BACKGROUND:We sought to determine real-world effectiveness of doxycycline postexposure prophylaxis (doxy PEP) in reducing sexually transmitted infections (STIs) among men who have sex with men attending an HIV preexposure prophylaxis (HIV PrEP) clinic in Philadelphia. METHODS:Data from eligible HIV PrEP patients who did and did not receive doxy PEP from September 1, 2019, to December 31, 2023, were analyzed. We used a cohort study design and Cox models to estimate the associations between doxy PEP receipt and incident gonorrhea (GC), chlamydia (CT), and/or syphilis. We also used a crossover design and Poisson models to estimate incidence rate ratios (IRRs) for any STI and each STI separately among individuals in the year before and after doxy PEP initiation. RESULTS:Among the 508 eligible men, most were young men of color, and 416 (82%) opted to receive doxy PEP. Receiving doxy PEP was associated with a reduction in any incident STI (hazard ratio, 0.61; 95% confidence interval [CI], 0.40-0.93) and any incident CT (hazard ratio, 0.40; 95% CI, 0.21-0.78). Participants experienced a 62% relative reduction in STI rates while taking doxy PEP (IRR, 0.38; 95% CI, 0.29-0.50), including a reduction in CT (IRR, 0.28; 95% CI, 0.20-0.39) and GC (IRR, 0.49; 95% CI, 0.37-0.65). CONCLUSIONS:We observed a significant reduction in any STI and CT in both analytic arms, suggesting that doxy PEP is effective in real-world settings. Enhancing doxy PEP implementation would likely reduce community STI transmission.

BACKGROUND:Syphilis in Florida increased 49% from 2016 to 2020. Moreover, many serological tests for syphilis (STS) do not indicate current infection. Traditionally, syphilis surveillance systems used reactor grids, a method for prioritizing STS for investigation based on age, nontreponemal titer, and/or sex. In 2022, Florida's sexually transmitted disease surveillance system implemented an automated method for processing electronically reported STS (eSTS), expanding upon the reactor grid, using an individual's current STS (treponemal and nontreponemal), treatment history, and historical STS results aiming for more efficiently processing eSTS. We compared the new method of processing eSTS results against the reactor grid and determined potential value in time/cost savings of this change. METHODS:All eSTSs (n = 4144) from January 2, 2023 to January 8, 2023, were compared by how the logic-based method processed test results versus how the reactor grid processed test results. Each method was compared using measurements of accuracy (e.g., sensitivity/specificity). Time and cost savings in eSTS processing were estimated. RESULTS:Using the surveillance case definition as reference, the accuracy of the logic-based method for processing eSTS was nearly double (82.3% vs. 43.6%), had greater specificity (79.0% vs. 33.0%), and increased positive predictive value (47.5% vs. 22.0%) when compared with the reactor grid method. Sensitivity (99.5% vs. 98.6%) and negative predictive value (99.9% vs. 99.2%) remained similar. The logic-based method is estimated to save 7783 hours annually (~$185,000). CONCLUSIONS:Processing eSTS based on current and historical STS results is significantly more accurate than using a reactor grid. Moreover, these improvements save time and resources that can be better allocated to other program prevention activities.

Background: The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) get tested annually for urethral and rectal chlamydia (CT) and gonorrhea (NG), and pharyngeal NG. There are no national recommendations to screen women and heterosexual men at extragenital sites. We assessed extragenital CT/NG screening among men and women at Louisiana's Parish Health Units (PHU). Methods: The Louisiana STD/HIV/Hepatitis Program piloted extragenital screening at 4 PHUs in February 2016 and expanded to 11 PHUs in 2017. Sexual histories were used to identify gender of sex partners and exposed sites. Because of billing restrictions, up to 2 anatomical sites were tested for CT/NG. Results: From February 2016 to June 2019, 70,895 urogenital and extragenital specimens (56,086 urogenital, 13,797 pharyngeal, and 1,012 rectal) were collected from 56,086 patients. Pharyngeal CT positivity was 160 of 7,868 (2.0%) among women, 54 of 4,838 (1.1%) among men who have sex with women (MSW) and 33 of 1,091 (3.0%) among MSM. Rectal CT positivity was 51 of 439 (11.6%) among women and 95 of 573 (16.6%) among MSM. Pharyngeal NG positivity was 299 of 7,868 (3.8%) among women, 222 of 4,838 (4.6%) among MSW, and 97 of 1,091 (8.9%) among MSM. Rectal NG positivity was 20 of 439 (4.6%) among women and 134 of 573 (23.4%) among MSM. Urogenital-only screening would havemissed: among women, 173 of 3,923 (4.4%) CT and 227 of 1,480 (15.3%) NG infections; among MSW, 26 of 2,667 (1%) CT and 149 of 1,709 (8.7%) NG infections; and among MSM, 116 of 336 (34.5%) CT and 127 of 413 (42.1%) NG infections. Conclusions: Many CT/NG infections would have been missed with urogenital-only screening. Men who have sex with men had much higher extragenital infection rates than women and MSW.

