The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008.
TL;DR: Sexually transmitted infections continue to impose a substantial cost burden on the payers of medical care in the United States, and HIV infection accounted for more than 81% of the total cost.
Abstract: BackgroundMillions of cases of sexually transmitted infections (STIs) occur in the United States each year, resulting in substantial medical costs to the nation. Previous estimates of the total direct cost of STIs are quite dated. We present updated direct medical cost estimates of STIs in the Unite
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14 Mar 2014
TL;DR: The performance of nucleic acid amplification tests (NAATs) with respect to overall sensitivity, specificity, and ease of specimen transport is better than that of any of the other tests available for the diagnosis of chlamydial and gonococcal infections.
Abstract: This report updates CDC's 2002 recommendations regarding screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections (CDC Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections—2002 MMWR 2002;51[No RR-15]) and provides new recommendations regarding optimal specimen types, the use of tests to detect rectal and oropharyngeal C trachomatis and N gonorrhoeae infections, and circumstances when supplemental testing is indicated The recommendations in this report are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available tests, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients
The performance of nucleic acid amplification tests (NAATs) with respect to overall sensitivity, specificity, and ease of specimen transport is better than that of any of the other tests available for the diagnosis of chlamydial and gonococcal infections Laboratories should use NAATs to detect chlamydia and gonorrhea except in cases of child sexual assault involving boys and rectal and oropharyngeal infections in prepubescent girls and when evaluating a potential gonorrhea treatment failure, in which case culture and susceptibility testing might be required NAATs that have been cleared by the Food and Drug Administration (FDA) for the detection of C trachomatis and N gonorrhoeae infections are recommended as screening or diagnostic tests because they have been evaluated in patients with and without symptoms Maintaining the capability to culture for both N gonorrhoeae and C trachomatis in laboratories throughout the country is important because data are insufficient to recommend nonculture tests in cases of sexual assault in prepubescent boys and extragenital anatomic site exposure in prepubescent girls N gonorrhoeae culture is required to evaluate suspected cases of gonorrhea treatment failure and to monitor developing resistance to current treatment regimens Chlamydia culture also should be maintained in some laboratories to monitor future changes in antibiotic susceptibility and to support surveillance and research activities such as detection of lymphogranuloma venereum or rare infections caused by variant or mutated C trachomatis
478 citations
TL;DR: The widely documented beneficial role of vaginal Lactobacillus species demonstrates the potential of data on the composition and activity of lactobacilli as biomarkers for vaginal health, and the substantiation and further validation of such biomarkers will allow the design of better targeted probiotic strategies.
Abstract: The human body is colonized by a vast number of microorganisms collectively referred to as the human microbiota. One of the main microbiota body sites is the female genital tract, commonly dominated by Lactobacillus spp., in approximately 70% of women. Each individual species can constitute approximately 99% of the ribotypes observed in any individual woman. The most frequently isolated species are Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii and Lactobacillus iners. Residing at the port of entry of bacterial and viral pathogens, the vaginal Lactobacillus species can create a barrier against pathogen invasion since mainly products of their metabolism secreted in the cervicovaginal fluid can play an important role in the inhibition of bacterial and viral infections. Therefore, a Lactobacillus-dominated microbiota appears to be a good biomarker for a healthy vaginal ecosystem. This balance can be rapidly altered during processes such as menstruation, sexual activity, pregnancy and various infections. An abnormal vaginal microbiota is characterized by an increased diversity of microbial species, leading to a condition known as bacterial vaginosis. Information on the vaginal microbiota can be gathered from the analysis of cervicovaginal fluid, by using the Nugent scoring or the Amsel’s criteria, or at the molecular level by investigating the number and type of Lactobacillus species. However, when translating this to the clinical setting, it should be noted that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply a diseased condition or dysbiosis. Nevertheless, the widely documented beneficial role of vaginal Lactobacillus species demonstrates the potential of data on the composition and activity of lactobacilli as biomarkers for vaginal health. The substantiation and further validation of such biomarkers will allow the design of better targeted probiotic strategies.
336 citations
TL;DR: The current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men, according to the United States Preventive Services Task Force (USPSTF).
Abstract: These recommendations from the USPSTF address screening for chlamydia and gonorrhea in sexually active, asymptomatic adolescents and adults, including pregnant women. The USPSTF recommends screenin...
249 citations
TL;DR: Preventing intimate partner violence is possible and could avoid substantial costs, and these findings can inform the potential benefit of prioritizing prevention, as well as evaluation of implemented prevention strategies.
207 citations
TL;DR: Interventions that include parents of youth disproportionately affected by HIV/STIs and designed to improve parent-child communications about sex can effectively reduce sexual risk for youth.
158 citations
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TL;DR: This letter is in response to your two Citizen Petitions, requesting that the Food and Drug Administration (FDA or the Agency) require a cancer warning on cosmetic talc products.
