STI Prevention: Using Epidemiology to Inform Polic

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Abstract/Syllabus

Courseware/Lectures

Test/Tutorials

STI Prevention: Using Epidemiology to Inform Policy and Program

Spring 2007

Description

Considers features of sexually transmitted diseases relevant to their control, reviewing the natural history of the infections and laboratory diagnoses. Emphasizes policy development and public health practice for STI control and prevention, including behavioral interventions and medical screening/treatment intervention of sexually transmitted diseases.

Course Goal

To increase public health practitioners' awareness of the scope of the STI problem and to demonstrate the application of biology, epidemiology, and behavioral aspects of STIs to the development of policy and program.

Course Objectives

Describe the etiology of common STIs
Define the epidemiology of selected STIs
Identify the clinical presentations of STIs and their sequelae
Explain the theoretical and practical issues related to the design and implementation of STI control interventions
Describe the social, policy, and political issues encountered in developing and implementing STI control interventions
Develop a presentation illustrating the importance of STI epidemiology to policy and program development

OCW offers a snapshot of the educational content offered by JHSPH. OCW materials are not for credit towards any degrees or certificates offered by the Johns Hopkins Bloomberg School of Public Health.

Syllabus

Course Description

This course is divided into four modules:

The Basics: The goal is to introduce the course, the role of public health in STI prevention, and the epidemiology and control of STIs. There is also a brief introduction to policy and program. The key concepts presented in this section lay the foundation and establish a common language for the remainder of the course.
STI-Specific Epidemiology and Biology: The goal is to gain appreciation of the epidemiologic and biological aspects of STIs that enable the development of prevention and control policy and program. Students are not expected to develop clinical or epidemiologic expertise, but rather to recognize STI infection patterns and manifestations that inform policy and program.
STI Policy and Program in Various Contexts: STI policy and programs exist in the context of human behavior. The goal of this module is to gain appreciation of the aspects of human behavior that enable the development of behavioral intervention programs in populations with varying risks of STI acquisitions and disease progression. Examples of successful behavioral intervention programs will be presented.
Summary: Development of STI Policy and Program: The module ties together the skills and concepts taught in the course. The goal is to integrate knowledge of STI epidemiology, biology, and behavior into viable control policies and programs.

Course Objectives

Upon completion of this course, students will be able to:

Describe the etiology of common STIs
Define the epidemiology of selected STIs
Identify the clinical presentations of STIs and their sequelae
Explain the theoretical and practical issues related to the design and implementation of STI control interventions
Describe the social, policy, and political issues encountered in developing and implementing STI control interventions
Develop a presentation illustrating the importance of STI epidemiology to policy and program development

Prerequisites

Principles of Epidemiology (340.601) or equivalent
Public Health Biology (550.630) or equivalent

Readings

There is no textbook for this course. Readings for each session are listed on the Readings page.

Course Requirements

Project: Create a briefing memo with an annotated bibliography and a three-minute slide presentation.

Midterm Exam: An open-book exam consisting of several different question-style formats: multiple choice, true/false, and short answer.

Schedule

SESSION #	TOPIC	ACTIVITIES

The Basics
1	Introduction to the Course: Housekeeping and How We Use Public Health (Althoff, Hogan, Schumacher)
2	Epidemiologic Basis of STD Control: Introduction and STD Surveillance (Zenilman)
3	STD Control: Introduction to Mathematical Models and STDs (Zenilman)
4	Introduction to STI Policy and Programming (Hogan, Althoff, Schumacher)

STI Specific Epidemiology
5	Gonorrhea and Chlamydia (Ghanem)
6	Vaginitis and PID (Zenilman, Ghanem)
7	Syphilis (Rompalo)
8	Update on Genital Herpes (Rompalo)
9	Genital Human Papillomavirus (Gravitt)
10	HIV and Other Sexually Transmitted Infections (Erbelding)
11	STD Diagnostic Tests (Gaydos)

STI Policy and Program in Various Contexts
12	Epidemiologic Basis for STI Policy and Programming: Interventions (Zenilman)
13	STDs in the International Setting (Gray)
14	Behavioral Interventions (Celentano)
15	Adolescents and STIs (Ellen)

Summary: Development of STI Policy and Program
16	Epidemiologic Basis for STI Policy and Programming: Development of Policy and Programming (Zenilman)

Readings

TOPIC	READINGS
General	O'Brien D, Royalance F. City considers unusual tactic against STDs: Patients would provide medications to partners. Baltimore Sun March 15, 2007 Bruckner H, Bearman P. After the promise: The STD consequences of adolescent virginity pledges. J Adolescent Health 2005;36:271-278 Klausner KD, et al. Tracing a syphilis outbreak through cyberspace. JAMA. 2000;284:447-449

The Basics
Lecture 1: Introduction to the Course: Housekeeping and How We Use Public Health	Institute of Medicine. Executive Summary. In: Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academies Press, 1997. National Coalition of STD Directors. STD Program Core Components and Strategies, 2006. WHO Guidelines for the Management of Sexually Transmitted Infections. Geneva: World Health Organization, 2003
Lecture 2: Epidemiologic Basis of STD Control: Introduction and STD Surveillance	Donavan B. Sexually transmissible infections other than HIV. Lancet 2004;363:545-56 Division of STD Surveillance. Sexually Transmitted Disease Surveillance 2005. Centers for Disease Control and Prevention, November 2006.
Lecture 3: STD Control: Introduction to Mathematical Models and STDs	Rothenberg R. Maintenance of endemicity in urban environments: a hypothesis linking risk, network structure and geography. Sex Transm Infect 2007;83:10-15 Golden MR, Manhart LE. Innovative approaches to the prevention and control of bacterial sexually transmitted infections. Infect Dis Clin N Am 2005;19:513-540 Holmes KK, et al. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization 2004;82(6):454-461 Stanberry LR, Rosenthal SL. Progress in vaccines for sexually transmitted diseases. Infect Dis Clin N Am 2005;19:477-490 Fisman DN. Syphilis resurgent in China. Lancet 2007;369:84-85
Lecture 4: Introduction to STI Policy and Programming	Glasier A, Gulmezoglu AM, Schmid GP, Moreno CG, Van Look PFA. Sexual and reproductive health: a matter of life and death. Lancet 2006;368:1595-1607

STI Specific Epidemiology
Lecture 5: Gonorrhea and Chlamydia	Turner CF, et al. Untreated gonococcal and chlamydial infection in a probability sample of adults. JAMA 2002;287:726-733 Peterman TA. High Incidence of New Sexually Transmitted Infections in the Year following a Sexually Transmitted Infection: A Case for Rescreening. Ann Intern Med 2006;145:564-572 Ghanem KG, et al. Fluoroquinolone-resistant Neisseria gonorrhoeae: the inevitable epidemic. Infect Dis Clin N Am 2005;19:351-365 Miller WC, et al. Prevalence of Chlamydial and Gonococcal Infections Among Young Adults in the United States. JAMA 2004;291:2229-2236 Peipert JF. Genital Chlamydial Infections. NEJM 2003;349:2424-30 U.S. Preventive Services Task Force. Screening for Chlamydial Infection. Recommendations and Rationale. Am J Prev Med 2001;20(3S):90-94 Nelson HD, Helfand M. Screening for Chlamydial Infection. Am J Prev Med 2001;20(3S):95-107
Lecture 6: Vaginitis and PID	Erbelding EJ, Zenilman J. Toward Better Control of Sexually Transmitted Diseases. NEJM 2005;352:7 Golden MR, et al. Effect of Expedited Treatment of Sex Partners on Recurrent or Persistent Gonorrhea or Chlamydial Infection. NEJM 2005;352:676-85 Marrazzo JM. Mucopurulent Cervicitis: No Longer Ignored, but Still Misunderstood. Infect Dis Clin N Am 2005;19:333-349 Ross JDC. Is Mycoplasma genitalium a Cause of Pelvic Inflammatory Disease? Infect Dis Clin N Am 2005;19:407-413 Sobel JD. What's New in Bacterial Vaginosis and Trichomoniasis? Infect Dis Clin N Am 2005;19:387-406
Lecture 7: Syphilis	Niccolai LM, et al. Early Syphilis Among Men in Connecticut: Epidemiologic and Spatial Patterns. Sex Transm Dis 2007;34:183-187. Golden MR, et al. Update on syphilis: Resurgence of an old problem. JAMA 2003;290:1510-1514 Peterman TA, et al. The Changing Epidemiology of Syphilis. Sex Transm Dis 2005;32:S4-S10
Lecture 8: Update on Genital Herpes	New York State Department of Health. Herpes simplex virus in the newborn. June 2006. New York State Department of Health. Circumcision Protocol Regarding the Prevention of Neonatal Herpes Transmission. November 2006. Purnick J. Taking a Stand on a Rite with Hazards. New York Times Jan 9, 2006 New York City Health Commissioner. 2005 Health Alert #46: Neonatal herpes infection with herpes simplex virus type 1 following circumcision with oral suctioning. December 13, 2005. Gesundheit B, et al. Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition. Pediatrics 2004;114:e259-e263 Patel R, Rampalo A. Managing Patients with Genital Herpes and their Sexual Partners. Infect Dis Clin N Am 2005;19:427-438 Tanne JH. Ultra-Orthodox Jews criticised over circumcision practice. BMJ 2006;332:137
Lecture 9: Genital Human Papillomavirus	Cox T, Cuzick J. HPV DNA testing in cervical cancer screening: From evidence to policies. Gynecologic Oncology 2006;103:8-11 Milloy C. District's HPV Proposal Tinged With Ugly Assumptions. Washington Post January 10, 2007 Levine S, Harris HR. Wave of Support for HPV Vaccination of Girls; D.C., Md. , Va. Proposals Part of National Effort to Prevent Cervical Cancer. Washington Post January 12, 2007 Saslow D, et al. American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors. CA Cancer J Clin 2007;57;7-28 Burchell AN, et al. Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. Vaccine 2006;24S3:S52-S61 Friedman LS, et al. Human Papillomavirus (HPV) Vaccine: A Position Statement of the Society for Adolescent Medicine. J Adolescent Health 2006;39:620 Gravitt PE, Jamshidi R. Diagnosis and Management of Oncogenic Cervical Human Papillomavirus Infection. Infect Dis Clin N Am 2005;19:439-458 Allan A. Don't rush to mandate HPV vaccine. Baltimore Sun February 8, 2007.
Lecture 10: HIV and Other Sexually Transmitted Infections	Centers for Disease Control and Prevention. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. MMWR 2006;55:RR-14 Centers for Disease Control and Prevention. CDC HIV/AIDS Science Facts: CDC Releases Revised HIV Testing Recommendations in Healthcare Settings. September 2006 Brown D. US Recommends Routine Testing For the AIDS virus. Washington Post September 22, 2006. Reynolds SJ, et al. Developments in STD/HIV Interactions: The Intertwining Epidemics of HIV and HSV-2. Infect Dis Clin N Am 2005;19:415-425
Lecture 11: STD Diagnostic Tests	Gaydos CA, et al. Internet-Based Screening for Chlamydia trachomatis to Reach Nonclinic Populations With Mailed Self-Administered Vaginal Swabs. Sex Transm Dis 2006;33:451-457 Donegan E, et al. Sexually Transmitted Infection/HIV Laboratory Testing in Resource-Limited Countries Steps to Improve Use Effective Testing and to Ensure Diagnostic Capacity. Sex Transm Dis 2003;30:905-908 Gaydos CA. Nucleic Acid Amplification Tests for Gonorrhea and Chlamydia: Practice and Applications. Infect Dis Clin N Am 2005;19:367-386

