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Background: In the United States, many public health sexually transmitted disease (STD) programs have experienced staff reductions or budget cuts in recent years. The scope of recent disruptions during COVID-19 along with any impacts on the provision of STD services has not been studied in a systematic way. Methods: We surveyed 668 and 669 local health departments (LHD) before (2018) and during (2021) the COVID-19 pandemic, respectively. STD program managers for each LHD jurisdiction were asked to complete a web-based survey including questions about staff reductions and budget cuts during the previous calendar year. In both surveys, if a manager indicated that their STD program had net staff reductions, they were asked a follow-up question about which staff had been lost. In the 2018 survey, managers reporting budget cuts were asked a followup question about subsequent negative program impacts. Responses were weighted by US Census region, jurisdiction population size, and nonresponse to be representative of approximately 2500 LHD in each survey. Results: A weighted 38.6% (95%CI=30.8-46.9) of STD program managers surveyed in 2021 indicated net staff reductions in calendar year 2020, a significant increase over 16.0% (95%CI=11.7-21.6) in calendar year 2017. Staff reductions by job category are reported in Table 1. In both surveys, LHD STD programs with net staff reductions were most likely to report decreases in clinical staff (78.6% and 77.3% in 2017 and 2020, respectively). Among LHD indicating net staff reductions in 2017, 16.5% (95%CI=7.7-32.0) reported decreases in disease intervention specialists (DIS). In 2020, during the height of the COVID-19 pandemic, that number increased significantly (38.0%, 95%CI=26.0-51.7). Budget cuts were reported by 24.1% (95%CI=18.3- 31.0) of respondents in 2017 and 21.1% (95%CI=13.6-31.3) in 2020. Of those reporting budget cuts in 2017, 40.6% (95%CI=26.8-56.2) reported reductions in clinical services as a result and 16.8% (95%CI=8.6-30.2) reported reductions in partner services. Conclusion: LHD STD programs report significantly more staff disruptions in 2020, at the height of the COVID-19 pandemic, than prior to the pandemic in 2017. These disruptions may impact the ability of LHD to meet the need for safety net STD services and partner services within their jurisdictions. [ABSTRACT FROM AUTHOR]

Background: Surveillance reports have shown that reported sexually transmitted diseases (STDs) are increasing. The provision of partner services is an effective tool for preventing and reducing the spread of STDs. We examined partner services provided by health departments and assessed for associations with jurisdiction size, STD morbidity, and region.Methods: We used stratified random sampling to select 668 local health departments (LHDs) and selected all (n = 50) state health departments (SHDs). Rao-Scott χ2 analyses were performed to examine partner services by health department type (SHD vs. LHD), region, jurisdiction size (LHD only), and STD morbidity (LHD only).Results: Approximately 49.0% of LHDs and 88.0% of SHDs responded to the survey. Most LHDs (81.6%) and SHDs (79.5%) provided partner services for some STDs (P = 0.63). Compared with SHDs, a higher proportion of LHDs provided expedited partner therapy for chlamydia (66.8% vs. 34.2%, P < 0.01) and gonorrhea (39.3% vs. 22.9%, P = 0.09). Partner service staff performed other activities such as conducting enhanced surveillance activities (23.0% of LHDs, 34.3% of SHDs; P = 0.20) and participating in outbreak response and emergency preparedness (84.8% of LHDs, 80.0% of SHDs; P = 0.51). Associations were found when partner services were stratified by health department type, jurisdiction size, STD morbidity, and region. All LHDs in high-morbidity areas provided partner services and 45.4% performed serologic testing of syphilis contacts in the field.Conclusions: A majority of STD programs in LHDs and SHDs provide a variety of partner services and partner service-related activities. It is imperative to continue monitoring the provision of partner services to understand how critical public health needs are being met. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to determine if and how the age distribution of Chlamydia trachomatis and Neisseria gonorrhoeae infections in women evolved from 2010 to 2017, given changes in sexual practices over this time.Methods: All Chlamydia trachomatis/Neisseria gonorrhoeae co-testing laboratory results from females aged 12-30 years tested at Quest Diagnostics during 2010-2017 (n=17,794,680) were evaluated to assess trends in Chlamydia trachomatis and Neisseria gonorrhoeae positivity over time. Data were collected and analyzed in November 2018.Results: Age-based positivity shifted toward older ages from 2010 to 2017 for both Chlamydia trachomatis and Neisseria gonorrhoeae. There was a declining trend in Chlamydia trachomatis positivity from 2010 to 2017 for the youngest age group (12-17 years; 17% decline, 8.9% to 7.4%, p<0.0001) but increasing trends for both those aged 18-24 years (21% increase, 6.1% to 7.4%, p<0.0001) and 25-30 years (50% increase, 2.2% to 3.3%, p<0.0001). The Chlamydia trachomatis positivity rate for 27-year-olds in 2017 (3.5%) and 24-year-olds in 2010 (3.5%) was the same. Similarly, there was a declining trend in Neisseria gonorrhoeae positivity from 2010 to 2017 for the youngest age group (12-17 years; 14% decline, 1.33% vs 1.17%, p<0.0001) but increasing trends for both those aged 18-24 years (27% increase, 0.79% vs 1.00%, p<0.0001) and 25-30 years (117% increase, 0.29% vs 0.63%, p<0.0001). For Neisseria gonorrhoeae, 30-year-old women tested in 2017 had an identical positivity rate to 23-year-old women tested in 2010, at 0.5%.Conclusions: Healthcare providers may want to consider this positivity rate age shift in Chlamydia trachomatis and Neisseria gonorrhoeae to inform prevention and control strategies, including considering the potential for increased risk in women aged 25-30 years. [ABSTRACT FROM AUTHOR]

