2004 STD Prevention Conference - Summaries of Highlighted Research

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Abstract 1034

Crystal methamphetamine (“crystal”) and Viagra linked to unprotected sex among men who have sex with men (MSM). According to new CDC research, MSM who use crystal or Viagra are significantly more likely to engage in unprotected sex than those who do not. CDC’s Dr. Gordon Mansergh and colleagues analyzed 2001 survey data from a diverse group of 388 MSM in San Francisco. Sixteen percent of participants had used crystal during their last anal sex encounter, and 6 percent had used Viagra. Use of both drugs was linked to unprotected sex: men who used crystal were twice as likely to engage in unprotected receptive anal intercourse as men who did not, and men who used Viagra were 6.5 times as likely to engage in unprotected insertive anal intercourse than those who did not. These findings held true even when participants’ partners were of different or unknown HIV status. [Crystal use, Viagra use, and specific sexual risk behaviors of men who have sex with men (MSM) during a recent anal sex encounter; Oral Session, Thursday, 8:30-10:15 am]

Abstract 1054

Chlamydia common in adolescent males. A new study shows that chlamydia, the most commonly reported STD, may be almost as common in adolescent males as in adolescent females. Previous data about chlamydia infection among men have been limited. Nicoline Collins and colleagues at the Minnesota Department of Health analyzed chlamydia prevalence among 1,301 male adolescents tested in a variety of settings between 1999 and 2001. As determined by urine tests, the overall prevalence of chlamydia among the young men was an unexpectedly high 9 percent – nearly as high as reported prevalence of 11 percent among adolescent females in the state. Prevalence rates were 17 percent in an outreach program serving the homeless, 12 percent in school-based clinics, 9 percent in juvenile detention centers, and 7 percent in community clinics. The authors conclude that chlamydia screening and prevention efforts need to focus on adolescent males, in addition to females. [Chlamydia prevalence in adolescent males: A multiple-site study; Poster]

Abstract 1127

Behaviors Do Not Change After STD Diagnosis. The diagnosis of an STD may not be enough to motivate adolescent females to engage in risk-reducing sexual behaviors, a new study finds. Dr. Trace Kershaw and colleagues at Yale University and CDC examined sexual behaviors and attitudes of 92 adolescent women who were diagnosed with an STD, and 216 without an STD, at two six-month intervals. The participants, who were 14 to 19 years old at the beginning of the study, were recruited from June 1998 to March 2000 from clinics in New Haven, Bridgeport, and Hartford, Connecticut, and were primarily African-American (48 percent) and Latina (41 percent). The researchers found that the young women did not significantly alter sexual behaviors, attitudes, intentions, or risk perceptions following an STD diagnosis. The authors hypothesized that adolescent females may not consider an STD diagnosis severe enough to change their behavior, and that the amount of prevention information provided by health care providers following a diagnosis may be insufficient to promote and sustain behavioral change. [Sexual risk following a sexually transmitted disease diagnosis: The more things change the more they stay the same; Poster]

Abstract 1128

HIV-positive MSM nearly twice as likely as HIV-negative MSM to have gonorrhea. An analysis of data from STD clinics in eight U.S. cities shows that MSM living with HIV are approximately twice as likely to have urethral, rectal, or pharyngeal gonorrhea, compared to their HIV-negative counterparts. Researchers led by CDC’s Dr. Catherine McLean analyzed 2002 gonorrhea test data from STD clinics in eight cities participating in the MSM Prevalence Monitoring Project – Chicago, Denver, Washington, DC, Houston, Long Beach, CA, Philadelphia, San Francisco, and Seattle. Analyzing information from 16,336 clinical visits, researchers found that the median percentage of MSM who tested positive for gonorrhea was nearly two times higher among HIV-positive men than among HIV-negative men for urethral (21.0 vs. 12.5 percent), rectal (10.3 vs. 5.5 percent), and pharyngeal (7.7 vs. 3.9 percent) gonorrhea. [Gonorrhea positivity among men who have sex with men attending STD clinics in the United States, 2002; Oral Session, Thursday, March 11, 8:30-10:15 am]

