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Try out PMC Labs and tell us what you think. Learn More. Partner notification services PNS remain the backbone of syphilis control. The popularity of internet-based apps to meet sex partners among early syphilis ES patients may hinder the success of PNS if partners cannot be located. We compared demographic and clinical characteristics between male ES patients indicating sex with men MSM and reported in North Carolina between and by reported use of an internet-based app to meet sex partners app user.
App users were more frequently white Overall, App users reported 2. Similar proportions of app PNS continues to be an important mechanism to locate and assure treatment for sex partners in this population. Case reports of syphilis have been increasing in the United States US sincewith primary and secondary i. The goal of PNS is to interrupt disease transmission by notifying sex partners of confirmed cases, providing risk reduction counseling, and referral to testing and treatment for both cases and their sex partners.
Public health officials responsible for performing PNS, Disease Intervention Specialists DIScollect the names and locating information of all sex partners at risk of syphilis infections from the index case. The increasing popularity of internet-based applications apps to find sex partners, particularly among MSM 5 can facilitate sex partner finding that does not require identification beyond a screenname, making the subsequent location of those partners difficult.
Because data are needed to support programmatic and policy change, we performed a retrospective review of the surveillance data for all Sex partner in North carolina ES cases reported in NC to assess the association between PNS outcomes and reported use of internet-based apps to meet sex partners. Widely-used PNS outcome indices were used to assure comparability of our observations to PNS assessments performed in other jurisdictions.
This system also contains DIS case investigative notes for primary, secondary and early latent syphilis index patients and their reported sex partners. We classified male patients that self-reported being homosexual, bisexual or reported a male sex partner during their infectious period as MSM. Only sex partners reported by the index patient during their infectious window Sex partner in North carolina included in our analysis. As part of their investigation, DIS ask all index patients whether they met sex partners on an internet-based app in the 12 months preceding their syphilis diagnosis.
However, we do not know which specific partners were met online. Patients who did not answer the internet-based app use question were excluded from our analysis. Reported sex partners were stratified into 2 groups: named partners index case provided enough locating information for the DIS to attempt location ; and unnamed partners index case did not provide enough locating information for the DIS to attempt location. Traditionally, a DIS needs at least one of the following pieces of locating information for the partner to initiate PNS: phoneresidential or employment address, or a social security.
Internet partner notification services IPNS refers to locating sex partners via internet-based platforms. Locating information needed to initiate IPNS include an e-mail address, social media username, or app screenname.
From NC EDSS, we extracted demographic, clinical, behavioral risk data, and syphilis treatment status information for ES index patients, notification of syphilis exposure, IPNS asment, and syphilis testing and diagnosis status for named sex partners, and HIV status for both ES index patients and their named sex partners.
Index patients were considered to have prevalent HIV if the HIV diagnosis date was before or within 60 days after the syphilis diagnosis date. We compared the following PNS outcomes between app and non-app users: partner notification index of named sex partners notified of their exposure per index patients interviewedtreatment index of named infected or exposed sex partners who received curative or empiric treatment for syphilis per index patients interviewed and the case finding index of named sex partners newly diagnosed with syphilis or HIV infection per index patients interviewed.
A sensitivity analysis was performed to compare the probability of notifying all versus fewer than all named sex partners, by reported app use. Variables ificantly associated with internet sex partner finding in bivariate analysis were included in the multivariate models. Most were male Reported use of internet-based apps to meet sex partners by MSM ES cases increased slightly throughout this analysis period DIS staff interviewed 3, The remaining 50 1. Excluded patients were more frequently older median age 34 versus 29reported no sex partners Selection of early syphilis patients included in analysis, North Carolina — Among app users, The most frequently reported apps used to meet sex partners were Adam4Adam One-third We were unable to determine where App using index patients were more frequently non-Hispanic, white App users were less likely than non-app users to be HIV co-infected The syphilis stage and the proportion of index cases that received treatment were similar for app and non-app users.
Demographic, clinical characteristics and partner notification outcomes of male index patients diagnosed with early syphilis who reported sex with men MSM by reported using an internet-based app to meet sex partners app user and non-app userJanuary through December These observations did not change when stratified by HIV serostatus data not shown.
Internet sex partners comprised Classification and of reported sex partners and the testing outcomes for partners named by MSM index patients with early syphilis who reported app user and did not report non-app user meeting sex partners on an internet-based app, January through December App users named more sex partners per index case interviewed than non-app users 1. Similar proportions of partners named by app and non-app users had appropriate HIV follow-up: either a record of prevalent HIV infection A lower proportion of partners named by app users received serologic testing for syphilis exposure The proportion of partners tested for HIV that were newly diagnosed, did not differ if named by an app user or non-app user 4.
