Sexual practices of women who have sex with women and condom use

Objective: to analyze the sexual practice of women who have sex with women and its association with condom use. Methods: correlational study involving 231 women who have sex with women, recruited through electronic application (Instagram and WhatsApp). A questionnaire was applied through Google Forms, containing sociodemographic data, sexual history, and the types of sexual practices. Results: most women performed oral sex (86.4%) and manual sex (86.9%) without using condoms. A large proportion (84.8%) reported the use of fomites in sexual practices without condoms. The inexistence of a fixed partnership (p=0.000) and the performance of sex with vaginal contact (p=0.013) were associated with sexual intercourse without condoms. Conclusion: the sexual practice of women who have sex with women points to greater vulnerability to sexually transmitted infections, by practicing oral and vaginal sex with manual practices without the use of barrier methods.

Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care

OBJECTIVES: Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children’s hospital Pediatric Hospital Medicine service. METHODS: We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions. RESULTS: From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected. CONCLUSIONS: The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.

Orgasm consistency and its relationship to women’s self-reported and genital sexual response

According to the Incentive Motivation Model (IMM) of sexual response, the rewarding and pleasurable aspects of a sexual act strengthen its incentive value and capacity to trigger sexual motivation. One such sexual reward is orgasm consistency, the percentage of time that orgasm is experienced during a sex act. Orgasm consistency may serve to influence the incentive value of a sexual behaviour. We tested this tenet of the IMM by examining whether orgasm consistency predicted women’s sexual responses to films depicting various sex acts. Data were collected from four separate studies examining women’s genital and subjective sexual response. Participants ( N = 144, age range = 18–65) were presented with neutral and erotic film stimuli while their genital arousal was assessed using vaginal photoplethysmography or thermography. Participants reported their sexual arousal level before, during, and after each stimulus presentation, and completed questionnaires assessing sexual history and experiences, sexual interests, and sexual functioning. Orgasm consistency during penile–vaginal intercourse (PVI) significantly predicted genital arousal to films depicting PVI, but similar relationships were not observed between genital or self-reported arousal and orgasm consistency during receptive oral sex and masturbation. Findings suggest that increasing orgasm consistency to a sex act may increase its incentive value, thereby triggering greater genital response to depictions of that act. Lack of consistent orgasm or generally pleasurable and rewarding sex may limit the capacity of sex acts to trigger sexual motivation in future sexual encounters, thus contributing to low sexual arousal and desire in women.

857. Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections among Veterans

Background Healthcare encounters for the diagnosis and treatment of sexually transmitted infections (STIs) are common and represent a window of opportunity to discuss and initiate HIV pre-exposure prophylaxis (PrEP). Little is known about how frequently PrEP is discussed and initiated in association with encounters for STIs. Methods We conducted a retrospective cohort and nested case control study in the national Veterans Administration (VA) healthcare system to determine the frequency of PrEP discussion and initiation in association with clinical encounters for bacterial STIs (i.e. early syphilis, gonorrhea, and chlamydia). We used administrative data to identify patients with a first STI based on ICD 9 / 10 codes from January 2013–December 2018 , excluding patients with prior HIV diagnosis or PrEP use, or STI diagnosed in context of a visit to initiate PrEP (Figure 1). We used pharmacy data to determine the frequency of PrEP initiation within 90 days of the encounter for STI in this cohort. In the case control study, we matched 90 PrEP starters to 180 non-starters by day of STI diagnosis and reviewed chart notes from the STI diagnosis encounter to determine frequency of documentation of sexual history taking and PrEP discussions among subsequent PrEP initiators and non-initiators. Results We identified 23,312 patients with a first STI, of whom 90 (0.4%) started PrEP within 90 days. Adjusting for age, PrEP initiation was associated with urban residence (OR=5.0, 95Cl 1.8–13.4), White compared to Black race (OR=1.7, 95 Cl 1.1–2.8), and syphilis diagnosis (OR = 7.4, 95 Cl 4.7–11.6, table 1). Chart review revealed that discussion of PrEP was rare among people with STIs who did not subsequently start PrEP (1.1%, 95 CI 0.1–4.0, table 2). PrEP initiation was associated with documentation of any sexual history (80.0% of initiators vs. 51.0% of non-initiators, p < 0.01) and discussion of PrEP (52.2% vs. 1.1%, p < 0.01) during the initial STI diagnosis encounter. Figure 1. Study flow chart Table 1. Characteristics of patients with a first healthcare encounter with an STI diagnosis, by PrEP initiation within 90 days of encounter. N= 23,312 Table 2. Chart review findings from case control study. Ninety people who initiated PrEP (i.e., “cases”) were randomly matched to 180 who did not initiate PrEP (i.e., “controls”) by date of STI. Conclusion Discussion and initiation of PrEP were rare in association with healthcare encounters for STIs. Not all individuals with STIs will benefit from starting PrEP, but interventions are needed to improve low rates of sexual history-taking and discussion of PrEP during healthcare encounters for STIs. Disclosures Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor)