Abstract 1131

Genital herpes infection prevalence declines sharply among U.S. youth. The prevalence of infection with herpes simplex virus type 2 (HSV-2), the most common cause of genital herpes, declined in the late 1990s, according to research led by CDC’s Dr. Fujie Xu. Based on data from two successive National Health and Nutrition Examination Surveys (NHANES) conducted in the periods 1988 to 1994 and 1999 to 2000, researchers found that overall HSV-2 prevalence among 14- to 49-year-olds declined 17 percent between the two periods, from 21.3 percent to 17.6 percent. Among 14- to 19-year-olds, prevalence dropped 74 percent (from 5.8 to 1.5 percent), and among 20- to 29-year-olds the decline was 48 percent (from 17.2 to 8.9 percent). Although the reasons for the declines are not clear, the researchers point out that the reductions in sexual risk behavior among youth that have been noted in other recent studies may be one explanation for the drop in HSV-2 prevalence. [Trends in herpes simplex virus type 2 infection in the United States; Oral Session, Wednesday, March 10, 3:45-5:30 pm]

Abstract 1135

High-risk strain of HPV common in both women and men. This new study, conducted in 2002 and 2003, is one of the first to examine the epidemiology of HPV – the most common STD in the United States – in both men and women. Dr. Deborah Thompson of the University of Colorado Health Sciences Center and team found that 30.2 percent of women and 18.7 percent of men in a randomized clinical trial had been infected with HPV-16, a strain of human papillomavirus linked to cervical cancer in women and anal cancer in men. The researchers examined data on 1,595 male and female participants enrolled in Project RESPECT, a clinical trial of risk-reduction counseling at STD clinics in five cities conducted from 1993-1996. The participants in this analysis were drawn from four of those five cities: Baltimore, Denver, San Francisco and Long Beach, CA. In contrast with previous studies, the researchers found that sexual risk behavior in the past three months was a stronger predictor of HPV infection than the number of lifetime sexual partners. [The seroepidemiology of HPV-16 infection among men and women attending STD clinics in the United States; Oral Session, Wednesday, March 10, 3:45-5:30 pm]

Abstract 1151

Providing patients with medication for their partners promising tool to fight chlamydia. Patient-delivered partner therapy has the potential to reduce the spread of chlamydia, according to new research. California was the first state to legalize this approach, whereby medical providers can prescribe antibiotics to treat STDs for both patients and their partners. Laura Packel, of the California STD Control Branch, surveyed 2,000 physicians and 1,815 nurse practitioners across the state in 2002. Of those who responded, 50 percent of the physicians and 48 percent of the nurse practitioners reported that they usually or always prescribed medications for their patients’ partners. By analyzing the reasons for not participating, Packel was able to identify the need for further training of physicians regarding the safety and legality of this practice. [Patient-delivered partner therapy for chlamydia infections: Attitudes and practices of California physicians and nurse practitioners; Oral Session, Thursday, March 11; 8:30-10:15 am]

Abstract 1165

Syphilis campaign increases knowledge. Dr. Carol Ciesielski and colleagues at the Chicago Department of Public Health reported the success of a syphilis awareness campaign targeting MSM in metropolitan Chicago. Data from 260 MSM surveyed in 2000 about their knowledge of syphilis symptoms were compared to survey data collected from 135 MSM in 2002. Over the two-year period, the proportion of respondents who incorrectly identified urethral discharge as a syphilis symptom declined slightly (from 62 to 58 percent), and the proportion of those correctly who identified rash as a sign more than doubled (23 to 51 percent). Awareness of syphilis and concern about the disease also increased significantly (from 41 to 67 percent and from 41 to 63 percent, respectively), as did the proportion of individuals who knew that syphilis facilitates HIV transmission (from 57 to 75 percent). [Syphilis knowledge and awareness among men who have sex with men in metropolitan Chicago, 2000-2002; Poster]

Abstract 1189

Partner-delivered medication effective for treating STDs. Tulane University researchers report that providing men who have urethritis with a single dose of antibiotics to give their sexual partners is an acceptable and effective means of treating STDs. Led by Dr. Patty Kissinger, the researchers compared the effectiveness of standard partner referral (patient informs partners to test for STD), booklet referral (patient receives booklet with tear-out cards for partners’ care at clinic), and patient-delivered partner medication among 789 New Orleans men with urethritis and their 1,592 partners in 2002 and 2003. The researchers found that patients in the patient-delivered partner medication and booklet referral arms of the study were less likely than the standard partner referral group to test positive for chlamydia and gonorrhea one month later. Men who received medications to give their partners were also more likely to have seen and spoken with them, to have thought their partners took the medication, and to have used a condom all of the time during follow-up. [A comparison of three different strategies to treat partners of men with urethritis; Oral Session, Monday, March 8, 3:45-5:30 pm]