Background: Cost-effective, scalable interventions are needed to address high rates of sexually transmitted diseases (STDs) in the United States. Safe in the City, a 23-minute video intervention designed for STD clinic waiting rooms, effectively reduced new infections among STD clinic clients. A cost-effectiveness analysis of this type of intervention could inform whether it should be replicated.Methods: The cost-effectiveness of a brief video intervention was calculated under a baseline scenario in which this type of intervention was expanded to a larger patient population. Alternative scenarios included expanding the intervention over a longer period or to more clinics, including HIV prevention benefits, and operating the intervention part time. Program costs, net costs per STD case averted, and the discounted net cost of the intervention were calculated from a health sector perspective across the scenarios. Monte Carlo simulations were used to calculate 95% confidence intervals surrounding the cost-effectiveness measures.Results: The net cost per case averted was $75 in the baseline scenario. The net cost of the intervention was $108,015, and most of the alternative scenarios found that the intervention was cost saving compared with usual care.Conclusions: Single session, video-based interventions can be highly cost effective when implemented at scale. Updated video-based interventions that account for the changing STD landscape in the United States could play an important role in addressing the recent increases in infections. [ABSTRACT FROM AUTHOR]

Background: The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques.Methods: We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008-2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008-2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites.Results: Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates.Conclusions: There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services. [ABSTRACT FROM AUTHOR]

Background: Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread.Methods: A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics.Results: Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake.Conclusions: Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical. [ABSTRACT FROM AUTHOR]

Background: Patients in sexually transmitted disease (STD) clinic waiting rooms represent a potential audience for delivering health messages via video-based interventions. A controlled trial at 3 sites found that patients exposed to one intervention, Safe in the City, had a significantly lower incidence of STDs compared with patients in the control condition. An evaluation of the intervention's cost could help determine whether such interventions are programmatically viable.Materials and Methods: The cost of producing the Safe in the City intervention was estimated using study records, including logs, calendars, and contract invoices. Production costs were divided by the 1650 digital video kits initially fabricated to get an estimated cost per digital video. Clinic costs for showing the video in waiting rooms included staff time costs for equipment operation and hardware depreciation and were estimated for the 21-month study observation period retrospectively.Results: The intervention cost an estimated $416,966 to develop, equaling $253 per digital video disk produced. Per-site costs to show the video intervention were estimated to be $2699 during the randomized trial.Conclusions: The cost of producing and implementing Safe in the City intervention suggests that similar interventions could potentially be produced and made available to end users at a price that would both cover production costs and be low enough that the end users could afford them. [ABSTRACT FROM AUTHOR]

Staffing reductions in state and local health departments in fiscal year 2012 were concentrated in disease investigation specialists and clinicians (local) and disease investigation specialists and administrative staff (state). Local health departments with budget cuts were significantly more likely to report reduced partner services if they had staffing reductions. [ABSTRACT FROM AUTHOR]

The Patient Protection and Affordable Care Act is expected to reduce the number of uninsured people in the United States during the next eight years, but more than 10% are expected to remain uninsured. Uninsured people are one of the main populations using publicly funded safety net sexually transmitted disease (STD) prevention services. Estimating the proportion of the uninsured population expected to need STD services could help identify the potential demand for safety net STD services and improve program planning. In 2013, an estimated 8.27 million people met the criteria for being in need of STD services. In 2023, 4.70 million uninsured people are expected to meet the criteria for being in need of STD services. As an example, the cost in 2014 U.S. dollars of providing chlamydia screening to these people was an estimated $271.1 million in 2013 and is estimated to be $153.8 million in 2023. A substantial need will continue to exist for safety net STD prevention services in coming years. [ABSTRACT FROM AUTHOR]