Standard PNS outcomes were higher for app versus non-app users; partner notification index 1. There were The inclusion of IPNS activities increased the overall proportion of named partners that DIS successfully brought to evaluation and treatment from In total, In sensitivity analysis, the probability of notifying all versus fewer than all named partners did not differ between the two groups data not shown. Association between reported use of internet-based apps to meet sex partners and notification of at least one sex partner of syphilis exposure among male index patients with early syphilis who report sex with men MSMJanuary through December In this analysis of MSM ES patients, the probability of notifying at least one named partner did not differ by reported use of internet-based apps to meet sex partners.
A similar proportion of both reported and named partners were located by DIS for app and non-app users, and nearly half of reported internet sex partners had enough contact information to initiate PNS or IPNS. Due to the larger of partners named by app users, those investigations identified and treated more partners than investigations of non-app users. Additionally, app and non-app using index patients reported similar proportions of unnamed sex partners, suggesting internet-based app sex partner finding may not be the main or only factor limiting partner investigations for MSM index patients.
Our analysis highlights the continued importance of PNS in locating and assuring the evaluation and treatment of named partners. As observed ly 10 11 12 13 14over half of MSM index patients reported using an internet-based app to meet sex partners and internet sex-seeking was correlated with larger s of reported sex partners per index patient.
Although PNS was able to assure the evaluation and treatment of a similar percentage of named partners, app users still had almost three-times as many partners that were either not located both named or unnamed or refused evaluation and treatment compared to non-app users. Additionally, as reported in other studies 15 14 16we observed a positive correlation between meeting sex partners on an internet-based app and reported STI risk factors such as a prior STD history, inconsistent condom use and engaging in sex during the syphilis infectious period.
Elevated STI risk behaviors and s of reported partners among MSM who meet sex partners on internet-based apps suggest websites used to find sex partners may provide a venue for increased syphilis transmission, and therefore may have contributed to the increasing syphilis epidemic in NC over the course of this analysis.
It is surprising that non-app users reported similar proportions of unnamed sex partners as app users and were more likely to report no sex partners during their infectious period. This may be partly explained by experience with DIS during this and interviews. Non-app users were more frequently HIV-positive, which has been ly associated with a lower of named sex partners and PNS indices among MSM syphilis patients. Qualitative research is underway in NC to identify, understand and address the barriers MSM syphilis patients experience Sex partner in North carolina reporting sex partners for PNS.
Incorporating IPNS with traditional PNS assured the evaluation and treatment of a similar proportion of partners named by app and non-app users, improving overall PNS outcomes for both groups. Our findings demonstrate the expanded benefit that IPNS could provide Sex partner in North carolina reaching populations who routinely utilize internet-based platforms to communicate. Unfortunately, like many jurisdictions 17and Sex partner in North carolina to legal concerns in NC regarding the use of government-owned electronic devices to access websites and apps used by patients to meet sex partners, state-employed DIS staff cannot directly perform IPNS.
In addition to enhancing disease intervention efforts, authorizing DIS to access these internet apps and websites for IPNS purposes would ensure DIS maintain cultural competency in the rapidly changing cyber landscape where MSM socialize and meet sex partners.
All index patient risk behavior and partner information obtained during DIS interviews was self-reported and therefore subject to recall or response bias. Limitations in data collection prohibited the identification of which sex partners were met online, therefore we cannot comment on differences in PNS outcomes by where partners were met. Some misclassification of app use exposure was possible among primary and secondary syphilis patients because the infectious period was shorter than the 12 month period used to assess internet sex partner finding.
However, we believe this misclassification to be minimal because most of these patients reported at least one internet sex partner during their infectious period. Given the high proportion of unnamed partners reported by index ES MSM patients, regardless of app usage, further study is necessary to understand how to provide PNS that is supportive of MSM culture and effective for notifying and treating partners. Though internet-based app use to find sex partners was associated with more overall sex partners, reported STI risk behaviors and infected partners, we observed no difference in the proportion of named partners notified of exposure.
Our analysis highlights the continued usefulness of PNS for syphilis intervention and the potential benefit that routinizing IPNS into DIS investigations could have on syphilis partner notification outcomes for MSM regardless of app use to meet sex partners. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Biotechnology InformationU.Sex partner in North carolina
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