BACKGROUND:Little evidence supports the need for 3 weekly benzathine penicillin G (BPG) injections to treat late or unknown duration syphilis, and completion of the regimen may be difficult. We compared treatment effectiveness of 1 versus 3 doses of BPG and doxycycline. METHODS:We conducted a retrospective cohort study using surveillance data for cases diagnosed with late or unknown duration syphilis between 2016 and 2021 from 6 jurisdictions. We categorized BPG and doxycycline treatment based on the recorded number and timing of doses received. We defined treatment effectiveness as a 4-fold decrease in nontreponemal serum titer by 24 months posttreatment and compared treatment effectiveness using log binomial regression. RESULTS:Among 18 027 cases eligible for inclusion, over half had 3 doses of BPG recorded (11 342, 63%); relatively few had only 1 dose recorded (1928, 11%) or received at least 28 days of doxycycline (3017, 17%). Fourfold titer decreases were observed for 75% and 80% of cases given 3 doses and 1 dose of BPG, respectively, and for the 74% given doxycycline. Treatment effectiveness was similar across all treatment dose/interval categories and remained comparable when stratified by baseline titer, pregnancy status, and human immunodeficiency virus (HIV) infection. CONCLUSIONS:We did not observe a difference in treatment effectiveness between 1 and 3 doses of BPG, or between 3 doses of BPG and doxycycline, for late or unknown duration syphilis. Additional observational and clinical studies with more complete treatment and serologic response information are needed to confirm these findings and inform practice recommendations.

Little evidence supports the need for 3 weekly benzathine penicillin G (BPG) injections to treat late or unknown duration syphilis, and completion of the regimen may be difficult. We compared treatment effectiveness of 1 versus 3 doses of BPG and doxycycline. We conducted a retrospective cohort study using surveillance data for male and female cases diagnosed with late or unknown duration syphilis between 2016 and 2021 from 6 jurisdictions. We categorized BPG and doxycycline treatment based on the recorded number of doses received and the timing between doses. We defined treatment effectiveness as a fourfold decrease in non-treponemal serum titer by 24 months post-treatment and compared treatment effectiveness using log binomial regression. Among 18,027 cases eligible for inclusion, over half had 3 doses of BPG recorded (11,342, 63%); relatively few had only 1 dose recorded (1,928, 11%) or received at least 28 days of doxycycline (3,017, 17%). Fourfold titer decreases were observed for 75% and 80% of cases given 3 doses and 1 dose of BPG, respectively, and for the 74% given doxycycline. Treatment effectiveness was similar across all treatment dose/interval categories and remained comparable when stratified by baseline titer, pregnancy status, and HIV infection. We did not observe a difference in treatment effectiveness between 1 versus 3 doses of BPG, or between 3 doses of BPG and doxycycline, for late or unknown duration syphilis. Additional observational and clinical studies with more complete treatment and serologic response information are needed to confirm these findings and inform practice recommendations.

ABSTRACT:We evaluated whether sexually transmitted infection clinic visits and chlamydia/gonorrhea tests in 5 jurisdictions had returned to pre-coronavirus disease levels by 2022. Patient volume and chlamydia/gonorrhea testing have not returned to pre-coronavirus disease levels, especially among people younger than 30 years.

We evaluated whether sexually transmitted infection clinic visits and chlamydia/gonorrhea tests in 5 jurisdictions had returned to pre–coronavirus disease levels by 2022. Patient volume and chlamydia/gonorrhea testing have not returned to pre–coronavirus disease levels, especially among people younger than 30 years.

