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1.
BMC Infect Dis ; 22(1): 519, 2022 Jun 04.
Article in English | MEDLINE | ID: covidwho-1879225

ABSTRACT

BACKGROUND: COVID-19 and Sexually Transmitted Diseases (STDs) are two very important diseases. However, relevant researches about how COVID-19 pandemic has impacted on the epidemiological trend of STDs are limited in China. This study aimed to analyze the impact of COVID-19 on STDs in China and proposed relevant recommendations to be used in bettering health. METHODS: The incidence of HIV infection, syphilis and gonorrhea in China from 2008 to 2020 were collected. Grey Model (1,1) were established to predict the incidence of STDs with the incidence data of these three STDs from 2013 to 2018 considering the impact of policies in China, respectively. We then calculated the predictive incidence of each STD in 2019, 2020 and 2021 by the established Model. And we estimated the extent of the impact of COVID-19 on the epidemiological changes of STDs by analyzing the difference between the absolute percentage error (APE) of the predictive incidence and actual rate in 2019 and 2020. RESULTS: The incidence of HIV infection and syphilis showed a trend of increase from 2008 to 2019 in China, but that for gonorrhea was fluctuant. Of note, the incidence of these three STDs decreased significantly in 2020 compared with that in 2019. The APE of HIV infection, syphilis and gonorrhea in 2020 (20.54%, 15.45% and 60.88%) were about 7 times, 4 times and 2 times of that in 2019 (2.94%, 4.07% and 30.41%). The incidence of HIV infection, syphilis and gonorrhea would be 5.77/100,000, 39.64/100,000 and 13.19/100,000 in 2021 based on our model. CONCLUSIONS: The epidemiological trend of STDs in China was significant influenced by COVID-19 pandemic. It is important to balance the control of COVID-19 and timely management of STDs during the COVID-19 epidemic to prevent or reduce the poor outcome among COVID-19 patients with STDs. New management strategies on STDs, such as leveraging social media, online medical care, rapid self-testing, timely diagnosis and treatment guarantee and balance of medical resources for STDs management should be adapted in the context of the long-term effects of COVID-19.


Subject(s)
COVID-19 , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Syphilis , COVID-19/epidemiology , China/epidemiology , Gonorrhea/epidemiology , Gonorrhea/prevention & control , HIV Infections/epidemiology , Humans , Pandemics , Sexually Transmitted Diseases/epidemiology , Syphilis/epidemiology , Syphilis/prevention & control
2.
Sex Transm Dis ; 49(2): 166-168, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1860989

ABSTRACT

ABSTRACT: A virtual partner services technical assistance (TA) project was piloted with the Minnesota Department of Health to address an ongoing syphilis outbreak. The TA reduced the health department's disease intervention specialist workload, achieved partner services outcomes comparable with in-person methods, and identified lessons learned to replicate with other jurisdictions.


Subject(s)
Syphilis , Centers for Disease Control and Prevention, U.S. , Disease Outbreaks/prevention & control , Humans , Minnesota , Pilot Projects , Syphilis/epidemiology , Syphilis/prevention & control , United States
3.
Commun Dis Intell (2018) ; 462022 May 19.
Article in English | MEDLINE | ID: covidwho-1856694

ABSTRACT

Abstract: An ongoing outbreak of syphilis in Australia, first reported in the state of Queensland in 2011, has led to increasing cases of congenital syphilis, including several deaths. Here, we applied multi-locus sequence typing (MLST) on available Treponema pallidum PCR-positive samples from the state of Queensland from the beginning of the outbreak to July 2020. In total, 393 samples from 337 males and 56 females were genotyped. Of 36 different Treponema pallidum sequence types (ST) observed, the two most common STs, ST 1 (also reported to be a dominant strain in various other countries) and ST 100 (the latter differing from ST 1 by only one single nucleotide polymorphism (SNP) based on the MLST scheme), together comprised 69% (271/393) of all samples, including the majority of samples in females (79%; 44/56). ST 1 was prevalent throughout the entire study period. Both strains remained the most common STs during the year 2020 where social distancing and other measures were implemented due to the COVID-19 pandemic. Both STs had high male-to-female ratios and included male rectal infections, therefore suggestive of occurrence primarily among men-who-have-sex-with-men (MSM). Hence, bridging from MSM to heterosexual networks may potentially contribute to infections among females, but further studies are needed to confirm this. Overall, there was considerable diversity of Treponema pallidum genotypes observed throughout the study period, but the fact that two key strains accounted for the majority of infections, including among females, stresses the need for further investigations into the transmission of these strains, and potentially a need for targeted public health interventions to better control the spread of syphilis in Queensland.


