Field Based Treatment of Chlamydia and Gonorrhea Nilmarie Guzmán,MD & Michael Sands,MD University of Florida/Jacksonville and the Duval County Health Department

Gonorrhea and Chlamydia Background Chlamydia and gonorrhea represent significant health problems in young adults Chlamydia and gonorrhea represent significant health problems in young adults Both are associated with genital and reproductive morbidity in women Both are associated with genital and reproductive morbidity in women – PID – Infertility – Ectopic pregnancy Urethritis is associated with increased risk of transmission and acquisition of HIV infection Urethritis is associated with increased risk of transmission and acquisition of HIV infection Racial disparities in prevalence of GC and CT in young AA men and women Racial disparities in prevalence of GC and CT in young AA men and women

Duval County, Florida 5 th largest county in Florida 5 th largest county in Florida Population of 850,000 Population of 850,000 Relatively young demographics Relatively young demographics – Mean age 33.8 years – 30% of the population is under 35 y/o Highest rates of Chlamydia and Gonorrhea in 15 – 19 year olds in Florida Highest rates of Chlamydia and Gonorrhea in 15 – 19 year olds in Florida Significant racial disparity Significant racial disparity

Chlamydia cases by age and race Duval County 2004

Gonorrhea cases by age and race Duval County 2004

Cases

Approaches to Improve GC & CT Therapy Rates Standard partner referral Standard partner referral Expedited partner therapy (EPT)/Patient delivered partner therapy (PDPT) Expedited partner therapy (EPT)/Patient delivered partner therapy (PDPT) –Probably a useful adjunct for infected heterosexual men and women –No data for MSM or adolescent populations –Depends upon the “honesty” of the partner to deliver medication –Legal limitations to medication delivery in many states –Missed opportunity for testing other STDs, HIV and for prevention counseling Field based therapy Field based therapy –Very limited published experience

Field Based Therapy for GC & Chlamydia in Duval County Field based therapy, contact investigation, prevention counseling and testing Field based therapy, contact investigation, prevention counseling and testing Conducted by trained STD field workers Conducted by trained STD field workers Utilizing an established written protocol Utilizing an established written protocol Physician available by phone Physician available by phone Targeting all year olds diagnosed with GC or CT infections Targeting all year olds diagnosed with GC or CT infections

Field Based Therapy for GC & Chlamydia in Duval County Assure appropriate treatment of infection Assure appropriate treatment of infection Contact interview Contact interview Prevention counseling Prevention counseling Condom distribution Condom distribution Syphilis and HIV serotesting with consent Syphilis and HIV serotesting with consent

Number of Sexual Partners in the Last 12 Months Cases

Chlamydia outcomes in the 15 – 24 y/o High Risk Target Population Cases

Partner Management under Field Based Therapy Attempt was made to locate all partners Attempt was made to locate all partners Partner received field based “epidemiologic treatment” using a standard USPHS regimen if not already treated Partner received field based “epidemiologic treatment” using a standard USPHS regimen if not already treated Partners were offered HIV and syphilis serotesting Partners were offered HIV and syphilis serotesting Prevention counseling and condoms distribution Prevention counseling and condoms distribution All contacts had field urines collected for GC & CT probe testing All contacts had field urines collected for GC & CT probe testing Men had a LE test done in the field and those found positive 2+ or greater had contact interviews done during the initial visit Men had a LE test done in the field and those found positive 2+ or greater had contact interviews done during the initial visit

HIV Serotesting in Contacts Field base intervention enables professional prevention counseling and serotesting for HIV in high risk populations Field base intervention enables professional prevention counseling and serotesting for HIV in high risk populations Acceptance of HIV testing evaluated in 200 contact investigations performed during Jan – June 05 Acceptance of HIV testing evaluated in 200 contact investigations performed during Jan – June 05 – 75% of AA women accepted testing – 57% of AA men accepted testing – Three new cases of HIV were identified and linked to care

Summary Field based intervention is an effective strategy for STD programs Field based intervention is an effective strategy for STD programs It can be accomplished successfully by trained field staff working under protocol It can be accomplished successfully by trained field staff working under protocol This is particularly useful for high risk target groups ie. adolescents and young adults This is particularly useful for high risk target groups ie. adolescents and young adults More patients can be brought into therapy than utilizing solely clinic based programs More patients can be brought into therapy than utilizing solely clinic based programs Prevention activities are incorporated into the program Prevention activities are incorporated into the program Further evaluation of FBT in other populations ie MSM and adult heterosexual men and women should be done Further evaluation of FBT in other populations ie MSM and adult heterosexual men and women should be done