Background: The Centers for Disease Control and Prevention recommends annual sexually transmitted infection (STI) and HIV testing and counseling for men who have sex with men (MSM) in the United States. We estimated the annual total direct medical cost of providing recommended STI and HIV testing and counseling services for MSM in the United States.Methods: We included costs for 9 STI (including anatomic site-specific) tests recommended by the Centers for Disease Control and Prevention (HIV, syphilis, gonorrhea, chlamydia, hepatitis B viral infection, and herpes simplex virus type 2), office visits, and counseling. We included nongenital tests for MSM with exposure at nongenital sites. All cost data were obtained from the 2012 MarketScan outpatient claims database. Men were defined as MSM if they had a male sex partner within the last 12 months, which was estimated at 2.9% (2.6%-3.2%) of the male population in a 2012 study. All costs were updated to 2014 US dollars.Results: The estimated average costs were as follows: HIV ($18 [$9-$27]), hepatitis B viral infection ($23 [$12-$35]), syphilis ($8 [$4-$11]), gonorrhea and chlamydia ($45 [$22-$67]) per anatomic site), herpes simplex virus type 2 ($27 [$14-$41]), office visit ($100 [$50-$149]), and counseling ($29 [$15-$44]). We estimated that the total annual direct cost of a universal STI and HIV testing and counseling program was $1.1 billion ($473 million-$1.7 billion) for all MSM and $756 (range, $338-$1.2 billion) when excluding office visit cost.Conclusions: These estimates provide the potential costs associated with universal STI and HIV testing and counseling for MSM in the United States. This information may be useful in future cost and/or cost-effectiveness analyses that can be used to evaluate STI and HIV prevention efforts. [ABSTRACT FROM AUTHOR]

To assess healthcare provider awareness of the Food and Drug Administration (FDA) 2019 approval of nucleic acid amplification tests (NAAT) using extragenital specimens for chlamydia and gonorrhea, several questions were included in fall 2020 Porter Novelli's DocStyles survey, a US nationally representative semi-annual web-based survey of healthcare providers. There were 1502 respondents included in this study, 1000 family practitioners/internists as primary care physicians (PCPs), 251 obstetricians/gynecologists (OBs/GYNs), and 251 nurse practitioners/physician assistants (NP/PA). Awareness of this FDA approval was 34.3% overall and significantly varied by provider specialty: 45.0% for OB/GYN versus 23.5% for NP/PA, p < 0.01. OB/GYN had the lowest rate of ordering any extragenital gonorrhea and chlamydia tests in the past 12 months (31.6%) versus the other providers (ranging from 46.2% for NP/PA to 60.7% for PCP). The respondents were more likely to be aware of the FDA approval if they had ordered extragenital chlamydia or gonorrhea testing for men who have sex with men (MSM) than those who did not order the tests for MSM (72.3% versus 43.7%, p < 0.01). Of 1502 respondents, lack of reimbursement as a barrier to ordering extragenital tests for chlamydia and gonorrhea was most mentioned (16.6%) overall and did not significantly vary by provider's specialty. Further outreach is needed to educate healthcare providers on the changes in the FDA approval for extragenital gonorrhea and chlamydia testing so that they can provide comprehensive care to their patients and to reduce the potential for antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic changed the environment in which disease intervention specialists (DISs) operate, as their skills were in demand beyond sexually transmitted disease (STD) control programs. Workforce conditions generally have changed in the last 2 years, imposing additional challenges. Retaining STD DIS has become more difficult in the changed environment. Materials andMethods: We conducted a landscape scan and obtained data from literature and personal observations to characterize current DIS workforce issues.We used published employment data to characterize current labor market conditions and described how cost-effectiveness analysis could be used to assess potential DIS retention interventions. An example illustrating cost-effectiveness concepts was developed. Results: Many STD control programs faced difficulties in retaining STD DIS, because competing positions often could be done without field work. Economic and crime issues posed additional challenges. Generalworkforce turnover has increased 33% since 2016. Turnover varies by age, sex, and education. Cost-effectiveness analysis can be used to assess DIS retention interventions, but data on costs and outcomes are needed on an ongoing basis. Changes in the workforce environment could impact both retention and the effectiveness of retention interventions. Conclusions: Workforce changes have impacted employee retention. Increased federal funding makes expansion of the DIS workforce possible, but the labor market environment will continue to pose challenges to recruitment and retention. [ABSTRACT FROM AUTHOR]

Chlamydia screening and partner notification as implemented in the United States for 2000 to 2015 has substantially improved population health and provided good value for money when considering associated health care services costs. Background: Chlamydia remains a significant public health problem that contributes to adverse reproductive health outcomes. In the United States, sexually active women 24 years and younger are recommended to receive annual screening for chlamydia. In this study, we evaluated the impact of estimated current levels of screening and partner notification (PN), and the impact of screening based on guidelines on chlamydia associated sequelae, quality adjusted life years (QALYs) lost and costs. Methods: We conducted a cost-effectiveness analysis of chlamydia screening, using a published calibrated pair formation transmission model that estimated trends in chlamydia screening coverage in the United States from 2000 to 2015 consistent with epidemiological data. We used probability trees to translate chlamydial infection outcomes into estimated numbers of chlamydia-associated sequelae, QALYs lost, and health care services costs (in 2020 US dollars). We evaluated the costs and population health benefits of screening and PN in the United States for 2000 to 2015, as compared with no screening and no PN. We also estimated the additional benefits that could be achieved by increasing screening coverage to the levels indicated by the policy recommendations for 2016 to 2019, compared with screening coverage achieved by 2015. Results: Screening and PN from 2000 to 2015 were estimated to have averted 1.3 million (95% uncertainty interval [UI] 490,000–2.3 million) cases of pelvic inflammatory disease, 430,000 (95% UI, 160,000–760,000) cases of chronic pelvic pain, 300,000 (95% UI, 104,000–570,000) cases of tubal factor infertility, and 140,000 (95% UI, 47,000–260,000) cases of ectopic pregnancy in women. We estimated that chlamydia screening and PN cost $9700 per QALY gained compared with no screening and no PN. We estimated the full realization of chlamydia screening guidelines for 2016 to 2019 to cost $30,000 per QALY gained, compared with a scenario in which chlamydia screening coverage was maintained at 2015 levels. Discussion: Chlamydia screening and PN as implemented in the United States from 2000 through 2015 has substantially improved population health and provided good value for money when considering associated health care services costs. Further population health gains are attainable by increasing screening further, at reasonable cost per QALY gained. [ABSTRACT FROM AUTHOR]

