Expedited treatment of sex partners reduces the rates of persistent or recurrent gonorrhea or chlamydial infection.

Background Strain typing is a tool for determining diversity and epidemiology of infections. Methods T. pallidum DNA was isolated from 158 syphilis patients from the US, China, Ireland, and Madagascar and from 15 T. pallidum isolates. Six typing targets were assessed: 1) number of 60 bp repeats in acidic repeat protein gene; 2) restriction fragment length polymorphism (RFLP) analysis of T. pallidum repeat (tpr) subfamily II genes; 3) RFLP analysis of tprC gene; 4) determination of tprD allele in tprD gene locus; 5) presence of 51 bp insertion between tp0126/tp0127; 6) sequence analysis of 84 bp region of tp0548. The combination of #1 and #2 comprises the CDC T. pallidum subtyping method. Results Adding sequence analysis of tp0548 to the CDC method yielded the most discriminating typing system. Twenty-four strain types were identified and designated as CDC subtype/tp0548 sequence. Type 14d/f was seen in 5 of 6 locations. In Seattle, strain types changed from 1999– 2008 (p<0.001). Twenty-two (50%) of 44 patients infected with type 14d/f had neurosyphilis compared to 9 (23%) of 39 infected with the other types combined (p=0.01). Conclusion We describe an enhanced T. pallidum strain typing system that shows biological and clinical relevance.

Summary Background Assisted partner services for index patients with HIV infections involves elicitation of information about sex partners and contacting them to ensure that they test for HIV and link to care. Assisted partner services are not widely available in Africa. We aimed to establish whether or not assisted partner services increase HIV testing, diagnoses, and linkage to care among sex partners of people with HIV infections in Kenya. Methods In this cluster randomised controlled trial, we recruited non-pregnant adults aged at least 18 years with newly or recently diagnosed HIV without a recent history of intimate partner violence who had not yet or had only recently linked to HIV care from 18 HIV testing services clinics in Kenya. Consenting sites in Kenya were randomly assigned (1:1) by the study statistician (restricted randomisation; balanced distribution in terms of county and proximity to a city) to immediate versus delayed assisted partner services. Primary outcomes were the number of partners tested for HIV, the number who tested HIV positive, and the number enrolled in HIV care, in those who were interviewed at 6 week follow-up. Participants within each cluster were masked to treatment allocation because participants within each cluster received the same intervention. This trial is registered with ClinicalTrials.gov, number NCT01616420. Findings Between Aug 12, 2013, and Aug 31, 2015, we randomly allocated 18 clusters to immediate and delayed HIV assisted partner services (nine in each group), enrolling 1305 participants: 625 (48%) in the immediate group and 680 (52%) in the delayed group. 6 weeks after enrolment of index patients, 392 (67%) of 586 partners had tested for HIV in the immediate group and 85 (13%) of 680 had tested in the delayed group (incidence rate ratio 4·8, 95% CI 3·7–6·4). 136 (23%) partners had new HIV diagnoses in the immediate group compared with 28 (4%) in the delayed group (5·0, 3·2–7·9) and 88 (15%) versus 19 (3%) were newly enrolled in care (4·4, 2·6–7·4). Assisted partner services did not increase intimate partner violence (one intimate partner violence event related to partner notification or study procedures occurred in each group). Interpretation Assisted partner services are safe and increase HIV testing and case-finding; implementation at the population level could enhance linkage to care and antiretroviral therapy initiation and substantially decrease HIV transmission. Funding National Institutes of Health.

Clinical and microbiologic cure rates for NGU were somewhat low and there was no significant difference between azithromycin and doxycycline. Mycoplasma genitalium treatment failure was extremely common. Clinical Trials Registration.NCT00358462.

Objective To develop and validate an easy-to-use prediction model for HIV acquisition among men who have sex with men (MSM). Methods We developed prediction models using medical records data from an STD clinic (2001–2008) and validated these models using data from the control arm of Project Explore, an HIV prevention trial (1999–2003). Results Of 1903 MSM who tested for HIV more than once in the development sample, 101 acquired HIV over 6.7 years of follow-up. Annual HIV incidence was 2.57% (95% confidence interval [CI]: 2.09%, 3.12%). During 4 years of follow-up of 2081 Project Explore control arm participants, 144 acquired HIV for an incidence of 2.32% (95%CI: 1.96%, 2.73%). A prediction model that included variables indicating use of methamphetamine or inhaled nitrites in the prior 6 months, unprotected anal intercourse with a partner of positive or unknown HIV status in the prior year, ≥10 male sex partners in the prior year, and current diagnosis or history of bacterial sexually transmitted infection was well calibrated overall (expected-observed ratio = 1.01; 95%CI: 0.97, 1.05) and had modest discriminatory accuracy at 1 year (area under the receiver-operator characteristic curve [AUC]=0.67; 95%CI: 0.60, 0.75) and at 4 years (AUC=0.66; 95%CI: 0.61, 0.71). Over four years, cumulative incidence ranged from 3.9% to 14.3% for groups of men defined by the prediction model. Conclusions A new risk score was predictive of HIV acquisition and could assist providers in counseling MSM and in targeting intensified prevention to MSM at greatest risk for HIV infection. Its accuracy requires further evaluation.

Access to free HIV self-testing increased testing frequency among high-risk men who have sex with men and did not impact sexual behavior or STI acquisition.

Objective Men who have sex with men (MSM) have higher rates of HIV and other sexually transmitted infections (STI) than women and heterosexual men. This elevated risk persists across age groups and reflects biological and behavioral factors, yet there have been few direct comparisons of sexual behavior patterns between these populations. Methods We compared sexual behavior patterns of MSM and male and female heterosexuals aged 18–39 using 4 population-based random digit dialing surveys. A 1996–1998 survey in 4 U.S. cities and 2 Seattle surveys (2003, 2006) provided estimates for MSM; a 2003–2004 Seattle survey provided data about heterosexual men and women. Results Sexual debut occurred earlier among MSM than heterosexuals. MSM reported longer cumulative lifetime periods of new partner acquisition than heterosexuals, and a more gradual decline in new partnership formation with age. Among MSM, 86% of 18–24 year olds and 72% of 35–39 year olds formed a new partnership during the prior year, compared to 56% of heterosexual men and 34% of women at ages 18–24, and 21% and 10%, respectively, at ages 35–39. MSM were also more likely to choose partners >5 years older and were 2–3 times as likely as heterosexuals to report recent concurrent partnerships. MSM reported more consistent condom use during anal sex than heterosexuals reported during vaginal sex. Conclusions MSM have longer periods of partnership acquisition, a higher prevalence of partnership concurrency, and more age-disassortative mixing than heterosexuals. These factors likely help explain higher HIV/STI rates among MSM, despite higher levels of condom use.

Serosorting offers MSM limited protection from HIV.