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Sexually Transmitted Infections01:26

Sexually Transmitted Infections

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Sexually transmitted infections (STIs) are diseases transmitted primarily through unsafe sexual interactions. Bacteria, viruses, or parasites cause them and can result in severe health complications if untreated.ChlamydiaThe bacterium Chlamydia trachomatis is responsible for the disease Chlamydia, the most common STI in the United States. This peculiar pathogen requires human cells to reproduce, residing intracellularly. The initial infection often goes unnoticed because it typically does not...
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Routinized Syphilis Screening Among Men Living With Human Immunodeficiency Virus: A Stepped Wedge Cluster Randomized

Ann N Burchell1,2,3, Darrell H S Tan2,4,5,6, Ramandip Grewal2

  • 1Department of Family and Community Medicine, St Michael's Hospital, Unity Health, Toronto, Toronto, Ontario, Canada.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 27, 2021
PubMed
Summary

Integrating syphilis testing with HIV viral load testing increased syphilis screening among HIV-positive men. While feasible, the intervention showed a modest increase in early syphilis detection compared to expectations.

Keywords:
HIVcluster-randomized controlled trialinterventionmenoutpatient clinicsscreeningsyphilis

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Area of Science:

  • Infectious Diseases
  • Public Health
  • Clinical Trials

Background:

  • Syphilis and HIV are co-infections often managed in similar patient populations.
  • Routine screening for syphilis in HIV-positive individuals is crucial for timely treatment and prevention of complications.

Purpose of the Study:

  • To evaluate the effectiveness of an opt-out, clinic-based intervention pairing syphilis tests with routine HIV viral load testing.
  • To determine if this intervention increased the detection of early syphilis among HIV-positive adult males.

Main Methods:

  • A stepped wedge cluster-randomized controlled trial (ESSAHM Trial) was conducted in 4 urban HIV clinics in Ontario, Canada (2015-2017).
  • The intervention involved standing orders for syphilis serological testing alongside viral load tests.
  • Data on syphilis diagnoses were collected through provincial laboratory linkage and medical record review.

Main Results:

  • The mean number of syphilis tests per person per year increased significantly with the intervention (0.53 to 2.02).
  • A total of 217 new syphilis diagnoses were made, with 147 classified as early syphilis.
  • The annualized proportion of newly detected early syphilis increased from 0.009 to 0.032, with a time-adjusted odds ratio of 1.25 (95% CI, .71-2.20).

Conclusions:

  • Implementing standing orders for syphilis testing with HIV viral loads is feasible and enhances syphilis screening frequency.
  • The intervention led to a less pronounced increase in early syphilis case detection than anticipated based on previous studies.