Abstract 1195

U.S. syphilis rate continues rise in 2003. Preliminary surveillance data from the CDC indicate a likely increase in 2003 syphilis rates – which would be the third year consecutive year of increases. From 2002 to 2003, cases of primary and secondary (P&S) syphilis increased slightly from 6,862 to 7,082. Rates also increased from 2.4 to 2.5 cases per 100,000. Since the first reported increases in P&S syphilis, the number of reported cases has jumped 18 percent, from 5,979 cases in 2000 to 7,082 cases in 2003. The overall rate also increased 19 percent during that time, from 2.1 to 2.5 cases per 100,000 people. Syphilis cases increased 65 percent among men (from 3,532 to 5,844 cases) between 2000 and 2003 but decreased 50 percent among women (from 2,445 to 1,229 cases). The increase in syphilis among men has been associated with outbreaks of syphilis among MSM (see Abstract 1222 for more information on syphilis among MSM). The new data were presented in a symposium led by CDC’s Dr. Hillard Weinstock. [Emerging patterns and trends in nationally notifiable sexually transmitted diseases, United States; Symposium, Monday, March 8, 3:45-5:30 pm]

Abstract 1220

STDs on the rise among Boston MSM, especially those who are HIV positive. Between 1997 and 2002, the annual number of men diagnosed with syphilis at Boston’s Fenway Community Health Center – the largest health center caring for MSM in New England – increased 15-fold (from two to 30). Over the same period, the number of gonorrhea diagnoses increased 139 percent (from 41 to 98), according to researchers led by Dr. Kenneth Mayer. Of 7,456 men over 20 years of age attending the clinic in 2002, 14.9 percent were HIV-positive. The researchers determined that being HIV-positive was the single most significant predictor of a new syphilis diagnosis in 2002. Among those patients whose HIV status was known, HIV-positive men were 2.6 times as likely as HIV-negative men to receive a new syphilis diagnosis. [STD trends among MSM at the largest health center caring for gay men in New England, 1997-2002; Poster]

Abstract 1222

U.S. syphilis cases rise twelve-fold among men who have sex with men (MSM). New CDC estimates indicate that the proportion of U.S. syphilis cases occurring among MSM increased twelve-fold between 1999 and 2003. CDC researchers led by Dr. James Heffelfinger estimated that between 1999 and 2003, the proportion of all syphilis cases occurring among MSM increased from 5 percent to 60 percent. Since U.S. syphilis surveillance data do not include information on behavioral factors that contribute to infection, including male-to-male sex, the research team developed a model to estimate the number of primary and secondary syphilis cases occurring among MSM. [Estimates of the number of cases of primary and secondary syphilis occurring among men who have sex with men in the United States, 1999-2002; Poster]

Abstract 1282

Internet highly effective tool for partner notification. Results from a study by Patricia Constant and colleagues at the Minnesota Department of Health suggest that the Internet can be an effective tool for notifying potentially infected sexual partners of people diagnosed with STDs. From June 2002 to May 2003, the researchers analyzed a cluster of 50 Internet users who were either infected or at risk for HIV or other STDs, and could only be located by e-mail addresses or screen names. These individuals were sent an e-mail explaining that the sender was contacting them concerning important health-related information, and that it was urgent they contact the sender. Thirty of the 50 subjects (60 percent) responded to online partner notification efforts – more than the investigators expected – while 13 (26 percent) did not respond. E-mail addresses or screen names for the other seven (14 percent) subjects, who resided outside Minnesota, were forwarded to their respective state health departments for follow-up. [Utilizing the Internet for partner notification; Oral Session, Wednesday, March 10, 10:00-11:45 am]

