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Emily J Erbelding

Publications and source records attributed to Emily J Erbelding.

At least 19 recordsLinked to original sources
PubMed2006

Provider-delivered, theory-based, individualized prevention interventions for HIV positive adults receiving HIV comprehensive care.

HIV prevention efforts are often difficult to emphasize in settings delivering comprehensive HIV care due to factors such as time constraints and differing priorities about the use of clinical time. To assist clinicians within dedicated HIV clinics to offer prevention strategies, investigators at two universities in the United States (Johns Hopkins University and the University of Alabama at Birmingham) have developed and implemented similar, audio-computerized-assisted, self-interviewing systems that have been programmed to assess individual patient risk factors and identify based on the patient's self-assessment, the patient's behavioral stage or, readiness for changing, each identified target behavior. Following the assessment, the systems provide printouts of key elements of this information along with individualized, theory-based intervention strategies to the medical provider. This paper will describe our efforts in developing provider-delivered, individualized, stage-based interventions intended to reduce high-risk behaviors among HIV-infected persons.

Adult↗
PubMed2006

The role of speculum and bimanual examinations when evaluating attendees at a sexually transmitted diseases clinic.

BACKGROUND: With the advent of molecular techniques, self-collected specimens without a clinician's examination are often adequate to detect common genital infections. OBJECTIVE: To evaluate the additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic. METHODS: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented. RESULTS: 15 918 of 21 703 records were included: 12 073 were symptomatic (SYM; discharge, rash, abdominal pain, dysuria, genital irritation or odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years; 94% were black. 11.8% of SYM, 4.6% of CON and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically relevant abnormalities in 6.5% of SYM, 0.8% of CON and 0.6% of ASYM patients. CONCLUSION: Symptomatic women are most likely to benefit from speculum and bimanual examinations. However, their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.

Adolescent↗
PubMed2006

Doxycycline compared with benzathine penicillin for the treatment of early syphilis.

BACKGROUND: Doxycycline is the preferred recommended second-line agent for the treatment of syphilis, although efficacy data from controlled trials are lacking. We compared the serological responses of patients with early syphilis treated with doxycycline with the responses of patients treated with benzathine penicillin G (BPG). METHODS: All patients who received a diagnosis of early syphilis attending 2 public sexually transmitted disease clinics in Baltimore, Maryland, who were treated with doxycycline (100 mg orally, twice daily for 14 days) between October 1993 and June 2000 were eligible. Patients treated with BPG (a single dose of 2.4 million units intramuscularly) were selected as the control group. Inclusion criteria included a clinician-recorded diagnosis of primary, secondary, or early latent syphilis with reactive serological test results at the time of diagnosis and at least 1 follow-up serological test titer. Serological failure was defined as lack of a 4-fold drop in rapid plasma reagin titer 270-400 days after treatment, or a 4-fold increase in titer 30-400 days after therapy. RESULTS: During the study period, 1558 patients were treated for early syphilis, and 87 received doxycycline. Of those treated with doxycycline, 34 met the inclusion criteria. Seventy-three patients from a randomly selected group of 200 age-matched individuals treated with BPG met the inclusion criteria. There were 4 patients with serological failure in the BPG group (5.5%; 95% confidence interval [CI], 1.6%-13.8%) and 0 patients with serological failure in the doxycycline group (0%; 95% CI, 0%-10.3%; P=.2). The median times to successful serological responses for patients in the doxycycline and BPG groups were 106 days (95% CI, 75-149 days) and 137 days (95% CI, 111-172 days), respectively (P=.6). CONCLUSION: Doxycycline appears to be an effective agent for the treatment of early syphilis.

Adolescent↗
PubMed2006

Cost-effectiveness of screening strategies for Gonorrhea among females in private sector care.

OBJECTIVE: To identify the optimal screening algorithm for gonorrhea infection among females in private sector care, using cost-effectiveness analysis. METHODS: We compared 6 strategies using decision analysis for urine nucleic acid amplification testing for gonorrhea testing in a theoretical cohort of 10,000 females aged 15-35 years: 1) screen women aged younger than 25 years; 2) screen women aged younger than 30 years; 3) screen women aged younger than 25 years who report any risk (pregnant, drug use, new sexual partner < 30 days); 4) screen women aged younger than 30 years who report any risk; 5) screen women aged younger than 25 years or those who report any risk; and 6) screen women aged younger than 30 years or those who report any risk. Infection prevalence and sensitivity and specificity were by direct observation from a retrospective cohort of females attending the Baltimore City Sexually Transmitted Disease Clinics between 1999 and 2002. The main outcome measures were untreated gonorrhea cases and their sequelae in women, transmission to a male partner, congenital outcomes, and cost to prevent a case. RESULTS: Prevalence of gonorrhea was 3.0%. Not screening would result in 300 untreated cases. Not screening was cost-saving over all screening strategies. Strategy 6 resulted in the fewest cases of untreated infection (82), although Strategy 3 was the most cost-effective of the screening strategies. Univariate sensitivity analysis identified a threshold of 4.75% gonorrhea prevalence, more than which Strategy 3 became cost-saving over not screening. CONCLUSION: Screening is recommended for females aged younger than 25 years with specific risks in populations with a gonorrhea prevalence of 4.75% or greater. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2006

Gonorrhea reinfection among sexually transmitted disease clinic attendees in Baltimore, Maryland.