Subject(s)
COVID-19 , Sexual and Gender Minorities , Syphilis , Australia/epidemiology , Female , Homosexuality, Male , Humans , Male , Multilocus Sequence Typing , Pandemics , Queensland/epidemiology , Syphilis/epidemiology , Treponema pallidum/genetics
4.
Nature ; 605(7911): 598-599, 2022 05.
Article in English | MEDLINE | ID: covidwho-1852398
5.
PLoS Med ; 19(3): e1003930, 2022 03.
Article in English | MEDLINE | ID: covidwho-1793652

ABSTRACT

BACKGROUND: Low syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. METHODS AND FINDINGS: An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win US$15 if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US$26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing. CONCLUSIONS: Compared to standard of care, providing SST significantly increased the proportion of MSM testing for syphilis in China and was cheaper (per person tested). TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1900022409.


Subject(s)
HIV Infections/diagnosis , Homosexuality, Male , Patient Participation/methods , Self-Testing , Syphilis/diagnosis , Adolescent , Adult , COVID-19/epidemiology , China/epidemiology , Follow-Up Studies , HIV Infections/prevention & control , Health Services Accessibility/organization & administration , Homosexuality, Male/statistics & numerical data , Humans , Immunoassay/methods , Male , Mass Screening/economics , Mass Screening/methods , Mass Screening/organization & administration , Middle Aged , Motivation , Pandemics , Reagent Kits, Diagnostic/economics , Reagent Kits, Diagnostic/supply & distribution , SARS-CoV-2 , Sexual and Gender Minorities/statistics & numerical data , Syphilis/epidemiology , Syphilis/prevention & control , Young Adult
6.
Front Public Health ; 10: 764203, 2022.
Article in English | MEDLINE | ID: covidwho-1775974

ABSTRACT

Background: Stigmatization and poor social support are challenges faced by individuals living with HIV or sexually transmitted disease, which can have a profound negative impact on their healthcare. Mother-to-child transmission of either HIV or syphilis can lead to adverse maternal and fetal outcomes. The aim of this study was to investigate stigmatization and social support of pregnant women with HIV or syphilis in eastern China. Methods: This was an explanatory sequential mixed-method study conducted in Zhejiang province, China in 2019. Stigmatization, social support, and the associated factors toward HIV or syphilis were evaluated using questionnaires. The social support rating scale was used to evaluate social support, where a score <25% was defined as poor social support. A logistic regression model was used to explore the association between stigmatization and poor social support. Results: A total of 448 women (HIV positive, N = 93; syphilis, N = 355) were recruited in this study. Higher stigmatization was observed in pregnant women with HIV compared to those with syphilis (53.76% vs. 24.36%, p < 0.001), and poorer social support was observed in women with HIV compared with those with syphilis (40.86% vs. 19.86%, p < 0.001), with significant distributions of the total social support scores (Z = -1.976, p = 0.048) and scores on objectivity (Z = -2.036, p = 0.042) and subjectivity (Z = -2.500, p = 0.012). Similar social support among HIV or syphilis pregnant women was observed in medical healthcare facilities. In multivariable logistic model analysis, stigmatization (OR adj = 2.927; 95%CI, 1.714-4.996; p < 0.001) and ethnic minority (OR adj = 2.373; 95%CI, 1.113-5.056; p = 0.025) were negatively associated with social support. Interestingly, employment status was associated with improved social support (OR adj = 0.345; 95%CI, 0.180-0.662; p = 0.001). Conclusion: Stigmatization among pregnant women with HIV or syphilis remains high. We demonstrated that stigmatization was a significant predictor of low social support in pregnant women with HIV or syphilis. The support shown in medical facilities was similar toward pregnant women with HIV or syphilis. Implementation of stigmatization eradication and social support strategies targeting pregnant women with HIV or syphilis may therefore improve the dual elimination of mother-to-child transmission service.


