Erika Samoff

Predictors of acceptance of hepatitis B vaccination in an urban sexually transmitted diseases clinic.

Background: Individuals who use sexually transmitted disease (STD) clinics are at high risk for hepatitis B virus (HBV). While HBV vaccine is frequently offered to clients in this setting, reported vaccination rates are low. More information is needed about HBV vaccine knowledge, attitudes, beliefs, and behavior among high risk populations. The current study assesses these issues at an urban STD clinic. Methods: A survey assessing knowledge, attitudes, and beliefs concerning HBV vaccine was administered to individuals seeking services at an STD clinic before seeing the physician. Immediately after the clinical visit these individuals were interviewed and asked whether they had accepted vaccination and their reasons for acceptance or rejection. Results: Fifty percent of unvaccinated study subjects elected to receive an HBV vaccine dose at the current visit. Significant predictors in a multiple logistic regression model for choosing to be vaccinated were: having a vaccinated acquaintance, perceived risk of disease, perceived healthfulness of vaccine, and clinician’s recommendation. Knowledge regarding hepatitis B risks and outcomes was not related to vaccine choices. Patients expressed concern about vaccine safety and provider motivation. Conclusions: The role of acquaintances and the physician are central to the decision to be vaccinated, as are risk perception and familiarity with the vaccine. Mistrust of the medical establishment and of vaccines is a barrier to acceptance of HBV vaccine.

Contact-tracing outcomes among male syphilis patients in Fulton County, Georgia, 2003.

Objectives: Contact tracing may be less effective in populations with casual sex partners such as male syphilis patients who report sex with men; this opinion is widely held, but few quantitative comparisons are available. Goal: The goal of this study was to compare contact-tracing outcomes among male syphilis patients reporting sex with men (MSM) or with women only (MSWO). Study Design: The authors conducted a record review of cases of early syphilis among MSM and MSWO comparing contact-tracing outcomes. Results: Interviews of MSM case-patients resulted in higher mean numbers of contacts named and located per case than interviews of MSWO. Mean numbers of contacts of MSM and MSWO diagnosed with syphilis per case were not significantly different. The mean number of unlocatable sex partners per case was slightly higher for MSM than MSWO. Conclusion: This study comparing contact tracing by the same trained health department personnel demonstrated that outcomes of contact tracing were similar for MSM and MSWO.

Pre-treatment Syphilis Titers: Distribution and Evaluation of Their Use to Distinguish Early From Late Latent Syphilis and to Prioritize Contact Investigations

Background: Treatment, contact investigation, and reporting decisions for syphilis cases are based on the stage of disease. Because of limitations of current staging protocols, the rapid plasma reagin (RPR) titer has been proposed as an alternative priority marker for contact investigation. Methods: We describe the RPR titers and stages for 10,021 syphilis cases reported between 1997 and 1999 in Columbia, South Carolina; Houston, Texas; and Jackson, Mississippi. We constructed receiver operating characteristic curves (ROC curves) to compare titer and stage. We calculated the number of infected contacts to evaluate the use of titer to prioritize contact investigation. Results: RPR titers differed by stage, with 67% of primary, 95% of secondary, 78% of early latent, and 41% of late latent and unknown duration having titers >1:8; however, there was considerable overlap in titer distributions. The ROC curve based on titer values demonstrated good agreement between titer and latent stage. Prioritization by titer (≥1:8) of latent cases would result in a similar number of cases interviewed and contacts located as stage prioritization, although different cases are prioritized. Conclusion: Titer distributions meaningfully but imperfectly distinguish populations with different stages. Recent analyses and anecdotal reports indicate the difficulty and inconsistency of staging latent syphilis. Over time, titer could provide a more objective and reliable historical record of syphilis trends. Titer may be a useful alternative or adjunct to stage in prioritizing latent syphilis cases for investigation.

Implementing Chlamydia screening programs in juvenile correctional settings: the california experience.

Objectives: To present strategies, methods, and tools for implementing a chlamydia screening program across diverse county juvenile justice systems in California, and to present screening and treatment outcomes of this program. Methods: Requirements for juvenile hall participants in a chlamydia screening program were described as well as the administrative structure of program implementation. An assessment of screening using administrative data was conducted. Facilitators and barriers to implementation were identified through interviews with local program coordinators and/or institutional medical and correctional staff. Results: Screening projects were implemented in January 2003 in 15 counties (18 juvenile halls) throughout the state. Among institutions with relevant data, the proportion of female detainees screened for chlamydia rose from 35% preprogram implementation to 66% in 2006. Conclusions: High screening levels with high case yields and treatment rates in the juvenile correctional setting can be accomplished and sustained, despite many barriers, if effective collaboration between public health and correctional entities is established.

The Number of Interviews Needed to Yield New Syphilis and Human Immunodeficiency Virus Cases Among Partners of People Diagnosed With Syphilis, North Carolina, 2015

Compare syphilis investigation yield among patient groups using number needed to interview. Goal To increase investigation efficiency. Study Design Retrospective review of North Carolina 2015 syphilis investigations, using the number of cases needed to interview (NNTI) and the total number of cases and contacts needed to interview (TNTI) to compare yield of new syphilis and human immunodeficiency virus diagnoses between patient groups. Results We reviewed 1646 early syphilis cases and 2181 contacts; these yielded 241 new syphilis cases (NNTI, 6.9; TNTI, 16.4) and 38 new human immunodeficiency virus cases (NNTI, 43). Interviews of women (prevalence difference [PD] = 6%, 95% confidence interval [CI], 12–16), patients <30 years old (PD = 5%, 95% CI, 1–8), and patients with titer >1:16 (PD = 5%, 95% CI, 1–9) yielded more new syphilis cases in our adjusted model; no other patient factors increased investigation yield. Conclusions The NNTI and TNTI are useful measures of efficiency. Prioritizing early syphilis investigation by gender, rapid plasmin reagin titer, and age provides small increases in efficiency; no other factors increased efficiency.

Increases in Ocular Syphilis—North Carolina, 2014–2015

Background Ocular syphilis is an inflammatory eye disease due to Treponema pallidum infection. In the United States, syphilis rates have increased since 2000; clusters of ocular syphilis were reported in 2015. We investigated ocular syphilis in North Carolina to describe the epidemiology and clinical course of disease. Methods We reviewed syphilis cases reported to North Carolina during 2014-2015 and abstracted information from health department interviews for cases with ocular symptoms and no other defined etiology. To assess duration and severity of ocular symptoms, we also reviewed medical records and conducted structured interviews. We compared the prevalence of ocular manifestations among reported syphilis cases by demographic and clinical characteristics. Results Among 4232 syphilis patients, 63 (1.5%) had ocular syphilis: 21 in 2014 and 42 in 2015, a 100% increase. Total syphilis cases increased 35% through 2015. No patient with ocular syphilis named another ocular syphilis patient as a sex partner. Patients presented in all syphilis stages; 24 (38%) were diagnosed in primary or secondary syphilis. Ocular manifestations were more prevalent among syphilis patients who were male, aged ≥40 years, white, and infected with human immunodeficiency virus. No risk behaviors were associated with ocular syphilis. Among 39 interviewed patients, 34 (87%) reported reduced vision during infection; 12 (31%) reported residual visual symptoms posttreatment. Conclusions In North Carolina, ocular syphilis increased from 2014 to 2015 and may be due to increased recognition of ocular manifestations, or a true increase in ocular syphilis. Many ocular syphilis patients experienced vision loss; however, most improved posttreatment.