Background: To describe recent trends in the receipt of sexually transmitted disease (STD) services among women (age, 15-44 years) from 2002 to 2006-2010 using the National Survey of Family Growth. Methods: We analyzed trends in demographics, health insurance, and visit-related variables of women reporting receipt of STD services (counseling, testing, or treatment) in the past 12 months. We also analyzed trends in the source of STD services and the payment method used. Results: Receipt of STD services reported by women in the past 12 months increased from 2002 (12.6%) to 2006-2010 (16.0%; P< 0.001). Receipt of services did not increase among adolescents (P = 0.592). Among women receiving STD services from a private doctor/HMO, the percentage with private insurance decreased over time (74.6%-66.8%), whereas the percentage with Medicaid increased (12.8%-19.7%; P = 0.020). For women receiving STD services at a public clinic or nonprimary care facility, there were no statistically significant differences by demographics, except that fewer adolescents but more young adults reported using a public clinic over time (P = 0.038). Among women who reported using Medicaid as payment, receipt of STD services at a public clinic significantly decreased (36.8%-25.4%; P = 0.019). For women who paid for STD services with private insurance, the only significant difference was an increase in having a copay overtime (61.3%-70.1%; P = 0.012). Conclusions: Despite a significant increase in receipt of STD services over time, many women at risk for STDs did not receive services including adolescents. In addition, we identified important shifts in payment methods during this time frame. [ABSTRACT FROM AUTHOR]

Observational studies have found mixed results on the impact of jail-based chlamydia screen-and-treat programs on community prevalence. In the absence of controlled trials or prospectively designed studies, dynamic mathematical models that incorporate movements in and out of jail and sexual contacts (including disease transmission) can provide useful information. We explored the impact of jail-based chlamydia screening on a hypothetical community's prevalence with a deterministic compartmental model focusing on heterosexual transmission. Parameter values were obtained from the published literature. Two analyses were conducted. One used national values (large community); the other used values reported among African Americans—the population with the highest incarceration rates and chlamydia burden (small community). A comprehensive sensitivity analysis was carried out. For the large-community analysis, chlamydia prevalence decreased by 13% (from 2.3% to 2.0%), and based on the ranges of parameter values (including screening coverage of 10%–100% and a postscreening treatment rate of 50%–100%) used in the sensitivity analysis, this decrease ranged from 0.1% to 58%. For the small-community analysis, chlamydia prevalence decreased by 54% (from 4.6% to 2.1%). Jail-based chlamydia screen-and-treat programs have the potential to reduce chlamydia prevalence in communities with high incarceration rates. However, the magnitude of this potential decrease is subject to considerable uncertainty. [ABSTRACT FROM PUBLISHER]

The article offers an examination of the cost of expedited partner therapy (EPT) for partners of patients with chlamydia or gonorrhea in the U.S. It says that EPT was lest costly than unassisted standard partner referral (SR) from the societal or health care system perspective. It states that, however, EPT may become costly than SR depending on the care received by the patients' partners from the same payer.

The article presents a study comparing the efficacy of a dual non-treponemal/treponemal syphilis point-of-care test (Dual-POC) to other syphilis testing algorithms in preventing adverse pregnancy outcomes in Sub-Saharan Africa. It says that point-of-care treponemal immunochromatographic strip (ICS) test prevented most cases of adverse pregnancy outcomes, followed by the Dual-POC. It states that Dual-POC was most cost-effective when its sensitivity was ⩾97%.

The article presents a study which assesses the program cost and cost-effectiveness of screening men for chlamydia to prevent pelvic inflammatory disease in women. It states that chlamydia is the most commonly reported disease in the U.S. and its sequelae of infection in women includes pelvic inflammatory disease (PID) which can lead to chronic pelvic pain, ectopic pregnancy, and infertility. It notes that it is a vital strategy to screen men for chlamydia trachomatis to decrease the prevalence of such disease. After conducting the investigations, it is concluded that the screening for men can be a cost-effective alternative to screening women. An overview of the methodology and the results obtained in the study is also offered.

The article presents a review of the literature for the cost effectiveness of screening men for chlamydia trachomatis. It discusses that C. trachomatis is the most common bacterial sexually transmitted disease and can lead to such pelvic inflammatory disease in men and also in women. It provides information on the results of the Ovid Medline search which was conducted for articles published between 1990 and July 2007. The proactive and opportunistic screening of the reviewed studies were examined including the screening of risk groups and general population. Some other studies which included enzyme immunoassays and nucleic acid amplification assays are discussed.