Subject(s)
HIV Infections , Pregnancy Complications, Infectious , Social Stigma , Social Support , Syphilis , China/epidemiology , Female , HIV Infections/epidemiology , HIV Infections/psychology , Humans , Infectious Disease Transmission, Vertical , Minority Groups , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/psychology , Pregnant Women , Syphilis/epidemiology , Syphilis/psychology
10.
Przegl Epidemiol ; 75(2): 151-158, 2021.
Article in English | MEDLINE | ID: covidwho-1485744

ABSTRACT

INTRODUCTION: COVID-19 pandemic had a big impact on the health services organisation, including that of sexually transmitted infections (STIs). AIM: To analyse and evaluate the influence of COVID-19 epidemic on the detection of STIs and healthcare services in a group of these patients on the base of the experience of the Department of Dermatology and Venereology and University Outpatient Clinic in Bialystok, Poland. MATERIAL AND METHODS: Analysis of the number of consultations for suspicion of STIs, number of newly diagnosed cases of syphilis, gonorrhoea, Chlamydia trachomatis infections and genital herpes in two periods: January 2019 - February 2020 (before the epidemic state was introduced) and March 2020 - April 2021 (during pandemic). STIs cases hospitalised in the same periods were also analysed. RESULTS: The number of hospitalisations and outpatient consultations decreased during pandemic as compared to the period before it (by 83.3% and 41.9%, respectively). Patients with syphilis constituted the majority in both periods, remaining STIs were few. During pandemic, the proportion of detected cases of syphilis was higher as compared to the time before it, despite the diminished number of consultations (39.4% and 28%, respectively). Majority of patients with syphilis were men (92.3% and 93.3%), among them men-who-have-sex-with-men constituted at least 50%. Early syphilis was diagnosed more frequently during pandemic than before it (92.3% and 78.6%, respectively), early symptomatic syphilis in particular (46.2% and 35.7%, respectively). HIV coinfection in syphilis patients was more frequent during pandemic (15.8% and 7.1%, respectively). More than half of these patients (53.8%) did not come for follow-up visits after treatment during pandemic. CONCLUSIONS: The pandemic caused the decrease in number of outpatient STIs consultations and hospitalisations. The proportion of newly diagnosed cases of syphilis per number of consultations increased. The percentage of early syphilis cases, especially early symptomatic syphilis increased. Adherence to after treatment follow up was suboptimal.


Subject(s)
COVID-19 , Gonorrhea , HIV Infections , Sexual and Gender Minorities , Sexually Transmitted Diseases , Syphilis , Female , Gonorrhea/diagnosis , Gonorrhea/epidemiology , HIV Infections/epidemiology , Homosexuality, Male , Humans , Male , Pandemics , Poland/epidemiology , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Syphilis/diagnosis , Syphilis/epidemiology
12.
Sex Transm Dis ; 48(10): 798-804, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1413349

