Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Grey JA [original query] |
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The congenital syphilis prevention cascade: Reimagining a missed prevention opportunities framework for effective intervention
O'Callaghan KP , Johnson Jones ML , Mcdonald R , Jackson DA , Grey JA , Kreisel KM , Torrone E . Sex Transm Dis 2023 51 (1) 8-10 Congenital syphilis (CS) rates have risen in the U.S. since 2013. Prevention of CS requires testing and treatment of pregnant and pregnancy-capable persons at high risk for syphilis. We developed a CS Prevention Cascade to assess how effectively testing and treatment interventions reached pregnant persons with a CS outcome. |
A sore subject An examination of national case-based chancroid surveillance
Ogale YP , Ridpath AD , Torrone E , Quilter LAS , Grey JA . Sex Transm Dis 2023 50 (8) 467-471 BACKGROUND: Chancroid has been a nationally notifiable condition in the United States since 1944, with cases reported to Centers Disease Control and Prevention through the National Notifiable Diseases Surveillance System. Although frequently reported during the 1940s, <20 cases have been reported annually since 2011. We assessed the performance and utility of national case-based chancroid surveillance. METHODS: We reviewed the literature to contextualize chancroid surveillance through National Notifiable Diseases Surveillance System. We then assessed 4 system attributes, including data quality, sensitivity, usefulness, and representativeness: we reviewed chancroid cases reported during 2011-2020, conducted interviews with (a) sexually transmitted disease programs reporting ≥1 case in 2019 or 2020 (n = 9) and (b) Centers Disease Control and Prevention subject matter experts (n = 10), and reviewed published communicable disease reporting laws. RESULTS: Chancroid diagnostic testing is limited, which affects the surveillance case definition. National case-based surveillance has poor data quality; of the 2019 and preliminary 2020 cases (n = 14), only 3 were verified by jurisdictions as chancroid cases. Sexually transmitted disease programs report the system has low sensitivity given limited clinician knowledge and resources; experts report the system is not useful in guiding national control efforts. Review of reporting laws revealed it is not representative, as chancroid is not a reportable condition nationwide. CONCLUSIONS: Critical review of system attributes suggest that national case-based chancroid surveillance data have limited ability to help describe and monitor national trends, and chancroid's inclusion on the national notifiable list might need to be reconsidered. Alternative strategies might be needed to monitor national chancroid burden. |
Primary and secondary syphilis among men who have sex with men and women, 2010-2019
Learner ER , Grey JA , Bernstein K , Kirkcaldy RD , Torrone EA . Sex Transm Dis 2022 49 (11) 794-796 The relative proportion of cases of P&S syphilis among men who have sex with men and women reported through national case report data from 2010 through 2019 appeared stable overall and stratified by race/ethnicity, region, and age group, but case counts increased. |
Predicting Emergence of Primary and Secondary Syphilis Among Women of Reproductive Age in U.S. Counties
Kimball A , Torrone EA , Bernstein KT , Grey JA , Bowen VB , Rickless DS , Learner ER . Sex Transm Dis 2021 49 (3) 177-183 BACKGROUND: Syphilis, a sexually transmitted infection that can cause severe congenital disease when not treated during pregnancy, is on the rise in the United States. Our objective was to identify U.S. counties with elevated risk for emergence of primary and secondary (P&S) syphilis among reproductive-aged women. METHODS: Using syphilis case reports, we identified counties with no cases of P&S syphilis among reproductive-aged women in 2017 and ≥ 1 case in 2018. Using county-level syphilis and sociodemographic data, we developed a model to predict counties with emergence of P&S syphilis among women and a risk score to identify counties at elevated risk. RESULTS: Of 2,451 counties with no cases of P&S syphilis among reproductive-aged women in 2017, 345 counties (14.1%) had documented emergence of syphilis in 2018. Emergence was predicted by the county's P&S syphilis rate among men; violent crime rate; proportions of Black, White, Asian, and Hawaiian/Pacific Islander persons; urbanicity; presence of a metropolitan area; population size; and having a neighboring county with P&S syphilis among women. A risk score of ≥20 identified 75% of counties with emergence. CONCLUSIONS: Jurisdictions can identify counties at elevated risk for emergence of syphilis in women and tailor prevention efforts. Prevention of syphilis requires multidisciplinary collaboration to address underlying social factors. |
