Sexual history taking and sexually transmitted infection screening in patients initiating erectile dysfunction medication therapy.

BACKGROUND: Erectile dysfunction medications are being prescribed frequently; however, little is known about the amount of sexual health screening occurring in this setting. METHODS: A retrospective cohort study evaluating sexual health and sexually transmitted infection screening occurring in veterans receiving initial erectile dysfunction medication prescription was conducted. RESULTS: A total of 252 patients received initial erectile dysfunction medication prescriptions between October 1, 2009, and December 31, 2009; had at least 1 health care provider visit 12 months before the date of initial prescription; and had no documentation of previous erectile dysfunction medication use. Approximately 3% of these patients had any aspect of a sexual history recorded in the 24 months surrounding initial erectile dysfunction medication prescription. Sexually transmitted infection screening was 9.9% for syphilis, 4.8% for HIV, and 4.3% for gonorrhea/chlamydia before prescription, with only a slight increase in HIV screening after prescription. CONCLUSIONS: Minimal sexual health assessment is being performed during the time surrounding initial prescription of erectile dysfunction medication. Further work needs to evaluate patient and provider barriers to basic elements of sexual health care, such as taking sexual histories or screening for sexually transmitted infections.

Clinical management of early syphilis.

Early syphilis therapy was a focus of intense research in the early 20th century with many and varied approaches being used. The development of penicillin and its efficacy in the treatment of syphilis transformed syphilis management for many with and at risk for infection. However, problems such as beta-lactam allergies and the desire for easily administered, alternate therapies have led to evaluation of multiple other drugs, with doxycycline currently recommended as the main alternative. Ceftriaxone and azithromycin have been shown to be effective, however, each has its own difficulties. Follow-up relies on serological testing, leading to concerns when these tests do not decline appropriately. Given concerns about the potential for increased risk for treatment failure, patients with HIV and pregnant women are of particular concern.

Rapid plasma reagin titer variation in the 2 weeks after syphilis therapy.

BACKGROUND: Serologic tests for syphilis results at the time of diagnosis are the basis for evaluating response to syphilis therapy. After treatment, however, serologic tests for syphilis titers may continue to increase for several weeks. We evaluated rapid plasma reagin (RPR) titer variation during the 14 days after therapy using data from a recent large, prospective randomized controlled trial. METHODS: Prospectively enrolled participants in North America and Madagascar with primary, secondary, or early latent syphilis were randomly assigned to penicillin, doxycycline (in the case of penicillin allergy), or azithromycin treatment. Blood for RPR analysis was drawn at days 0, 7, and 14 posttreatment. All RPR titers were determined simultaneously at a central laboratory. RESULTS: Four hundred and seventy patients had data available for at least 2 of 3 RPR measurements. Overall, 20% of patients showed a titer increase of at least 1 dilution in the 14 days after therapy. The greatest proportion of titer increases following therapy was observed in patients with primary syphilis. Comparing outcome of therapy using the initial (day 0) RPR titer versus the maximal RPR titer (during 14 days) resulted in outcome reclassification in 2.98% of participants. CONCLUSIONS: Despite the fact that about 20% of early syphilis patients had increases in RPR titers immediately after treatment, these changes rarely influenced assessment of therapeutic outcome. Only 3% of patients treated would have been reclassified.