BackgroundHigh sexually transmitted infection (STI) rates in the South, especially among young black men who have sex with men (YB MSM), make STI testing imperative for public health.PurposeTo identify STI testing preferences in this population to improve testing delivery and utilization.MethodsYB MSM ages 16–35 in Birmingham, Alabama participated in focus groups (FG). A trained qualitative researcher coded transcripts after each FG and added questions to explore emerging themes.ResultsBetween September 2017 and January 2018, 36 YB MSM participated in 5 focus groups. Median age was 25.5 (Interquartile range 22–30). Participants preferred STI testing at doctors’ offices conducted by physicians but they also preferred having options related to testing locations, frequency, and timing to address diverse needs. Participants did not prefer testing by non-physician staff or home self-testing.ConclusionA variety of options, including varied locations, personnel, and methods (self-collected and provider collected) are needed to make patient-preferred STI testing a reality among YB MSM in the Deep South. Further, the desire to be tested by a trusted physician highlights the need for access to primary care providers. Results suggest that newer home-based tests and self-collected tests are less preferable to YB MSM in the South, which deserves further study as these tests are rapidly integrated into clinical care.

Objective: To assess whether the number of community-acquired MRSA (CA-MRSA) infections in otherwise healthy children has been increasing in Alabama during the study period from 1999-2004 and whether the pattern of infection has changed. Methods: A retrospective chart review was done for patients during the years of 1999-2003 and prospective interviews were done for patients selected for the study during [2003][2004]. These patients were screened for enrollment in the study based on their culture results and determination of their risk category. Those patients with positive cultures for CA-MRSA and a low or intermediate risk category assignment were included in the study. Those that were selected as CA-MRSA had a positive culture within 72 hours of admission and no previous MRSA infections. To determine the risk category a questionnaire was utilized to assess the patients' exposure to MRSA and select for only those patients with a low or intermediate risk classification. A low risk patient was one that had no risk factors while intermediate patients were those with a single risk factor, that factor most often being the placement of ear tubes at some point. Results: The incidence of CA-MRSA has been increasing since the year 2000 from 20% to 33% (2001) to 36% (2002) to 52% ( 2003) of all MRSA patients. Out of all the cases of CA-MRSA over the past five years, 28% of children have shown resistance to clindamycin, 84% to erythromycin, and 46% to ciprofloxacin. 34% of children with suspected CA-MRSA have presented with skin infections (abscess, cellulitis) and 5% with more severe infections like osteomyelitis, pneumonia, or sepsis. These more severe infections have been seen in recent years while the less invasive infections were the only type seen early on in the study (1999)(2000)(2001). Conclusions: The onset of more invasive infections in recent years suggests that maybe this new CA-MRSA strain of bacteria is more virulent. The steady increase in the number of CA-MRSA indicates that these numbers will continue to rise.

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ObjectiveTo assess the incidence and pattern of community-acquired MRSA (CA-MRSA) infections among Alabama children during the 1999-2005 study period.MethodsMRSA infections were considered community acquired if patients had positive cultures within 72 hours of admission and no prior history of MRSA infection. A retrospective chart review was performed for patients with cultures positive for MRSA infections at the Children's Hospital of Alabama from 1999 through the first 5 months of 2004. Prospective interviews were done for 33 CA-MRSA hospitalized patients identified in 2005. Patients were assigned a risk classification for resistant infections. Low-risk patients had no risk factors. Intermediate-risk patients had a single risk factor, often the presence of myringotomy tubes. High-risk patients typically had hospitalizations or surgery within the preceding 12 months. CA-MRSA and hospital-acquired MRSA (HA-MRSA) isolates collected in 2005 were genetically tested via pulse field gel electrophoresis (PFGE) for comparison of their genotypes. HA-MRSA patients had a positive MRSA culture taken after 72 hours of admission or had a history of a previous MRSA infection.Results63% of CA-MRSA cases presented as skin infections, 21% as otorrhea, and 6% as invasive infections. Cases of CA-MRSA rose from 17 in 2000 to 96 in the first 5 months of 2004. From 1999-2003 31% of CA-MRSA cases were resistant to clindamycin. Of 33 cases of CA-MRSA studied prospectively in 2005, only 1 was resistant to clindamycin, confirmed by D-zone test. According to PFGE, CA-MRSA is a new strain genetically distinct from most HA-MRSA; however, some clinical HA-MRSA genetically matched CA-MRSA strains.ConclusionsThe increased incidence and genetic distinction of CA-MRSA indicate that these infections deserve increased medical and public health intervention.