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Sexually Transmitted Infections

STIs were a significant cause of morbidity and mortality before the advent of penicillin treatment. With new medications and treatment options available in the 1940s, the Department of Defense (DoD) shifted its focus away from STIs and turned to other more militarily impactful diseases. However, with the development of antibiotic resistant gonorrhea, there has been a renewed global interest in STIs. The Armed Forces Health Surveillance Center (AFHSC) has examined data to show that CT and HPV infections are on the rise among military personnel. IDCRP has developed an STI clinical research network to create research opportunities at various military installations and expand the knowledge base of these infections.

Service members are often young, active and may engage in risky behaviors at any point during their military career, including international deployment. Prior to the repeal of Don’t Ask Don’t Tell, STI research in the military was limited due to the inability to ask sensitive risk-behavior questions. Since then, STI research in the military has begun to examine these sensitive issues, which can lead to a better understanding of the difference between STI rates among service members and civilians.


At this time, our primary study is the GC resistance study, which conducts gonorrhea surveillance at five MTF sites across the U.S. This study also includes the development of a repository where GC isolates are stored and used for further research and testing. Advances in sample collection, plating, shipping and molecular testing will all contribute to the literature. We are in the process of receiving isolates from international sites, which will be included in the repository.

The STI research area at IDCRP is rapidly growing and has spent the past few years developing an STI clinical research network at many sites. With the help of the Global Emerging Infections Surveillance (GEIS) division at the AFHSC, the Uniformed Services University (USU) and the National Institute of Allergy and Infectious Diseases (NIAID), STI research has been able to integrate into five military sites across the US and will be expanding the research portfolio at all sites in the coming year. This has been a lengthy process of finding key players at each site, building relationships with local clinics and developing lab capacity.

Beyond surveillance, the clinical research network is expanding to start new research that will adapt studies conducted in civilian populations to the military. This includes testing for gonorrhea at three different anatomic sites in two separate populations: HIV-positive personnel and military women. Additionally, sexual and social networks have been extensively examined in various populations including adolescents, incarcerated populations and HIV+ civilian populations.

The STI research area continues to establish relationships with new collaborators and build off of already existing connections. There are many opportunities for STI-related research and a need exists to include additional sites in current and future protocols.

Publications 2014

Sanchez JL, Russell KL, Hiser ML, Cummings JF, Agan BK, Macalino GE, Gaydos JC. Non-HIV Sexually-Transmitted Infection Surveillance Efforts in the United States Military: The Past Decade. International Review of the Armed Forces Medical Services. Jan 2015, accepted.

Lee T, Ganesan A. Results of a pilot screening program for genital and extragenital gonocococcal and chlamydial infections in a military population following the repeal of “Don’t Ask, Don’t Tell". Sexually Transmitted Infections. Jan 2015, accepted.

Ganesan A, Mesner O, Okulicz JF, O’Bryan T, Deiss RG, Lalani T, Whitman TJ, Weintrob AC, Macalino G, Agan BK, IDCRP HIV/STI Working Group. A single dose of benzathine penicillin G is as effective as multiple doses in HIV-infected persons with early syphilis. Clinical Infectious Disease. Dec 2014.

Presentations 2014

Ganesan A, Mesner O, Bebu I, Bradley C, Bavaro M, Okulicz J, Whitman T, Agan B, Macalino G. Syphilis has emerged as a common co-infection at HIV diagnosis. STD Prevention Conference, 9-12 June 2014, Atlanta, GA. Poster #WP 94.

Macalino G, Wang X, Ganesan A, Okulicz J, Lalani T, Bavaro M, Agan B. The impact of moving (permanent change of station) on syphilis incidence among HIV+ active duty members and beneficiaries. STD Prevention Conference, 9-12 June 2014, Atlanta, GA. Poster # 6B3.

Hiser M, Sanchez JL, Cummings JF, Agan BK, Macalino GE. Expanded sexually transmitted infection surveillance efforts in the United States military: A time for action. STD Prevention Conference, 9-12 June 2014, Atlanta, GA.

Kao TC, Macalino G, Agan BK. Differences in gender and ethnic groups of lifestyles associated with sexual transmitted infection in 2008 worldwide military survey. Joint Statistical Meetings, 2-7 August 2014, Boston, MA.

Lee T, Wang X, Okulicz J, Deiss R, Whitman T, Bavaro M, Lalani T, Ferguson T, O’Bryan T, Agan B, Macalino G, Ganesan A. Incident genitourinary and extragenital gonococcal and chlamydial infections in a racially diverse well characterized cohort of HIV-infected persons with free access to care and counseling. Infectious Disease Society of America, ID Week 8-12 October 2014, Philadelphia, PA.

Sanchez JL, Hiser ML, Cummings JH, Russell KL, Agan BK, Macalino GE. Expanded sexually transmitted infection surveillance efforts in the United States military: A time for action. 4th International Committee on Military Medicine Pan Arab Regional Working Group Congress on Military Medicine, 4-7 November 2014, Dead Sea, Jordan.