ABSTRACT

BACKGROUND: To describe changes in reported sexually transmitted diseases (STDs) during the US coronavirus disease 2019 pandemic, we compared the weekly number of reported nationally notifiable STDs in 2020 to 2019. METHODS: We reviewed cases of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis reported to the US National Notifiable Disease Surveillance System in 2020. For each STD, we compare the number of 2020 cases reported for a given Morbidity and Mortality Weekly Report (MMWR) week to the number of 2019 cases reported in the same week, expressing 2020 cases as a percentage of 2019 cases. We also calculated the percent difference between 2020 and 2019 cumulative case totals as of MMWR week 50 (week of December 9). RESULTS: During MMWR weeks 1 to 11 (week of December 29, 2019-March 11, 2020), the weekly number of cases of STDs reported in 2020 as a percentage of the cases in the same week in 2019 was similar. However, 2020 numbers were much lower than 2019 numbers in week 15 (week of April 8; chlamydia, 49.8%; gonorrhea, 71.2%; and P&S syphilis, 63.7%). As of week 50, the 2020 cumulative totals compared with 2019 were 14.0% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for P&S syphilis. CONCLUSIONS: During March-April 2020, national case reporting for STDs dramatically decreased compared with 2019. However, resurgence in reported gonorrhea and syphilis cases later in the year suggests STD reporting may have increased in 2020, underscoring the importance of continued STD prevention and care activities.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexually Transmitted Diseases , Syphilis , Chlamydia Infections/epidemiology , Gonorrhea/epidemiology , Humans , Pandemics , SARS-CoV-2 , Sexually Transmitted Diseases/epidemiology , Syphilis/epidemiology
14.
BMC Public Health ; 21(1): 1637, 2021 09 07.
Article in English | MEDLINE | ID: covidwho-1398851

ABSTRACT

BACKGROUND: Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. METHODS: Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. RESULTS: We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. CONCLUSIONS: The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Syphilis , Artifacts , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Communicable Disease Control , Female , Gonorrhea/epidemiology , HIV Infections/epidemiology , Humans , Incidence , Male , Pandemics , SARS-CoV-2 , Sexually Transmitted Diseases/epidemiology , Syphilis/epidemiology
16.
Sex Transm Dis ; 48(8S): S66-S70, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1315723

ABSTRACT

BACKGROUND: Despite advances in implementing human immunodeficiency virus (HIV)/sexually transmitted infection (STI) services for men who have sex with men (MSM), many remain underserved because of barriers like stigma, low facility coverage, and provider competency. This article describes the implementation of centralized nationwide mailed HIV/STI home testing (CareKit). METHODS: The Emory Center for AIDS Research developed CareKit for research study participants to request HIV self-test kits, STI specimen collection kits, and condom/lubricant packs to be shipped to any mailing address in the United States. Sexually transmitted infection kits were customized according to study needs and could include materials to collect whole blood, dried blood spots, urine sample, and rectal and pharyngeal swab samples for syphilis, gonorrhea, and chlamydia testing. Specimens were mailed back to a central Clinical Laboratory Improvement Amendments-approved laboratory for testing, and results were returned to participants. RESULTS: CareKit was used by 12 MSM studies and mailed 1132 STI kits to 775 participants between January 2018 and March 2020. Participants returned 507 (45%) STI kits, which included 1594 individual specimens. Eighty-one kits (16%) had at least one positive STI test result: pharyngeal chlamydia (n = 7), pharyngeal gonorrhea (n = 11), rectal chlamydia (n = 15), rectal gonorrhea (n = 12), genital chlamydia (n = 6), genital gonorrhea (n = 1), and syphilis (n = 54). In this same 2-year period, 741 HIV self-test kits were mailed to 643 MSM. CONCLUSIONS: CareKit successfully met studies' needs for home HIV/STI testing and diagnosed many STIs. These processes continue to be adapted for research and programs. The ability to mail home test kits has become increasingly important to reach those who may have limited access to health care services, particularly during the COVID-19 pandemic.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , HIV Infections , Sexual and Gender Minorities , Sexually Transmitted Diseases , Syphilis , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Gonorrhea/diagnosis , Gonorrhea/epidemiology , HIV Infections/diagnosis , HIV Infections/epidemiology , Homosexuality, Male , Humans , Male , Pandemics , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Syphilis/epidemiology , United States
17.
J Infect Dis ; 224(5): 798-803, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1270740

ABSTRACT

Early in the coronavirus disease 2019 (COVID-19) crisis, a statewide executive order (PAUSE) severely restricted the movement of New Yorkers from 23 March to 7 June 2020. We used New York City surveillance data for human immunodeficiency virus (HIV), chlamydia, gonorrhea, and syphilis to describe trends in diagnosis and reporting surrounding PAUSE. During PAUSE, the volume of positive HIV/sexually transmitted infection tests, and diagnoses of HIV, chlamydia, gonorrhea, and syphilis declined substantially, reaching a nadir in April before rebounding. Some shifts in characteristics of reported cases were identified.