The article presents an analysis of the cost effectiveness of screening strategies namely, qualitative RPR (on-site RPR) and treponemal immunochromatographic strip assay (on-site ICS) to prevent congenital syphilis in rural eastern Cape Province in South Africa. With the findings from the decision analysis of the estimates, the study concludes that the on-site ICS is a cost-effective approach to reduce the incidence of congenital syphilis in a setting where maternal syphilis is prevalent.

Abstract: Background : Prevention efforts can reduce the considerable health and economic burdens imposed by sexually transmitted diseases (STDs). The objective of this study was to estimate the reduction in direct medical costs associated with reductions in gonorrhea and syphilis incidence in the United States from 1990 to 2003. Methods : Using published estimates of the per-case costs of STDs, we estimated the annual costs from 1990 to 2003 of four main outcomes: primary and secondary (P&S) syphilis, congenital syphilis, gonorrhea, and HIV costs attributable to the facilitative effects of gonorrhea and syphilis on HIV transmission and acquisition. Results : Reductions in syphilis and gonorrhea from 1990 to 2003 have saved an estimated $5.0 billion (in 2003 U.S. dollars): $1.1 billion in costs associated with P&S syphilis, congenital syphilis, and gonorrhea, and $3.9 billion in HIV costs attributable to syphilis and gonorrhea. In additional analyses, the estimated reductions in disease burden were substantially lower (1) when calculated incrementally (rather than cumulatively) and (2) when long-term costs of STDs were excluded. Conclusions : These estimated reductions in the burden of gonorrhea and syphilis show the economic benefits of reducing the incidence of these STDs and preventing their resurgence. [Copyright &y& Elsevier]

The article evaluates the cost-effectiveness of the chlamydia screening and partner notification programs for men conducted in a jail in Massachusetts. It was found that age-based screening could lower costs without substantially sacrificing effectiveness and notification of the partners of the infected inmates was a cost-effective adjunct to screening inmates.

The article examines the productivity losses attributable to untreated chlamydial infection and associated pelvic inflammatory disease (PID) in reproductive-aged women. In 2001 the mean weighted productivity losses per untreated chlamydia infection were $130 and $649 for acute PID. The productivity losses attributable to untreated chlamydia and to sequelae of this infection form a substantial portion of the total economic burden of the disease.

The article reports evaluates direct medical costs of epididymitis and orchitis, the primary sequelae of acute chlamydia and gonorrhea in men, from insurance claims data in the U.S. in 1998 and 1999. The cost per episode calculated was lower than previously published estimates which can be attributed to a lower rate of inpatient care than previously observed and recorded.

Background: Persons who have been infected with chlamydia or gonorrhea (CT/GC) are at elevated risk for reinfection. The cost-effectiveness of interventions designed to encourage public sexually transmitted disease (STD) clinic patients to return for rescreening has not been well-evaluated. Goal: The goal of this study was to conduct a program- and societal-perspective cost-effectiveness analysis of five interventions designed to encourage public STD clinic patients infected with CT/GC to return for rescreening 3 months after initial treatment. Study: Researchers at two STD clinics collected cost data for the five interventions. These were combined with study data on return rates and CT/GC positivity rates among returning patients to compare the cost-effectiveness of the interventions. Results: The cost per patient counseled with a brief recommendation to return, followed by a telephone reminder after 3 months, was higher than two interventions: a brief recommendation to return with no reminder and a $20 incentive, received on return. However, the brief recommendation with a telephone reminder yielded the highest return rate (33%) and was the least costly in terms of cost per infection treated ($622 program, $813 societal). In-depth motivational counseling that helped clients identify risk factors and provided reasons for returning was more costly than a phone reminder alone and was not more effective. Conclusions: Phone reminders are more cost-effective than motivational counseling and improve return rates over a brief recommendation given at the time of initial treatment. [ABSTRACT FROM AUTHOR]

Background: Treatment of incubating syphilis with intramuscular benzathine penicillin in exposed sex partners is not always practical in the field, and exposed partners may not adhere to referrals for treatment at clinical facilities. The availability of a single-dose oral therapy could increase the number of partners treated and reduce future infections.Goal: The goal of the study was to evaluate the cost-effectiveness of directly observed oral administration of azithromycin as an alternative to referral for treatment with benzathine penicillin.Study Design: Using published probability and cost estimates, we constructed a decision-analysis model to compare the direct costs and effectiveness of field treatment with azithromycin (1-g single dose) versus referral for standard benzathine penicillin therapy.Results: At public-sector pricing ($11.50 U.S. dollars), directly observed field treatment with azithromycin is cost-saving from both the program and healthcare system perspectives at efficacy levels as low as 75%. Azithromycin therapy is cost-saving at the wholesale price of $17.32 U.S. dollars (sachet formulation) when efficacy is at least 90%. The more expensive tablet formulation (average wholesale price of $27.89 U.S. dollars) is not cost-saving from a program perspective, but it remains cost-saving from a healthcare system perspective if efficacy rates are at least 90%. Azithromycin therapy (1-g single dose) will result in fewer cases of early syphilis among exposed partners, provided that the drug's efficacy is at least 87%.Conclusions: Azithromycin is a cost-effective alternative treatment for incubating syphilis in settings where standard intramuscular therapy is not practical. [ABSTRACT FROM AUTHOR]