OBJECTIVES: We hypothesized that an active follow-up program to assess for reinfection after gonorrhea treatment could be a useful disease control strategy. GOAL: We evaluated an active follow-up and repeat testing program for all Baltimore sexually transmitted disease clinic patients diagnosed with gonorrhea. STUDY DESIGN: From September 2003 to May 2004, all clients with a treated gonorrhea infection were advised to return 3 months later for repeat testing. If clients did not return as scheduled, field outreach was attempted. At follow-up visits, urine was tested for gonorrhea and consenting participants completed a behavioral survey. In addition, we reviewed morbidity records for any intercurrent gonorrhea infections reported during the project period. RESULTS: Of the 667 participants diagnosed with gonorrhea at baseline, 54 had a gonorrhea reinfection diagnosed for an incidence of 13.8 per 100 person-years. One hundred seventy-eight (27%) either presented for a follow-up visit or were located through field efforts, and of these, 5 (2.8%) had gonorrhea detected on follow-up urine testing. No measured factors had predictive value in identifying gonorrhea reinfection. CONCLUSIONS: Although reinfection rates were high, we found that field staff intervention to increase follow-up testing rates did not identify a significant amount of repeat infections compared with passive surveillance.

Adult↗
PubMed2006

HIV seroconversion among public sexually transmitted disease clinic patients: analysis of risks to facilitate early identification.

OBJECTIVES: We identified risks for HIV seroconversion among public sexually transmitted disease (STD) clinic patients. DESIGN: This was a retrospective cohort study conducted January 1993 through October 2002 of STD clinic attendees aged > or =12 years in Baltimore, Maryland. METHODS: A negative HIV enzyme immunoassay (EIA) test was required for staggered cohort entry. Observation time was 30 days to 3 years. The outcome for multivariate Poisson regression was HIV seroconversion (positive EIA and/or Western blot test) compared among patients with or without sexual risk behaviors, drug use, an STD diagnosis, and signs and symptoms at an initial HIV test. RESULTS: One hundred twenty-five HIV seroconversions occurred among 10,535 individuals and 13,693 person-years of observation, for an incidence of 0.91 HIV seroconversions per 100 person-years (95% confidence interval [CI]: 0.76 to 1.09). Median time to HIV seroconversion was 1.54 years (95% CI: 1.11 to 1.73). In multivariate analysis, increased HIV seroconversion risk was associated with older age, drug use, a sexual partner with syphilis or HIV, genital ulcers, and gonorrhea. HIV incidence per 100 person-years was 4.86 for subjects with an HIV-positive sexual partner, 3.06 for those with injection drug use, and 2.40 for those with genital ulcers. CONCLUSIONS: We found a high rate of HIV seroconversion among STD clinic patients with specific risks. Algorithms with HIV RNA testing targeted to patients at the highest risk for seroconversion may optimize prevention and resource utilization.

Adolescent↗
PubMed2005

Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy.

BACKGROUND: Patient-delivered partner therapy (PDPT) is the practice of providing disease-specific antimicrobial agents to patients for delivery to their sex partners. Some partners who receive PDPT may forgo clinical evaluation, resulting in missed opportunities for the diagnosis and treatment of comorbid conditions. METHODS: We conducted a review of electronic charts for 8623 individuals attending 4 sexually transmitted disease clinics who were sex partners of patients with selected sexually transmitted infections (STIs). We evaluated the concordance between STIs diagnosed in partners and their reported exposures for which they might have received PDPT. RESULTS: Among 3503 female and 4647 heterosexual male partners, 19 (0.4%) of 4716 individuals tested were newly diagnosed with human immunodeficiency virus (HIV) infection, and 61 individuals (0.7%) had syphilis. Pelvic inflammatory disease was diagnosed in 133 women (3.8%). Seventy-two (3.2%) of 2226 female and heterosexual male partners reporting exposure to patients with chlamydial infection had gonorrhea diagnosed. Chlamydial infection or gonorrhea was diagnosed in 81 heterosexual male partners (10.3%) who reported contact with women with trichomoniasis. Among 473 men who have sex with men (MSM; including bisexual men), 13 (6.3%) of 207 tested were newly diagnosed with HIV infection, and 8 (1.7%) had syphilis. Six (6.1%) of 98 MSM reporting exposure to patients with chlamydial infection had gonorrhea diagnosed. CONCLUSIONS: Infrequent coinfections in female and heterosexual male partners exposed to patients with chlamydial infection or gonorrhea would not preclude use of PDPT. However, PDPT for male partners of women with trichomoniasis and for MSM requires further study.

Adolescent↗
PubMed2004

Defining core gonorrhea transmission utilizing spatial data.

