screening for hepatitis C.

Background: Current US guidelines recommend limiting hepatitis C virus (HCV) screening to high-risk individuals, and 50%-75% of infected persons remain unaware of their status.

Methods: To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years to current guidelines, we developed a decision analytic model for the screening intervention and Markov model with annual transitions to estimate natural history. Subanalyses included protease inhibitor therapy and screening those at highest risk of infection (birth year 1945-1965).

Prevalence and characteristics of femoral injection among Seattle-area injection drug users.

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010.

Mycoplasma genitalium: should we treat and how?

Mycoplasma genitalium is associated with acute and chronic urethritis in men. Existing data on infection in women are limited and inconsistent but suggest that M. genitalium is associated with urethritis, cervicitis, pelvic inflammatory disease, and possibly female infertility.

Population-based metrics for the timing of HIV diagnosis, engagement in HIV care, and virologic suppression.

Objective: To compare population-based metrics for assessing progress toward the US National HIV/AIDS Strategy (NHAS) goals.

Design: Analysis of surveillance data from persons living with HIV/AIDS (PLWHA) in King County, Washington, USA, 2005-2009.

Methods: We examined indicators of the timing of HIV diagnosis [intertest interval, CD4 cell count at diagnosis, and AIDS ≤ 1 year of diagnosis (late diagnosis)]; linkage to initial care (CD4 or viral load report ≤3 months after diagnosis) and sustained care (a laboratory report 3-9 months after linkage); engagement in continuous care in 2009 (at least two laboratory reports ≥3 months apart); and virologic suppression.

The cost and cost-effectiveness of expedited partner therapy compared with standard partner referral for the treatment of chlamydia or gonorrhea.

Background: Partner treatment is an important component of sexually transmitted disease control. Several randomized controlled trials have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, whereas some found that EPT significantly lowered reinfection rates in index patients.

A randomized, controlled trial of inSPOT and patient-delivered partner therapy for gonorrhea and chlamydial infection among men who have sex with men.

Background: The efficacy of patient-delivered partner therapy (PDPT) and inSPOT, a web-based partner notification service, in increasing partner treatment and/or notification among men who have sex with men (MSM) has not been evaluated.

Methods: We enrolled MSM with chlamydia and/or gonorrhea in a randomized, controlled trial with the following 4 arms: inSPOT, PDPT, combined inSPOT and PDPT (inSPOT/PDPT), and standard partner management. Men were offered enrollment when contacted for partner services.

Ureaplasma urealyticum is associated with nongonococcal urethritis among men with fewer lifetime sexual partners: a case-control study.

Background: Ureaplasmas have been inconsistently associated with nongonococcal urethritis (NGU). We evaluated the association of the newly differentiated species Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) with NGU using 2 separate control groups.

Methods: Case patients were men who attended a sexually transmitted disease (STD) clinic in Seattle, Washington, during the period 2007-2009 with NGU (defined as visible urethral discharge and/or ≥5 polymorphonuclear neutrophils per high-powered field; n = 329).

Patient acceptance of universal screening for hepatitis C virus infection.

Background: In the United States, about 70% of 2.9-3.7 million people with hepatitis C (HCV) are unaware of their infection.

Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.

Background: Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually transmitted disease (STD) clinics serving men who have sex with men, hospital emergency departments (EDs), settings where patients are likely to be diagnosed early, and inpatient diagnosis based on clinical manifestations.

Methods And Findings: We developed the Progression and Transmission of HIV/AIDS model, a health state transition model that tracks index patients and their infected partners from HIV infection to death.

Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study.

Background: Nongonococcal urethritis (NGU) is common, yet up to 50% of cases have no defined etiology. The extent to which risk profiles and clinical presentations of pathogen-associated and idiopathic cases differ is largely unknown.

Methods: Urethral swabs and urine specimens were collected from 370 NGU treatment trial participants who sought care at a sexually transmitted disease clinic in Seattle, WA from 2007 to 2009 and had a visible urethral discharge and/or microscopic evidence of urethral inflammation assessed by Gram-stain (≥5 polymorphonuclear leukocytes per high-powered field [PMNs/HPF]).

Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial.

Background: Methamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness.

Stroke in a patient with human immunodeficiency virus and syphilis treated with penicillin and antiretroviral therapy.

With the rising incidence and prevalence of syphilis, meningovascular syphilis and other forms of neurosyphilis have reappeared, particularly among persons infected with human immunodeficiency virus. We present a patient with meningovascular syphilis leading to stroke after treatment with penicillin and antiretroviral therapy.

Enhanced molecular typing of treponema pallidum: geographical distribution of strain types and association with neurosyphilis.

Background: Strain typing is a tool for determining the diversity and epidemiology of infections.

Methods: Treponema pallidum DNA was isolated from 158 patients with syphilis from the United States, China, Ireland, and Madagascar and from 15 T. pallidum isolates.

Awareness and use of HIV pre-exposure prophylaxis among attendees of a seattle gay pride event and sexually transmitted disease clinic.

We surveyed a convenience sample of 215 HIV-negative men who have sex with men (MSM) recruited at a Gay Pride event and in an STD clinic about their willingness to use pre-exposure prophylaxis (PrEP). Overall, 44% reported that they would take PrEP every day if it helped prevent HIV. There was no association between sexual risk behavior and interest in taking PrEP.

Persistence of racial differences in attitudes toward homosexuality in the United States.

Background: Stigma may mediate some of the observed disparity in HIV infection rates between black and white men who have sex with men (MSM).

Methods: We used data from the General Social Survey to describe race-specific trends in the US population's attitude toward homosexuality, reporting of male same-sex sexual behavior, and behaviors that might mediate the relationship between stigma and HIV transmission among MSM.

Results: The proportion of blacks who indicated that homosexuality was "always wrong" was 72.

Increasing public health partner services for human immunodeficiency virus: results of a second national survey.

Background: Recent US national efforts taken to prevent human immunodeficiency virus (HIV) infection have emphasized HIV case-finding, including partner services (PS).

Methods: We collected data on HIV PS procedures and outcomes in 2006 from health departments in US metropolitan areas with the highest number of cases of acquired immunodeficiency syndrome, gonorrhea, chlamydial infection, and primary and secondary syphilis, and compared our results with the data collected through a similar study carried out in 2001.

Results: Of the 71 eligible jurisdictions, 51 (72%) participated in this study.

Expedited partner therapy: a robust intervention.

Background: Expedited partner therapy (EPT) has been shown to reduce the risk of persistent or recurrent gonorrhea and chlamydial infection in heterosexuals, and to increase the proportion of sex partners receiving treatment. The objective of this analysis was to evaluate the consistency of EPT's effect across sociodemographic and behavioral subgroups.

Methods: Subset analyses from a randomized controlled trial compared EPT to standard partner referral (SPR) in sociodemographic and behaviorally defined subgroups.

Public health rationale for rapid nucleic acid or p24 antigen tests for HIV.

Rapid diagnostic tests that might be capable of detecting human immunodeficiency virus (HIV) antigens or nucleic acids represent the possibility of merging 2 key advancements in HIV testing: rapid testing and detection of acute HIV infection. In this article, we review the public health goals of rapid HIV testing and acute HIV testing and explore how rapid tests to directly detect HIV antigens or nucleic acids might alter current approaches to HIV case identification in clinical and public health screening settings. We discuss the specific types of HIV screening programs and settings in which direct viral rapid testing would offer an important advantage.