827. High KSHV Seroprevalence Among MSM with HIV Associated with Oral Intercourse and Methamphetamine Use in the Southern United States

Background Despite a decrease in Kaposi’s sarcoma (KS) cases in much of the US, the incidence of KS and associated mortality is increasing in specific subpopulations, particularly young, African American men in the South. To further understand this disparity, we sought to describe the seroprevalence and risk factors associated with Kaposi’s sarcoma herpesvirus (KSHV) among men who have sex with men (MSM) and transgender women (TGW) with HIV in Dallas, Texas. Methods We enrolled MSM and TGW with HIV and without known KSHV-related disease from a large urban safety-net clinic in Dallas. Blood samples were collected from participants for IgG testing (K8.1 and ORF73), followed by KSHV PCR on blood and saliva samples for those with positive IgG results. We also collected demographics, sexual history, sexual practices, HIV history, substance use, and insurance status. Multivariate logistic regression modeling was performed to identify associations with KSHV seropositivity. Results Of 159 participants, 110 (69.2%) were seropositive for KSHV. Seroprevalence varied by race/ethnicity, with 27/34 (79.4%) Hispanic, 27/37 (73.0%) white, and 54/84 (64.3%) black participants testing positive for KSHV IgG, though this difference was not statistically significant. 31/104 (29.8%) seropositive participants had detectable KSHV in saliva and 10/104 (9.6%) seropositive participants had detectable KSHV in blood. Risk factors independently associated with KSHV seropositivity include oral-anal sex (OR 4.02, 95% CI 1.89 – 8.54), oral-penile sex (OR 3.66, 95% CI 1.16 – 11.57), and methamphetamine use (OR 2.73, 95% CI 1.23 – 6.04). Current CD4 count, HIV viral load, history of intravenous drug use, tobacco or alcohol use were not associated with KSHV seropositivity. Table 1. Patient Characteristics Conclusion We found that over two-thirds of MSM and TGW with HIV in Dallas are KSHV seropositive, which is relatively high compared to other studies of US MSM with HIV (30-70%). In our study, KSHV was more common among Hispanic and white individuals, and was associated with higher rates of oral sex and methamphetamine use. Differences in KSHV seroprevalence alone are unlikely to explain racial disparities in the incidence of KS. Further study is needed to better understand drivers of KSHV infection and KSHV-related diseases in highly impacted groups in the US. Disclosures All Authors: No reported disclosures

1357. Patterns of Extragenital Gonorrhea and Chlamydia Testing at a Community-Based Academic Emergency Department in Columbus, Ohio

Background Sexually transmitted infections (STI), including gonorrhea (GC) and chlamydia (CT), are on the rise in the U.S. and emergency department (ED) visits for STI-related complaints are common. The ED plays a key role in testing for GC/CT. In addition to testing genital sites for GC/CT, the Centers for Disease Control and Prevention (CDC) recommends extragenital testing (oral/rectal) based on sexual history and exposure. In this study, we reviewed the proportion of extragenital GC/CT tests performed at a community-based academic ED in Columbus, Ohio. Methods This study was a retrospective chart review of all GC/CT tests performed at the Ohio State University Hospitals East ED from November 1, 2018 to November 1, 2020. Clinical and demographic information was collected for all patients who received extragenital GC/CT testing, including symptoms, test results, and documentation of sexual practices. A random convenience sample of 100 patients who only had genital GC/CT testing performed was also reviewed. Results Of the 5644 GC/CT tests performed during the study period, only 364 (6.4%) were from extragenital sites, which included 311 (5.5%) from oral and 53 (< 1%) from rectal sites. Of the 100 patients reviewed who did not have extragenital GC/CT testing performed, only 5 (5%) had documentation of sexual practices, compared with 177/311 (56.9%) of those who had oral testing and 27/31 (50.94%) who had rectal testing performed. In the cohort of 100 patients who did not receive extra genital testing 28% were male and average age was 29. In the group who received extragenital testing 40% were male and average age was 30. The most common complaint across all groups was genital discharge Conclusion Despite the substantial number of CG/CT tests performed in the ED, only a very small proportion were from extragenital sites. Interventions are needed to identify and overcome barriers to extragenital GC/CT testing in the ED. Disclosures Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069) Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)