Spatial distribution of repeat and singly occurring gonorrhea in Baltimore, Maryland, was examined to identify clusters of core transmitters. Gonorrhea reported between 2001 and 2002 was geocoded and mapped. Those with more than one gonorrhea infection separated by more than 14 days during the 2-year period were considered repeaters. Other cases were treated as isolated events. Six definitions of core transmission were examined by census tracts with the highest quintiles of 1) cases for 2001, 2) cases for 2002, 3) rates for 2001, 4) rates for 2002, 5) counts of repeaters over the 2-year period, and 6) proportion of total cases that were repeaters. Of the 6,108 gonorrhea cases analyzed, 9% were repeaters. Repeaters were more likely to be female and younger. Core areas identified by definitions based on overall disease burden agreed well with each other but had poor agreement with definitions based upon repeat infections. Repeaters clustered to a greater extent at smaller distances than did singly occurring gonorrhea cases. Repeat gonorrhea infections are prevalent in Baltimore and likely represent behavior consistent with core transmission. Census tracts of core transmission defined by geographic distribution of repeat infections may indicate foci of highest risk sexual behaviors and high transmission.

Adolescent↗
PubMed2004

The prevalence of psychiatric disorders in sexually transmitted disease clinic patients and their association with sexually transmitted disease risk.

BACKGROUND AND OBJECTIVES: Psychiatric disorders could limit the success of behavioral counseling strategies. We evaluated the prevalence of psychiatric disorders among sexually transmitted disease (STD) clinic patients and their association with STD risk. METHODS: A systematic sample of 201 patients presenting to a public STD clinic in Baltimore, Maryland, participated in the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. RESULTS: Overall, 45% of 201 STD clinic patients interviewed had a current axis I disorder and 29% had an axis II personality disorder. Substance use disorders predominated among axis I diagnoses; antisocial personality disorder (ASPD) predominated among axis II diagnoses, with an ASPD prevalence of 29.4% in men. ASPD was associated with a diagnosis of an STD (odds ratio, 3.67; 95% confidence interval, 1.63-8.30; P = 0.002). Substance use was not associated with an STD diagnosis. CONCLUSIONS: STD clinic patients have complex psychopathology that could increase HIV risk and compromise prevention interventions. Specialized counseling strategies, particularly targeting personality traits of ASPD, could improve prevention outcomes.

Adolescent↗
PubMed2004

Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic.

OBJECTIVE: The authors' goal was to investigate the relationship between depression and HIV risk behaviors or sexually transmitted disease (STD) diagnosis at an urban STD clinic. METHOD: Using audio computer-assisted self-interview, 671 STD clinic patients answered questions about HIV risk behaviors and depression in a large-scale, cross-sectional study. A subset of the patients (N=201) was evaluated for current major depressive disorder by interviewers using the nonpatient edition of the Structured Clinical Interview for DSM-IV. RESULTS: Depressed patients were more likely to have sex for money or drugs, to have had sex with an intravenous drug user, to have sex when "high" on alcohol or drugs, to have a greater number of lifetime sex partners, and to abuse alcohol or drugs than were nondepressed patients. Associations of HIV risk behaviors with depression persisted after adjustment for substance abuse. CONCLUSIONS: Depression in STD clinic patients is associated with HIV risk behaviors but not STD diagnosis. Identifying depression and developing strategies to intervene effectively may reduce HIV risk behaviors and improve health outcomes.

Adolescent↗
PubMed2004

Syphilis rates climb again.

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Centers for Disease Control and Prevention, U.S.↗
PubMed2003

New sexually transmitted diseases in HIV-infected patients: markers for ongoing HIV transmission behavior.

OBJECTIVE: The objective of this study was to describe the rate of new sexually transmitted diseases (STDs) among HIV-infected patients and to define the behavioral and clinical characteristics of HIV-infected patients who return with a new STD in follow-up. DESIGN: The study design was a record-based clinical cohort study focusing on patients testing HIV-seropositive in the STD clinics of Baltimore, Maryland from 1993 to 1998. METHODS: The authors identified those HIV-infected patients later diagnosed with an STD in follow-up and compared their demographic, behavioral, and clinical characteristics with those who were not diagnosed with an STD in follow-up. RESULTS: Of 796 men and 354 women with HIV infection, 13.9% of men and 11.9% of women were diagnosed with an STD after their initial HIV diagnosis. HIV-infected men returned with a new STD at a rate of 7 cases per 100 person-years; HIV-infected women returned at a rate of 5.6 cases per 100 person-years. In men, multiple sex partners and sex worker contact were associated with a subsequent STD diagnosis (OR = 1.67, p =.037; OR = 1.82, p =.015, respectively). In women, age younger than 30 years was associated with the diagnosis of an STD after the diagnosis of HIV infection (OR = 2.94, p =.0009). CONCLUSIONS: Patients diagnosed with HIV in an STD clinic setting commonly return with new STDs in follow-up, suggesting continued exposure of HIV to others. More intensive screening and counseling interventions focused on STD prevention in those with HIV infection is a necessary HIV prevention strategy.

Adult↗