MRSA was likely spread predominantly during practice play, with skin breaks facilitating infection. Measures to minimize skin breaks among athletes should be considered, including prevention of turf burns and education regarding the risks of cosmetic body shaving. MRSA-contaminated pool water may have contributed to infections at covered sites, but small numbers limit the strength of this conclusion. Nevertheless, appropriate whirlpool disinfection methods should be promoted among athletic trainers.

US physicians experience many policy-based, logistical, and educational barriers to HIV testing. Although some barriers are exclusive to the practice setting studied, substantial overlap was found across practice settings. Some or all of these barriers must be addressed before the CDC recommendation for routine HIV testing can be realized in all US medical settings.

Background: While the Centers for Disease Control and Prevention recommends at least annual human immunodeficiency virus (HIV) screening for men who have sex with men (MSM), a large number of HIV infections among this population go unrecognized. We examined the association between disclosing to their medical providers (eg, physicians, nurses, physician assistants) same-sex attraction and self-reported HIV testing among MSM in New York City, New York.Methods: All men recruited from the New York City National HIV Behavioral Surveillance (NHBS) project who reported at least 1 male sex partner in the past year and self-reported as HIV seronegative were included in the analysis. The primary outcome of interest was a participant having told his health care provider that he is attracted to or has sex with other men. Sociodemographic and behavioral factors were examined in relation to disclosure of same-sex attraction.Results: Among the 452 MSM respondents, 175 (39%) did not disclose to their health care providers. Black and Hispanic MSM (adjusted odds ratios, 0.28 [95% confidence interval, 0.14-0.53] and 0.46 [95% confidence interval, 0.24-0.85], respectively) were less likely than white MSM to have disclosed to their health care providers. No MSM who identified themselves as bisexual had disclosed to their health care providers. Those who had ever been tested for HIV were more likely to have disclosed to their health care providers (adjusted odds ratio, 2.10; 95% confidence interval, 1.01-4.38).Conclusions: These data suggest that risk-based HIV testing, which is contingent on health care providers being aware of their patients' risks, could miss these high-risk persons.

Staphylococcus aureus is both a commensal organism and also an important opportunistic human pathogen, causing a variety of community and hospital-associated pathologies, such as bacteremia-sepsis, endocarditis, pneumonia, osteomyelitis, arthritis and skin diseases. The resurgence of S. aureus during the last decade in many settings has been facilitated not only by bacterial antibiotic resistance mechanisms but also by the emergence of new S. aureus clonal types with increased expression of virulence factors and the capacity to neutralize the host immune response. Prevention of the spread of S. aureus infection relies on the use of contact precautions and adequate procedures for infection control that so far have not been fully effective. Prevention using a prophylactic vaccine would complement these processes, having the potential to bring additional, significant progress toward decreasing invasive disease due to S. aureus.

Increased screening for history of unprotected anal intercourse and, for those who report recent unprotected anal intercourse, counseling and testing for HIV and STDs would likely reduce STD infections.

We compared syndromic categorization of chief complaint and discharge diagnosis for 3,919 emergency department visits to two hospitals in the U.S. National Capitol Region. Agreement between chief complaint and discharge diagnosis was good overall (kappa=0.639), but neurologic and sepsis syndromes had markedly lower agreement than other syndromes (kappa statistics 0.085 and 0.105, respectively).

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In 2006, the Centers for Disease Control and Prevention (CDC) endorsed routine voluntary HIV testing in health care settings to identify the many HIV-infected but undiagnosed persons. Realizing this goal will require primary care providers including internal medicine physicians to order HIV tests routinely. In particular, urban internal medicine trainees who work in high HIV prevalence settings need to adopt this approach. We therefore examined the practice of routine HIV testing and to identify factors that correlate with offering HIV testing to this group. We conducted a self-administered electronic cross-sectional survey of New York City's (NYC) internal medicine residents on HIV testing-related knowledge, attitudes, and behaviors with 29 close-ended questions. Fifteen of 42 NYC internal medicine residency programs participated in early 2007. Of 1175 residents, 450 (38.3%) responded. Most (63.9%) ordered approximately 10 HIV tests in the past 6 months; 32.6% were aware of the 2006 guidelines; 35.8% utilized a routine testing approach. Respondents aware of current guidelines were more likely to practice routine testing (odds ratio [OR] 3.7, 95% confidence interval [CI]: 2.4-5.6). Two common barriers to testing were procedural: time-consuming consent process (27.1%); difficulty locating consent forms (19.3%). Most (68.4%) respondents indicated that oral consent would facilitate more testing. Most NYC internal medicine residents are not routinely offering HIV tests as advised by the 2006 CDC HIV testing guidelines and continue to test patients according to perceived patient HIV risk. This is likely contributing to their low testing rates. Most identified institutional and policy barriers to routine testing. Efforts should be made to improve dissemination of guidelines and address institutional and policy barriers to allow more people to learn their HIV status.