Subject(s)
COVID-19/epidemiology , HIV Infections/epidemiology , Sexually Transmitted Diseases/epidemiology , Adolescent , Adult , COVID-19/diagnosis , COVID-19/virology , Chlamydia , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Female , Gonorrhea/diagnosis , Gonorrhea/epidemiology , HIV Infections/diagnosis , HIV Infections/virology , Humans , Male , Middle Aged , New York City/epidemiology , Pandemics , Public Health Surveillance , SARS-CoV-2/isolation & purification , Sexually Transmitted Diseases/diagnosis , Syphilis/diagnosis , Syphilis/epidemiology , Young Adult
18.
Curr HIV/AIDS Rep ; 18(4): 280-288, 2021 08.
Article in English | MEDLINE | ID: covidwho-1258268

ABSTRACT

PURPOSE OF REVIEW: To highlight recent trends in the epidemiology of HIV and syphilis, the impact of the COVID epidemic, our approach to care of co-infected patients, and our views on important next steps in advancing the field. RECENT FINDINGS: HIV and syphilis co-infection has been on the rise in recent years although since the COVID pandemic there is a decrease in new diagnoses-it remains unclear if this represents a true decline or inadequate testing or under-reporting. Standard HIV care should include regular syphilis serology .Treatment and serological follow-up of syphilis in HIV positive and negative patients can be conducted similarly. Challenges remain in the diagnosis and management of neurosyphilis. New models for testing and prevention will be crucial next steps in controlling co-infection. The intersection of HIV and syphilis infections continues to pose new and unique challenges in diagnosis, treatment, and prevention.


Subject(s)
COVID-19 , HIV Infections , Syphilis , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , SARS-CoV-2 , Syphilis/diagnosis , Syphilis/drug therapy , Syphilis/epidemiology , Syphilis Serodiagnosis
20.
Sex Transm Dis ; 48(8S): S44-S49, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1221513

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, Washington State's Stay Home, Stay Healthy (SHSH) order was implemented on March 24, 2020. We hypothesized that pandemic mitigation measures might reduce sexually transmitted infection (STI) screening and/or transmission. METHODS: We used King County, WA STI surveillance and sexual health clinic (SHC) data from January 1, 2019, to July 31, 2020. We calculated mean weekly case counts for gonorrhea, primary and secondary (P&S) syphilis, male urethral gonorrhea, and early latent (EL) syphilis for 3 periods in 2020: pre-SHSH (January 1-March 23), SHSH (March 24-June 5), and reopening (June 6-July 31). Primary and secondary syphilis and male urethral gonorrhea were used as proxies for sexual behavior, and EL syphilis was used as a proxy for STI screening. We compared SHC visits (2019 vs. 2020) and SHC gonorrhea treatment practices (across 2020 periods). RESULTS: Compared with January to July 2019, from January to July 2020, reported cases of gonorrhea, male urethral gonorrhea, P&S syphilis, and EL syphilis decreased by 9%, 5%, 16%, and 22%, respectively. Mean weekly case counts of gonorrhea, male urethral gonorrhea, and EL syphilis decreased pre-SHSH to SHSH, but all returned to pre-SHSH levels during reopening. Sexual health clinic visits during SHSH were 55% lower in 2020 than in 2019. In the SHC during SHSH, ceftriaxone treatment of gonorrhea decreased, whereas cefixime/cefpodoxime treatment and gonorrhea treatment with no testing increased. CONCLUSIONS: Decreases in reported STIs concurrent with COVID-19 SHSH may reflect a true decline in STI transmission. However, the larger decreases in asymptomatic infections indicate that much of the observed decrease was likely due to decreased screening.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Syphilis , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , Chlamydia Infections/epidemiology , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Gonorrhea/epidemiology , HIV Infections/epidemiology , Humans , Male , Pandemics , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/drug therapy , Sexually Transmitted Diseases/epidemiology , Syphilis/diagnosis , Syphilis/drug therapy , Syphilis/epidemiology , Washington/epidemiology
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