Frontline STI Screening Starts with Primary Care.

In this supplement to Family Practice, Heather M. Territo, MD, and Gale R. Burstein, MD, MPH discuss how primary care physicians play an essential role in screening for STIs in young patients.

Trichomonas Infection Rates in Males Presenting to the Emergency Department for Sexually Transmitted Infections.

BACKGROUND: Trichomonas vaginalis (TV) is one of the most common sexually transmitted infections (STIs). Overall prevalence is reported to be 3.1%, with rates approaching 12.9-14.4% in high-risk female populations. Although there is a plethora of data on TV in the female population, the corresponding data for the male population are limited. OBJECTIVE: Our aim was to determine the infection rate of TV in male patients seeking care for STIs in the emergency department (ED) and determine the symptoms associated with TV infection in male patients. METHODS: We conducted a retrospective study of male patients aged 13 years or older who presented to the ED for STI evaluation. Male patients included had nucleic acid amplification test (NAAT) TV testing as part of standard STI evaluation. RESULTS: Of the 2137 male patients included, 95 (4.4%) were positive for TV. Male patients who tested positive were significantly older (mean age 38.9 years vs. 30.7 years for male patients who tested negative; p < 0.05). Black male patients were more likely than White male patients to be positive for TV (6.3% prevalence vs. 1.8%; p < 0.05). TV-positive male patients were more likely to have discharge, specifically clear penile discharge, on examination (p < 0.05), and were less likely to have testicular pain or testicular tenderness (p < 0.05). Higher rates of TV were seen in an urban (4.9%) compared with suburban ED (1.6%; p < 0.05). CONCLUSIONS: Rates of TV in male patients who receive STI testing in the ED are similar to rates published previously for female patients. We found higher rates among older and African-American male patients. TV among male patients is prevalent and testing should continue when evaluating for STIs.

Sexual and Reproductive Health Care Services in the Pediatric Setting.

Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.

Adolescent Sexuality: Updates to the Sexually Transmitted Infection Guidelines.

Adolescents are at high risk for acquisition and transmission of sexually transmitted infections (STI) secondary to both cognitive and biological susceptibility. The prevention, diagnosis, and treatment of STIs are a critical part of adolescent health care. This article discusses the most common bacterial, parasitic, and viral STIs encountered in this age group with an emphasis on new guidelines for screening and management.

Prescription Opioid Dependence in Western New York: Using Data Analytics to Find an Answer to the Opioid Epidemic.

Opioid dependence and overdose is on the rise. One indicator is the increasing trends of prescription buprenorphine use among patient on chronic pain medication. In addition to the New York State Department of Health's prescription drug monitoring programs and training programs for providers and first responders to detect and treat a narcotic overdose, further examination of the population may provide important information for multidisciplinary interventions to address this epidemic. This paper uses an observational database with a Natural Language Processing (NLP) based Not Only Structured Query Language architecture to examine Electronic Health Record (EHR) data at a regional level to study the trends of prescription opioid dependence. We aim to help prioritize interventions in vulnerable population subgroups. This study provides a report of the demographic patterns of opioid dependent patients in Western New York using High Throughput Phenotyping NLP of EHR data.

A New Strategy for Trichomonas Testing Female Adolescents in the Emergency Department.

STUDY OBJECTIVE: Sensitive trichomonas diagnostic testing has become available, including nucleic acid amplification tests (NAATs) and a rapid antigen test. The study purpose was to determine if adding sensitive trichomonas testing to routine female sexually transmitted infection (STI) evaluations would increase trichomonas identification and treatment. DESIGN: Two study time periods. Study time 1 (T1) was used for a retrospective review. Study time 2 (T2) was used for a prospective study. SETTING: Emergency Department. PARTICIPANTS: Symptomatic female patients aged 13-20 years (N = 447). INTERVENTIONS: Implementation of routing trichomonas testing in the Emergency Department during T2. MAIN OUTCOME MEASURES: Trichomonas diagnosis and treatment rates were compared during T1 and T2. RESULTS: During T1 31 of 234 of eligible patients (13%) were trichomonas-tested. Laboratory-confirmed trichomonas was identified in 3 of 234 (1.3%). During T2, 212 of 213 of eligible patients (99.5%) were trichomonas-tested; 39 of 212 tested trichomonas-positive (18.4%); 29 of 212 tested rapid trichomonas antigen test-positive (13.6%; P < .001), and 33 of 188 tested trichomonas NAAT-positive (15.5%; P < .001). Trichomonas treatment was given to 3 of 3 laboratory-confirmed trichomonas cases during T1 (100%) compared with 37 of 39 during T2 (95%; P = .688). During T1, 14 of 17 women who received trichomonas treatment (82.4%) did not have a laboratory-confirmed trichomonas diagnosis and during T2 13 of 52 women without a laboratory-confirmed trichomonas diagnosis (25%) were treated for trichomonas (P < .001). Rapid trichomonas antigen tests and trichomonas NAATs were concordant in 178 of 188 patients (94.6%). CONCLUSION: Incorporating trichomonas rapid antigen tests and NAATs into routine female adolescent STI testing significantly increased the number of laboratory-confirmed adolescent trichomonas diagnosis and treatment and are useful Emergency Department STI screening tools.

