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. 2024 Sep 18;11(9):ofae512.
doi: 10.1093/ofid/ofae512. eCollection 2024 Sep.

Adherence to CDC Guidelines for mpox Evaluation: Practice Patterns Across an Academic Medical System During the 2022 Epidemic

William M Garneau  1 , Joyce L Jones  2 , Gabriella M Dashler  3 , Nathan Kwon  3 , Matthew M Hamill  2 , Elizabeth A Gilliams  2 , David S Rudolph  3 , Jeanne C Keruly  2 , Eili Y Klein  3 , Nae-Yuh Wang  4 , Bhakti Hansoti  3 , Kelly A Gebo  2
Affiliations

Adherence to CDC Guidelines for mpox Evaluation: Practice Patterns Across an Academic Medical System During the 2022 Epidemic

William M Garneau et al. Open Forum Infect Dis. .

Abstract

Background: Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care.

Methods: We conducted an observational study of patients undergoing mpox testing between 1 June 2022 and 15 December 2022. We assessed concomitant sexually transmitted infection (STI) testing, sexual history, and anogenital examination and a composite outcome of all 3, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic).

Results: Of 276 patients included, more than half (62.7%) were evaluated in the ED. Sexual history, anogenital examination, and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox; syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in an ID clinic had higher odds ratio of completing all 3 measures (adjusted odds ratio, 3.6 [95% confidence interval, 1.4-9.3]) compared to PCP setting adjusted for age, gender, and men who have sex with men status. Cisgender men who have sex with men, transgender males, and transgender females had higher odds ratio of completing all 3 measures compared to cisgender females (adjusted odds ratio, 4.0 [95% confidence interval, 1.9-8.4]) adjusted for age and venue of care.

Conclusions: Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients.

Keywords: Coinfection; mpox; orthopoxvirus; quality of care; sexually transmitted infections.

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Conflict of interest statement

Potential conflicts of interest. K.A.G. receives royalties from UpToDate, non-paid position at Pfizer, and personal consulting from Spark HealthCare, Premier HealthCare, Harrison Consulting and MedEd Learning. W.M.G. reports receiving honorarium from DKBmed; serving as a scientific advisor to Gilead Sciences, Inc; and owning stock in Abbott Laboratories, Danaher, Eli Lilly and Company, Iqvia, Johnson & Johnson, Stryker, UnitedHealth Group, and AstraZeneca Pharmaceuticals. M.M.H. receives royalties from UpToDate and BMJ publishing and has received consultant fees from Chembio, Cepheid, and Roche diagnostics. He has also received donations of test kits for research studies from Chembio, Cepheid, Roche diagnostics, and Hologic. All other authors report no potential conflicts.

Figures

Graphical Abstract
Graphical Abstract
https://tidbitapp.io/tidbits/adherence-to-cdc-guidelines-for-mpox-evaluation-practice-patterns-across-an-academic-medical-systemduring-the-2022-epidemic-open-forum-infectious-diseases-27479f5a-4e5b-4629-a475-8fd0a49e2152?utm_campaign=tidbitlinkshare&utm_source=ITP
Figure 1.
Figure 1.
Identification of patients with mpox test and clinical evaluation within the Johns Hopkins Health System 1 June 2022—15 December 2022.
See this image and copyright information in PMC

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