High congenital syphilis case counts among U.S. infants born in 2020
Bowen VB , McDonald R , Grey JA , Kimball A , Torrone EA . N Engl J Med 2021 385 (12) 1144-1145 Congenital syphilis, a life-threatening infection caused by the transmission of Treponema pallidum from a woman to her fetus during pregnancy, can result in miscarriage, stillbirth, preterm birth, low birth weight, and infant death.1 Whereas many infants with congenital syphilis are asymptomatic at birth,2 classic signs can appear in the first 2 years of life, including rash, copious nasal discharge (“snuffles”), hepatosplenomegaly, jaundice related to syphilitic hepatitis, bone deformities, and neurologic involvement. Although these sequelae can be prevented when maternal syphilis is diagnosed and treated 30 days or more before delivery,3 the incidence of congenital syphilis in the United States is increasing.2 |
Population and individual-level effects of HIV pre-exposure prophylaxis (PrEP) on STI epidemics among men who have sex with men (MSM)
Grey JA , Torrone EA , Sullivan PS , Weiss KM , Aral SO . Sex Transm Dis 2019 46 (12) 759-761 Human immunodeficiency virus (HIV) preexposure prophylaxis (HIV PrEP)1 provides substantial individual-level HIV risk reduction and may confer a population-level decrease in HIV incidence among gay, bisexual, and other men who have sex with men (MSM) when high HIV PrEP coverage is obtained.2 Unfortunately, the effect of HIV PrEP on sexually transmitted infection (STI) epidemics among MSM is less clear. We review recent trends in reported STIs among MSM in the United States, discuss the mechanisms by which HIV PrEP may impact STI rates, and consider the resulting population and individual-level effects of HIV PrEP on STI epidemics. |
Geographic correlates of primary and secondary syphilis among men who have sex with men in the United States
Leichliter JS , Grey JA , Cuffe KM , de Voux A , Cramer R , Hexem S , Chesson HW , Bernstein KT . Ann Epidemiol 2019 32 14-19 e1 PURPOSE: Primary and secondary (P&S) syphilis in men who have sex with men (MSM) has been increasing; however, there is a lack of research on geographic factors associated with MSM P&S syphilis. METHODS: We used multiple data sources to examine associations between social and environmental factors and MSM P&S syphilis rates at the state- and county-level in 2014 and 2015, separately. General linear models were used for state-level analyses, and hurdle models were used for county-level models. Bivariate analyses (P < .25) were used to select variables for adjusted models. RESULTS: In 2014 and 2015 state models, a higher percentage of impoverished persons (2014 beta = 1.24, 95% confidence interval, 0.28-2.20; 2015 beta = 1.19; 95% confidence interval, 0.42-1.97) was significantly associated with higher MSM P&S syphilis rates. In the 2015 county model, policies related to sexual orientation (marriage, housing, hate crimes) were significant correlates of MSM P&S syphilis rates (P < .05). CONCLUSIONS: Our state-level findings that poverty is associated with MSM P&S syphilis are consistent with research at the individual level across different subpopulations and various sexually transmitted diseases. Our findings also suggest that more research is needed to further evaluate potential associations between policies and sexually transmitted diseases. Geographic-level interventions to address these determinants may help curtail the rising syphilis rates and their sequelae in MSM. |
Increased methamphetamine, injection drug, and heroin use among women and heterosexual men with primary and secondary syphilis - United States, 2013-2017