Background Shigella species, which cause acute diarrheal disease, are transmitted via fecal-oral and sexual contact. To better understand the overlapping populations affected by Shigella infections and sexually transmitted infections (STIs) in the United States, we examined the occurrence of reported STIs within 24 months among shigellosis case-patients. Methods Culture-confirmed Shigella cases diagnosed from 2007 to 2016 among residents of 6 US jurisdictions were matched to reports of STIs (chlamydia, gonorrhea, and all stages of syphilis) diagnosed 12 months before or after the shigellosis case. We examined epidemiologic characteristics and reported temporal trends of Shigella cases by sex and species. Results From 2007 to 2016, 10,430 shigellosis cases were reported. The annual number of reported shigellosis cases across jurisdictions increased 70%, from 821 cases in 2007 to 1398 cases in 2016; males saw a larger increase compared with females. Twenty percent of male shigellosis case-patients had an STI reported in the reference period versus 4% of female case-patients. The percentage of male shigellosis case-patients with an STI increased from 11% (2007) to 28% (2016); the overall percentage among females remained low. Conclusions We highlight the substantial proportion of males with shigellosis who were diagnosed with STIs within 24 months and the benefit of matching data across programs. Sexually transmitted infection screening may be warranted for male shigellosis case-patients.

Background Syphilis rates have continued to rise in the United States. Florida and Louisiana consistently report high numbers of cases. In a previous study, reinfections accounted for 30.4% of new infections among men in 2018. In this analysis, we evaluated rates of reported reinfections in women. Methods We evaluated all syphilis records, all stages (primary, secondary, early latent, and late latent) in females aged 15–70 years from the Florida and Louisiana Departments of Health surveillance databases during 2000–2018. Demographics of cases and repeaters (individuals reported with 2 or more cases of syphilis) were examined. Percentages of syphilis cases from repeaters by year were calculated as were percentages from HIV+ females. Results From 2000–2018, 124,827 syphilis cases were reported from 107,405 individuals: 33,594(31%) were female accounting for 35,279(28%) of all cases. Of 33,594 females, 32,050(95%) reported a single episode of syphilis and 1,544(5%) were repeaters. Most women with a single case report were African American 18,429(57.5%) and 1,510(4.7%) of single cases were HIV+. Women with a single episode of syphilis were likely in the age range of 20–39 (primary child-bearing years) 20,037(63%). Repeaters were primarily African American 914(59.2%) and 218(14.1%) were HIV+. Women reported with two or more episodes of syphilis also were likely to be of child-bearing age 20–39: 1,065(69%). Repeaters had 1,685 cases reported; range 2 to 5. Mean time to second infection was 3.5 years (median=2.3 years). From 2010–2018, repeaters accounted for a slowly increasing percentage of all syphilis reported: 2010 (5.1%), 2013 (5.9%), 2016 (6.8%), and reached (10.3%) in 2018. Within females living with HIV, cases from repeaters also increased: 2010 (13%), 2014 (16%), 2016 (21%), and 2018 (25%). Conclusion Most syphilis diagnosed in Florida and Louisiana was among persons infected for the first time and among men. However, syphilis infection and reinfections are increasing in women.

Syphilis rates have continued to rise in the United States. Florida and Louisiana consistently report high numbers of cases. We evaluated rates of reinfection to see if frequent rescreening might lead to earlier treatment and prevent infections. All syphilis records of all stages for males and females aged 15-70 years from the Florida and Louisiana Departments of Health surveillance databases 2000-2018 were evaluated. The first episode of syphilis during this period was considered the initial diagnosis for each person. Demographics of cases and repeaters (individuals reported with two or more cases of syphilis) were examined. Percentages of syphilis cases from repeaters by year were calculated as were percentages from HIV+ males. During 2000-2018, 124,827 syphilis cases were reported from 107,405 individuals: 73,811 (68.7%) males; 33,594 (31.3%) females. There were 12,545 individuals (repeaters) with two or more syphilis diagnoses (n=17,422 cases; range, 2-10). From 2010 to 2018, repeaters accounted for steadily increasing percentage of all syphilis reported: 2010 (11%), 2013 (16%), 2015 (20%), and 2018 (26%). Among HIV+ male cases the percentage from repeaters also increased: 2010 (28%), 2013 (35%), 2015 (42%), and 2018 (50%). In 2018, 19% of all cases (n=2455) were from HIV+ males who had a previous syphilis diagnosis. Among HIV+ males diagnosed with syphilis in 2015, 34% had a repeat syphilis diagnosis within 3 years. Most syphilis diagnosed in Florida and Louisiana was among persons infected for the first time. However, some subgroups could possibly benefit from more frequent screening. Males living with HIV who had a prior syphilis diagnosis were at very high risk of repeat infection.