BACKGROUND:Health departments prioritize reproductive-aged women for syphilis partner services (PS) to prevent congenital syphilis (CS). We assessed trends in PS effectiveness among women. METHODS:We classified reported syphilis cases (all stages) between 2015 and 2022 from 8 US jurisdictions as nonpregnant women (NPW) older than 45 years ("non-reproductive-aged NPW," a group sometimes not assigned for PS), NPW aged between 15 and 45 years ("reproductive-aged NPW"), pregnant women without a CS outcome ("pregnant no CS"), and pregnant women with a CS outcome ("pregnant and CS"). We compared trends in the yearly proportion within each group who reported partners and whose partners were treated (preventatively or if infected, before or due to PS). RESULTS:During 2015-2022, annual counts of syphilis increased (non-reproductive-aged NPW, +151.5%; reproductive-aged NPW, +208.0%; pregnant no CS, +160.4%; pregnant and CS, +559.3%). Overall, 88% of women were assigned for PS, >90% of assigned cases were interviewed, and >94% of interviewed cases were treated. Across groups, the proportion interviewed naming ≥1 locatable partner was higher in 2015 compared with 2022 (non-reproductive-aged NPW, 53.3%-36.3%; reproductive-aged NPW, 68.6%-42.8%; pregnant no CS, 80.8%-65.0%; pregnant and CS, 73.6%-47.0%), and the proportion with ≥1 partner treated was higher (non-reproductive-aged NPW, 31.3%-21.7%; reproductive-aged NPW, 43.7%-24.9%; pregnant no CS, 53.0%-38.0%; pregnant and CS, 41.5%-23.4%). CONCLUSIONS:As syphilis increased, health departments reached most women with syphilis and assured treatment. A decreasing proportion of women reported locatable partners. Integration of PS with other strategies is needed to prevent reinfection and syphilis transmission in women.

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 Approximately 20% of chlamydia (CT) and gonorrhea (GC) cases in Louisiana are diagnosed at Parish Health Units. Patient notification of CT and GC test results involves nurses' phone calls and letters to positive patients, which is time-consuming and inefficient. Methods In December 2018, electronic results notification was implemented in Caddo Parish Health Unit using Chexout software to notify enrolled patients via text or email when test results are ready to view in a patient portal. We compared the timeliness of GC/CT results notification and treatment pre-Chexout (December 2017 to November 2018) and post-Chexout (December 2018 to November 2019) implementation. A random sample of patients was interviewed to assess acceptability. Results During December 2018 to November 2019, 5432 patients were tested for CT/GC, 3924 (72%) enrolled in Chexout, and notifications were sent to 3884 (99%). Among CT-positives, 472 of 568 (83%) viewed results in the portal compared with 2451 of 3356 (73%) CT-negatives. Among GC-positives, 300 of 353 (85%) viewed results compared with 2657 of 3571 (74%) GC-negatives. Treatment success for CT improved from 493 of 670 (74%) to 506 of 568 (89%), and for GC, from 332 of 409 (81%) to 325 of 353 (92%). Mean time to treatment decreased for CT (13.4-10.7 days) and GC (11.3-9.2 days). Enrolled patients found Chexout notification satisfactory in 168 of 169 (99%) and easy to use in 130 of 141 (92%). Reasons for declining electronic notification included lack of personal cell phone for 55 of 86 (64%) and confidentiality concerns for 42 of 86 (49%). Conclusions Electronic messaging decreased time to notification and increased treatment success. Nurses spent less time notifying patients leaving more time for patient care.

Background Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient. Methods We reviewed data from early syphilis cases reported during the 2015-2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate. Results Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%-14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%-28.3%). Treatment for >= 1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed <= 7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%). Conclusions Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.

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.

Background Reducing transmission depends on the percentage of infected partners treated; if many are missed, impact on transmission will be low. Traditional partner services metrics evaluate the number of partners found and treated. We estimated the proportion of partners of syphilis patients not locatable for intervention. Methods We reviewed records of early syphilis cases (primary, secondary, early latent) reported in 2015 to 2017 in 7 jurisdictions (Florida, Louisiana, Michigan, North Carolina, Virginia, New York City, and San Francisco). Among interviewed syphilis patients, we determined the proportion who reported named partners (with locating information), reported unnamed partners (no locating information), and did not report partners. For patients with no reported partners, we estimated their range of unreported partners to be between one and the average number of partners for patients who reported partners. Results Among 29,719 syphilis patients, 23,613 (80%) were interviewed and 18,581 (63%) reported 84,224 sex partners (average, 4.5; 20,853 [25%] named and 63,371 [75%] unnamed). An estimated 11,138 to 54,521 partners were unreported. Thus, 74,509 to 117,892 (of 95,362–138,745) partners were not reached by partner services (78%–85%). Among interviewed patients, 71% reported ≥1 unnamed partner or reported no partners; this proportion was higher for men who reported sex with men (75%) compared with men who reported sex with women only (65%) and women (44%). Conclusions Approximately 80% of sex partners were either unnamed or unreported. Partner services may be less successful at interrupting transmission in networks for men who reported sex with men where a higher proportion of partners are unnamed or unreported.

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.