Kidd SE , Grey JA , Torrone EA , Weinstock HS . MMWR Morb Mortal Wkly Rep 2019 68 (6) 144-148 During 2013-2017, the national annual rate of reported primary and secondary (P&S) syphilis cases in the United States increased 72.7%, from 5.5 to 9.5 cases per 100,000 population (1). The highest rates of P&S syphilis are seen among gay, bisexual, and other men who have sex with men (collectively referred to as MSM) (2), and MSM continued to account for the majority of cases in 2017 (1). However, during 2013-2017, the P&S syphilis rate among women increased 155.6% (from 0.9 to 2.3 cases per 100,000 women), and the rate among all men increased 65.7% (from 10.2 to 16.9 cases per 100,000 men), indicating increasing transmission between men and women in addition to increasing transmission between men (1). To further understand these trends, CDC analyzed national P&S syphilis surveillance data for 2013-2017 and assessed the percentage of cases among women, men who have sex with women only (MSW), and MSM who reported drug-related risk behaviors during the past 12 months. Among women and MSW with P&S syphilis, reported use of methamphetamine, injection drugs, and heroin more than doubled during 2013-2017. In 2017, 16.6% of women with P&S syphilis used methamphetamine, 10.5% used injection drugs, and 5.8% used heroin during the preceding 12 months. Similar trends were seen among MSW, but not among MSM. These findings indicate that a substantial percentage of heterosexual syphilis transmission is occurring among persons who use these drugs, particularly methamphetamine. Collaboration between sexually transmitted disease (STD) control programs and partners that provide substance use disorder services will be important to address recent increases in heterosexual syphilis. |
Estimating prevalent diagnoses and rates of new diagnoses of HIV at the state level by age group among men who have sex with men in the United States
Jones J , Grey JA , Purcell DW , Bernstein KT , Sullivan PS , Rosenberg ES . Open Forum Infect Dis 2018 5 (6) ofy124 Background: Men who have sex with men (MSM) in the United States experience a disproportionate rate of diagnosis of HIV. Surveillance data demonstrate age-based disparities among MSM, with higher rates of diagnosis among MSM age </=34 years nationally. Population size estimates within age group at the state level have not been available to determine rates for each state. We estimated the size of the MSM population in 5 age groups in each state and estimated the rate of prevalent HIV diagnoses in 2013 and new HIV diagnoses in 2014. Methods: We used data from the General Social Survey, American Community Survey, and previously published estimates from the National Health and Nutrition Examination Survey to estimate the population of MSM in 5 age groups at the state level. We combined these estimates with surveillance data to estimate age-stratified rates of prevalent diagnoses in 2013 and new diagnoses in 2014 in each state. We estimated standardized prevalence and diagnosis ratios comparing the Northeast, South, and West regions with the Midwest. Results: Rates of prevalent diagnoses increased with increasing age, and rates of new diagnoses were highest among younger age groups. In the United States, the new diagnosis rate among those age 18-24 years in 2014 was 1.4 per 100 MSM without a diagnosis. The highest diagnosis rates were observed among men age </=34 years in the South. Conclusions: Age-stratified estimates of HIV prevalence and new diagnosis rates at the state level can inform public health prevention strategies and resource allocation. |
Patterns of racial/ethnic disparities and prevalence in HIV and syphilis diagnoses among men who have sex with men, 2016: A novel data visualization
Sullivan PS , Purcell DW , Grey JA , Bernstein KT , Gift TL , Wimbly TA , Hall E , Rosenberg ES . Am J Public Health 2018 108 S266-s273 OBJECTIVES: To describe disparities in HIV infection and syphilis among gay, bisexual, and other men who have sex with men (MSM) in US states through ratio-based measures and graphical depictions of disparities. METHODS: We used state-level surveillance data of reported HIV and syphilis cases in 2015 and 2016, and estimates of MSM population sizes to estimate HIV and syphilis prevalence by race/ethnicity and rate ratios (RRs) and to visually display patterns of disparity and prevalence among US states. RESULTS: State-specific rates of new HIV diagnoses were higher for Black than for White MSM (RR range = 2.35 [Rhode Island] to 10.12 [Wisconsin]) and for Hispanic than for White MSM (RR range = 1.50 [Tennessee] to 5.78 [Pennsylvania]). Rates of syphilis diagnoses were higher for Black than for White MSM in 42 of 44 states (state RR range = 0.89 [Hawaii] to 17.11 [Alaska]). Scatterplots of HIV diagnosis rates by race showed heterogeneity in epidemic scenarios, even in states with similar ratio-based disparity measures. CONCLUSIONS: There is a widely disparate impact of HIV and syphilis among Black and Hispanic MSM compared with White MSM. Between-state variation suggests that states should tailor and focus their prevention responses to best address state data. |