BACKGROUND:Human immunodeficiency virus (HIV) prevention interventions for prevention interventions for women include screening, partner notification, promoting condoms, and preexposure prophylaxis (PrEP). Women's risk of acquiring HIV can help guide recommendations. METHODS:We used data from Louisiana's sexually transmitted infection (STI) and HIV registries to study 13- to 59-year-old women following first diagnosis of syphilis, gonorrhea, or chlamydia during 2000-2015. We measured HIV rates reported subsequent to STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11 000 per year, and effectiveness estimated as 100%. RESULTS:STIs were syphilis (6574), gonorrhea (64 995), or chlamydia (140 034). These 211 603 women had 1 865 488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5186 HIV diagnoses over 24 359 397 person-years. HIV rates diagnosis (per 100 000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7 371 111 000 and could have prevented 546 HIV diagnoses. Limiting PrEP to 1 year after syphilis or gonorrhea diagnosis would cost $963 847 334, but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis. CONCLUSIONS:Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.

“Shock and kill” therapeutic strategies toward HIV eradication are based on the transcriptional activation of latent HIV with a latency-reversing agent (LRA) and the consequent killing of the reactivated cell by either the cytopathic effect of HIV or an arm of the immune system. We have recently found several benzotriazole and benzotriazine analogues that have the ability to reactivate latent HIV by inhibiting signal transducer and activator of transcription 5 (STAT5) SUMOylation and promoting STAT5 binding to the HIV long terminal repeat and increasing its transcriptional activity.

Background: Chlamydial infections are common among young women and can lead to serious reproductive health complications. We assessed the risk of reported repeat chlamydial infection among young women in Louisiana and time interval between infections by age and race/ethnicity. Methods: We analyzed surveillance data on chlamydial infections reported among women in Louisiana from January 1, 2000, to December 31, 2015. Multiple reports for the same person were matched using unique codes. Chlamydial infections reported more than 30 days after a previous positive test were considered new infections. Women aged 15 to 34 years at first infection during 2000 to 2012 were censored after 3 years or after they had a repeat infection. Cumulative incidence and incidence rate of repeat chlamydial infection among women were determined by year of first infection. Race- and age-specific results were obtained using stratified analyses. Results: One in 4 women diagnosed with a chlamydial infection at 15-34 years of age in Louisiana had a reported repeat infection in 3 years or less. Risk of repeat infection increased for younger women, racial/ethnic minorities, and women in more recent cohorts. Young black women aged 15 to 19 years in 2012 had the highest risk (44%). Black women also had shorter intervals between infections than white women. Conclusions: Repeat chlamydial infections were common, especially among young black women. The true number is likely higher because surveillance data only count infections that were detected and reported. Comprehensive prevention strategies are needed to address high rates of repeat chlamydial infections among women.

Background From 2012 to 2014, rates of congenital syphilis increased in Louisiana and Florida. We evaluated the effectiveness of early (first or second) and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. Methods Reported syphilis cases among pregnant women in Louisiana and Florida during January 1, 2013, to December 31, 2014, were reviewed for documented screening for syphilis in the first 2 trimesters and third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether the pregnancy led to a reported congenital syphilis case. Results Seven hundred ten pregnant women with syphilis in Louisiana and Florida were linked to 155 congenital syphilis cases. Three hundred seventy (52%) pregnant women with syphilis were staged as early syphilis (n = 270) or high-titer late or unknown duration-latent syphilis (n = 100), and 109 (70% of the total) were linked to congenital syphilis cases. Screening in the first 2 trimesters identified 513 pregnant women who tested positive for syphilis, and 470 (92%) potential congenital syphilis were averted. One hundred nine pregnant women tested positive for syphilis in the third trimester, and 85 (78%) had babies without congenital syphilis. During their pregnancy, 85 (12%) women tested negative at least once, and 55 (65%) had babies with congenital syphilis. Thirty-nine women had no reported syphilis screening 30 days or longer before delivery. Conclusions Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women.

Introduction Between 2012 and 2014, rates of congenital syphilis increased in Louisiana (LA) (from 52.7 to 73.4 cases per 1 00 000 live births) and Florida (FL) (from 17.4 to 22.1 cases per 1 00 000 live births) ranking them among the highest in the United States. Both states have rules and regulations that require testing pregnant women for syphilis during the first trimester, early third trimester, and at delivery. We evaluated the effectiveness of early and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. Methods Reported syphilis cases among pregnant women in FL and LA during January 1, 2013–December 31, 2014, were reviewed for documented screening for syphilis in the first two trimesters and the third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether their pregnancy led to a reported congenital syphilis case. Results 710 pregnant women with syphilis in LA and FL led to 155 congenital syphilis cases. 555 (78%) potential congenital syphilis cases were averted. 370 (52%) of the pregnant women with syphilis were staged as early syphilis or high-titer late-latent syphilis, and they were linked to 109 (70%) of the congenital syphilis cases. 513 pregnant women tested positive for syphilis in the first two trimesters and 470 (92%) of them had babies without congenital syphilis. Of the remaining 197 women, 109 tested positive for syphilis in the third trimester, and 85 (78%) of them had babies without congenital syphilis. 39 (6%) women had no reported syphilis screening ≥30 days prior to delivery. 85 women had at least one negative screening test during pregnancy before the positive test, and 55 of them had a baby with congenital syphilis. Conclusion Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women.