Abstract 1290

Nearly three-quarters of adolescent women in a public clinic infected with high-risk HPV strains. New CDC research found that 72 percent of adolescent women attending a public clinic in Atlanta were infected with strains of human papillomavirus (HPV) that are linked to cervical cancer. Researchers led by CDC’s Dr. Erika Samoff also examined the persistence of HPV infection among the 282 young women in the study, finding that 27 percent still had evidence of infection with the same high-risk virus type after six months and 10 percent had evidence of infection after one year. The researchers also found a link between chlamydia infection and persistence of HPV infection. When chlamydia infection was detected at the same time as HPV infection, the HPV infection was more likely to persist for more than six months. [Incidence, clearance and persistence of HPV in a cohort of female adolescents; Oral Session, Wednesday, March 10, 3:45-5:30pm]

Abstract 1313

Internet chatrooms offer potential for partner notification. A survey conducted in 2003 showed that Internet chatrooms may be another useful venue for partner notification. While at the Howard Brown Health Center in Chicago, Andrew Delicata (now of the Chicago Department of Public Health) sent online messages to individuals in chatrooms who were potentially exposed to STDs, indicating that they needed to contact him about a health-related matter. Of the eight people he contacted, seven responded and were successfully referred to appropriate health care. Delicata found that notification via chatrooms was more effective than via e-mail, since it gave the sender an opportunity to establish a rapport with the online user and was less likely to be viewed as junk mail. [Initiating partner notification over the Internet; Oral Session, Wednesday, March 10, 10:00-11:45 am]

Abstract 1349

Chlamydia screening in high schools can save money by preventing pelvic inflammatory disease (PID). To help combat STDs among Philadelphia’s youth, the Philadelphia Department of Public Health collaborated with the School District of Philadelphia to conduct an STD screening and education program in public high schools. In all, 754 (8.5 percent) of the 9,378 female students screened in the 2002-2003 school year had chlamydia infections. Based on a 30 percent probability of developing PID, researchers led by Danielle Lawrence at the Department of the Public Health estimated that 238 cases of PID were prevented that year. Taking into account the cost of the program ($906,650), the research team calculated a net savings of some $300,000 to the healthcare system for the treatment of PID and its complications. [An evaluation of a citywide school-based screening program for Chlamydia trachomatis; Poster]

Abstract 1357

Crystal methamphetamine use associated with more STDs, increased number of sex partners. MSM attending the San Francisco municipal STD clinic who use crystal are more likely than non-users to have HIV infection or to be diagnosed with syphilis, gonorrhea, or chlamydia, a new behavioral study finds. Researchers at the San Francisco Department of Public Health examined survey data from 1,263 MSM who visited the clinic between November 2002 and March 2003, of whom 17.4 percent reported using crystal during the four-week period leading up to their clinic visit. In this study, the researchers found that, compared to non-users, men who used crystal were:

  • 2.2 times more likely than non-crystal users to be HIV-positive
  • 4.1 times more likely to have syphilis
  • 1.9 times more likely to have chlamydia
  • 1.7 times more likely to have gonorrhea.

MSM who used the drug also had a median of four sexual partners over the four-week period prior to their visit, compared to two partners for non-users. [Methamphetamine use, sexual behavior, and sexually transmitted diseases among men who have sex with men seen in an STD clinic, San Francisco 2002-2003; Oral Session, Thursday, March 11, 8:30-10:15 am]

Abstract 1359

Many gay and bisexual men do not get complete information on partners’ HIV status before sex. An ongoing analysis of MSM attending Seattle HIV testing sites shows that among the limited number of men who discuss HIV status before having sex, many rely on incomplete information to decide whether or not to have sex – and whether or not to use a condom. Led by Rebecca Hutcheson of Public Health – Seattle & King County, researchers conducted interviews with 34 newly diagnosed HIV-positive and 115 HIV-negative MSM. Interim findings from 2003 show that 59 percent of the men discussed HIV status with their most recent anal sex partner, and only 36 percent knew their partners’ status before sex. Even after discussing HIV status, many participants disregarded positive disclosures by their partners, usually due to sexual desire or substance use. Many participants also took risks based on negative disclosure alone, without obtaining additional key information such as the last time their partner was tested. [HIV status disclosure among men who have sex with men (MSM): Use, mis-use, and implications for prevention; Oral Session, Wednesday, March 10, 10:00-11:45 am]