Rates of prevalent and new HIV diagnoses by race and ethnicity among men who have sex with men, U.S. states, 2013-2014
Rosenberg ES , Purcell DW , Grey JA , Hankin-Wei A , Hall E , Sullivan PS . Ann Epidemiol 2018 28 (12) 865-873 PURPOSE: Men who have sex with men (MSM) bear a disproportionate burden of new and existing HIV infections in the United States, with black and Hispanic MSM facing the highest rates. A lack of data on MSM population sizes has precluded the understanding of state-level variations in these rates. METHODS: Using a recently developed model for estimating state-level population sizes of MSM by race that synthesizes data from the American Community Survey and the National Health and Nutrition Examination Survey, in conjunction with Centers for Disease Control and Prevention-based HIV diagnosis data, we estimated rates of living with an HIV diagnosis (2013) and new diagnosis among MSM (2014) by state and race. RESULTS: Nationally, state-level median prevalence of living with an HIV diagnosis was 10.6%. White MSM had lower prevalence in all but five states; black MSM were higher in all but three. Hispanic MSM had highest concentrations in Northeast and Mississippi Delta states. Patterns were similar for new diagnoses rates. CONCLUSIONS: Results suggest that racial disparities in HIV infection among MSM are more prominent than geographic ones. Interventions should be differentially tailored to areas of high proportionate and absolute burden. Continued efforts to understand and address racial differences in HIV infection are needed. |
Rates of primary and secondary syphilis among white and black non-Hispanic men who have sex with men, US states, 2014
Grey JA , Bernstein KT , Sullivan PS , Kidd SE , Gift TL , Hall EW , Hankin-Wei A , Weinstock HS , Rosenberg ES . J Acquir Immune Defic Syndr 2017 76 (3) e65-e73 BACKGROUND: Men who have sex with men (MSM) in the United States experience an approximately 100-fold greater rate of primary and secondary (P&S) syphilis diagnoses compared to men who have sex with women only. As in the general population, racial/ethnic disparities in P&S syphilis diagnosis rates may exist among MSM, but MSM-specific P&S syphilis rates by race/ethnicity are unavailable. We enhanced a published modeling approach to estimate area-level MSM populations by race/ethnicity and provide the first estimates of P&S syphilis among black and white non-Hispanic MSM. METHODS: We used data from the American Community Survey (ACS), published findings from the National Health and Nutrition Examination Survey (NHANES), and national syphilis surveillance data to estimate state-level rates of P&S syphilis diagnoses among MSM, overall and for black and white non-Hispanic MSM. We also used variability around ACS and NHANES estimates to calculate 95% confidence intervals for each rate. RESULTS: Among 11,359 cases of P&S syphilis among MSM with known race/ethnicity in 2014, 72.5% were among white (40.3%) or black (32.2%) MSM. The national rate of P&S syphilis diagnosis was 168.4/100,000 for white MSM and 583.9/100,000 for black MSM. Regional rates for black MSM ranged from 602.0/100,000 (South) to 521.5/100,000 (Midwest) and were consistently higher than those for white MSM. CONCLUSIONS: Although white MSM accounted for the majority of P&S syphilis diagnoses in 2014, when evaluating diagnoses based on rate per 100,000, black MSM had consistently and markedly higher rates than white MSM, with the highest-impacted states located in the US South. |
State-specific rates of primary and secondary syphilis among men who have sex with men - United States, 2015
de Voux A , Kidd S , Grey JA , Rosenberg ES , Gift TL , Weinstock H , Bernstein KT . MMWR Morb Mortal Wkly Rep 2017 66 (13) 349-354 In 2015, the rate of reported primary and secondary syphilis in the United States was 7.5 cases per 100,000 population, nearly four times the previous lowest documented rate of 2.1 in 2000. In 2015, 81.7% of male primary and secondary syphilis cases with information on the sex of the sex partner were among gay, bisexual, and other men who have sex with men (collectively referred to as MSM) (1). These data suggest a disproportionate incidence of disease among MSM. However, attempts to quantify this disparity have been hindered by limited data on the size of the MSM population at the state level. To produce the first estimates of state-specific rates of primary and secondary syphilis among MSM, CDC used MSM population estimates based on a new methodology and primary and secondary syphilis case counts reported in 2015 to the National Notifiable Diseases Surveillance System. Among 44 states reporting information on the sex of sex partners for ≥70% of male cases, the overall rate of primary and secondary syphilis among all men (aged ≥18 years) in the United States in 2015 was 17.5 per 100,000, compared with 309.0 among MSM and 2.9 among men who reported sex with women only. The overall rate of primary and secondary syphilis among MSM was 106.0 times the rate among men who have sex with women only and 167.5 times the rate among women.