Lori E. Fantry

Background: Most Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) infections in men who have sex with men (MSM) are diagnosed at extragenital sites. However, testing at these sites is often lacking. The purpose of this study was to determine if a standardized questionnaire administered by physicians and clinical assistants improves documentation of sex activity and increases extragenital testing and diagnoses of GC and CT among MSM. Methods: A standardized sexual history questionnaire was implemented on 11/1/2022. Electronic medical records of 664 MSM with human immunodeficiency virus, including 1064 encounters, were reviewed to compare preimplementation and postimplementation sexual history documentation, adequacy of documentation, extragenital GC and CT testing, and GC and CT diagnoses. Analysis included χ² and exact tests and logistic regression adjusting for physician cluster effects. Results: The standardized questionnaire was used by 53.7% of physicians and 85.9% of coordinators. Documentation of whether sexual activity occurred increased from 79.3% (95% confidence interval [CI], 0.758–0.828) in the preintervention pre-COVID-19 period to 95.2% (95% CI, 0.925–0.970) in the postintervention period with an adjusted odds ratio of 4.7 (95% CI, 2.7–8.8). Specific questions about anal and oral sex increased from 42.0% to 88.1% (P < 0.001) and 23.7% to 88.7% (P < 0.001), respectively. Anal and pharyngeal testing increased from 14.4% to 20.2% (P = 0.040) and 17.2% to 23.3% (P = 0.045), respectively. Conclusions: This study demonstrates that using a standardized questionnaire during clinical encounters can improve documentation of sexual activity and testing for GC and CT at extragenital sites.

HIV pre-exposure prophylaxis (PrEP) is underutilized among Hispanics, women, and low-income individuals. To better understand PrEP barriers in this population, questionnaires were administered to 500 patients attending public health clinics in southern Arizona which provide family planning and sexually transmitted infections care. Sixty-three percent believed that they had no risk of HIV infection. When asked “Before today, did you know that there was a pill that can prevent HIV infection?” 80% of persons answered no. Among women, 88% answered no to this question. As expected, individuals with a higher perceived HIV risk (OR 1.76) or one HIV risk factor (OR 5.85) had a higher probability of knowledge. Among survey participants 87% would take a daily pill, 91% would visit a health-care provider every 3 months, and 92% would have laboratory testing every 3 months. Fifty-four percent would not be afraid or embarrassed if friends or family knew they were taking PrEP. Seventy-two percent would take PrEP despite temporary nausea. Sixty-two percent would pay ≥ $40 every 3 months for PrEP. Lack of knowledge, rather than patient attitudes, is the more important barrier to wider utilization of PrEP among individuals, especially women, attending public health clinics in Southern Arizona. Future efforts need to focus on education and access to PrEP in underserved populations including women and Hispanics.

The objective of this study was to examine the median age of menopause, factors associated with postmenopausal status, and the prevalence of menopausal symptoms in HIV-infected women. We surveyed 120 HIV-infected women between 40 and 57 years old who attended an inner city infectious diseases clinic. Ninety-five percent of the women surveyed were African American and almost half of the women (44%) had used methadone, heroin, cocaine, marijuana, or a combination of these drugs within the past 6 months. Eighty-seven percent had smoked cigarettes at least some time during their life and 45% drank alcohol between the ages of 40 and 49 years old. Thirty women were postmenopausal (having no menstrual periods in the previous 12 consecutive months), 31 were perimenopausal (having 1-11 periods within the previous 12 months), and 59 were premenopausal (having 12 or more periods within the previous 12 months). The median age of menopause was 50 years old (95% confidence interval = 49, 53). In a multivariate model, methadone use within the past 6 months was associated with postmenopausal status. We did not find an association between postmenopausal status and body mass index, number of pregnancies, CD4 cell counts, HIV viral load, individual and grouped antiretroviral therapies, cigarette smoking, and current or past oral contraceptive use. In multivariate analysis, postmenopausal status was associated with hot flashes and cocaine use was associated with vaginal dryness.

Persons with HIV infection, leukemia, lymphoma, solid organ and bone marrow transplants, and inherited immune deficiencies as well as those on immunosuppressive drugs are at high risk for infections of the gastrointestinal tract. Pathogenic as well as opportunistic viruses, bacteria, fungi, and protozoa cause infections in the esophagus, stomach, small intestine, and large intestine. Symptoms may be mild but more often are severe and even life threatening. This article reviews what is new in the field of gastrointestinal infections in the immunocompromised host during the past year. I will place specific emphasis on articles that are most pertinent to clinical care.

Mycobacterium avium complex (MAC) is commonly associated with fever, fatigue, nausea, diarrhea, and cytopenias related to invasion of the intestine and bone marrow. Infection and clinical disease has been reported in other organs as well. We report the first case of cholecystitis associated with MAC infection of the galbladder.

Immunocompromised patients, including patients with AIDS, solid organ and bone marrow transplant recipients, patients with leukemia and lymphoma, patients with inherited immune deficiencies, and patients on immunosuppressive therapy for a variety of disorders, are at risk for infections—particularly opportunistic infections, which, by definition, do not infect the healthy host. All systems of the body, including the gastrointestinal tract, are susceptible. The esophagus, stomach, small intestine, and large intestine are sites of infection for viruses, bacteria, fungi, and protozoa. Symptoms can range in severity from fevers of unknown etiology to life-threatening hemorrhage and perforation. This review summarizes recent case reports, clinical studies, and reviews pertaining to pathogens that uniquely cause disease, more frequently cause disease, or cause more severe disease in the immunocompromised host than in the immunocompetent host.

Vertigo can cause significant morbidity and make a person unable to perform activities of daily life. A human immunodeficiency virus (HIV)-infected patient experienced vertigo while taking abacavir that resolved immediately on cessation of therapy. The mechanism by which abacavir appeared to be associated with vertigo in this patient is unknown.

When discussing indications for the treatment of latent tuberculosis infection, Small and Fujiwara (July 19 issue)¹ follow the joint statement of the American Thoracic Society and the Centers for Disease Control and Prevention (CDC)² in considering patients regardless of age. Prior guidelines did not recommend routine treatment for those older than 35 years, the point at which isoniazid hepatotoxicity was thought to be more likely to occur than disease reactivation.³ Is age no longer a concern? For example, since treatment is now recommended for all tuberculin-positive persons who have emigrated from high-prevalence areas to the United States within the preceding five years, should we prescribe isoniazid to a recently arrived 75-year-old person? Should we withhold therapy from a 26-year-old who came to the United States at the age of 19?