Objectives. To characterize the intersection of social determinants of health, measured as the availability of community opportunities for healthy living, and sexually transmitted infections (STIs) in California. Methods. Geocoded 2013-2021 California bacterial STI cases were aggregated into Healthy Places Index (HPI) quartiles. Communities in the lowest scoring HPI quartile have the fewest opportunities for healthy living, while communities in the highest scoring quartile have the most opportunities. Results. As community opportunities became more available, bacterial STI risk decreased. Asian people had the lowest bacterial STI rates, while Black/African American people had the highest. As community opportunities increased, White people had the largest overall STI risk reduction, Native Hawaiian and other Pacific Islander people had the smallest reduction, Hispanic/Latino people had equivalent gonorrhea and early syphilis risk, and American Indian/Alaska Native people had equivalent chlamydia risk. Conclusions. Although STI incidence decreased as community opportunities increased, people of different racial and ethnic identities were differentially affected. Because the availability of community opportunities is not enough to mitigate racial health disparities, more work is needed to ensure community-level STI prevention efforts are accessible and inclusive. (Am J Public Health. 2025;115(5):799-807. https://doi.org/10.2105/AJPH.2024.307963).

BACKGROUND: Exposures associated with mpox infection remain imperfectly understood. METHODS: We conducted a case-control study enrolling participants who received molecular tests for mpox/orthopoxvirus in California from November 2022 through June 2023. We collected data on behaviors during a 21-day risk period before symptom onset or testing among mpox cases and test-negative controls. RESULTS: Thirteen of 54 (24.1%) cases and 5/117 (4.3%) controls reported sexual exposure to individuals they identified as potential mpox cases ("index contacts"; odds ratio [OR] = 7.7 [95% confidence interval: 2.5-19.3]). Among these participants, 10/13 (76.9%) cases and 2/5 (40.0%) controls reported their index contacts were not experiencing symptoms visible to participants during sex (OR = 14.9 [3.6-101.8]). Only 3/54 cases (5.6%) reported exposure to symptomatic index contacts. Cases reported greater numbers of anal/vaginal sex partners than controls (adjusted OR = 2.2 [1.0-4.8] for 2-3 partners and 3.8 [1.7-8.8] for ≥4 partners). Male cases with penile lesions more commonly reported insertive anal/vaginal sex than those without penile lesions (adjusted OR = 9.3 [1.6-54.8]). Cases with anorectal lesions more commonly reported receptive anal sex than cases without anorectal lesions (adjusted OR = 14.4 [1.0-207.3]). CONCLUSIONS: Sexual exposure to contacts known or suspected to have experienced mpox was associated with increased risk of infection, often when index contacts lacked apparent symptoms. Exposure to greater numbers of sex partners, including those whom participants did not identify as index contacts, was associated with increased risk of infection in a site-specific manner. While participants' assessment of symptoms in partners may be imperfect, these findings suggest individuals without visibly prominent mpox symptoms transmit infection.

BACKGROUND: HIV co-infection among persons diagnosed with gonorrhea is not well characterized. Trends in HIV prevalence among persons diagnosed with gonorrhea may have significant implications for HIV prevention interventions, especially for MSM. MSM are increasing and disproportionately represented among incident gonorrhea cases reported in a multi-state sentinel surveillance network. Using data from this network, we estimated HIV prevalence among MSM by self-report and explored trends in co-infection by key demographics. DESIGN: Observational study using enhanced surveillance data. METHODS: Six geographically diverse jurisdictions in the STD Surveillance Network (SSuN) 2010 - 2019 randomly sampled laboratory-confirmed gonorrhea cases. Enhanced investigations on sampled cases included patient interviews eliciting demographic, behavioral and HIV testing history. These data were weighted to adjust for study design and non-response to estimate trends in HIV prevalence. RESULTS: Of 653,522 reported cases, 28,979 were sampled and investigated. The proportion of cases reporting living with diagnosed HIV at the time of their gonorrhea diagnosis increased 61% across the study period from 6.6% in 2010 to 10.8% in 2019. The observed increase in HIV prevalence is concurrent with an increase in the proportion of gonorrhea cases attributable to MSM. HIV prevalence among MSM decreased in two jurisdictions and increasing trends were observed among Non-Hispanic Black and Hispanic MSM. HIV prevalence decreased among non-Hispanic White MSM, MSM under 20 and those 40 years of age or older. CONCLUSIONS: Diagnosis with gonorrhea, especially among MSM, should be a sentinel event triggering screening for HIV, referral to high-impact HIV prevention interventions or to HIV primary care.

BACKGROUND: Expedited partner therapy (EPT) has been shown to prevent reinfection in persons with gonorrhea and to plausibly reduce incidence. The Centers for Disease Control and Prevention recommends EPT as an option for treating sex partners of heterosexual patients. Few studies that examine how the reported use of this valuable intervention differs by patient and provider characteristics and by geography across multiple jurisdictions in the United States are currently available. METHODS: Case and patient interview data were obtained for a random sample of reported cases from 7 geographically disparate US jurisdictions participating in the Sexually Transmitted Disease (STD) Surveillance Network. These data were weighted to be representative of all reported gonorrhea cases in the 7 study sites. Patient receipt of EPT was estimated, and multivariate models were constructed separately to examine factors associated with receipt of EPT for heterosexuals and for men who have sex with men. RESULTS: Overall, 5.4% of patients diagnosed and reported as having gonorrhea reported receiving EPT to treat their sex partners. Heterosexual patients were more likely to have received EPT than men who have sex with men at 6.6% and 2.6% of patients, respectively. Receipt of EPT did not vary significantly by race, Hispanic ethnicity, or age for either group, although significant variation was observed in different provider settings, with patients from family planning/reproductive health and STD clinic settings more likely to report receiving EPT. Jurisdiction variations were also observed with heterosexual patients in Washington State most likely (35.5%), and those in New York City, Connecticut, and Philadelphia least likely to report receiving EPT (<2%). CONCLUSIONS: With the exception of one jurisdiction in the STD Surveillance Network actively promoting EPT use, patient-reported receipt of the intervention remains suboptimal across the network. Additional efforts to promote EPT, especially for patients diagnosed in private provider and hospital settings, are needed to realize the full potential of this valuable gonorrhea control intervention.