Snowstorm-Related Mortality - Erie County, New York, November 2014.

During November 18-21, 2014, a narrow band of central and southern Erie County in New York received unprecedented amounts of snowfall. The duration of the storm and amount of snowfall rapidly exceeded weather service forecasts, with some areas receiving 60-84 inches (1.5-2.1 meters) of snow. The rapid accumulation resulted in stranded drivers, travel bans, and logistical challenges associated with snow removal. Sporadic power outages affected a limited number of households. Eleven deaths were linked to the snowstorm, including one that was directly related, nine that were indirectly related, and one that was classified as possibly storm-related.

Adolescents' attitudes toward expedited partner therapy for sexually transmitted infections.

Adolescents (N = 392) attending 2 urban adolescent health clinics in 2010 were surveyed regarding likelihood completing expedited partner therapy (EPT), by bringing a partner exposed to chlamydia a prescription. Eighty-five percent (330/387; 95% confidence interval, 81%-89%), reported acceptance of EPT. Adjusted analyses showed higher education, notification self-efficacy, and romantic partner were associated with EPT acceptance.

Diagnosis and treatment of chlamydia, gonorrhea, and trichomonas in adolescents.

CME EDUCATIONAL OBJECTIVES: 1.Determine and discuss issues surrounding consent, confidentiality, and billing for sexually transmitted infection (STI) care delivery in the adolescent population.2.Review currently available testing modalities for STIs and their applicability in the adolescent population.3.Provide treatment and prevention strategies for the most commonly encountered STIs in the adolescent demographic. Adolescents and young adults, 15 to 24 years of age, carry a disproportionate burden of sexually transmitted infections compared with other age groups in the United States (see Figure 1).1.

Expedited partner therapy for sexually transmitted infections.

PURPOSE OF REVIEW: In 2006, the Centers for Disease Control and Prevention recommended Expedited Partner Therapy (EPT) as a clinical option for assuring treatment of sex partners of persons infected with sexually transmitted infections. In this review, we provide an update on research, evaluation and efforts to increase EPT coverage. We also attend to EPT for gonorrhea in the context of antimicrobial resistance. RECENT FINDINGS: Controlled trials in the United States and United Kingdom have presented increasing variety in intervention approaches. Trials and program evaluations typically demonstrate increased partner treatment rates, although only some studies show reductions in follow-up infection rates. Coverage has increased substantially, with over 30 states permitting EPT for chlamydial infection, gonorrhea, or both. The prospect of cephalosporin-resistant gonorrhea, however, raises the prospect that EPT may become less feasible as a partner treatment approach for gonorrhea patients. SUMMARY: Clinicians should continue to be aware of the importance of partner managements for STD-infected patients, with EPT being an evidence-based intervention in that respect. The variety in EPT models provides alternatives that may suit some practices and venues. For clinicians seeing gonorrhea patients, effective counseling models - enhanced patient referral - should be closely examined in case oral treatment for gonorrhea becomes infeasible.

Delivering adolescent preventive services in an office setting.

Adolescence has long been recognized as a vulnerable period. Although several major medical professional organizations have published adolescent preventive care guidelines, regional and national surveys of youth, providers, and medical records all suggest many gaps exist in the delivery of recommended preventive services. In this article, we review the development of adolescent preventive health guidelines, describe current rates of preventive health screening and counseling, and explore barriers to delivery of preventive care for this age group. We present resources and practical suggestions to help the reader create an adolescent-friendly environment and to facilitate preventive health care delivery in your practice.

Partner notification in the clinician's office: patient health, public health and interventions.

PURPOSE OF REVIEW: Partner notification is an essential element of sexually transmitted disease infection control. Patients may be interviewed by public health staff, followed by public health staff notification of those partners (provider referral), or they receive some form of instruction to notify and refer their own partners (patient referral). In this review, we review partner notification and current research and programmatic activity. RECENT FINDINGS: Resource limitations restrain provider referral to a minority of cases. Patient referral is far more widely practiced and is the subject of some recent enhancements. Foremost among these is the growing practice of expedited partner therapy, in which partner treatment may occur through the provision of medications or prescriptions prior to a clinical evaluation. Trials in which patients took medications to their partners have been supported, and the practice is gaining acceptance nationally. Other counseling also increases patient referral efficacy. Finally, the role of the internet in both provider and patient referral has received increasing attention and is being incorporated into program practice. SUMMARY: Clinical providers can intervene at the point of care to serve both patients as individuals and infection control more broadly. Cooperation between public health agencies, other organizations and clinical providers can facilitate both goals.

The adolescent sexual health visit.

Addressing sexual health, screening, and counseling to prevent sequelae of risky sexual behavior are essential components of the adolescent visit to the gynecologist. Discussing sexuality and taking a sexual history may cause feelings of discomfort for the provider and adolescent patient alike. Taking the time to build rapport and trust and the guarantee of confidentiality are key to engaging adolescent patients to discuss their personal health concerns with their provider. This article offers recommendations to facilitate dialog with the adolescent patient, addresses special considerations for the adolescent examination, discusses the use of some of the newly available tests for sexually transmitted infections (STIs), and suggests the recommended approach to management of STIs in adolescents.

Adolescent immunizations and other clinical preventive services: a needle and a hook?

Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes.