Human Papilloma Virus, Herpes Simplex Virus, Syphilis, Gonorrhea and Chlamydia infections among HIV-positive Patients at the Emergency Department [ED] of University Medical Center New Orleans

Publication Date

July 2019

Location

LSU Health Medical Education Building

Document Type

Abstract

Start Date

26-7-2019 9:00 AM

End Date

26-7-2019 12:00 PM

Description

Background: Although progress has been made for the health and wellness for HIV+ patients, the sexual health of these patients falls behind the general population’s (Shapiro et al). HPV and HIV are often co-infected, and HIV+ patients are disproportionately affected by HPV-related cancers (Konopnicki et al, 2013). Cervical cancer, anal cancer, genital warts, vaginal cancer, vulvar cancer, penile cancer are the most common HPV-related health conditions and cancers (CDC). Despite being more at risk for HPV-related cancers, almost one in four HIV+ women do not receive an annual cervical cancer screening. (Norwood et al, 2018). Moreover, HIV+ patients are less likely to receive an HPV vaccination (Wigfall et al). Being HIV+ puts patients at a higher risk for STDs, as HSV, syphilis, gonorrhea, and chlamydia are associated with HIV co-infection. Because STD and HIV cases are rising in New Orleans, it is imperative to study the correlation between the two. This study aims to access the prevalence of HPV-related cancers, other STDs, demographic variables, and clinical referral rates. Methods: This was a retrospective chart review of 792 HIV+ patients at the UMC ED during a five-year period (March 2013 to December 2018). In this study, medical charts were reviewed for demographic variables and clinical variables related to the disease conditions of interest (HPV, HSV, gonorrhea, chlamydia, and syphilis). Results: Of patients studied, 75.88% were Black, 17.38% were White, and 6.74% were Other. The mean age is 38.7 years. 20% of the population had IV drug use, 55.53% had current alcohol use, and 64.94% had current tobacco use. 20% of the population was homeless, and 20% was uninsured. 76.25% of the population is male, 22.09% is female, and 1.66% is transgender. Over 10% of the study population had an HPV diagnosis, but only 3.58% had received an HPV vaccination. Patients who are younger than 40 are 11.9 times more likely to get an HPV vaccination. Patients who use alcohol are 4.2 times more likely to get a vaccination. Patients who use tobacco are .4 times less likely ro receive an HPV vaccination. With regards to lifetime diagnosis, 11.28% had gonorrhea, 9.36% had chlamydia, 26.15% had syphilis, 11.04% had HPV, and 11.04% had HSV. Of patients not referred for STD treatment, 25.71% had gonorrhea, 24.67% had syphilis, 19.61% had chlamydia, 16.39% had HPV, and 21.21% had HSV. There is no correlation between syphilis, gonorrhea, chlamydia and HPV cancer; however, there is a relationship between HSV, HPV, and HPV cancer. 19 out of 126 females and 26 out of 595 males have HPV cancer. Blacks are more likely to have two or more STDs when compared to whites and other. Conclusion: Our results show that Blacks are over-represented. Over 95% of the population have not been vaccinated against HPV as the average age is 38.7 and the recommended vaccination cut¬off age is 26. Moreover, the vaccine is relatively new and marketed towards pre-teens. Literature has shown that tobacco users are more likely to get HPV, and in this study, were less likely to be vaccinated agaisnt it. HSV, HPV, and HPV-related cancer are related, which is consistent with current literature. Low referral rates were noted for STD patients across all the clinics, highlighting the need for specific interventions for both patients and ED providers. Over 25% of the population had syphilis, thus emphasizing the need for sexual health education in the HIV population. Past studies have proven a relationship among tobacco, alcohol, and HPV, respectively, in the general population. Therefore, it is recommended for further research to investigate these correlations with HPV-related cancer in the HIV population.

Comments

Mentor: Lisa Moreno-Walton MD, MS, MSCR, FAAEM , UMCNO Emergency Medicine Department

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Jul 26th, 9:00 AM Jul 26th, 12:00 PM

Human Papilloma Virus, Herpes Simplex Virus, Syphilis, Gonorrhea and Chlamydia infections among HIV-positive Patients at the Emergency Department [ED] of University Medical Center New Orleans

LSU Health Medical Education Building

Background: Although progress has been made for the health and wellness for HIV+ patients, the sexual health of these patients falls behind the general population’s (Shapiro et al). HPV and HIV are often co-infected, and HIV+ patients are disproportionately affected by HPV-related cancers (Konopnicki et al, 2013). Cervical cancer, anal cancer, genital warts, vaginal cancer, vulvar cancer, penile cancer are the most common HPV-related health conditions and cancers (CDC). Despite being more at risk for HPV-related cancers, almost one in four HIV+ women do not receive an annual cervical cancer screening. (Norwood et al, 2018). Moreover, HIV+ patients are less likely to receive an HPV vaccination (Wigfall et al). Being HIV+ puts patients at a higher risk for STDs, as HSV, syphilis, gonorrhea, and chlamydia are associated with HIV co-infection. Because STD and HIV cases are rising in New Orleans, it is imperative to study the correlation between the two. This study aims to access the prevalence of HPV-related cancers, other STDs, demographic variables, and clinical referral rates. Methods: This was a retrospective chart review of 792 HIV+ patients at the UMC ED during a five-year period (March 2013 to December 2018). In this study, medical charts were reviewed for demographic variables and clinical variables related to the disease conditions of interest (HPV, HSV, gonorrhea, chlamydia, and syphilis). Results: Of patients studied, 75.88% were Black, 17.38% were White, and 6.74% were Other. The mean age is 38.7 years. 20% of the population had IV drug use, 55.53% had current alcohol use, and 64.94% had current tobacco use. 20% of the population was homeless, and 20% was uninsured. 76.25% of the population is male, 22.09% is female, and 1.66% is transgender. Over 10% of the study population had an HPV diagnosis, but only 3.58% had received an HPV vaccination. Patients who are younger than 40 are 11.9 times more likely to get an HPV vaccination. Patients who use alcohol are 4.2 times more likely to get a vaccination. Patients who use tobacco are .4 times less likely ro receive an HPV vaccination. With regards to lifetime diagnosis, 11.28% had gonorrhea, 9.36% had chlamydia, 26.15% had syphilis, 11.04% had HPV, and 11.04% had HSV. Of patients not referred for STD treatment, 25.71% had gonorrhea, 24.67% had syphilis, 19.61% had chlamydia, 16.39% had HPV, and 21.21% had HSV. There is no correlation between syphilis, gonorrhea, chlamydia and HPV cancer; however, there is a relationship between HSV, HPV, and HPV cancer. 19 out of 126 females and 26 out of 595 males have HPV cancer. Blacks are more likely to have two or more STDs when compared to whites and other. Conclusion: Our results show that Blacks are over-represented. Over 95% of the population have not been vaccinated against HPV as the average age is 38.7 and the recommended vaccination cut¬off age is 26. Moreover, the vaccine is relatively new and marketed towards pre-teens. Literature has shown that tobacco users are more likely to get HPV, and in this study, were less likely to be vaccinated agaisnt it. HSV, HPV, and HPV-related cancer are related, which is consistent with current literature. Low referral rates were noted for STD patients across all the clinics, highlighting the need for specific interventions for both patients and ED providers. Over 25% of the population had syphilis, thus emphasizing the need for sexual health education in the HIV population. Past studies have proven a relationship among tobacco, alcohol, and HPV, respectively, in the general population. Therefore, it is recommended for further research to investigate these correlations with HPV-related cancer in the HIV population.