Goal: The goal was to determine the optimal strategy for screening coverage, test selection, and treatment for infection in asymptomatic women for a given family-planning-program budget.Study Design: We developed a resource allocation model to determine the optimal strategy using data from 5078 visits by women universally screened for infection in a publicly funded family planning clinic system in Philadelphia. We maximized the number of infected women cured from the clinic perspective and maximized the cost-savings from the healthcare system perspective. The model incorporated the following age distributions: <20 years (27%), 20 to 24 years (30%), and >24 years (43%), with prevalences of 10.6%, 6.9%, and 2.3%, respectively. We modeled two screening test assays (DNA probe and ligase chain reaction [LCR] for cervical specimens) and two treatments (doxycycline and azithromycin). The model allowed for different test and treatment choices by age group.Results: At the baseline annual budget of $6 per visit, the strategy that maximized both the number of infected women cured and cost savings would be to screen all women with DNA probe and to treat all women with positive tests with azithromycin. This strategy would result in 183 women cured at a cost-savings of $140,176. Sensitivity analysis showed that the total budget had a great impact on the optimal strategy, incorporating screening coverage, test selection, and treatment.Conclusions: Using resource allocation models enables clinic managers operating with a fixed budget to identify a strategy that maximizes the number of asymptomatic women cured and cost savings when the clinic age distribution and age-specific prevalences are known. [ABSTRACT FROM AUTHOR]

Background: Because patients infected with Neisseria gonorrhoeae are frequently coinfected with Chlamydia trachomatis, routine dual treatment of patients with N gonorrhoeae infection is frequently practiced and has long been recommended.Goal: The goal of this study was to examine the cost-effectiveness of routine dual treatment of women with infection, with or without separate testing for C trachomatis, compared with an alternative of testing for both infections and restricting treatment for C trachomatis to women testing positive for C trachomatis.Study Design: A decision analysis compared the cost-effectiveness of these options using cases of pelvic inflammatory disease prevented as the outcome. Parameter values were taken from the literature.Results: Routine dual treatment is not an effective or cost-effective replacement for testing for C trachomatis, but it can increase the number of cases of C trachomatis treated when combined with testing. Dual treatment results in more overtreatment of infection C trachomatis than treatment based on test results.Conclusions: Testing for both infections is more cost-effective than routine presumptive treatment for C trachomatis. Providing both presumptive treatment and testing for C trachomatis can also be cost-effective in some settings. [ABSTRACT FROM AUTHOR]

Background: Particularly in resource-poor settings, simple, inexpensive, and cost-effective algorithms are needed to direct antibiotic prophylaxis to prevent sequelae of infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis-associated organisms among women undergoing abortion.Goal: To assess the prevalence of and risk factors for infections among women seeking abortion in Bali, Indonesia, and to use these data in designing a cost-effective risk-based prophylaxis algorithm.Study Design: A cross-sectional analysis and data-based simulation of risk-based and alternative prophylaxis algorithms were performed.Results: The risk-based algorithm would have provided prophylaxis to 70% (95% CI, 53-83%) of women with cervical infection, 64% (95% CI, 54-74%) of those with bacterial vaginosis, and 57% (95% CI, 42-72%) of those with trichomoniasis. For cervical infection, the algorithm was more cost effective than all others evaluated. The cost-effectiveness was acceptable for bacterial vaginosis.Conclusions: Risk-based algorithms may be cost effective in identifying women likely to benefit from preabortion prophylaxis. Prospective evaluation is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Productivity costs of sexually transmitted infections (STIs) reflect the value of lost time due to STI morbidity and mortality, including time spent traveling to, waiting for, and receiving STI treatment. The purpose of this study was to provide updated estimates of the average lifetime productivity cost for chlamydia, gonorrhea, and syphilis, per incident infection. Methods: We adapted published decision tree models from recent studies of the lifetime medical costs of chlamydia, gonorrhea, and syphilis in the United States. For each possible outcome of infection, we applied productivity costs that we obtained based on published health economic studies. Productivity costs included the value of patient time spent to receive treatment for STIs and for related sequelae such as pelvic inflammatory disease inwomen. We used a human capital approach and included losses inmarket (paid) and nonmarket (unpaid) productivity. We conducted 1-way sensitivity analyses and probabilistic sensitivity analyses. Results: The average lifetime productivity cost per infection was $28 for chlamydia in men, $205 for chlamydia in women, $37 for gonorrhea in men, $212 for gonorrhea in women, and $411 for syphilis regardless of sex, in 2023 US dollars. The estimated lifetime productivity cost of these STIs acquired in the United States in 2018 was $795 million. Conclusions: These estimates of the lifetime productivity costs can help in quantifying the overall economic burden of STIs in the United States beyond just the medical cost burden and can inform cost-effectiveness analyses of STI prevention activities. [ABSTRACT FROM AUTHOR]

Investigates situations in which a rapid screening test for the detection of Chlamydia trachomatis infections in women could lead to cost-effective and better patient treatment in the United States. Comparison of point-of-care test and laboratory-based test; Variables used in the analysis; Test sensitivities and specificities.