* These data highlight the disproportionate impact of syphilis among MSM and underscore the need for innovative and targeted syphilis prevention measures at the state and local level, especially among MSM. It is important that health care providers recognize the signs and symptoms of syphilis, screen sexually active MSM for syphilis at least annually, and provide timely treatment according to national sexually transmitted diseases treatment guidelines. |
Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey
Grey JA , Bernstein KT , Sullivan PS , Purcell DW , Chesson HW , Gift TL , Rosenberg ES . JMIR Public Health Surveill 2016 2 (1) e14 BACKGROUND: In the United States, male-to-male sexual transmission accounts for the greatest number of new human immunodeficiency virus (HIV) diagnoses and a substantial number of sexually transmitted infections (STI) annually. However, the prevalence and annual incidence of HIV and other STIs among men who have sex with men (MSM) cannot be estimated in local contexts because demographic data on sexual behavior, particularly same-sex behavior, are not routinely collected by large-scale surveys that allow analysis at state, county, or finer levels, such as the US decennial census or the American Community Survey (ACS). Therefore, techniques for indirectly estimating population sizes of MSM are necessary to supply denominators for rates at various geographic levels. OBJECTIVE: Our objectives were to indirectly estimate MSM population sizes at the county level to incorporate recent data estimates and to aggregate county-level estimates to states and core-based statistical areas (CBSAs). METHODS: We used data from the ACS to calculate a weight for each county in the United States based on its relative proportion of households that were headed by a male who lived with a male partner, compared with the overall proportion among counties at the same level of urbanicity (ie, large central metropolitan county, large fringe metropolitan county, medium/small metropolitan county, or nonmetropolitan county). We then used this weight to adjust the urbanicity-stratified percentage of adult men who had sex with a man in the past year, according to estimates derived from the National Health and Nutrition Examination Survey (NHANES), for each county. We multiplied the weighted percentages by the number of adult men in each county to estimate its number of MSM, summing county-level estimates to create state- and CBSA-level estimates. Finally, we scaled our estimated MSM population sizes to a meta-analytic estimate of the percentage of US MSM in the past 5 years (3.9%). RESULTS: We found that the percentage of MSM among adult men ranged from 1.5% (Wyoming) to 6.0% (Rhode Island) among states. Over one-quarter of MSM in the United States resided in 1 of 13 counties. Among counties with over 300,000 residents, the five highest county-level percentages of MSM were San Francisco County, California at 18.5% (66,586/359,566); New York County, New York at 13.8% (87,556/635,847); Denver County, Colorado at 10.5% (25,465/243,002); Multnomah County, Oregon at 9.9% (28,949/292,450); and Suffolk County, Massachusetts at 9.1% (26,338/289,634). Although California (n=792,750) and Los Angeles County (n=251,521) had the largest MSM populations of states and counties, respectively, the New York City-Newark-Jersey City CBSA had the most MSM of all CBSAs (n=397,399). CONCLUSIONS: We used a new method to generate small-area estimates of MSM populations, incorporating prior work, recent data, and urbanicity-specific parameters. We also used an imputation approach to estimate MSM in rural areas, where same-sex sexual behavior may be underreported. Our approach yielded estimates of MSM population sizes within states, counties, and metropolitan areas in the United States, which provide denominators for calculation of HIV and STI prevalence and incidence at those geographic levels. |
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