Is jail screening associated with a decrease in Chlamydia positivity among females seeking health services at community clinics?-San francisco, 1997-2004.

BACKGROUND: Young adults entering jail are at increased risk for sexually transmitted diseases (STD) such as chlamydia, are released quickly, and are unlikely to be tested for STDs elsewhere. San Francisco jails performed targeted chlamydia screening and treatment since 1996. GOAL: To determine this program's impact on chlamydia positivity among females attending neighborhood medical clinics. STUDY DESIGN: During 1997-2004, jail testing density, a measure of the proportion of persons from year 2000 census blocks that were tested in jail, was compared by neighborhood. Chlamydia positivity among females aged 15 to 25 years were compared at 2 clinics serving areas with different jail testing densities. RESULTS: Of persons offered screening at intake, 89% accepted. A total of 42,952 tests were performed among 23,561 persons in jail (45% black, 73% male). A total of 2765 (6.4%) tests were positive for chlamydia; 81% of chlamydial infections were treated. Jail testing density significantly correlated with neighborhood female chlamydia rates. Mean jail testing density at Clinic S, calculated by using the residence of persons tested for chlamydia, was 7 times greater than that at Clinic O. Chlamydia positivity declined at Clinic S from 16.1% to 7.8% (Ptrend <0.001). No significant change occurred at Clinic O in chlamydia (4.7% in 1997 and 2004, Ptrend = 0.81). CONCLUSIONS: In San Francisco, screening young adults in jail focused testing on persons from neighborhoods with high chlamydia rates. Jail screening started immediately before chlamydia declines among young females at a clinic serving neighborhoods with high jail testing density. These programs might help reduce community prevalence and racial/ethnic disparities in STDs.

Stay in school? Results of a sexually transmitted diseases screening program in San Francisco high schools-2007.

OBJECTIVES: To provide chlamydia and gonorrhea screening and treatment to adolescents presumed to be at high risk, school screening was conducted among the 11th and 12th graders in San Francisco. STUDY DESIGN: Two schools in neighborhoods with high chlamydia and gonorrhea rates and student populations > or = 15% black were chosen. Students viewed a 10-minute presentation and received test kits. Students decided in a private bathroom stall whether to test. All students were encouraged to return a test kit (whether they returned a urine specimen). RESULTS: Of 967 eligible students, 853 (88%) were in attendance. Of these, 21 (2%) declined to participate and 537 (63%) returned a specimen for testing. Students who tested were predominately heterosexual (93%) and nonwhite (99%). No students tested positive for gonorrhea; 7 (1.3%) tested positive for chlamydia. Positivity was 2.2% (5 of 227) for female students and 0.6% (2 of 310) for male students. Positivity by race/ethnicity was 5.4% (4 of 74) for blacks, 2.0% (2 of 98) for Hispanics, 0.3% (1 of 342) for Asian/Pacific Islanders, and 0% (0 of 4) for whites. The highest positivity was among black female students: 9.3% (4 of 43). Not including planning and follow-up, each case identified used 63 staff hours. CONCLUSIONS: Despite high participation among students attending school in high morbidity neighborhoods, few infections were identified. This is likely because students have low rates of sexual activity and do not necessarily attend neighborhood schools. Screening used substantial resources. Sexually transmitted disease control programs considering school screening should consider local epidemiology and whether schools have substantial proportions of students likely at high risk for sexually transmitted diseases.

High prevalence of gonococcal and chlamydial infection in men who have sex with men with newly diagnosed HIV infection: an opportunity for same-day presumptive treatment.

BACKGROUND: The increasing use of point-of-care HIV tests in sexually transmitted disease (STD) clinics allows for rapid identification of patients with newly diagnosed HIV infection who may also be at risk for more common sexually transmitted infections. Positive point-of-care HIV test results might be used to identify and provide presumptive treatment to patients who are likely to be coinfected with gonorrhea (GC) and chlamydia (CT). METHODS: Data from 6864 STD clinic visits by men who have sex with men (MSM) with no history of HIV infection and an HIV antibody test at that visit were analyzed. Results from rectal, pharyngeal, and urine nucleic acid amplification tests were used to calculate the prevalence of infection with GC and CT. RESULTS: MSM with newly diagnosed HIV infection were more likely than HIV-uninfected MSM to be infected with GC (25.9% [53 of 205] vs. 10.9% [728 of 6659]; P < 0.001) and CT (18.5% [38 of 205] vs. 7.8% [518 of 6659]; P < 0.001). CONCLUSIONS: GC and CT are common in MSM with newly diagnosed HIV infection at an STD clinic. In this population, a positive point-of-care HIV test result is a useful risk marker for untreated gonococcal and chlamydial infections and provides a justification for presumptive GC and CT treatment.

Optimising sexually transmitted infection screening in correctional facilities: San Francisco, 2003-2005.

OBJECTIVES: Sexually transmitted infection (STI) screening in correctional facilities provides access to people at high risk for STIs who might not be screened elsewhere. These screening programmes are becoming more widespread, but with decreasing funding for STI control, maximising screening impact has become increasingly important. We aimed to make recommendations about the impact of age and sex targeted screening in correctional facilities. METHODS: We compared the prevalence of chlamydia and gonorrhoea for January 2003-July 2005 among different age groups of females and males screened in San Francisco correctional facilities -- youth detention (12-17 years) and adult jail (18-35 years). RESULTS: 16 975 chlamydia tests and 13,443 gonorrhoea tests were performed. The age specific chlamydia test positivity among females aged 12-17 years, 18-25 years, and 26-30 years, respectively, was 9.6% (105/1092), 9.4% (196/2088), and 6.3% (40/639), compared with 3.3% (100/3065), 6.2% (400/6470), and 3.9% (118/3046) among males. The age specific gonorrhoea test positivity among females in these same age groups was 3.2% (34/1062), 2.7% (57/2082), and 2.4% (15/635), compared with 0.7% (7/1026), 1.2% (67/5507), and 1.0% (25/2555) among males. Of the 1198 STIs identified, 1,020 (85.1%) were treated. CONCLUSIONS: On the basis of this report and national data, STI control programmes with limited funds should prioritise screening females in youth detention first, women aged < or = 30 years in adult jail second, and men aged < or = 25 years in adult jail third. Males in youth detention should have a lower priority than young adults in jails.

Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting.

This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.

Online syphilis testing--confidential and convenient.

OBJECTIVE: In response to the current syphilis epidemic among men who have sex with men, the San Francisco Department of Public Health sought to increase syphilis testing by offering testing in nonclinical settings. GOAL: The goal of this study was to collaborate with a community-based organization, Internet Sexuality Information Services, Inc. (ISIS), to design an innovative, confidential, online testing service for syphilis. STUDY: The service, called STDTest.org, was launched in June 2003. The web site allows people to print out a laboratory requisition slip, have their blood drawn, and receive their test results online. RESULTS: During the first year, 218 tests were performed and 13 persons had reactive serologies. Six patients were diagnosed with a new syphilis infection and treated. CONCLUSIONS: Online syphilis testing offers a free and convenient alternative to getting tested at the San Francisco municipal sexually transmitted disease clinic and an additional means for detecting syphilis cases.