Background: Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM.Methods: Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence.Results: Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection.Conclusions: Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM. [ABSTRACT FROM AUTHOR]

The article presents a literature review of studies concerning the estimated economic burden of sexually transmitted diseases (STD) in the U.S. It mentions that the authors have found three studies which estimated the overall economic burden of STD and included several STD such as chlamydia infections, gonorrhea and genital herpes. It also notes that the components of the economic burden of STD can be classified as direct medical costs, direct nonmedical costs and indirect costs.

To determine the effects of school closure, we surveyed 214 households after a 1-week elementary school closure because of pandemic (H1N1) 2009. Students spent 77% of the closure days at home, 69% of students visited at least 1 other location, and 79% of households reported that adults missed no days of work to watch children. [ABSTRACT FROM AUTHOR]

The article presents a study which analyses costs of treatment for acute gonorrhea infections using an employer-sponsored private insurance claims data estimates in the U.S. on 2003-2007. The study identified the drugs used for the treatment of gonococcal infections using MarketScan Database and their corresponding National Drug Codes for identification of drugs claims for such disease. Results show that 210 dollars is the estimated overall average cost for each episode of treated patients.

The article discusses the epidemiology of epididymitis or orchitis by analyzing the single and multiple insurance claims of 14-45 year-old privately-insured males in the U.S. from 2001-2004. It reviews the single and multiple claim records of inpatients and outpatient using the MarketScan Database from Medstat Group Inc. to select the population of the study. It reveals the highest rate of orchitis in southern part of the U.S. and the subsequent increase in insurance claims among men.

Background: Since common diagnostic tests for gonorrhea do not provide information about susceptibility to antibiotics, treatment of gonorrhea remains empiric. Antibiotics used for empiric therapy are usually changed once resistance prevalence exceeds a certain threshold (e.g., 5%). A low switch threshold is intended to increase the probability that an infection is successfully treated with the first-line antibiotic, but it could also increase the pace at which recommendations are switched to newer antibiotics. Little is known about the impact of changing the switch threshold on the incidence of gonorrhea, the rate of treatment failure, and the overall cost and quality-adjusted life-years (QALYs) associated with gonorrhea. Methods and findings: We developed a transmission model of gonococcal infection with multiple resistant strains to project gonorrhea-associated costs and loss in QALYs under different switch thresholds among men who have sex with men (MSM) in the United States. We accounted for the costs and disutilities associated with symptoms, diagnosis, treatment, and sequelae, and combined costs and QALYs in a measure of net health benefit (NHB). Our results suggest that under a scenario where 3 antibiotics are available over the next 50 years (2 suitable for the first-line therapy of gonorrhea and 1 suitable only for the retreatment of resistant infections), changing the switch threshold between 1% and 10% does not meaningfully impact the annual number of gonorrhea cases, total costs, or total QALY losses associated with gonorrhea. However, if a new antibiotic is to become available in the future, choosing a lower switch threshold could improve the population NHB. If in addition, drug-susceptibility testing (DST) is available to inform retreatment regimens after unsuccessful first-line therapy, setting the switch threshold at 1% to 2% is expected to maximize the population NHB. A limitation of our study is that our analysis only focuses on the MSM population and does not consider the influence of interventions such as vaccine and common use of rapid drugs susceptibility tests to inform first-line therapy. Conclusions: Changing the switch threshold for first-line antibiotics may not substantially change the health and financial outcomes associated with gonorrhea. However, the switch threshold could be reduced when newer antibiotics are expected to become available soon or when in addition to future novel antibiotics, DST is also available to inform retreatment regimens. Using a mathematical model of gonococcal infection, Xuecheng Yin and co-authors project the burden of gonorrhea in a population of men who have sex with men in the US and, the gonorrhea-associated costs and loss in quality adjusted life-years under various antibiotic switch thresholds and scenarios for antibiotic availability. Author summary: Why was this study done?: Antibiotics used for the empiric therapy of gonorrhea are usually changed once the prevalence of resistance to the antibiotic exceeds a certain threshold, currently set at 5%. A low switch threshold is often selected to ensure that the first-line antibiotic remains effective for most patients with gonorrhea. However, little is known about the impact of changing the switch threshold on the incidence of gonorrhea, the rate of treatment failure, and the overall cost and quality-adjusted life-years (QALYs) associated with gonorrhea. What did the researchers do and find?: We developed a mathematical model of gonococcal infection among a population of men who have sex with men (MSM) in the United States to project the burden of gonorrhea and the overall associated cost and QALYs under various switch thresholds and scenarios for the future availability of antibiotics and drug-susceptibility testing (DST). We found that changing the switch threshold between 1% and 10% does not meaningfully impact the annual number of gonorrhea cases, and total cost and total QALY loss associated with gonorrhea. However, if a new antibiotic is expected to become available in the future choosing a lower threshold could improve the population net health benefit (NHB). What do these findings mean?: Changing the switch threshold may not substantially impact the health and financial outcomes associated with gonorrhea. However, the switch threshold could be reduced when newer antibiotics are expected to become available soon or when DSTs is available to inform retreatment regiments. Our study was limited to MSM in the US and future studies should evaluate the generalizability of our findings to other populations. [ABSTRACT FROM AUTHOR]

