Sexually transmitted diseases
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Rising rates of sexually transmitted infections (STIs) warrant a renewed focus on the management of STIs in health care organizations. The extent to which hospitals and community health centers (CHCs) have established processes and allocated staff for the management of STIs within their organizations remains poorly understood. ⋯ Most facilities report STI cases to comply with public health surveillance requirements but do not measure infection rates, assess the quality of STI care, or coordinate its work throughout the facility. The development of this organizational capacity would likely decrease STI rates, improve treatment outcomes, and address local public health goals.
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Syphilis is a systemic disease caused by the spirochete Treponema pallidum that is usually acquired through sexual exposure.
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In 2010, the Centers for Disease and Control and Prevention recommended using nucleic acid amplification tests (NAATs) for extragenital gonorrhea (GC) and chlamydia (CT) testing because of NAATs' improved sensitivity compared with culture. ⋯ Extragenital testing with NAAT substantially increases the number of infected MSM identified with GC or CT infection and should continue to be promoted.
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Review Case Reports
Pathologically confirmed malignant syphilis using immunohistochemical staining: report of 3 cases and review of the literature.
Malignant syphilis is a rare ulcerative variety. In the classical description of the disease, the absence of spirochetes in tissue samples was considered as a diagnostic criterion. We report 3 cases of malignant syphilis; in all of them, spirochetes were identified in cutaneous biopsy samples using immunohistochemical staining.
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HIV-infected men who have sex with men (MSM) are at increased risk for transmitting and acquiring sexually transmitted diseases (STDs). Guidelines recommend at least annual screening of HIV-infected MSM for syphilis and for chlamydia and gonorrhea at exposed anatomical sites, to protect their health and their sexual partners' health. Despite these guidelines, STD screening has been suboptimal, with very low nongenital chlamydia and gonorrhea testing rates. Our objective was to better understand barriers encountered by HIV care providers in adhering to STD screening guidelines for HIV-infected MSM. ⋯ Providers reported many obstacles to routine chlamydia and gonorrhea screening. Interventions are needed to help to mitigate barriers to STD screening, such as structural and patient-directed health services models that might facilitate increased testing coverage of these important preventive services.