Abstract: This letter is in response to your two Citizen Petitions dated November 17, 1994 and May 13, 2008, requesting that the Food and Drug Administration (FDA or the Agency) require a cancer warning on cosmetic talc products. Your 1994 Petition requests that all cosmetic talc bear labels with a warning such as \"Talcum powder causes cancer in laboratory animals. Frequent talc application in the female genital area increases the risk of ovarian cancer.\" Additionally, your 2008 Petition requests that cosmetic talcum powder products bear labels with a prominent warning such as: \"Frequent talc application in the female genital area is responsible for major risks of ovarian cancer.\" Further, both of your Petitions specifically request, pursuant to 21 CFR 1 0.30(h)(2), a hearing for you to present scientific evidence in support of this petition.
9,350 citations
TL;DR: The spectrum of engagement in care for HIV-infected individuals in the United States is reviewed and this information is applied to help understand the magnitude of the challenges that pooragement in care will pose to test-and-treat strategies for HIV prevention.
Abstract: For individuals with human immunodeficiency virus (HIV) infection to fully benefit from potent combination antiretroviral therapy, they need to know that they are HIV infected, be engaged in regular HIV care, and receive and adhere to effective antiretroviral therapy. Test-and-treat strategies for HIV prevention posit that expanded testing and earlier treatment of HIV infection could markedly decrease ongoing HIV transmission, stemming the HIV epidemic. However, poor engagement in care for HIV-infected individuals will substantially limit the effectiveness of test-and-treat strategies. We review the spectrum of engagement in care for HIVinfected individuals in the United States and apply this information to help understand the magnitude of the challenges that poor engagement in care will pose to test-and-treat strategies for HIV prevention.
1,746 citations
"The estimated direct medical cost o..." refers background in this paper
...However, this estimate is applicable when considering the best-case scenario of HIV care in the United States, implying that applying their estimate could overestimate the total direct cost of HIV, because not all patients with HIV receive care and not all those who receive care get the best care available.(25,26) Hutchinson et al....
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TL;DR: Three STDs accounted for 88% of all new cases of STD among 15-24-year-olds in 2000 and emphasize the toll that STDs have on American youth.
Abstract: CONTEXT In the United States, young people aged 15–24 represent 25% of the sexually experienced population. However, the incidence and prevalence of sexually transmitted diseases (STDs) among this age-group are unknown.
METHODS Data from a variety of sources were used to estimate the incidence and prevalence of STDs among 15–24-year-olds in the United States in 2000. The quality and reliability of the estimates were categorized as good, fair or poor, depending on the quality of the data source.
RESULTS Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48%) were among persons aged 15–24. Three STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15–24-year-olds.
CONCLUSIONS These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.
1,661 citations
TL;DR: Sexually transmitted infections are common in the United States, with a disproportionate burden among young adolescents and adults, and public health efforts should focus on prevention among at-risk populations to reduce the number and impact of STIs.
Abstract: BackgroundMost sexually active people will be infected with a sexually transmitted infection (STI) at some point in their lives. The number of STIs in the United States was previously estimated in 2000. We updated previous estimates to reflect the number of STIs for calendar year 2008.MethodsWe revi
1,179 citations
TL;DR: Overall, HIV incidence in the United States was relatively stable 2006–2009; however, among young MSM, particularly black/African American MSM, incidence increased and expanded, improved, and targeted prevention is necessary to reduce HIV incidence.
Abstract: Background
The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200–64,500). We updated the 2006 estimate and calculated incidence for 2007–2009 using improved methodology.
Methodology
We estimated incidence using incidence surveillance data from 16 states and 2 cities and a modification of our previously described stratified extrapolation method based on a sample survey approach with multiple imputation, stratification, and extrapolation to account for missing data and heterogeneity of HIV testing behavior among population groups.
Principal Findings
Estimated HIV incidence among persons aged 13 years and older was 48,600 (95% CI: 42,400–54,700) in 2006, 56,000 (95% CI: 49,100–62,900) in 2007, 47,800 (95% CI: 41,800–53,800) in 2008 and 48,100 (95% CI: 42,200–54,000) in 2009. From 2006 to 2009 incidence did not change significantly overall or among specific race/ethnicity or risk groups. However, there was a 21% (95% CI:1.9%–39.8%; p = 0.017) increase in incidence for people aged 13–29 years, driven by a 34% (95% CI: 8.4%–60.4%) increase in young men who have sex with men (MSM). There was a 48% increase among young black/African American MSM (12.3%–83.0%; p<0.001). Among people aged 13–29, only MSM experienced significant increases in incidence, and among 13–29 year-old MSM, incidence increased significantly among young, black/African American MSM. In 2009, MSM accounted for 61% of new infections, heterosexual contact 27%, injection drug use (IDU) 9%, and MSM/IDU 3%.
Conclusions/Significance
Overall, HIV incidence in the United States was relatively stable 2006–2009; however, among young MSM, particularly black/African American MSM, incidence increased. HIV continues to be a major public health burden, disproportionately affecting several populations in the United States, especially MSM and racial and ethnic minorities. Expanded, improved, and targeted prevention is necessary to reduce HIV incidence.
1,001 citations
"The estimated direct medical cost o..." refers background in this paper
...For instance, in the past few years, the reported annual incidence of chlamydia, syphilis, and genital warts has increased,(6) although the annual incidence of gonorrhea and HIV infection has been relatively stable.(6,7) In addition, given the rapid changes in health care technology and service delivery, the lifetime cost per case of STIs can change, as well....
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