Background: In the 2022 multinational mpox outbreak, most cases have occurred among gay, bisexual, and other men who have sex with men (MSM), but sexual contacts between men and women may also transmit mpox. However, despite almost 30,000 cases of mpox reported in the United States, there is little evidence of sustained transmission among persons with opposite-sex partners (PWOSP). Here we explore the behavioral conditions that could produce sustained mpox transmission between PWOSP on college campuses, where smaller mixing pools and more frequent sexual activities relative to the general population may increase exposure. Methods: We develop a baseline dynamic network model (STERGM) using publicly available data from the 2011-2015 cycle of the National Survey of Family Growth (NSFG) to parameterize frequency and duration of three partnership types among collegeattending PWOSP: main, casual, and one-time. We then vary the frequency and duration of these partnerships. We track the infection generation of each case (where introduced cases have an infection generation of 0) across all scenarios. To summarize mpox transmission intensity, we calculate the mean infection generation (MIG) of infections. MIG is similar to R0 but provides a directly measurable estimate of spread across a structured population; MIG >1 indicates sustained transmission of mpox. Findings: In the baseline model and most additional scenarios, mpox transmission is not sustained. Conclusions: Rapid turnover of partners may be necessary for sustained mpox transmission. The MIG is low across many scenarios, suggesting that persistent mpox transmission is unlikely among college-attending PWOSP. However, the lack of recent, detailed data on the mixing patterns, frequency, and type of sexual behaviors of college students of all sexual orientations and gender identities could lead us to misclassify likely mpox transmission. Additional data collection should be considered for the development of robust models to understand the risk of mpox and other sexually transmitted infections among all college-attending students in the United States. [ABSTRACT FROM AUTHOR]

Abstract: We used 2016-2017 administrative claims data to calculate the direct medical cost and productivity loss per diagnosed case of chlamydia and gonorrhea treatment. In 2018 US dollars, the direct cost per diagnosed case was $151 for chlamydia (n = 9180) and $85 for gonorrhea (n = 3048); productivity loss was $206 (n = 31) and $246 (n = 7), respectively, among those missing work seeking care. [ABSTRACT FROM AUTHOR]

Background Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear. Methods Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay. Results In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9–8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1–2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000–22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%. Conclusions POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options. [ABSTRACT FROM AUTHOR]

Rapid point-of-care tests that diagnose gonococcal infections and identify susceptibility to antibiotics enable individualized treatment. This could improve patient outcomes and slow the emergence and spread of antibiotic resistance. However, little is known about the long-term impact of such diagnostics on the burden of gonorrhea and the effective life span of antibiotics. We used a mathematical model of gonorrhea transmission among men who have sex with men in the United States to project the annual rate of reported gonorrhea cases and the effective life span of ceftriaxone, the recommended antibiotic for first-line treatment of gonorrhea, as well as 2 previously recommended antibiotics, ciprofloxacin and tetracycline, when a rapid drug susceptibility test that estimates susceptibility to ciprofloxacin and tetracycline is available. The use of a rapid drug susceptibility test with ≥50% sensitivity and ≥95% specificity, defined in terms of correct ascertainment of drug susceptibility and nonsusceptibility status, could increase the combined effective life span of ciprofloxacin, tetracycline, and ceftriaxone by at least 2 years over 25 years of simulation. If test specificity is imperfect, however, the increase in the effective life span of antibiotics is accompanied by an increase in the rate of reported gonorrhea cases even under perfect sensitivity. [ABSTRACT FROM AUTHOR]

Abstract: We used 2016-2018 outpatient claims data to calculate direct outpatient medical costs per case of trichomoniasis in 2019 US dollars. The outpatient, drug, and total costs per treated case of trichomoniasis were $174, $39, and $213, respectively. Total costs were higher for female patients ($220) than for male patients ($158). [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a meeting sponsored by the Centers for Disease Control and Prevention on Chlamydia screening in men is presented. Topics include a review of surveillance data on Chlamydia trachomatis in men, partner management, and characteristics beneficial to target screening. The meeting featured several consultants.

The article presents a discussion on the health utility measures for pelvic inflammatory diseases. It is noted that the health utility measures should be deemed as significant tools in the analysis of health since they render a single standard to value the utility associated with a provided health state or disease quantitatively. Moreover, they provide measurement on the gap between death and perfect health, which includes social functioning, perception of well-being, as well as physical functioning.

A letter to the editor is presented about drops in AIDS mortality and hikes in primary and secondary syphilis in men who have sex with men in the U.S.

Focuses on the factors influencing the cost effectiveness of gonorrhea screening in emergency departments. Prevalence of sexually transmitted disease among low-income emergency department patients; Clinical benefits of rapid immunochromotographic strip test; Effectiveness and cost of gonorrhea screening against alternatives of chlamydia screening.