Abstract 1386

Chlamydia screening program uncovers high number of asymptomatic infections. A successful chlamydia screening program for youth in Oakland County, Michigan tested more than 3,400 youth for the infection in a variety of non-traditional settings, including high school clinics, county detention facilities, youth shelters, and other sites. Among the 18 percent of students who tested positive for chlamydia, most infections – 83 percent among males and 59 percent among females – were asymptomatic and would have otherwise remained undiscovered. In school-based clinics, where the majority of clinic attendees were offered testing, nearly 50 percent of infections would have been missed if only students requesting STD services were tested. [Adolescent screening project – Partnerships within the community; Oral Session, Wednesday, March 10, 3:45-5:30pm]

Abstract 1410

Syphilis awareness campaign increases testing. An awareness campaign in Houston increased the number of MSM tested for syphilis, according to a new study. Led by Eric Roland, Director of Education for Houston’s Montrose Clinic, the campaign began with a survey of sexual behaviors and attitudes among 112 MSM, followed by the development of campaign materials, dissemination of those materials at anonymous sex venues, and advertisements in publications targeting MSM. The number of MSM tested for syphilis in Houston rose by 22 percent between 2002 and 2003, an estimated 8 percent of which could be attributed to this particular awareness campaign. [Developing, designing, and disseminating a syphilis awareness campaign targeting MSM; Oral Session, Monday, March 8, 3:45-5:30 pm]

Abstract 1429

Crystal methamphetamine use and HIV infection linked to syphilis among MSM. New research conducted by the San Francisco Department of Public Health shows that HIV infection and crystal use are primary risk factors for syphilis infection among MSM. Researchers led by Dr. Will Wong analyzed the results of a behavioral survey completed by 1,318 MSM attending the San Francisco municipal STD clinic between November 2002 and March 2003. The researchers found the following:

  • Four percent of the men were diagnosed with early-stage syphilis
  • 1.9 percent of those with syphilis were also infected with HIV
  • HIV-infected MSM were 4.2 times as likely to have syphilis as those whose HIV status was negative or unknown
  • Men who used crystal and Viagra were 6.1 times as likely to have syphilis as men who did not use either drug
  • Men who met sex partners on the Internet were two times more likely to have syphilis than those who did not meet sex partners online
  • Those with stronger ties to the gay community were 2.9 times more likely to have syphilis than those who had weaker gay community ties.

[Risk factors for early syphilis among men who have sex with men seen in an STD clinic, San Francisco 2002-03; Oral Session, Wednesday, March 10, 3:45-5:30 pm]

Abstract 1440

MSM with syphilis who meet partners at bathhouses more likely to be HIV positive and to engage in high-risk sexual behavior. Between 2001 and 2003, 28 percent of all MSM diagnosed with early-stage syphilis in Los Angeles met one or more sex partners in commercial sex venues, such as bathhouses and sex clubs. Researchers at the Los Angeles County Department of Health Services STD Program, led by Dr. Getahun Aynalem, found that MSM with syphilis who met partners at bathhouses were twice as likely as those who did not to be infected with HIV, and nearly six times more likely to report having sex with an anonymous partner. These MSM also more frequently reported condom non-use and drug use (both injection and non-injection drugs). [Commercial sex venues: A closer look at their impact on the syphilis epidemics among men who have sex with men (MSM) in Los Angeles; Oral Session, Wednesday, March 10, 3:45-5:30 pm]

Abstract 1441

The Internet is a significant factor in the MSM syphilis epidemic. Nearly one-quarter (22 percent) of MSM diagnosed with early-stage syphilis in Los Angeles reported meeting one or more of their sexual partners through the Internet around the time they were likely infected, according to research by Dr. Getahun Aynalem of the Los Angeles Department of Health Services STD Program. Analyzing data from 2001 through 2003, Dr. Aynalem’s team found that MSM who used the Internet to meet sex partners were:

  • 1.2 times more likely to be HIV-positive than non-Internet users
  • 3.5 times more likely to have anonymous sex than non-Internet users
  • Twice as likely to use injection drugs than non-Internet users.

In all, two-thirds (67 percent) of MSM who met sex partners through the Internet were HIV positive. [The Internet: Emerging venue for syphilis epidemics among men who have sex with men in Los Angeles; Oral Session, Wednesday, March 10, 3:45-5:30 pm]