Background:We estimated the lifetime medical costs attributable to sexually transmitted infections (STIs) acquired in 2018, including sexually acquired human immunodeficiency virus (HIV). Methods:We estimated the lifetime medical costs of infections acquired in 2018 in the United States for 8 STIs: chlamydia, gonorrhea, trichomoniasis, syphilis, genital herpes, human papillomavirus (HPV), hepatitis B, and HIV. We limited our analysis to lifetime medical costs incurred for treatment of STIs and for treatment of related sequelae; we did not include other costs, such as STI prevention. For each STI, except HPV, we calculated the lifetime medical cost by multiplying the estimated number of incident infections in 2018 by the estimated lifetime cost per infection. For HPV, we calculated the lifetime cost based on the projected lifetime incidence of health outcomes attributed to HPV infections acquired in 2018. Future costs were discounted at 3% annually.Results: Incident STIs in 2018 imposed an estimated $15.9 billion (25 th -75 th percentile: $14.9-16.9 billion) in discounted, lifetime direct medical costs (2019 US dollars). Most of this cost was due to sexually acquired HIV ($13.7 billion) and HPV ($0.8 billion). STIs in women accounted for about one fourth of the cost of incident STIs when including HIV, but about three fourths when excluding HIV. STIs among 15-to 24-year-olds accounted for $4.2 billion (26%) of the cost of incident STIs.Conclusions: Incident STIs continue to impose a considerable lifetime medical cost burden in the United States. These results can inform health economic analyses to promote the use of cost-effective STI prevention interventions to reduce this burden.
The gastric human pathogen Helicobacter pylori faces formidable challenges in the stomach including reactive oxygen and nitrogen intermediates. Here we demonstrate that arginase activity, which inhibits host nitric oxide production, is post-translationally stimulated by H. pylori thioredoxin (Trx) 1 but not the homologous Trx2. Trx1 has chaperone activity that renatures urea-or heat-denatured arginase back to the catalytically active state. Most reactive oxygen and nitrogen intermediates inhibit arginase activity; this damage is reversed by Trx1, but not Trx2. Trx1 and arginase equip H. pylori with a "renox guardian" to overcome abundant nitrosative and oxidative stresses encountered during the persistence of the bacterium in the hostile gastric environment.The gastric human pathogen Helicobacter pylori causes chronic gastritis and ulcers and has a strong link with gastric cancer. Despite enormous knowledge gleaned from two completely sequenced strains (1, 2), little is known about how this organism escapes the host innate and adaptive immune systems. The extensive inflammatory response observed in H. pylori-infected patients contributes to gastric damage; some of this damage is mediated by ROI/RNIs 3 such as NO and hydrogen peroxide. Arginase (RocF), which hydrolyzes L-arginine to urea and L-ornithine, inhibits macrophage NO production by directly competing with host nitric-oxide synthase for arginine availability (3). The urea can then be hydrolyzed by the copious H. pylori urease to yield carbon dioxide and ammonium, the latter of which neutralizes gastric acid. Indeed, acid treatment (pH 2) of H. pylori in the presence of arginine protects H. pylori in an arginase-dependent fashion (4). The arginase of H. pylori exhibits several unusual features, including optimal catalytic activity with cobalt, rather than manganese, and an acidic pH optimum (5). Furthermore, H. pylori arginase inhibits human T cell proliferation and T cell CD3 expression by siphoning arginine away from the host cell (6), potentially contributing to the inability of T cells to clear H. pylori infections. These findings point to a critical role for arginase in disarming two innate host defenses (acid and NO) and adaptive immunity (T cells), thereby disabling the two arms of the immune system. The critical questions remaining are: how is arginase modulated, and is arginase itself sensitive to ROI/RNIs? Here, we provide compelling evidence that H. pylori arginase is modulated at the post-translational level by thioredoxin 1 (Trx1) and that Trx1 protects arginase from ROI/RNIs and is an arginase chaperone.
Background:The purpose of this study was to provide updated estimates of the average lifetime medical cost per infection for chlamydia, gonorrhea, and trichomoniasis.
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.
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