Browsing by Subject "Sexual and Gender Minorities"

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    LGBTQ-Affirmative Behavioral Health Services in Primary Care.
    (Primary care, 2021-06) Heredia, Dagoberto; Pankey, Tyson L; Gonzalez, Cesar A
    Behavioral health concerns related to sexual and gender minority stress impair functioning and limit quality of life. With greater interest in implementing LGBTQ-affirmative health care practices, primary care providers likely will see larger numbers of LGBTQ individuals presenting with behavioral health concerns. Behavioral health and medical providers may not feel prepared to address the biological, psychological, social, and cultural minority stress factors that have an impact on LGBTQ patients. LGBTQ-affirmative behavioral health providers in primary care can offer a unique service by conducting tailored evaluations and individualized interventions targeting multifactorial influences that cause and perpetuate psychological distress in LGBTQ patients.
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    Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022.
    (MMWR. Morbidity and mortality weekly report, 2022-11) Miller, Maureen J; Cash-Goldwasser, Shama; Marx, Grace E; Schrodt, Caroline A; Kimball, Anne; Padgett, Kia; Noe, Rebecca S; McCormick, David W; Wong, Joshua M; Labuda, Sarah M; Borah, Brian F; Zulu, Isaac; Asif, Amimah; Kaur, Gurpreet; McNicholl, Janet M; Kourtis, Athena; Tadros, Andrew; Reagan-Steiner, Sarah; Ritter, Jana M; Yu, Yon; Yu, Patricia; Clinton, Rachel; Parker, Corrine; Click, Eleanor S; Salzer, Johanna S; McCollum, Andrea M; Petersen, Brett; Minhaj, Faisal S; Brown, Ericka; Fischer, Michael P; Atmar, Robert L; DiNardo, Andrew R; Xu, Ya; Brown, Cameron; Goodman, Jerry Clay; Holloman, Ashley; Gallardo, Julia; Siatecka, Hanna; Huffman, Georgia; Powell, John; Alapat, Philip; Sarkar, Pralay; Hanania, Nicola A; Bruck, Or; Brass, Steven D; Mehta, Aneesh; Dretler, Alexandra W; Feldpausch, Amanda; Pavlick, Jessica; Spencer, Hillary; Ghinai, Isaac; Black, Stephanie R; Hernandez-Guarin, Laura N; Won, Sarah Y; Shankaran, Shivanjali; Simms, Andrew T; Alarcón, Jemma; O'Shea, Jesse G; Brooks, John T; McQuiston, Jennifer; Honein, Margaret A; O'Connor, Siobhán M; Chatham-Stephens, Kevin; O'Laughlin, Kevin; Rao, Agam K; Raizes, Elliot; Gold, Jeremy AW; Morris, Sapna Bamrah; CDC Severe Monkeypox Investigations Team
    As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States.§ Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy†† in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox.§§ Engaging all persons with HIV in sustained care remains a critical public health priority.
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    Test-of-Cure After Treatment of Pharyngeal Gonorrhea in Durham, North Carolina, 2021-2022.
    (Sexually transmitted diseases, 2022-10) Jenks, Jeffrey D; Hester, Lizeth; Ryan, Emily; Stancil, Candy; Hauser, Quinn; Zitta, John-Paul; Mortiboy, Marissa; Rayner, Malkia; Stevens, Elizabeth; Carrico, Savannah; Jenkins, Rodney

    Background

    In December 2020, the Centers for Disease Control and Prevention updated its treatment guidelines for gonococcal infection and, for the first time, recommended universal test-of-cure for all individuals treated for pharyngeal gonorrhea. After the release of these guidelines, data are lacking on rates of return for the test-of-cure, particularly in populations other than men who have sex with men.

    Methods

    We analyzed the demographic characteristics, clinical characteristics, rate of return for the recommended test-of-cure, and percent positivity for Neisseria gonorrhoeae on repeat pharyngeal specimens at a local public health department in Durham, NC.

    Results

    Of 101 individuals treated for pharyngeal gonorrhea between March 2021 and April 2022, 54.5% were men, 71.2% Black or African American, and 58.4% between the ages of 20 and 29 years. Most identified as either women who have sex with men (38.6%), men who have sex with men (24.8%), or men who have sex with women (22.8%). Of these individuals, 41 (40.6%) returned for a test-of-cure, with LGBTQ+ individuals more likely to return than men who have sex with women and women who have sex with men. Of those who returned for the test-of-cure, 4.9% of pharyngeal samples were equivocal and 2.4% positive for N. gonorrhoeae by nucleic acid amplification testing, likely reflecting false-positive tests.

    Conclusion

    Despite recommendations to perform a test-of-cure 7 to 14 days after treatment of pharyngeal gonorrhea, rates of return continue to be low. Alternative strategies should be investigated to increase test-of-cure rates.