Sexually transmitted diseases
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Previous studies have shown screening for gonorrhea and chlamydia to be cost-effective for limiting the sequelae of infection and the associated costs of management. ⋯ The authors recommend urine ligase chain reaction screening for gonorrhea and chlamydia in women aged 18 years to 31 years in the ED, in conjunction with standard ED practice, to decrease the occurrence of the sequelae and costs associated with infection.
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The identification of Neisseria gonorrhoeae isolates resistant to antimicrobial agents currently recommended for the treatment of gonococcal infections continues to escalate globally. Thus, in some areas, resistance to fluoroquinolone drugs is commonplace; several reports document resistance to third-generation cephalosporins, and the sporadic isolation of spectinomycin-resistant isolates continues unabated. Gonococcal resistance to azithromycin, an antibiotic used for the primary treatment of gonococcal infections in some Latin American countries, also has been described. Because the prevalence of resistant isolates is insufficiently documented in many areas of Latin America, the efficacy of locally recommended therapies for gonococcal infections is often unknown. ⋯ This study supports the continued use of third-generation cephalosporins, spectinomycin, and fluoroquinolone drugs for the primary treatment of gonococcal infections in Manaus. The occurrence of isolates with reduced susceptibility to azithromycin and ciprofloxacin underscores the importance of ongoing antimicrobial susceptibility monitoring to support decisions regarding appropriate drugs for the treatment of gonococcal infections.
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Individuals who repeatedly acquire sexually transmitted infections (STIs) may facilitate the persistence of disease at endemic levels. Identifying those most likely to become reinfected with an STI would help in the development of targeted interventions. ⋯ In this STD clinic population, teenage females, homosexual men, black Caribbean attendees, individuals with a history of STI, and those reporting high rates of sexual partner change repeatedly re-presented with acute STIs. Directing enhanced STD clinic-based interventions at these groups may be an effective strategy for STI control.
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The advent of more sensitive diagnostic testing technologies and competition in public healthcare spending have resulted in a reevaluation of sexually transmitted disease (STD) screening practices in an attempt to target populations at greatest risk. Screening among populations with a < 2% prevalence of chlamydia and a < 1% prevalence of gonorrhea may not be cost-effective. ⋯ These data identified low-prevalence subpopulations among asymptomatic STD patients. As a result, the STD screening criteria at San Francisco City Clinic were changed accordingly.
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Many studies have observed that African Americans have comparatively high rates of selected STDs, often 10 to 20 times higher than whites and other racial/ethnic groups, but without convincing explanation. ⋯ African Americans' higher infection rate for bacterial diseases can be explained by the patterns of sexual networks within and between different racial/ethnic groups. First, infections are more widespread in the African American population at large because partner choice is more highly dissortative--meaning that "peripheral" African Americans (who have had only one partner in the past year) are five times more likely to choose "core' African Americans (who have had four or more partners in the past year) than "peripheral" whites are to choose "core" whites. Secondly, sexually transmitted infections stay within the African American population because their partner choices are more segregated (assortative mating) than other groups. The likelihood of African Americans having a sexually transmitted infection is 1.3 times greater than it is for whites because of this factor alone.