STI Policy and Program in Various Contexts
Lecture 12: Epidemiologic Basis for STI Policy and Programming: Interventions	Manhart LE, Holmes KK. Randomized Controlled Trials of Individual-Level,Population-Level, and Multilevel Interventions for Preventing Sexually Transmitted Infections: What Has Worked? J Infect Dis 2005;191(Suppl 1):S7-24 Cleland J, et al. Family planning: the unfi nished agenda. Lancet 2006;368:1810-1827 Zenilman J. Behavioral Interventions: Rationale, Measurement, and Effectiveness. Infect Dis Clin N Am 2005;19:541-562
Lecture 13: STDs in the International Setting	World Health Organization. Consultation on STI interventions for preventing HIV: appraisal of the evidence. July 2006
Lecture 14: Behavioral Interventions	Halifors DD, et al. Sexual and Drug Behavior Patterns and HIV and STD Racial Disparities: The Need for New Directions. Am J Public Health 2007;97:125-132 Lyles CM, et al. Best-Evidence Interventions: Findings From a Systematic Review of HIV Behavioral Interventions for US Populations at High Risk, 2000-2004. Am J Public Health. 2007;97:133-143 Philpott A, et al. Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy. Lancet 2006;368:2028-2031 Mayaud P, Mabey D. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Transm Infect 2004;80:174-182
Lecture 15: Adolescents and STIs	Ellen JM, et al. Perceived Social Cohesion and Prevalence of Sexually Transmitted Diseases. Sex Transm Dis 2004;31:117-122

Summary: Development of STI Policy and Program
Lecture 16: Epidemiologic Basis for STI Policy and Programming: Development of Policy and Programming	Zenilman J. Policy and Behavioral Interventions for STDs. In: Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases. Aral SO, Douglas JM Jr, eds. Lipshutz JA, assoc ed. New York: Springer Science+Business Media, LLC; 2007. Society for Adolescent Medicine. Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2006;38:83-87 Santelli JS, et al. Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health 2006;38:72-81 UK Department of Health. The national strategy for sexual health and HIV implementation action plan. 26 June 2006.