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s the potential of microbiota modulators to treat SSc-related GI disorders.

Despite advances in implementing human immunodeficiency virus (HIV)/sexually transmitted infection (STI) services for men who have sex with men (MSM), many remain underserved because of barriers like stigma, low facility coverage, and provider competency. This article describes the implementation of centralized nationwide mailed HIV/STI home testing (CareKit).

The Emory Center for AIDS Research developed CareKit for research study participants to request HIV self-test kits, STI specimen collection kits, and condom/lubricant packs to be shipped to any mailing address in the United States. Sexually transmitted infection kits were customized according to study needs and could include materials to collect whole blood, dried blood spots, urine sample, and rectal and pharyngeal swab samples for syphilis, gonorrhea, and chlamydia testing. Specimens were mailed back to a central Clinical Laboratory Improvement Amendments-approved laboratory for testing, and results were returned to participants.

CareKit was useo mail home test kits has become increasingly important to reach those who may have limited access to health care services, particularly during the COVID-19 pandemic.

Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN), or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts.

All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. Chi-square tests compared indicators between PN approaches.

Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean 5.5, standard deviation [SD] 5.2 days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least one notifiable partner for a total of 1,094 partners (mean 3.9, SD 5.5 partners/patient). Compared to PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1%, 573/817 versus 89.8%, 211/235; P = 1.88×10-9), but there was no difference in the proportion of partners tested and/or treated (90.2%, 517/573 versus 86.7% 183/211; P = 0.203), and diagnosed (12.8%, 66/517 versus 16.4%, 30/183; P > 0.271).

PH- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.

PH- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.

Syphilis diagnosis relies on serological tests, which may be falsely nonreactive or may be reactive but not reflect current syphilis.

Polymerase chain reaction for detection of T. pallidum DNA was performed on 123 oropharyngeal swabs, 120 whole bloods and 46 lesion exudate swabs from 123 untreated individuals with syphilis (cases); oropharyngeal swabs from 148 at-risk controls without syphilis; and 73 oropharyngeal swabs and 36 whole bloods from 73 individuals recently treated for syphilis.

Most (90.2%) cases had early syphilis. T. pallidum DNA was detected in 33 (26.8%) of 123 oropharyngeal swabs, 32 (26.7%) of 120 bloods, and 30 (65.2%) of 46 lesion exudate swabs. T. pallidum DNA was detected in 49 (40.8%) of 120 individuals in whom both oropharyngeal swabs and blood were tested. T. pallidum was more likely to be amplified from oropharyngeal swabs when it was amplified from blood than when it was not (15 [46.9%] of 32 vs. 17 [19.3%] of 88, p = 0.003). For each 2 fold increase in serum RPR titer, the odds of detection of T. pallidum DNA in oropharyngeal swabs increased by 1.44 (95% CI, 1.14-1.82, p = 0.003). T. pallidum DNA was not detected in oropharyngeal samples from controls, but it was detected in 3 (8.3%) of 36 bloods from individuals recently treated for syphilis two at 1 day and one at 5 days after initiation of syphilis treatment.

Nucleic amplification tests can identify recent T. pallidum infection and may be particularly useful for diagnosis of very early or asymptomatic syphilis.

Nucleic amplification tests can identify recent T. pallidum infection and may be particularly useful for diagnosis of very early or asymptomatic syphilis.

Direct-to-consumer test services have gained popularity for sexually transmitted infections (STIs) in recent years, with substantially increased use as a result of the SARS-CoV-2 (CoVID-19) global pandemic. This method of access has been variously known as ‘self-testing’, ‘home testing’, and ‘direct access testing’. While these online services may be offered through different mechanisms, here we focus on those that are consumer driven, require self-collected samples, and sample shipment to a centralized laboratory without involvement of healthcare providers and/or local health departments. We provide ASTDA’s position on utilization of these services and recommendations for both consumers and healthcare providers.

Direct-to-consumer test services have gained popularity for sexually transmitted infections (STIs) in recent years, with substantially increased use as a result of the SARS-CoV-2 (CoVID-19) global pandemic. CPI1205 This method of access has been variously known as ‘self-testing’, ‘home testing’, and ‘direct access testing’. While these online services may be offered through different mechanisms, here we focus on those that are consumer driven, require self-collected samples, and sample shipment to a centralized laboratory without involvement of healthcare providers and/or local health departments. We provide ASTDA’s position on utilization of these services and recommendations for both consumers and healthcare providers.