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Biomedical subjects

C E Stevens

Publications and source records attributed to C E Stevens.

171 records · Page 10Linked to original sources
PubMedDate not supplied

The frequency of unrecognized type 2 herpes simplex virus infection among women. Implications for the control of genital herpes.

To evaluate the prevalence of symptomatic versus asymptomatic or unrecognized type 2 herpes simplex virus (HSV-2) infection, the authors performed physical examination, viral cultures, and type-specific serologic assays in 776 randomly selected women attending an STD clinic and 636 female university students. Forty-six percent of women attending the STD clinic compared with 8.8% of the university students had serologic evidence of HSV-2 infection. Clinical or historical evidence of genital herpes was present in only 34% of the HSV-2 seropositive women attending the STD clinic and in 29% of the HSV-2 seropositive women attending the university clinic. Among women attending the STD clinic, the prevalence of recognized genital infection was more common among those with HSV-2 antibodies only versus those with HSV-1 and -2 antibodies (odds ratio = 2.39; 95% confidence interval = 1.30-4.37), suggesting that HSV-1 infection reduces the likelihood of recognizing HSV-2 infection. In view of the high proportion of seropositive individuals with unrecognized HSV-2 infection in both high and low prevalence HSV-2 seropositive populations, newly developed HSV type-specific serologic methods should be evaluated for detecting carriers of HSV-2 infection and counseling these individuals about strategies for avoiding sexual and perinatal transmission of HSV-2.

Adolescent↗
PubMedDate not supplied

Underestimation of HSV-2 seroprevalence in a high-risk population by microneutralization assay.

BACKGROUND: Complement independent neutralizing antibody assays (CINA) have been used in seroepidemiologic studies and in diagnostic laboratories to distinguish between antibodies to herpes simplex virus types 1 (HSV-1) and 2 (HSV-2). The accuracy of CINA has not been rigorously tested against protein-specific typing assays, such as Western blot. GOAL OF THIS STUDY: To determine the ability of CINA to identify HSV-2 antibodies alone or in the presence of HSV-1 antibodies. STUDY DESIGN: Sera from randomly selected women at the Seattle King County Sexually Transmitted Disease Clinic were tested by CINA and Western blot. RESULTS: Of 521 women tested, 81% had HSV antibodies by Western blot and 76% had neutralizing antibodies. Of 220 sera with HSV-2 antibodies by Western blot, 106 (48%) were serotyped correctly by CINA. Of the women studied, 140 (27%) had type-indeterminate neutralizing antibodies; 55 of these sera (39%) had antibody only to HSV-1 by Western blot. CONCLUSION: The seroprevalence of HSV-2 in an STD clinic population was seriously underestimated by CINA.

Antibodies, Viral↗
PubMedDate not supplied

Significance of mild cervical cytologic atypia in a sexually transmitted disease clinic population.

While the clinical management of patients with cytologic atypia consistent with cervical intraepithelial neoplasia (CIN) is well established, the management of so-called nondyskaryotic or benign atypias is controversial. The natural history of such atypias was prospectively studied in 124 patients attending a sexually transmitted disease clinic. The benign atypias were subdivided into different categories according to the cell type involved, and the patients were followed cytologically and colposcopically without cervical biopsy until they reached one of the study end points. Benign atypias often signified the presence of CIN: 17% of the patients had a smear consistent with CIN on the first study visit, and an additional 24% had such a smear by six months of follow-up. After 30 months of follow-up, the overall cumulative rate of biopsy-confirmed CIN 2 to CIN 3 was 13.5%; it was 12.5% among those with two consecutive smears showing benign atypias. Of the ten patients who reached biopsy-confirmed CIN 2 to CIN 3, a cytologic smear consistent with CIN was obtained in less than one year of follow-up in all but one case; however, colposcopic evidence of progression was seen in only half of the ten cases, suggesting a sampling error rather than true progression in many cases. Patients with metaplastic cell atypia had a higher progression rate to biopsy-confirmed CIN 2 to CIN 3 (21%) than did those with nonmetaplastic cell atypia (3%). This study provides direct evidence of the potential significance of metaplastic atypia as a marker of CIN. We conclude that patients with mild atypia are often found to have CIN and warrant further investigation by colposcopy and biopsy.

Adult↗
PubMedDate not supplied

Group specific component (Gc) and HIV diseases.

A previous report suggested a relationship between particular phenotypes of group specific component (Gc), and susceptibility or resistance to HIV infection, whereas other recent investigations failed to corroborate this finding. The present study demonstrated that Gc allele frequencies in white homosexual men corresponded to those expected, regardless of HIV serology and related disease. Assignment of phenotype was not influenced by Gc complexing secondary to tissue damage, or the process of infection per se. However, Gc allele frequencies in black patients with AIDS were significantly different from those in black control subjects, suggesting that the previously observed results might be in part explicable on the basis of gene admixture in ethnically mixed populations.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Perinatal hepatitis B virus transmission in the United States. Prevention by passive-active immunization.

Among infants born to women in whom sera are positive for both the hepatitis B surface antigen and the e antigen, 85% to 90% are infected with hepatitis B virus and become chronic hepatitis B surface antigen carriers. In a study to assess the effectiveness of passive-active prophylaxis (hepatitis B immune globulin and hepatitis B vaccine) of such infants, we screened 18,842 pregnant Asian-American women: 8.7% were positive for hepatitis B surface antigen and 3.0% were also positive for hepatitis B e antigen. Thus far, 113 infants have received hepatitis B immune globulin (0.5 mL at birth) and hepatitis B vaccine (three 20-micrograms doses beginning at birth or at 1 month) and have been followed up for nine to 18 months. Among these infants, 16 have become chronic carriers, an incidence of only 14.2%. All of the uninfected infants have retained high levels of antibody to surface antigen, suggesting that they have had an active immune response to the vaccine and should have long-term protection against hepatitis B virus.

Asian↗
PubMedDate not supplied

Persistence of Mycoplasma hominis after therapy: importance of tetracycline resistance and of coexisting vaginal flora.

In past studies Mycoplasma hominis has persisted after treatment with placebo, penicillins, or rifampin in 88-97% of women and 49-77% of men with infections of the lower genital tract. Among women with nonspecific vaginitis, M. hominis persisted in only a third of those treated with metronidazole as compared with at least 70% of those treated with ampicillin (P = 0.01), even though M. hominis is resistant in vitro to metronidazole and to its acid and hydroxy metabolites. Persistence of M. hominis after treatment with metronidazole was significantly associated with persistence of Bacteroides species in the vagina (P = .03). These results suggest that colonization of the vagina with M. hominis is partly dependent on other components of the vaginal microbial flora. In prior studies, M. hominis has persisted in zero to 50% of women and in zero to 30% of men after treatment with tetracycline or lincomycin, but the role of tetracycline resistance in treatment failure was not defined. The susceptibility of M. hominis to tetracycline is bimodal; and the minimal inhibitory concentration (MIC) of tetracycline for strains isolated before or soon after treatment was greater than or equal to 16 micrograms/ml for seven (78%) of nine that did persist and for two (17%) of 12 that did not persist after tetracycline therapy for cervicitis in women (P = .002). The MIC of tetracycline was greater than or equal to 16 micrograms/ml for two (12%) of 17 isolates from women in Seattle in 1972-1973, as compared with 27 (34%) of 79 isolates from Seattle men and women in 1979-1982.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Mycoplasma hominis in nonspecific vaginitis.

The prevalence of nonspecific vaginitis was 24% among 98 randomly selected women examined at a clinic for sexually transmitted diseases and 32% among 135 women with suspected cervicitis at the same clinic. Mycoplasma hominis was isolated more often and serum antibody levels to M. hominis were higher in women with nonspecific vaginitis than in women without nonspecific vaginitis. Similarly, the rate of isolation of Gardnerella vaginalis and the quantitative growth of G. vaginalis were higher for women with nonspecific vaginitis. Abnormal results of gasliquid chromatographic analysis of vaginal fluid and the presence of abnormal diamines in the vaginal fluid also were associated with nonspecific vaginitis and with the isolation of M. hominis, whether or not G. vaginalis was isolated. Further studies of the ecologic interactions among M. hominis, G. vaginalis, and anaerobes in nonspecific vaginitis are needed for a better understanding of the pathogenesis of this syndrome.

Adolescent↗
PubMedDate not supplied

Mycoplasma hominis in cervicitis and endometritis.

The presence of serum IgG antibody to Mycoplasma hominis was studied by enzyme immunoassay in 150 women with suspected cervicitis at a clinic for sexually transmitted diseases. Positive levels of antibody were associated with gravidity and parity but not with age, method of birth control, or sexual behavior. Women from whom M. hominis was isolated had higher antibody levels than those from whom M. hominis was not isolated, regardless of the presence or absence of mucopurulent cervicitis. In women with mucopurulent cervicitis, M. hominis did not interact synergistically with Chlamydia trachomatis to affect the severity of cervicitis or the number of polymorphonuclear leukocytes on gram-stained cervical tissue. A striking association was found between plasma cell endometritis and the prevalence and level of serum antibody to M. hominis. Similarly, clinical findings suggesting endometritis were associated with the prevalence and level of this antibody. In contrast, endometritis was not associated with the isolation of M. hominis from the cervix, although it was associated with the isolation of C. trachomatis and Neisseria gonorrhoeae. Urethritis in male sexual partners of women with mucopurulent cervicitis was associated with the isolation of C. trachomatis but not of M. hominis from the women.

Antibodies, Bacterial↗